JATMS

Transcription

JATMS

JATMS
JOURNAL OF THE AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY
Volume 17
Number
2
J
U
N
E
2
0
1
1
Effective research
Dietary phytates #2
Homoeopathy and headache
Vitamin D3, the super nutrient
Working with musculoskeletal headache
The Australian Traditional-Medicine Society
Limited (ATMS) was incorporated in 1984 as a
company limited by guarantee
ABN 046 002 844 2333.
ATMS has three categories of membership.
All prices include GST.
Accredited member $165
Associate member $66
Plus a once only joining fee of $44
Student membership is free
Sandi Rogers
VICE-PRESIDENT
Bill Pearson
Maggie Sands
TREASURER
Allan Hudson
S E C R E TA R Y Matthew Boylan
Membership and General Enquiries
ATMS
PO Box 1027
Meadowbank NSW 2114
Tel: 1800 456 855
Fax: (02) 9809 7570
[email protected]
http://www.atms.com.au
A COMPREHENSIVE OVERVIEW OF …
VIC, Patricia Oakley
7 Second Ave Hoppers Crossing VIC 3029
T (03) 9974 6394
TOXINS IN THE 21ST CENTURY
NTH QLD, Cathy Lee
PO Box 10136 Mt Pleasant Mackay QLD 4740
T (07) 4953 3491
SUMMARY SEMINAR OUTLINE:
STH QLD, Judith Carlsson
14 Beech St Maleny QLD 4554
T (07) 5419 4355
SA, Sandra Sebelis
25 Lancelot St Hazelwood Park SA 5066
T (08) 8338 1267 F (08) 8379 9977
WA, Paul Alexander
384 Oxford St Mt Hawthorn WA 6016
T (08) 9444 4190 F (08) 9444 4192
TAS, Bill Pearson
148 Springfield Ave Moonah TAS 7009
T/F (03) 6272 9694
How to Identify, Treat, Protect & Chelate using Natural Medicines
HTMA Primary Course (Saturday)
Introduction to HTMA in Clinical Practice
• Importance of mineral ratios
• Mineral synergists and antagonists
• Metabolic Typing
• Case studies
HTMA Advanced Course (Sunday)
Toxins in the 21st Century
• Heavy metals, PCBs, BPA, toxins in the home
• Foods, lifestyle and endogenous toxins
• How to treat and chelate toxins in the body
• Case studies
ACT, John Warouw
3 Zelman Pl Melba ACT 2615
T 0418 183 383 F (02) 6259 1460
Copyright 2005. All rights reserved. The opinions expressed in
this journal are those of each author. Advertisements are solely
for general information and not necessarily endorsed by ATMS
M E M B E R S ’ R E P R E S E N TAT I V E
Patrick de Permentier
T (02) 9385 2465
PRESENTED BY:
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Technical Director,
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NSW, Antoinette Balnave
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T 0418 294 055
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Contents
June 2011
Help your clients
cope with ARTHRITIS
& JOINT PAIN
this Winter NEW!
6
President’s Message
RECENT RESEARCH
Massage
38
8
Secretary’s Report
38
Western Herbal Medicine
39
Nutrition
40
TCM
41
Homoeopathy
Sandi Rogers
Matthew Boylan
ARTICLES
11
Myofascial Techniques:
Working with Musculoskeletal
Headaches
Til Luchau, Bethany Ward and Larry Koliha
Rediscover the joys
of intimacy
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16
Now you can
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22
24
26
45
Nutritional advantages and disadvantages
of dietary phytates:
A literature review Part 2
Patrice Connelly
Effective Research:
A discussion of essential elements
Robert Medhurst
Vitamin D3, The Super Nutrient:
An Independent of complementary
Medicine Evidence
Clinical hypnosis textbook
44
Fundamentals of Complementary and Alternative Medicine
Reviewed by Leon Cowen
Reviewed by Penny Robertshawe
LETTERS
48
Letters to the Editor
Reflecting on Relaxation
NEWS
50
State News
Sandra Sebelis
Independent Contractor
Ingrid Pagura
54
Health Fund News
56
Health Fund Update
57
Continuing Professional Education
59
Code of Conduct
1800 026 161
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1300 887 188
1300 797 668
1300 724 537
08 9311 6810
1300 882 849
www.sunherbal.com.au PRACTITIONER SUPPORT LINE 1300 797 668
ATMS Gi13316
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Russell Setright
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ACUPUNCTURE AUSTRALIA
1800 886 916
ACUNEEDS AUSTRALIA
1800 678 789
BETTALIFE DISTRIBUTORS
1300 553 223
CHINA BOOKS
1800 448 855
CHINA BOOKS SYDNEY
1300 661 484
CHINESE HERBAL AND
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07 3852 2288
FAR NORTH QUEENSLAND NUTRITIONALS
TOWNSVILLE
07 4728 7555
CAIRNS
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BOOK REVIEWS
42
Clinical Naturopathy
Reviewed by Penny Robertshawe
Homeopathy and its Role in the
Management of Headaches
L AW R E P O R T
36 Employment law: Employee v
41Naturopathy
JATMS
. Volume 17 Number 2 . June 2011
5
RE C E N T LY R A I S E D I S S UE S
•
D r S andi R o g ers E d . D , N D
W
elcome to our new look journal; and what
great feedback we have received about it.
Thank you to those that have called or emailed
to acknowledge they like it. I would like to take this
opportunity to acknowledge the team who have put the
new look together, along with the diverse articles which
have made it a great success.
C H A N G E I S N O W BE I N G O F F ERE D
Excitement is truly in the air. The reason for the
excitement is the Board of Directors have finally agreed
on all the changes to be put forward to the members
and these will be offered for voting at the 2011 AGM.
The changes that will be put forward are:
• Reduction in numbers on the Board
• Members to vote for directors
• Terms of office to be three years
If these changes are successful then there will be a
transition time frame where six existing board members
will stay to assist the new Directors.
ATMS is and has always been a democratic society
and there can be no changes to the constitution without
the vote of the members. This is your opportunity to
vote on these changes and also to think about running for
election. It is a chance to participate and help guide your
profession. It takes dedication and commitment to be a
Director. Often it may feel like a thankless and onerous
position to be in, yet it does mean you can help guide the
profession.
Over many years there has always been criticism that
the Board comprised only college owners. Although I
believe this has been a strength, the fact is that there are
not many small colleges left and the need to change has
been expressed long and hard by a few members. Well, the
time has come for change to take place yet it does mean
you need to participate and have your say. You will receive
a pack with all the information you need and you will be
asked to vote. Please participate and do not leave it up to
a few.
VOTING
Voting for Directors will be in accordance with a
Quote Preferential Model and this will be explained as
part of the information packs you will all receive.
6
JATMS
President’s
message
N E W LOO K
Within the process of change come along to the
AGM and see the new look the Board of Directors has
developed for ATMS.
N A ME C H A N G E
In relation to the name change that was put forward
and was defeated I would like to reaffirm that there is no
move to change the name of ATMS. I have had feedback
from three members who feel that the name change is still
an issue. Please let me say publicly that the current board
have no agenda to do this.
RE G UL AT I O N
The Inter Association Regulatory Forum is working
toward a Co-Regulation model and many of you have
availed yourselves of the free DVD, free E Book, Facebook
page and / or visited our website, and have offered
positive feedback on the information made available to
you around this subject. ATMS has also made available
the report sent to AHMAC and if you have not read it
yet please go to the website and have a read. If you did not
read the last journal that described IARF please refer to
page 4, March journal and May 2010 journal. These fully
explain our participation.
The value of the newspaper to members is
questionable especially in terms of the cost of publication. However most feedback from members has been encouraging and the decision
has been taken to continue publishing the newspaper.
• The expenditure on the China visit was not justified by its value to members. I would point out that negotiations are continuing for ATMS members to be part of an academic training process to visit one of the most prestigious research facilities in China, with a proud and enviable reputation.
• The new Practising Education Seminars points system is too restrictive, and lunches at the
events were not provided within the daily
fee. But nowadays it is common practice for attendees at such events to pay for their meals. In general terms, the fees charged by ATMS for these seminars are very low yet deliver excellent training. There are also many other ways CPE points can be gained. Please visit the website.
AGM
The AGM is an opportunity to come along and meet
fellow members and also to be part of a fun day. The total
focus is on you, the member. Throughout the day there
will be giveaways and the talks will be all about helping
you. Speakers for the day:
Kate van der Voort will excite and stimulate you with
the ways social media can help you in your business.
Although many members are using Facebook as a private
social networking medium, Kate will show how you can
use it as a professional tool to help grow your business.
Ann Vlass will talk about ‘Back to Basics’. It does not
matter if you are a masseur, a naturopath, a herbalist, a
nutritionist or any other practitioner within the world of
natural medicine, she will share tips to help you see your
clients in a different light.
Sandi Rogers will offer 20 helpful hints for you to
make an immediate difference to your natural medicine
business. Sandi wants all practitioners to be successful in
their businesses and the 20 tips will be a goldmine for each
person to start using instantly.
The day will conclude with a cocktail party where I
would hope all will stay and mingle.
Location:
Rydges Hotel, 186 Exhibition Street, Melbourne
Contact for accommodation:
Jacqui Couche, 039635 1244
Mention ATMS.
Patricia Oakley, Victoria State Representative, and
I look forward to meeting you all. We are planning for
200 attendees so please let us make this a most wonderful
event as it will be one of the most historical that have ever
taken place within our organisation.
And finally a quote to ponder:
If you are not part of the solution, you are part of the problem
(Charles Rosner). Let us all be united and work toward
solutions and put our energy to work in the very best way
possible. Surely we, as part of the natural and traditional
medicine profession, can do that. Find happiness in every
moment.
S O C I A L ME D I A
Well, what a great event this has been. When I
reported on the social networking initiative in the
March journal we had just commenced our journey and
I am absolutely delighted with the results. Members are
becoming more engaged through Facebook and the blog
and I encourage you all to participate.
Please visit www.atms.com.au and see the Facebook and
blog links.
We do have some critics. Within ATMS we have we
have a membership that is by and large happy with the
way their Society is managed, but among whom there is a
valued core of members always ready to offer a dissenting
voice when they feel it is warranted; and I would like to
say I think it is great we have these few members. The
reason for this is the opportunity the administration
and the Board are offered to review our procedures and
decisions. I am pleased to say that I am confident with all
decisions that have been made.
SIBO Advertisement.indd 2
JATMS
19/04/2011 12:21:48 PM
7
Secretary’s
report
M atthew B oylan
W
elcome everyone to the June issue of JATMS.
On behalf of the editor, Dr Sandra Grace,
I would like to thank all those members
who have complimented the new look and style for
the Journal. This new look and style is exciting, and it
is inspiring to know that we can look forward to more
enhancements in the future. Congratulations Sandra and
your editorial team.
I M P OR TA N T C O N S T I T U T I O N C H A N G E S
P RO P O S A L
The attention of all members is drawn to the insert
with this issue of the Journal, outlining important changes
that will be put to a vote by members at the 2011 AGM,
to be held in Melbourne on 18 September 2011. The
proposed changes are to allow for the appointment of
ATMS Directors to be made by election by the ATMS
accredited membership.
It is fair to say that these changes are the most
important ever made to the ATMS Articles of Association
(the Constitution). To be implemented 75% of the
members who vote will need to be in favour of the
changes. Members will be issued formal voting papers at
the same time the Annual Report and formal notice of the
AGM are circulated. So there is no need for any member
to take any action at present. However all members are
strongly encouraged to take the time to read in detail the
outline included with this issue, and to commence their
reflections on this historic proposal.
Members are also invited to post comments, questions
etc about this initiative on the ATMS Facebook page.
N S W W OR K I N G W I T H C H I L D RE N
All members who treat patients who live in NSW and
who may have unsupervised contact with children are
reminded that from 1 May 2011 it has been a mandatory
legal requirement to hold a NSW Government
Commission for Children and Young People “Certificate
for Self Employed People”.
Large fines and possibly other penalties may apply if
you do not hold this Certificate and have unsupervised
contact while undertaking your practice with a
young person. For more information please visit the
Commission’s web site https://check.kids.nsw.gov.
au/#self-employed.
8
JATMS
F ROM T H E BO A R D O F D I RE C T OR S
The Board of Directors has as usual been very busy.
Two meetings, on 25 March and 6 May 2011, have been
held since the last meeting in September 2010. A major
topic for discussion at both meetings was the proposed
changes to the Articles of Association to allow for the
appointment of member elected Directors. The outcome
of those discussions are best summarised in the insert
with this issue of JATMS, and so I will not take up space
by repeating them in this section. Other major topics of
discussion were:
• Meeting of 25 March 2011
• Reports
Sandi Rogers provided her President’s Report
outlining key areas of work Directors had been involved
in, including:
• Participation in the Inter-Association Regulatory
Forum. Meetings are continuing to be held and
although progress has been slow, it was hoped
that soon some working documents would be
ratified by the Forum.
• National meetings pertaining to Regulation of TCM practitioners. (See later report)
• The development of a Public Relations
document outlining future strategies, visions and
position statements for ATMS. This includes the
drafting of a two year plan which will be
published at the 2011 AGM.
• Planning and co-ordination of the 2011
International Summit.
Sandi concluded her presentation by noting that
ATMS and the profession “are facing challenging times.
We will work through each of the challenges and offer our
members the very best organisation. Change is the hardest
thing for most to work through and it is at times like this
we call upon the expertise that sits around this table. We
have a proud tradition for caring, honesty and integrity
and it is these qualities that will get us through.”
Treasurer Allan Hudson referred the Board to various
financial reports tabled at the meeting. A major item of
discussion was the office update costs. The ATMS Chief
Administrative Officer Matthew Boylan outlined the
office update works undertaken and costs. He advised the
new carpet in all units (about 350sqm) cost $18,000 and
painting of just one unit, 10/27, cost $2500. Therefore
Matthew advised that he took the decision to not go
ahead with the painting of units 11,12 & 13, and other
updates have also been put on hold. However, necessary
work was still undertaken, primarily the purchase of
additional secure storage space for the files, and new
computer cabling. Additionally the phone system
was upgraded to increase from 4 to 10 the number of
incoming lines, plus other benefits. Details of all costs
and quotes sought were provided in full for the Board.
Matthew outlined however how further updates were
required, in particular to replace an improperly installed
power switch and to properly lay the existing computer
cabling. Additional spending on these items was approved
by the Board.
Concerns were raised about ongoing costs. It was
agreed that a Cost Cutting Working Party would
commence activities, and that an Internal Audit
Committee would be established. It was agreed that the
role of Treasurer would be reviewed by Allan Hudson
to ensure that ‘best practice’ activities were being
implemented by ATMS. Additionally the appointment of
a new accountant and auditor was to be investigated.
A C A D EM I C I S S UE S
Academic matters decided included that as from
1 May 2011 ATMS would not consider applications
for membership supported only by qualifications
obtained overseas. Additionally any applications for
accredited membership from persons normally resident
overseas would not be considered unless the supporting
qualification has been completed at an ATMS accredited
College.
Allan Hudson and Matthew Boylan reported on their
meeting with NSW WorkCover. Unfortunately NSW
WorkCover have suspended accepting new applicants
while they review their assessment and acceptance
processes. WorkCover indicated that the (then) upcoming
NSW election might delay this review and that this
review might be a relatively long process.
C M PA C
Bill Pearson reported on the Complementary
Medicine Practitioner Associations Council (CMPAC).
He noted how this Council had reduced to just two
Associations, ATMS and one other. It was agreed that
ATMS would also cease its involvement in CMPAC.
Simon Schot Scholarships
The Simon Schot Scholarships prizes were drawn.
Members who each won a $1000 educational grant were
Cynthia Gibson; Melanie Parsons; Sanna Reeves; Katie
Knight; Maree Beattie; Myung Bae; Julie Carroll; Robyn
Cameron; Joy Brown; Fiona Abbott.
ATMS gratefully thanks MARSH for their continuing
sponsorship of this scholarship.
MEMBER M AT T ER S
Matthew Boylan noted that the recent initiative to
contact members who had not renewed their membership
had now attracted about extra 80 renewals. This was
not only good for the members concerned who had
overlooked this vital matter, but also brought in over
JATMS
$10,000 net in extra funds.
Matthew further reported on the results of the ceased
membership survey. He was pleased that only two
members left due to perceived poor service by the office
staff, but that it was a concern that some 40% of members
had left the profession due to being unable to earn a
sufficient income. These survey results were discussed.
Matthew advised that the ATMS Official Policies
pertaining to practitioner conduct were now being sent
to all new members, and were also now posted on the
web site. An open letter to the ATMS Executive from
a member was discussed, and the major points to be
addressed in the reply were settled on.
T C M S TA N D A R D I S AT I O N A N D
S TAT U T ORY RE G I S T R AT I O N
Bill Pearson noted there had been little progress from
the meetings concerning the standardisation of TCM,
with disagreements over matters such as to the most
appropriate terminology for TCM.
Regarding TCM statutory registration, Bill reported
that consultation meetings were currently being
undertaken throughout Australia. These are quite
difficult as there is little definite information that may
be provided to attendees as nothing re qualifications,
grandparenting etc has been decided. The Board
recommended that Bill be nominated for appointment to
the TCM Registration Board on behalf of ATMS.
MEE T I N G O F 6 M AY 2 0 11
New Model For The Appointment Of Directors
It was agreed at the conclusion of the meeting of 25
March 2011 that the Board would meet again on 6 May
to near exclusively consider what would be the best
new model for the appointment of ATMS Directors by
member election. The Board invited Phillip Staindl from
InsideOut Organisation (political/media consultants
utilised by ATMS) to make a presentation on appropriate
voting methods and other related issues. Again, please
refer to the insert to this issue of JATMS for the outcome
of the Board’s discussions on these matters.
These discussions took up the majority of this May
2011 meeting, however other matters considered were:
New Accountant and Auditor
It was formally resolved that Winn Croucher Partners be
appointed as the ATMS auditors.
ATMS Logo Modernisation
New logo designed by Sally Wright Design was tabled and
accepted. Agreed that this new modern logo which also
emphasises “ATMS” would be officially launched at the
2011 AGM. Also that ATMS would continue to work
with Sally Wright Design on the modernisation of the
overall ATMS brand.
Other Matters
Other matters considered included: That the concept
of a “Hall Of Fame” program be adopted and further
investigated to honour those who were judged to have
served the profession extraordinarily. That the concept of
the ATMS China Academy of Chinese Medical Sciences
- CACMS Practitioner Clinical Exchange and Research
Programme be adopted for further investigation. That
the implementation of a Quality Assurance Program for
members be investigated.
9
ARTICLE
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Til Luchau, Bethany Ward and Larry Koliha
1. Musculoskeletal origins (such as tension head
aches and others related to myofascial or articular
restriction).
2. Vascular factors (such as migraines and cluster headaches).
3. Comingled causes (those arising from a combina
tion of both musculoskeletal and vascular
sources).
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ATMS Journal Specials*
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Image 1: The superficial fascia of the cranium is a tough fibroadipose layer just under the skin. Inset: the galea aponeurosis is
deep to the superficial fascia and is continuous with the frontalis
and occipitalis muscles. These layers play a role in many tension
and musculoskeletal headaches through direct fascial tension
and referred pain. Images courtesy of Primal Pictures. Used with
permission.
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TA K E A G UE S S : H O W M A N Y K I N D S
O F H E A D A C H E S A RE T H ERE ? W I T H
G OO G LE A N D A F E W M I N U T E S , Y OU
C A N C OM P I LE A L I S T O F H U N D RE D S O F
DISTINCT TYPES OF HEADACHES.
T
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hese include cryogenic headache (from eating
ice cream), hair wash headache (due to the heavy
weight of long wet hair after washing), coital
cephalalgia (the “morning after” headache), ictal headache
(accompanying seizures), thunderclap headache (sudden
severe onset), and many more. How would you begin to
formulate a coherent approach to dealing with headaches
when there are so many kinds and causes?
Fortunately, we can understand headaches by breaking them down into general types. Headaches are conventionally classified as either primary (not caused by
another condition) or secondary (you guessed it, caused
by another condition). Examples of secondary headaches
include those resulting from head injuries, from metabolic
and medical conditions, and so on. Although manual approaches can help in many cases, these and other secondary headaches usually merit an initial referral to a physician. This is generally a good practice with any persistent
or recurring headache.
Primary headaches are further sub-classified as arising
from either:
JATMS
This article will help you distinguish between these
types of headaches and gives you some simple but highly effective tools for working with headaches that are of
musculoskeletal nature — the kind you will most often see
in your practice. Techniques shown are from AdvancedTrainings.com’s Advanced Myofascial Techniques series.
Let’s begin by further clarifying the difference between musculoskeletal and vascular headaches (Table 1).
Although comingled headaches, which result from both
factors, are common, this musculoskeletal/vascular distinction is important because the pain from vascular headaches (the case of many migraines) can be worsened by the
same techniques that relieve musculoskeletal headache
pain.
MIGRAINES &
OTHER
VASCULAR
HEADACHES
TENSION
& OTHER
MUSCULOSKELETAL
HEADACHES
TYPICAL PAIN
LOCATION
1-sided
Bilateral
COMMON PAIN
DESCRIPTORS
Throbbing or stabbing
Pressure or
aching
RESPONSE TO
ACTIVITY
Usually worsened
Usually no
change
EPIPHENOMENA
Consistently accompanied by either
nausea, light/sound
sensitivity, or aura
(visual disturbances)
Not commonly
associated with
nausea, light/
sound sensitivity,
or aura (unless
comingled)
REOCCURRENCE
Recurrent, with
pain-free intervals
Variably intermittent, or persistent
HANDS-ON GOAL
Reduce cranial
compression
Reduce myofascial tension
Comparison of musculoskeletal and vascular headaches. Comingled headaches, since they arise from both musculoskeletal
and vascular causes, can have characteristics of both types.
Musculoskeletal headaches are the most common,
though not necessarily the most severe. Tension or musculoskeletal headache pain is usually more widespread,
11
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encompassing both sides of the head and exhibiting more
generalized pain described as pressure, fullness, or ache —
as opposed to the one-sided, throbbing, stabbing sensation
of many migraines and other vascular-related headaches.
Furthermore, tension headaches are less likely to have a
regular pattern of occurrence and are rarely accompanied
by nausea or sensitivity to light and sound.
This following techniques address musculoskeletal and
many comingled headaches — the majority of the headaches that you are likely to encounter in your office.
T E C H N I Q UE : S U P ER F I C I A L A N D D EE P
FA S C I A S O F T H E S C A L P
The superficial fascia of the scalp (Images 1 and 2) is
directly continuous with the superficial fascial membranes
of the back of the neck, and by extension, the superficial
fascia of the rest of the body. Its position on the crown of
the head gives it the unique role of connecting the front
of the body to the back, and the left side to the right. As
such, it is a mediator and transmitter of fascial stresses and
compensations elsewhere in the body. Also known as the
subcutaneous fibro-adipose layer, the superficial layer lies
between the outer layers of skin and the underlying galea
aponeurotica or epicranium.
Although the deeper galea aponeurotica is also mainly
membranous, it contains the occipitofrontalis muscles.
Because this layer is continuous laterally with the temporal fascia overlying the temporalis muscle, it is particularly
sensitive to jaw tension. Below the galea is the pericranium
on the bones of the skull themselves.
Image 2: Observing deep to superficial, visible cranial fascial
layers include the arachnoid mater (thin, red layer just atop the
brain), the dura mater, the bony cranium, pericranium, galea
aponeurotica, and the superficial fascia of the scalp (continuous
with the skin, and forming the outer layer in this view). Image
courtesy of Primal Pictures. Used with permission.
Image 2 shows a stepped dissection of the cranial fascial layers, including the visible layers of the arachnoid
mater just superficial to the brain; the dura mater; the
bony cranium; pericranium; galea aponeurotica (with the
muscle fibers of frontalis and occipitalis visible anteriorly
12
JATMS
and posteriorly); and the superficial fascia of the scalp presented continuous with the skin.
Besides transmitting strain and referred pain from the
rest of the body’s fascias, cranial layers play a direct role
in headaches associated with face, neck, and eye strain, as
well as mental exertion or stress. Addressing these layers
can be especially effective for clients who spend a lot of
time at the computer (in our modern society, just about
everyone).
The adaptability and pliability of the cranial fascial layers is essential to free motion of the underlying sutures and
cranial bones. Sutures are a prime location for adhesions
and restrictions can play a role in both musculoskeletal
and vascular headaches. Ensuring differentiation and freedom of cranial fascial layers is a logical first step in working
with headaches. Here’s how.
top of her head, or even out of her ears. Get creative. Use
imagery and somatic language (Table 2) to help your client find ways to relax the mandible, maxilla, pallet, eyes
and cranium. Incorporating experiential cues can go a long
way toward reeducating long-held movement patterns,
which contribute to chronic tension.
VERBAL CUES: MOVEMENT REEDUCATION TO
SUPPORT MYOFASCIAL WORK
“Relax your brain. Just let your brain rest in the back of your skull.”
“See if you can release pressure by breathing out of your ears.”
Or: “…out of the top of your head.”
“What if you allowed your jaw and pallet to rest…”
“Let your eyes have weight. Just let their weight rest against the
back of your head.”
When cueing clients to make facial movements, be sure
to maintain a steady tactile connection with the tissue. It
can be easy to get distracted and lose connection or sink
to a deeper level. Additionally, clients are often self-conscious, so be willing to make any face or sounds right along
with them! Images 5&6 demonstrate the use of facial expression (and practitioner participation) while addressing
the frontalis scalp fascias. Ask for active movements using
descriptive language, such as “lift your eyebrows into my
fingers,” “squeeze your eyes together, wrinkling your whole
face,” or “snarl and bare your teeth.” This technique is also
effective for areas around the temporalis. In this case, cuing your client to open and elongate the jaw can induce
greater release. Each client is different, so be creative. Feel
for your client’s unique tension patterns and explore corresponding movements that create the greatest release.
Rather than reaching out to see things with your eyes, could you
allow the images to come to you?
Image 3: Using firm finger pressure, slide the superficial and
deep fascias of the scalp against one another and against the
bones of the cranium. Pay particular attention to any thickenings over the slightly raised lines of the sutures — their freedom
will be affected by cranial fascia restrictions. Image courtesy of
Advanced-Trainings.com.
To release the cranial fascias, use your fingertips to
move the various layers against each other and against the
skull (Image 3). We’re not scrubbing the surface of the
scalp or shampooing the hair; we’re sliding, shearing, and
freeing these layers from each other. Imagine loosening the
rind of a cantaloupe around the flesh of the melon: use
firm, deep transverse pressure to assess and release adhesions, pulls, and thickenings. Use a decisive but sensitive
touch; be patient and thorough.
Be willing to spend at least several minutes with this
technique, working the various layers over the entire head.
Check in with your client regarding pressure and sensitivity. Many clients will experience this work as “pure heaven,”
while others will report significant sensitivity, especially
in areas that feel knotty or adhered to the underlying layers. With these clients, adjust your touch and work slowly,
while continuing to gently hook into the tissue and slide
fascial layers.
Holding your client’s head, notice her breath. Can
you feel the subtle movement of breath continue into her
head? Many people with headaches tend to have shallow
breath, restricting the airflow and feeling of expansion
transmitted into the neck and head. Verbally cue your client to breath into your hands. A great image is that of a
whale or dolphin. Ask your client to breathe out of the
. Volume 17 Number 2. June 2011
Additionally, the ears can be useful tools in your quest
to release the layers of the cranium. With your client’s
head turned to one side, use your thumb and forefinger of
one hand to gently pull on your client’s exposed earlobe.
Maintain a pull while using the fingers of the opposite
hand to release tension away from the ear. Release tension
in all directions around the ear, paying close attention to
fascial relationships involving the jaw, mastoid process,
and the area surrounding transverse process of C1. Releasing the superficial layers around C1 in this manner is very
effective at this layer, and will also prepare your client for
deeper work described in the nuchal ligament technique
towards the end of this article.
Once the outer layers have been released, continue
the technique while cuing facial movements. Because the
galea aponeurotica contains the muscle fibers of frontalis
(Image 4) and occipitalis, engaging active and exaggerated
eye, brow, and face movements deepens and extends the
fascial release.
Image 5 & 6: Galea aponeurotica contains muscle fibres of frontalis and occipitalis; engaging active and exaggerated eye, brow
and face movements will deepen and extend fascial release.
T E C H N I Q UE : S U P ER F I C I A L A N D D EE P
FA S C I A S O F T H E N U C H A L W I N D O W
T E C H N I Q UE
Image 4: The frontalis muscles (in green). Image courtesy of Primal Pictures. Used with permission.
JATMS
The central nuchal ligament and the suboccipital
and greater occipital nerves pass through the suboccipital muscles and play a role in posterior cranium tension
headaches. Addressing the suboccipital muscles is a wellknown way to relieve tension headaches. The Nuchal
Window Technique is a variation on this approach.
With your client supine, place your fingertips along
either side of the nuchal ligament, with your middle fingers just under the occipital ridge at the superior end of
the nuchal ligament (Images 8 and 9). Allow the weight
of the client’s head and neck to rest into your hands as you
curl your fingertips into the midline of the neck.
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ARTICLE
With firm but patient pressure, encourage the musculature and soft tissue on either side of the ligament to
release laterally. Our intention is to “open the window” of
the suboccipital space in order to provide more room for
the small muscles as well as the important cervical nerves
that pass between them (Image 7), often a source of posterior head pain. (You can view a video clip of this technique among excerpts from Advanced-Trainings.com’s
workshops on YouTube.)
This is a great time to use movement cues. Encourage
your client to imagine her brains resting back into the
table or cue her to allow her head melt into your hands.
Check once again to see if you can feel the movement of
the breath transmitting through her neck and head.
Although very effective for tension headaches, working the suboccipital region has sometimes been observed
to worsen vascular headaches, perhaps because it may increase cranial circulation. Review the distinctions outlined
in Table 1; if you suspect vascular elements, use suboccipital work carefully, watching how your client responds.
Musculoskeletal headaches are seldom related to just
the cranial fascia or suboccipital muscles: jaw, neck, eye,
and shoulder tension will also contribute to many headache patterns, so think broadly. Although headaches have
many causes, the two techniques described here are simple
but extremely effective hands-on work that will provide
relief and help prevent recurrence when there is musculoskeletal involvement.
Til Luchau, Larry Koliha, and Bethany Ward are instructors at
the Rolf Institute® of Structural Integration and faculty members
of Advanced-Trainings.com, which offers continuing education
seminars internationally. Bethany Ward and Larry Koliha will
be teaching classes throughout Australia (Oct. - Nov. 2011), with
return visits in 2012. Techniques in this article are from AdvancedTrainings.com’s Advanced Myofascial Techniques workshops. For
upcoming classes and dates, go to advanced-trainings.com.
• Identify key causative factors behind male and female infertility and the best
practices to support fertility
• Learn the critical factors for preconception care for both him and her
Biocompatibility testing for dental materials conducive
to good health
Care in the removal of mercury amalgam filling
Effective non-drug treatment of tension headaches,
neckaches and migraines
Effective treatment for sleep disturbances
Revolutionary OZONE treatment of decay preserving
natural tooth structure
Care in dealing with anxious patients
• Discover which epigenetic factors can alter the health of the offspring and how to
avoid them
• Become familiar with standard assisted reproductive technologies and know how
to safely work in conjunction with them to facilitate conception
• Understand how to help prevent adverse pregnancy outcomes such as miscarriage
and pre-eclampsia
• Learn about clinically relevant methods to support patients preconception,
pregnancy and post-partum
• Improve your condence in prescribing during pregnancy for common complaints
14
JATMS
MET2820 - 05/11
Image 7 shows the central nuchal ligament (orange) and the
suboccipital and greater occipital nerves (green) which pass
through the suboccipital muscles and play a role in posterior
cranium tension headaches. Source images courtesy of Primal
Pictures. Used with permission. Images 8 & 9 (right): Nuchal
Window Technique: fingers encourage lateral release on either
side of the longitudinal ligament, opening the “window” of the
suboccipital space.
MET2820_ATMS June 2011 Advert.indd 1
JATMS
9/05/2011 2:50:09 PM
15
ARTICLE
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Nutritional Advantages and Disadvantages of Dietary Phytates:
A Literature Review Part 2
Patrice Connelly
B.Nat.Therapies, ADN
A N T I O X I D A N T, A N T I - C A N C ER A N D
P REB I O T I C
T
he work of Graf and Eaton during the 1980s
showed that phytate functions as an antioxidant
in the human body, and as such has considerable
health benefits as well as potential for dietary therapeutic
use. The authors showed that phytate is a stable compound
with many binding sites, and its ability to chelate iron is
also a health benefit because it prevents iron-catalysed reactions that produce hydroxyl radicals which cause oxidative damage to the body, and slows lipid peroxidation.9
In the form of myo-inositol hexaphosphate (IP6), the
phosphate groups at positions 1, 2 and 3 specifically interact with free iron to completely inhibit the formation
of hydroxyl radicals, hence phytate’s antioxidant power.14
Also, hydrolysis of phytic acid generates several compounds that are effective against iron ion-induced lipid
peroxidation. IP3, IP4 and IP5 are all able to significantly
suppress hydroperoxide decomposition through occupation of iron ion coordination sites.37
Research papers over the last ten years have hypothesised that dietary inclusion of foods with a high phytate
content would play a strong preventative role against colon cancer.2, 38, 39 Subsequent studies have borne this out in
both in vitro and in vivo experiments. 40 Phytate has been
found to have a role in cell-signalling in its breakdown to
the lower inositol phosphates which are important second
messengers. IP3 initiates a number of cellular functions
including mitosis through mobilisation of intracellular
calcium. IP6 therefore has a controlling influence on mitosis through its degradation to lower inositol phosphates,
inhibiting the proliferative nature of neoplastic activity.41
Phytate-containing foods also have high levels of dietary fibre, fermentation of which by colonic bacteria produces short chain fatty acids (SFCA) which in turn lower
colonic pH and precipitate carcinogenic factors such as
secondary bile acids.8 In this sense phytate acts as a prebiotic, decreasing bowel transit time, contributing to the
lower pH which improves mineral uptake, particularly of
calcium. It appears that a calcium-SCFA exchange system
may also be located in the colon, and this may provide sufficient calcium to limit depletion from bone.42
Phytates in wheat bran may help to regulate apoptosis, or normal cell death, by mechanical sloughing action
of cells from along the tops of intestinal crypts. Dietary
phytates also increase butyrate levels in the colon. In various in vitro studies, this has been shown to induce cell differentiation, and promotes apoptosis via a p53-independent pathway.38, 39, 43 Apoptosis is particularly important in
cancer prevention to counter the indiscriminate proliferation of tumour cells.44
16
JATMS
A further synergy with docosahexaenoic acid (DHA)
has been discovered in mouse studies and this has potentially important ramifications for both colon health and
calcium regulation in the body. Fermentable fibre when
combined with fish oil containing DHA exhibits an enhanced ability to induce apoptosis and protect against colon tumorigenesis. DHA alters colonocyte mitochondrial
membrane composition and function to create a pathway
for butyrate and other metabolites to induce apoptosis.
An increase in mitochondrial Ca2+ contributes to the induction of apoptosis by DHA and butyrate cotreatment.45
The authors go on to review the current literature regarding the role of Ca2+ as a trigger for apoptosis. Ca2+
concentration inside cells is regulated by a variety of mechanisms that turn cell signalling on or off. Endoplasmic reticulum (ER) is a major storage area for Ca2+, but more
recent studies have identified other organelles, particularly
the mitochondria, as having a key role through regulation
of energy metabolism in determining whether apoptosis
or necrosis results. Mitochondria are in close proximity to
IP3-gated channels on the ER, and Ca2+ is rapidly taken
up into the mitochondria through active pumps.46
Research is showing that mRNA is affected by IP6,
which can induce transcriptional activation of p53 and
p21 genes in human cancer HT-29 cells. They found that
there may be a p53-dependent mechanism which affects
the up-regulation of the p21 gene by IP6.47 In another paper, the same authors found that IP6 at a 5mM dose inhibited the growth of colon cancer HT-29 and Caco-2 cells.48
Other studies have yielded very similar results.49, 50
The anti-cancer effects of IP6 are not limited to colon
cancer. Vucenik et al list human in vitro experiments on
blood, liver, mammary tissue, uterine cervix, prostate and
soft tissue, along with murine studies of skin and lung, all
of which have found an anti-tumour effect for IP6.14 They
further note that leukemic cell lines have a very high susceptibility to IP6, which may suggest that some tissues are
more responsive to this effect than others. In a later study,
the same authors found that IP6 also induces differentiation of malignant cells, enhances chemotherapy and helps
to prevent metastasis.40
Studies of IP6 and breast cancers in vitro and in biopsied human cells have shown that IP6 alone at concentrations between 0.91-5.5mM show anti-tumour effects, and
when combined with Tamoxifen and other breast cancer
drugs, show a synergistic effect.51 The same authors have
moved on to examining the effects of enzymes – particularly protein kinase C and others – on breast cancer cells,
showing that IP6 can arrest their growth by upregulation
of p27/Kip1, which causes inhibition of retinoblastoma
protein 1. However, as yet the mechanism by which this
happens is not understood.52
Prostate cancer is another disease where IP6 has shown
useful therapeutic results. In an in vitro study, results suggest that IP6 could be a potent dietary agent in controlling the growth of advanced prostate cancer cells and
inducing their apoptotic death, in part, by its inhibitory
effect on the NF-kappa B signalling pathway.53 The same
authors also found that IP6 was capable of inhibiting the
G1 phase of the cell cycle, increasing its arrest in prostate
cancer cells, as well as upregulating p27/Kip1 and p21/
Cip1 which contribute to this effect. However, this effect
is unlikely to be produced with normal dietary levels of
phytate, and that higher levels are needed for efficacy.54
Pancreatic cancer has also been tested with IP6. A US
team has carried out in vitro studies, one with IP6 alone, 55
and another with IP6 and catechins found in green tea and
grapeseeds. The first study showed that 2.5 mM of IP6 significantly increased early apoptosis. In the later study both
substances were found to show significant results in reducing cellular proliferation and when they were combined
the synergy produced considerably higher benefits.56
Melanoma studies have demonstrated that dietary
phytate has across the board implications for inhibiting
cancer cell growth.57 The melanoma studies are still at the
in vitro stage, with significant reductions in cellular proliferation observed in the HTB68 melanoma cell line. Some
animal experiments have also commenced that show that
topical administration of IP6 can significantly inhibit skin
tumour development.58 A study of the topical use of IP6
has shown that it can achieve important concentrations
in tissues and biological fluids, which demonstrates that
it is possible to propose the topical use as a new InsP(6)
administration route, which may be of use in skin cancer
treatment or prevention.59 Further study is needed on this
application.
Lung cancer has so far only been studied in mice. Mice
were fed dietary phytate after administration of benzopyrene or methylnitrosamino-1-(3-pyridyl)-1-butanone
(NNK). A significant inhibitory effect was found.60
An in vitro study has shown that the chelation effect
of phytate on iron inhibited asbestos-induced decreases in
epidermal growth factor receptor (EGFR) phosphorylation in human lung epithelial (A549) cells, human pleural
mesothelial (MET5A) cells, and normal human small airway epithelial (SAEC) cells. This shows phytate’s potential as a treatment for asbestos-related lung damage, but
further study is required in vivo.61
O T H ER P H Y TAT E H E A LT H BE N E F I T S
Renal lithiasis
As early as the 1980s, the possibility of phytate having
preventative activity against renal lithiasis was proposed.62
More recent studies have borne this out, with 96,245
younger women who took part in the Nurses Health
Study II, demonstrating a strong inverse association between phytate intake and the risk of stone formation. The
women in the highest quintile of phytate intake had a 36%
lower risk of forming kidney stones.63 Phytate exhibits a
strong inhibitory effect on the crystallisation of calcium
salts such as calcium oxalate and calcium phosphate. ReJATMS
search found that people who form calcium oxalate stones
have an abnormally low level of urinary phytate, which
would be a direct result of low dietary phytate intake.64
Dental caries prevention
Observation of the lower incidence of dental caries in
native tribes with high plant-food intake has given rise to
research in this area. While the reason for the lower incidence of dental caries may be multifactorial, past in vitro
experiments have shown a strong affinity for phytate and
calcium hydroxyapetite in tooth enamel, forming a physical barrier that protects against acid attacks.65 However, as
phytate is only processed within the colon, it would need
to be used as a food additive to have a protective effect
within the mouth, although the accompanying fibre in the
food may also help to protect teeth by stimulating saliva
secretion which is alkaline, and may therefore help to resist acid attack.66
Benefits in post-menopausal conditions
Higher homocysteine (Hcy) levels, higher cholesterol
and progression of cardiovascular disease are all more common after menopause and, in particular, women’s homocysteine levels increase by 7-20% after menopause.67 Studies of soy products (which include high levels of phytate)
have shown some benefit for older people in reducing
iron absorption. This relates to its anti-nutritional role of
chelating divalent ions, but in this case it is beneficial for
older women who may be at risk of oxidative damage from
elevated iron levels once menstruation has ceased.68
In general, studies in this area have revealed mixed results, with some findings showing that phytates and isoflavones (from soy products) have mostly insignificant results on cholesterol, 69 and C-reactive protein and Hcy.68
However the authors raise the possibility that their use of
healthy human volunteers meant that there was not room
for a significant improvement to be made. Their results
contrast with another study where 42 healthy postmenopausal women were given three daily servings of soy foods
for 12 weeks. A significant increase in HDL cholesterol
and a decrease in total cholesterol were found, while levels
of serum osteocalcin, a sensitive and specific marker of osteoblastic activity, were boosted.70
Earlier studies have found positive benefits for inclusion of soy and other phytate-rich plant foods. One study
of 25 people with hyperlipidaemia who consumed a soyrich breakfast cereal did not find a reduction in overall
LDL levels, but did find a significant reduction in oxidised
LDL in the test group compared to the control. This could
assist in reduction of cardiovascular risk.71 Further study
particularly on symptomatic volunteers, and with clear delineation of the different risk factors and the food source
(i.e. whether dietary phytate, isoflavones and/or other
components), needs to be done in this important area.
Blood glucose management in diabetes and hyperlipidaemia
Research in the 1980s showed that a diet high in legumes resulted in a slower rate of digestion in vitro and a
lower blood glucose response in vivo compared to a diet
high in breads and cereals. Phytic acid is present in higher
concentrations in legumes than in cereals and bread. This
was confirmed in a study of navy bean flour that examined
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results of addition and removal of phytic acid on digestion. Removal of phytate and addition of calcium speeded
up digestion and glycaemic response, while adding phytate
to the flour did the opposite.72 These results show promise
for the use of phytate-rich foods such as legumes in the diets of patients with glycaemic conditions such as diabetes.
More recent research has shown a further benefit of
IP6 in type II diabetes, where loss of glucose-stimulated
insulin exocytosis from the pancreatic beta-cell is an early
pathogenetic event. IP6 dose-dependently and differentially inhibited enzyme activities of ser/thr protein phosphatases in physiologically relevant concentrations. This
may be a novel regulatory mechanism linking glucosestimulated polyphosphoinositide formation to insulin
exocytosis in insulin-secreting cells.73
N O V EL U S E S O F P H Y TAT E
In recent research, phytate’s chelating ability has been
hypothesised as a potential chelate for uranium contamination in humans. Once deposited in the body uranium
is retained in various organs, particularly the kidneys, and
in the sbones, with highly toxic effects. Sodium bicarbonate is one standard treatment for uranium poisoning, but
has its limits. In an in vitro assay phytic acid’s ability to
chelate uranium was found to be twice as high as ethane1-hydroxy-1 and 1- bisphosphonate (EHBP), 2.6 times
higher than citric acid, and 16 times higher than Diethylene triamine penta-acetic acid (DTPA), which have all
been examined in animals as potential chelating agents for
humans. The authors suggest that further in vivo study is
required.74
M A N A G I N G P H Y TAT E
Phytate clearly has both advantages and disadvantages
for human health. However it is clear that in communities where phytates are responsible for widespread mineral
deficiencies means have to be found to overcome these
problems. A number of traditional communities have
done that, through means such as fermentation, soaking
in water, germination, mechanical pounding and cooking,
and combinations of these processes. The use of enzymes
to break down phytate has also been studied.75
Fermentation and germination of grains have been
shown to activate endogenous phytases to convert phytate
to the lower inositol phosphates. When phytate was completely hydrolysed after germination and fermentation of
white sorghum, the amount of soluble iron was strongly
increased.18 Cooking will produce moderate phytate
losses of between 5-15%, depending on the type of plant
species, temperature and pH.76
In many African countries, traditional processing of
grains is frequently achieved by fermentation of gruels.
Fermentation, as well as degrading phytates, has sanitation benefits in that the reduction in pH inhibits growth
of microorganisms. A study carried out in Burkina Faso
which examined the lactic acid fermentation of pearl millet (ben-saalga), a food that is regularly consumed by up
to 49% of the population, showed that phytate degraded
naturally with a 75% reduction.77
Anaemia is a common problem for pregnant women
18
JATMS
in South America. Quinoa, a pseudocereal species of chenopodium common in Andean countries, is a good source
of minerals, but also of phytate. Soaking, germination and
lactic acid fermentation of quinoa were all found to enhance iron solubility and degrade phytate. Fermentation
of germinated quinoa flour was found to yield almost 98%
phytate hydrolysis.78
However, germination and fermentation do not always result in higher mineral bioavailability. In a study of
zinc and iron in food grains, germination of finger millet
and green gram (mung bean) did not result in higher zinc
availability but did assist iron availability. A fermented
batter of rice and black gram did provide higher levels of
zinc, and much higher levels of iron. Bioavailability did
not improve after fermentation of a combination of chickpea, green gram, black gram and rice.79
Magnesium absorption is also affected by dietary
phytates. A study of the addition of phytic acid to white
bread showed that fractional magnesium absorption is
significantly impaired by the addition of phytic acid, in
a dose-dependent manner, at amounts similar to those
naturally present in whole-meal and brown bread.80 But
fermentation of dietary fibre has been shown to have a
beneficial effect on magnesium absorption in the presence
of phytate-rich foods. Inulin was one substance studied,
where magnesium absorption was increased by up to 10%
above that of the control group when the study group consumed 40 mg inulin for 28 days.81
It appears that a combination of methods shows the
greatest efficacy for phytate degradation. Simply soaking
grains and legumes with no other intervention does not
reduce phytate levels sufficiently to make a difference to
nutrition. Soaking also has different outcomes for various
metals. A French study found that some iron leaches into
the soaking medium, while zinc does not. They found that
soaking grains and legumes may have a slightly beneficial
effect on zinc bioavailability, but not on iron.82 More
studies are needed to better understand the mechanisms
involved.
C O N C LU S I O N
It is clear from published research that phytates have
many advantages for human health, despite earlier studies suggesting that they should be avoided due to their effects on mineral status. There are methods, such as soaking, fermentation, germination and mechanical processes
available to all communities that allow them to mitigate
the disadvantages of high-phytate consumption. Diseases
such as anaemia, rickets and birth defects do not need to
occur in future in these communities as long as education
is provided to help people to maximise the benefits of
phytate, and to counteract the effects of mineral chelation.
Given the abundant health advantages of phytate-rich
foods, it would appear that the breeding of low phytate
crops for human consumption is a less than profitable
route to pursue. They may have some advantages for animal consumption in the prevention of phosphorus imbalance in the environment of feedlots.
In order to benefit human populations phytate-rich
foods need to be available and utilised in diets, particu-
larly in first world countries where cancer, diabetes, renal
lithiasis and other diseases are rife. The inclusion of greater
amounts of plant-based foods in the diet provides many
phytonutrients including phytate, a high fibre content,
and a balance to animal foods. However, it is clear that
more education is required in the community regarding
these foods and how to balance them to avoid mineral deficiencies.
It is also clear that phytate also has therapeutic uses in
higher dosages than would be consumed in a normal diet.
Further testing to refine optimum dosages and methods of
administration is required, as well as education of medical
professionals in the potential of phytate or IP6 as a therapeutic substance.
51. Tantivejkul, K., et al., Inositol hexaphosphate (IP6) en
hances the anti-proliferative effects of adriamycin and
tamoxifen in breast cancer. Breast Cancer Res Treat, 2003. 79(3): p. 301-12.
37. Miyamoto, S., et al., Protective effect of phytic acid hy
drolysis products on iron-induced lipid peroxidation of liposomal membranes. Lipids, 2000. 35(12): p. 1411-
3.
39. Hague, A., et al., Sodium butyrate induces apoptosis in human colonic tumour cell lines in a p53-independ
ent pathway; implications for the possible role of di
etary fiber in the prevention of large bowel cancer. Int J Cancer, 1993. 55: p. 498-505.
40. Vucenik, I. and A.M. Shamsuddin, Protection against cancer by dietary IP6 and inositol. Nutr Cancer, 2006.
55(2): p. 109-25.
41. Shamsuddin, A.M., I. Vucenik, and K.E. Cole, IP6: a
novel anti-cancer agent. Life Sci, 1997. 61(4): p. 343-
54.
42. Lim, C.C., L.R. Ferguson, and G.W. Tannock, Dietary fibres as “prebiotics”: implications for colorectal can
cer. Molecular Nutrition & Food Research, 2005. 49: p. 609-619.
43. Jenab, M. and L.U. Thompson, Docosahexaenoic acid and butyrate synergistically induce colonocyte apoptosis by enhancing mitochondrial Ca2+ accumu
lation. Carcinogenesis, 2000. 21(8): p. 1547-1552.
45. Kolar, S.S.N., et al., Docosahexaenoic acid and bu
tyrate synergistically induce colonocyte apoptosis by enhancing mitochondrial Ca2+ accumulation. Can
cer Research, 2007. 67(11): p. 5561-5568.
46. Parekh, A.B. and J.W. Putney, Jr., Store-operated cal
cium channels. Physiol Rev, 2005. 85(2): p. 757-810.
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Weglarz, L., et al., Quantitative analysis of the level of
p53 and p21WAF1 mRNA in human colon cancer HT29 cells treated with inositol hexaphosphate. Acta Bio
chimica Polonica, 2006. 53(2): p. 349-356.
48. Weglarz, L., et al., Anti-proliferative effects of inositol hexaphosphate and verampamil on human colon can
cer Caco-2 and HT-29 cells. Acta Pol. Pharm., 2006. 63(5): p. 443-5.
49. Tian, Y. and Y. Song, Effects of inositol hexaphos
phate on proliferation of HT-29 human colon carcino
JATMS
52.
Vucenik, I., et al., Inositol hexaphosphate (IP6) blocks
proliferation of human breast cancer cells through a
PKCdelta-dependent increase in p27Kip1 and de
crease in retinoblastoma protein (pRb) phosphoryla
tion. Breast Cancer Res Treat, 2005. 91(1): p. 35-45.
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Agarwal, C., et al., Inositol hexaphosphate inhibits
constitutive activation of NF- kappa B in androgen-in
dependent human prostate carcinoma DU145 cells.
Anticancer Res, 2003. 23(5A): p. 3855-61.
54.
Singh, R.P., C. Agarwal, and R. Agarwal, Inositol
hexaphosphate inhibits growth, and induces G1 ar
rest and apoptotic death of prostate carcinoma DU145
cells: modulation of CDKI-CDK-cyclin and pRb-re
lated protein-E2F complexes. Carcinogenesis, 2003. 24(3): p. 555-63.
55. Somasundar, P., et al., Inositol hexaphosphate (IP6): a novel treatment for pancreatic cancer. J Surg Res, 2005. 126(2): p. 199-203.
56. McMillan, B., et al., Dietary influence on pancreatic cancer growth by catechin and inositol hexaphos
phate. J Surg Res, 2007. 141: p. 115-119.
57. Rizvi, I., et al., Inositol hexaphosphate (IP6) inhibits cellular proliferation in melanoma. J Surg Res, 2006. 133(1): p. 3-6.
58.Gupta, K.P., J. Singh, and R. Bharathi, Suppression of DMBA-induced mouse skin tumor development by inositol hexaphosphate and its mode of action. Nutr Cancer, 2003. 46(1): p. 66-72.
59.Grases, F., et al., Study of the absorption of myo-ino
sitol hexakisphosphate (InsP6) through the skin. Bio
logical and Pharmaceutical Bulletin, 2005. 28(4): p. 764-7.
44. Evan, G.I. and K.H. Vousden, Proliferation, cell cycle and apoptosis in cancer. Nature, 2001. 411(6835): p. 342-348.
ma cell line. World Journal of Gastroenterology, 2006.
12(26): p. 4137-4142.
50.Garcia-Casal, M., I. Leets, and M. Layrisse, B-car
otene and inhibitors of iron absorption modify iron up
take by Caco-2 cells. Journal of Nutrition, 1999. 130(1): p. 5-9.
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38. Augeron, C. and C.L. Laboisse, Emergence of per
manently differentiated cell clones in a human colonic cancer cell line in culture after treatment with sodium butyrate. Cancer Research, 1984. 44: p. 3961-3969.
60. Wattenberg, L.W., Chemoprevention of pulmonary carcinogenesis by myo-inositol. Anticancer Res, 1999.
19(5A):p. 3659-61.
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Baldys, A. and A.E. Aust, Role of iron in inactivation
of epidermal growth factor receptor after asbestos
treatment of human lung and pleural target cells. Am J
Respir Cell Mol Biol, 2005. 32(5): p. 436-42.
62. Modlin, M., Urinary phosphorylated inositols and renal
stone. Lancet, 1980. 2(8204): p. 1113.
63. Curhan, G.C., et al., Dietary factors and the risk of in
cident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med, 2004. 164(8):
p. 885-91.
64. Taylor, E.N. and G.C. Curhan, Role of nutrition in the formation of calcium-containing kidney
stones. Nephron Physiol, 2004. 98(2): p. p55-63.
65. Magrill, D.S., The reduction of the solubility of hy
droxyapatite in acid by adsorption of phytate from so
lution. Archives of Oral Biology, 1973. 18: p. 591-600.
66. Moynihan, P., Foods and factors that protect against . Volume 17 Number 2 . June 2011
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JOURNAL OF AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY
dental caries. Nutrition Bulletin, 2000. 25: p. 281-286.
67. Hak, A.E., et al., Increased plasma homocysteine af
ter menopause. Atherosclerosis, 2000. 149(1): p. 1638.
68. Hanson, L.N., et al., Effects of soy isoflavones and phytate on homocysteine, C-reactive protein, and iron
status in postmenopausal women. Am J Clin Nutr, 2006. 84(4): p. 774-80.
69. Engelman, H.M., et al., Blood lipid and oxidative stress responses to soy protein with isoflavones and phytic acid in postmenopausal women. Am J Clin Nutr,
2005. 81(3): p. 590-6.
70. Scheiber, M.D., et al., Dietary inclusion of whole soy
foods results in significant reductions in clinical risk
factors for osteoporosis and cardiovascular disease in normal postmenopausal women. Menopause, 2001. 8(5): p. 384-392.
71. Jenkins, D.J., et al., Effect of soy-based breakfast ce
real on blood lipids and oxidized low-density lipopro
tein. Metabolism, 2000. 49(11): p. 1496-500.
72. Thompson, L.U., C.L. Button, and D.J. Jenkins, Phytic
acid and calcium affect the in vitro rate of navy bean starch digestion and blood glucose response in hu
mans. Am J Clin Nutr, 1987. 46(3): p. 467-73.
73. Lehtihet, M., R.E. Honkanen, and A. Sjoholm, Inositol hexakisphosphate and sulfonylureas regulate beta-
cell protein phosphatases. Biochem Biophys Res Commun, 2004. 316(3): p. 893-7.
74. Cebrian, D., et al., Inositol hexaphosphate: a potential
chelating agent for uranium. Radiat Prot Dosimetry, 2007(July 12).
75. Knorr, D., T.R. Watkins, and B.L. Carlson, Enzymatic reduction of phytate in whole wheat bread. Journal of Food Science, 1981. 46: p. 1866-1869.
76. Hotz, C. and R.S. Gibson, Traditional food-processing
and preparation practices to enhance the bioavailabil
ity of micronutrients in plant-based diets. J Nutr, 2007.
137(4): p. 1097-100.
77.
78. Valencia, S., et al., Processing of quinoa (Chenopodi
um quinoa, Willd): effects on in vitro iron availability
and phytate hydrolysis. Int J Food Sci Nutr, 1999.
50(3): p. 203-11.
79.
Tou, E.H., et al., Study through surveys and fermenta
tion kinetics of the traditional processing of pearl millet
(Pennisetum glaucum) into ben-saalga, a fermented
gruel from Burkina Faso. Int J Food Microbiol, 2006.
106(1): p. 52-60.
Hemalatha, S., K. Platel, and K. Srinivasan, Influence
of germination and fermentation on bioaccessibility of
zinc and iron from food grains. Eur J Clin Nutr, 2007.
61(3): p. 342-8.
81. Coudray, C., et al., Effect of soluble or partly soluble dietary fibres supplementation on absorption and bal
ance of calcium, magnesium, iron and zinc in healthy
young men. Eur J Clin Nutr, 1997. 51(6): p. 375-80.
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21
ARTICLE
Effective Research: A Discussion of Essential Elements
BSc (Hons), UNSW, MSc (Research), UNSW, Grad Cert H Ed (UNSW), Diploma Remedial Massage
(NSW School of Therapeutic Massage)
Lecturer, Anatomy Department, School of Medical Sciences, Faculty of Medicine, UNSW. Lecturer in
Anatomy and Physiology, NSW School of Massage, Sydney. ATMS Member’s Representative, Council
member ANZACA (Australian and New Zealand Association of Clinical Anatomists), Member ANS
(Australian Neuroscience Society)
A
s a researcher involved in collaborative projects in
neuronal plasticity in sensory systems supported
by NH&MRC Research Grants and in research in
teaching in the area of virtual microscopy supported by an
ALTC Grant, I would like to convey to ATMS members
some of the main elements involved in conducting effective research. I feel that the best way to convey this discussion is in point form. The information supplied is based
on my own experience as well as discussions with research
colleagues.
Effective research should commence with a specific
question that ideally should, when answered, add to a body
of knowledge, solve a problem or offer new insight into
an issue. In my experience, the question should be fairly
simple in order to be quite certain that one can achieve an
outcome. The question should encompass the main concepts of the research to be undertaken. Researchers can
become too ambitious and subsequently find that the time
scale of the project is not manageable. A research question should not lead to too many variables in the design of
the project because excessive variables can lead to criticism
about the validity of the project. It may seem frustrating
to spend time obtaining a good research question but in
the long run it will provide the project with direction.
One should examine the target audience in order to
focus the project on those who have a particular interest
in the outcome of the research. This is especially significant in natural therapies as there is a considerable variety
of modalities and the project may bridge several of these.
Another important element before commencing a
research topic is to undertake a literature review which
should reveal how much is already known about the topic
and also narrow the area of research especially if one is
dealing with a very broad area of interest. Ideally, a comprehensive literature review should attempt to avoid duplication of research.
Effective research should convey clear aims and methodology, which includes an examination of reliable data
collection and an adequate sample size so that the data
analysis becomes statistically meaningful. A small sample
can lead to conclusions which are not statistically relevant
and are unreliable. One should also examine the availability of resources within budget constraints such as easy access to participants, the type of equipment required, the
involvement of organizations, the types of procedures to
be followed in the data analysis, etc.
22
JATMS
Ethical considerations are very important and essential
in developing a research project. For example, protecting
the confidentiality of participants, maintaining the strict
codes of practice outlined by professional organizations
and avoiding plagiarism. Before commencing a research
project, one should always investigate if ethics approval is
required.
The results of the project should be able to withstand
critical scrutiny in order to support important elements
such as reliability and validity, which allow for replication of the research. Conclusions should remain within
the justification of the data and avoid sweeping statements
which cannot be substantiated.
Other elements of good research are to be passionate
in order to gain an understanding in a particular area of
interest and to have a strong commitment to objectivity
and logical reasoning which enhances the ability of good
decision-making both at the instigation of, and during the
course of, the project.
Collaboration is another area, which should be explored as it enables people of different backgrounds and
views to add unique aspects to the research topic. For
instance, a research project in natural therapies may be
enhanced by the inclusion and subsequent experiences
of a massage therapist, naturopath, and acupuncturist. In
many ways, this multimodal investigation to a research
question can only serve to enrich the conclusions derived.
In collaborative research a management plan is important in order to clarify individual responsibilities for the
project and to appoint a person who is responsible for its
overall co-ordination. In my experience, the principal researcher is usually responsible for the latter task. In collaborative research feedback (from within the group and
external to it) is vital for examining elements of the project
which have been achieved, determining if there is a need
for a change in focus and envisaging future directions.
In summary, these are by no means all the elements
of effective research but based on my experience they are
some of the main ones. Although it may seem daunting
at first, following the guidelines presented in this article
will encourage effective research which is more likely to be
published in a reputable refereed journal.
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23
ARTICLE
ARTICLE
Homoeopathy and its Role in the Management of Headaches
Robert Medhurst
B.Nat. D.Hom
H
eadaches can manifest in a dizzying array of
forms. Left-sided, right-sided, frontal, occipital,
temporal, throbbing, constant, coming and going with the sun, appearing only on weekends, only when
accompanying menses, at the onset of rain, and on and on
they go. In some cases of course a headache may be the
only obvious symptom of a serious intracranial or extracranial disorder and so they should never be taken lightly.
But in the main they’re a relatively benign but nonetheless
painful problem.
A study referred to in an article on headaches by Abdul Abbas in The Practitioner (August 8, 1989, Vol 233,
1081-1084) found that 90% of males and 95% of females
had experienced at least 1 headache in the preceding 12
months. Clearly, this is a common problem and, unfortunately, the first thing the headache sufferer normally
reaches for is a pharmaceutical analgesic. I use the word
unfortunately because the risk to benefit ratio of such a
strategy is rarely considered. If it were, the first choice
would be something that is virtually risk free and has
proved its usefulness again and again around the world for
over 200 years.
When used according to traditional homeopathic
principals properly indicated homeopathic medicines
can relieve the pain of headache quickly and permanently.
Where this doesn’t happen within a reasonable period of
time priority should be given to the cause of the problem
should being identified and appropriate management
strategies developed.
Constitutional treatment aimed at prescribing on the
totality of the symptoms is always preferable, but a number of authors 1, 2, 3, 4, 5, 6 have found consistently useful
outcomes provided by the following homeopathic medicines.
DIFFERENTIATING FEATURES
ACONITE
Aconite headaches, often frontal, are frequently described as burning or bursting in character, with feelings as if the
brain is boiling and may protrude through the forehead. Symptoms are worse in cold, dry wind or weather, at night,
during motion and after sunstroke, and are better for open air and rest.
ARSENICUM ALBUM
Typically used for hemicrania associated with weakness, restlessness and an icy feeling in the scalp, the pain of an
Arsenicum headache is often burning in character. Symptoms are aggravated by other people talking, and better for
cold.
BELLADONNA
The sufferer may have a nervous headache, facial flushing and drooping eyelids. The headache is frequently frontal
or temporal with a preference for the right side, is frequently throbbing in nature and may be associated with exposure to the sun. Symptoms are aggravated by cold, light, noise, motion, lying down and at around 5pm, and better
for pressure and sitting in a semi-erect posture.
BRYONIA
Often associated with constipation, the headache here is usually frontal, temporal, occipital or left supraorbital and
is bursting or splitting in character. It may arise in the early morning and continue through the day. Aggravated by
stooping or coughing, and better for rest or cold.
CHINA
This is often of use in temporal headaches of a bursting or throbbing character. It may be associated with vertigo
and a sensitive scalp. Symptoms are aggravated by exposure to sunlight, open air, touching or combing the hair, and
better for hard pressure, rubbing, or moving the head up or down.
CIMICIFUGA
Commonly indicated in headaches of the vertex, during which sufferers may notice a sensation as if the brain were
opening and shutting or the vertex feels as if it would fly off. The pain may be shooting or throbbing in character,
or be described as a pressing outwards. It may arise from mental overexertion. Aggravated by being in the open air,
better for going upstairs.
COCCULUS
Commonly used for sick headaches, vertigo and nausea, Cocculus has great use in occipital headaches associated
with menstruation, nausea or vomiting. Such headaches are aggravated by motion, sleeping, drinking and eating
and better for sitting or bending backwards.
GELSEMIUM
Tremors, debility, drowsiness, vertigo, nausea, neck pain, visual disturbances and ptosis of the upper eyelids may
be seen here. The headache is normally occipital or temporal, the pain dull in character, the head feels heavy and
symptoms may be associated with exposure to the sun. Aggravated by damp, humid weather or the heat of the sun,
better for pressure.
GLONOINE
Useful in congestive, throbbing headaches, particularly when associated with menstrual disorders or exposure to the
sun. Aggravated by laying the head on a pillow, motion, jarring or shaking; better for cold or open air.
IGNATIA
The Ignatia headache may feel as if a nail were being driven out through the side of the head. It’s often associated
with vomiting, vertigo or visual disturbances and may follow the use of coffee or exposure to tobacco smoke. Aggravated by emotions, grief or anxiety, better for pressure or lying on the affected part.
IRIS VERSICOLOR
A favourite remedy for sick headaches or migraine, where the condition is preceded by a blurring of the vision and
sour, watery vomiting. The pain is felt predominantly in the right temporal region. The pain itself may be described
as shooting in character. Aggravated by cold air, rest, violent motion or coughing and better for gentle motion.
24
JATMS
Headaches related to sun exposure or coryza, and in which there are visual disturbances. The vision is dim, the face
is pale. These headaches often respond well to Lachesis. Aggravated by heat and motion, and better for cold drinks
or discharges.
NAT CARB
Orbital headaches and vertigo from mental exertion or exposure to the sun may be alleviated by this remedy. Symptoms are often aggravated by heat, lights, sun, mental exertion, and better for movement.
NAT MUR
The Nat mur headache is often congestive, blinding and bursting in nature, and the sufferer may have a great thirst.
The pain is usually supraorbital or felt in the vertex. Worse from sunrise to sunset, aggravated by the heat of the sun,
mental exertion or reading, better for open air or rest.
NUX VOMICA
One of the most commonly indicated headache remedies, it’s often associated with hangovers and overindulgence
generally. The headache is usually confined to the frontal, temporal or supraorbital regions. Aggravated by sunshine
or cold, open air, light, noise and better for rest or strong pressure
PETROLEUM
In this case there’s frequently an association with vertigo. The pain is usually felt in the occiput, the pain is aching in
character and the head feels numb. Symptoms are aggravated by shaking the head or coughing and better for pressure on the temples.
PICRIC ACID
This remedy may be helpful in occipital headaches that arise from mental exertion, grief or depression. They often
occur during the day. Aggravated by mental exertion or sexual excitement, better for sleep and a tight bandage
around the head.
RE F ERE N C E S
REMEDY
LACHESIS
1. Das RBB, Select Your Remedy, 14th Edition, May
1992, B Jain, New Delhi, India.
2. Clarke JH, A Clinical Repertory to the Dictionary of the
Materia Medica, Health Sciences Press, England,
1979. ISBN 0 85032 061 5.
3. Dewey WA, Practical Homoeopathic Therapeutics, 2nd Edition, B Jain, New Delhi, 1991.
Bouko Levy MM, Homeopathic and Drainage Reper
tory, Editions Similia, France, 1992, ISBN-2-904928-
4. 70-7.
5. Raue CG, 4th Edition, Special Pathology and Diag
nostics with Therapeutic Hints, 1896, B Jain, New Delhi.
6. Knerr KB, Repertory of Hering’s Guiding Symptoms of
our Materia Medica, 1997, B Jain, New Delhi.
7. Samuel Lilienthal, Homoeopathic Therapeutics, 3rd
edition, 1890, Indian Books and Periodicals.
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JATMS
25
ARTICLE
ARTICLE
Vitamin D3, The Super Nutrient: An Independent Review of
Complementary Medicine Evidence
Russell Setright
Russell Setright is an accredited Naturopath, Medical Herbalist, Acupuncturist and an educator in Advanced Life Support, First Aid, Emergency Care and Rescue. Russell is the author of seven books on
complementary medicine, with one published in the Chinese and Malay languages, and he currently has
a Health Talk Back Radio Show with Brian Wilshire on 2GB Sydney, Leon Byner on 5AA Adelaide and
Richard Perno in Country NSW.
I
s there a vitamin D deficiency epidemic in Australia,
and if so, is this a major contributing factor to disease
and is vitamin D3 the new super nutrient? A summary
of evidence.
ABSTRACT
A review of published studies found that a significant
number of Australians and New Zealanders have less than
optimal serum vitamin D levels, with mild to moderate
deficiency ranging from 33% to 84% depending on age,
skin colour and whether subjects were in residential care.
These studies have also reported a significant relationship
between low vitamin D status and an increase in the prevalence of diseases including; diabetes, CVD, metabolic
syndrome, osteoporosis, hypertension, certain cancers,
several autoimmune diseases, influenza, of which many
cause mortality. The data also suggest that normalising
blood 25(OH)VitD levels by supplementation with vitamin D3 may have a positive effect in disease prevention.
Methods The literature up to April 2010 was searched
without language restriction using the following databases: PubMed, ISI Web of Science (Science Citation Index
Expanded), EMBASE, and the Cochrane Library.
B A C K G ROU N D
Ecological studies have suggested that mortality from
several potentially life-threatening chronic diseases increase in incidence with a decreased exposure to sun light
(Grant WB. Ecologic studies of solar UV-B radiation
and cancer mortality rates. Recent Results Cancer Res.
2003;164:371-377) Because sun exposure is necessary for
the synthesis of vitamin D in the skin, this review will show
that the associations found between sun exposure, vitamin
D intake and mortality(death) from several chronic conditions could be owing to variations in vitamin D status.
There are two forms of vitamin D that are important
in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by plants
and obtained by humans through diet. Vitamin D3 is
made in the skin when 7-dehydrocholesterol reacts with
ultraviolet-B (UVB) rays from sunlight at wavelengths between 270–300 nm and stored in the blood as calcidiol
(25-hydroxy-vitamin D). Both D2 and D3 precursors are
hydroxylated in the kidneys and liver to form 25- hydroxyvitamin D (25(OH)vit.D), the non-active ‘storage’ form,
and 1,25-dihydroxyvitamin D. 1,25 (OH)2D, the biolog-
26
JATMS
ically active (hormone) form that is tightly controlled by
the body.
One of the functions of vitamin D is to maintain normal blood levels of calcium and phosphorus, which helps
form and maintain strong bones. However, research also
suggests that increased blood levels of 25(OH)VitD may
provide protection from CVD, diabetes, osteoporosis, hypertension, certain cancers, and several autoimmune diseases.
The sun is a significant contributor to our daily production of vitamin D3. However, the amount of sun exposure required to produce enough vitamin D3 is dependent
on a number of factors including, skin colour, latitude,
types of clothing, body mass, age, cloud cover, atmospheric pollution. In Australia we are exposed to around 40%
more UV rays than the equivalent latitude in the Northern Hemisphere and this creates a dilemma. (Madronich
S, et al. Changes in biologically active ultraviolet radiation reaching the earth’s surface. Photochem Photobiol B
1998;46:5-19).
Is this increased UV exposure in the Southern Hemisphere and the resulting damage to the skin from exposure
to sunlight more detrimental to overall health than vitamin D deficiency?
There is evidence that excessive sun exposure increases
the risk of skin damage, ageing and skin cancers. Excessive
exposure to sunlight causing sunburn at any time in life
increases a person’s risk of developing skin cancer. However, people who experience intermittent exposure to high
levels of UV radiation such as tanning on the beach on
the weekend appear to be at greater risk, while those who
experience continual exposure to lower levels even if the
total dose of UV radiation is the same have the lowest incidence of melanoma. That is, non-burning regular sun exposure such as is obtained in the early morning and later in
the afternoon seems to have a protective effect against skin
cancer (Article, Prevention & Early Detection, Memorial
Sloan-Kettering Cancer Centre 2008). As well, a moderate amount of unblocked sunlight may actually be beneficial to most people, and could reduce the risk of many
other diseases – including, paradoxically, melanoma itself.
Another example of this paradox is research from
the University of California School of Medicine. This
study found that a higher incidence of melanoma occurred among Navy desk workers than among sailors who
worked outdoors (Garland FC. et al. Occupational sun-
light exposure and melanoma in the U.S. Navy. Arch Environ Health. 1990 Sep-Oct;45(5):261-7).
Also, a study (Nürnberg B, et al. 2008) from the Department of Dermatology, The Saarland University Hospital, Hamburg, Germany, that examined the progression
of malignant melanoma reported Basal 25-hydroxyvitamin D levels were lower in melanoma patients as compared to the control group. Progression of malignant melanoma was associated with significantly reduced 25(OH)
vit D serum levels. Their findings add to the growing body
of evidence that 25(OH)vit D serum levels may be of importance for pathogenesis and progression of malignant
melanoma (Nürnberg B, et al. Progression of malignant
melanoma is associated with reduced 25-hydroxyvitamin
D serum levels.Exp Dermatol. 2008 Jul;17(7):627).
As the growing body of evidence supports the theory
that low blood serum levels of 25(OH)vit D is also associated with an increase of many diseases including CVD,
diabetes, certain cancers, osteoporosis, muscular and bone
strength. (Dobnig H, et al. Independent association of
low serum 25-Hydroxyvitamin D with all cause mortality. Archives of Internal Medicine. 2008 Jun 23;168:13401349).
A strategy of timed low dose sun exposure needs to be
developed to maintain adequate vitamin D levels. However, given the vast difference in geographical location, skin
type and ethnic origin we have in Australia a “One Fits
All” program would be of questionable value. As the data
support maintaining adequate serum vitamin D levels,
while at the same time reducing the risk of overexposure
of UV rays from the sun, supplementation with vitamin
D3 may be the best way of achieving both goals.
V I TA M I N D D E F I C I E N C I E S I N A U S T R A L I A
The data are consistent in that low blood serum levels
of 25(OH)VitD (25-hydroxyvitamin D) are at an alarming rate in Australia. Those people with dark or olive skin,
the elderly and veiled (80% of whom may have mild deficiency) as well as those who wear protective clothing and
always use sun screen have the greatest risk of vitamin D
deficiency (FIG 1). In addition, those taking anticonvulsant medication or suffering from renal, hepatic or cardiopulmonary disease or those who have fat malabsorption
syndromes (e.g., cystic fibrosis) or inflammatory bowel
disease such as Crohn’s disease, are at risk. (Vitamin D,
SKIN COLOUR
SKIN
COVERING
VERY
DARK
INTERLIGHT
MEDIATE
TOTAL
CONSISTENTLY
COVERED
6/6
(100%)
1/2 (50%)
23/25 (92%)
30/33 (91%)
3/5 (60%)
INCONSISTENTLY
COVERED
1/3 (33%)
18/24 (75%)
22/32 (69%)
UNCOVERED
2/2
(100%)
2/3 (67%)
0 (0)
4/5
(80%)
TOTAL
11/13
(85%)
4/8 (50%)
41/49 (84%)
56/70 (80%)
JATMS
National Health and Medical Research Council 2010,
Ministry of Health. Australian Government).
Figure 1: Proportion of women with serum vitamin D (25-hydroxyvitamin D3) levels under 22.5nmol/L, according to skin
covering and skin colour
*Consistently covered - women always covered up, including
arms, hair and neck, when outdoors; inconsistently covered
- women did not usually cover fully in their own garden; and
uncovered - women did not generally cover their arms, hair and
neck when outdoors.
Nozza J et al. MJA 2001; 175: 253-255
W H AT A RE S ERUM 2 5 ( O H ) V I T D N ORM S ?
It has already been established that low serum levels of
vitamin D below 27.5nmol/Lt result in inadequate mineralisation/demineralisation of the skeleton, which is a
contributing factor to rickets in young children. (Vitamin
D, National Health and Medical Research Council 2010,
Ministry of Health. Australian Government). In a position statement, a Working Group from the Australian and
New Zealand Bone and Mineral Society, the Endocrine
Society of Australia and Osteoporosis Australia (2005)
defined mild deficiency for adults as serum 25-OHvitD
levels between 25 and 50nmol/L, which may contribute
to an increased risk of osteoporosis and, less commonly,
osteomalacia in adults (NHMRC).
The question often asked is, what blood serum 25(OH)
VitD level is considered to be adequate?
Any level below 50nmol/Lt may also place an individual at high risk of vitamin D associated deficiency diseases and mortality from any cause. Levels of vitamin D
between 73 – 100 nmol/Lt would appear to be adequate.
One prospective cohort study of 3258 consecutive male
and female patients found that those with low levels of
serum vitamin D had a 54% to 2.34 times increased risk
mortality from any cause when compared to people with
adequate levels of around 72nmol/Lt. (Fig. 2)
25(OH)VITD
STATUS
MOL/LT
DEFICIENT
HIGHEST RISK
‹ 37.4
DEFICIENT
HIGH RISK
37.4 - 50
INSUFFICIENT
MODERATE RISK
50-72
ADEQUATE
LOW RISK
›73
Figure 2: 25(OH)VitD blood levels (Dobnig H et al 2008)
Also, this study found that 25-hydroxyvitamin D levels that are in the lower 50% of the vitamin D range of
the study population have an increased risk for all-cause
mortality after adjustment for traditional cardiovascular
27
ARTICLE
ARTICLE
risk factors. In subgroup analysis, the relationship of low
25-hydroxyvitamin D levels to mortality is consistent regardless of co-morbidity or physical activity level. The researchers concluded that a low 25-hydroxyvitamin D level
can be considered a strong risk indicator for death from
any cause in men and women (Dobnig H, et al. Independent association of low serum 25-Hydroxyvitamin D with
all cause mortality. Archives of Internal Medicine. 2008
Jun 23;168:1340-1349).
C V D A N D D I A BE T E S
Recent research has found significant association between low serum levels of 25(OH)vit D and an increase in
the incidence of diabetes, CVD and metabolic syndrome.
This research examined 28 studies that included 99,745
men and women across a variety of ethnic groups. The
studies revealed a significant association between high
levels of vitamin D (25(OH)VitD) and a decreased risk of
developing cardiovascular disease (33% compared to low
levels of vitamin D), type 2 diabetes (55% reduction) and
metabolic syndrome (51% reduction) ( Levels of vitamin
D and cardiometabolic disorders: Systematic review and
meta-analysis J.Maturitas Volume 65, Issue 3, 225-236,
March 2010).
Further evidence relating to the benefits of adequate
vitamin D levels was presented at the American College of
Cardiology’s annual scientific session in Atlanta in March
2010. Researchers from the Intermountain Medical Center Heart Institute in Murray, Utah, reviewed 31,000 of
their patients aged 50 or older and found that those with
the lowest levels of serum 25(OH)vitD had a 170-percent greater risk of heart attacks than those with the highest serum levels.
Also, according to the authors of this study, the benefits of having more vitamin D were not limited to a cut in
heart-attack risk. Those with the lowest readings also had
an 80-per-cent greater risk of death, a 54-per-cent higher
risk of diabetes, a 40-per-cent higher risk of coronary artery disease, a 72-per-cent higher risk of kidney failure and
a 26-per-cent higher risk of depression.
D I A BE T E S
The incidence of diabetes in Australia is increasing and,
at the same time we are seeing a corresponding deficiency
in vitamin D levels. As the above studies show there is a
strong link between the development of diabetes type-2
and vitamin D deficiency. The following study examines
the link in childhood type-1 diabetes and vitamin D supplementation.
A review and meta-analysis of the data from five trials
that included 6455 infants, of which 1429 were cases and
5026 controls, was published in the Archives of Disease in
Childhood. The data from the five observational studies
found that infants who received vitamin D supplements
were 29 per cent less likely to develop type-1 diabetes than
non-supplemented infants (Zipitis C et al. “Vitamin D
supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis” Archives of
Disease in Childhood (British Medical Journal) .2007).
Also, a study published in the Journal of the Ameri-
28
JATMS
can Medical Association, September 2007 looked at 1770
children at high risk of developing type-1 diabetes. This
study reported that an increased intake of omega-3 fatty
acids from marine sources may reduce a child’s risk of developing type-1 diabetes by 55 per cent. Vitamin D found
in cod liver oil, a popular marine supplement, may have
been a contributing factor.
C A R D I O VA S C UL A R D I S E A S E
Results of a large case-control study (Health Professionals Follow-up Study) was conducted in 18, 225 men.
During the following 10 years of follow-up 454 men developed nonfatal myocardial infarction or fatal coronary
heart disease. After adjustment for matched variables, men
deficient in 25(OH)D less than 37.4nmol/Lt were at increased risk for MI (heart attack) compared with those
considered to be sufficient in 25(OH)D 74nmol/mL. After additional adjustment for family history of myocardial
infarction, body mass index, physical activity, alcohol consumption, history of diabetes mellitus and hypertension,
ethnicity, region, marine n-3 intake, low- and high-density
lipoprotein cholesterol levels, and triglyceride levels, this
relationship remained significant. Even men with intermediate 25(OH)D levels were at elevated risk relative to
those with sufficient 25(OH)D levels. The authors concluded that low levels of 25(OH)D are associated with
higher risk of myocardial infarction, even after controlling
for factors known to be associated with coronary artery
disease (Giovannucci, E. et al. 25-Hydroxyvitamin D and
Risk of Myocardial Infarction in Men, Arch Intern Med.
2008;168(11):1174-1180).
These benefits in part may be explained by maintaining
optimal vitamin D intake which can slow the turnover of
leukocytes by inhibiting pro-inflammatory overreaction
resulting in a reduction of leukocyte telomere shortening.
Shortening of leukocyte telomeres is a marker of aging
and a predictor of aging-related disease. Length of these
telomeres decreases with each cell division and with increased inflammation.
A study that examined whether vitamin D levels
would attenuate the rate of telomere attrition in leukocytes, such that higher vitamin D concentrations would be
associated with longer LTL suggested that higher vitamin
D (25(OH)VitD) concentrations, which can be modified through vitamin D supplementation, are associated
with longer LTL, would explain the potentially beneficial
effects of vitamin D on aging and age-related diseases.
(Richards J, et al. Higher serum vitamin D concentrations
are associated with longer leukocyte telomere length in
women, American Journal of Clinical Nutrition, Vol. 86,
No. 5, 1420-1425, November 2007)
V I TA M I N D S TAT I N S A N D
C H OLE S T EROL .
Studies have found that statins, medications used to
lower cholesterol, decrease the risk of CVD. However, the
dietary-heart-cholesterol hypothesis may need to be questioned as statins may reduce this risk in ways other than
lowering cholesterol.
A study examining this hypothesis, and benefits pro-
duced by statins, reports that based on published observations, the unexpected and unexplained clinical benefits
produced by statins have also been shown to be properties
of vitamin D. It seems likely that statins act as vitamin D
analogues(Grimes D, Are statins analogues of vitamin D?
The Lancet, Volume 368, Issue 9529, Pages 83 - 86, 1 July
2006).
Further evaluation of this proposed action needs to be
undertaken as it could explain in part the reduced incidence of CVD associated with an increase in serum vitamin D levels.
I MMU N E F U N C T I O N
Basically there are two types of immune functions:
our adaptive immune system, which is activated when we
mount a defence against a new invader and retains antibodies and memory for immunity in the future; and our
innate immune system, the almost immediate reaction
your body has, for instance, when you get a cut or a skin
infection. In primates, this action of “turning on” an optimal response to microbial attack only works properly in
the presence of adequate vitamin D.
Vitamin D is vital for the innate immune system to
function properly. T cells signal the immune systems
killer cells to activate and to do this they require vitamin
D. When T cells find an invading pathogen their vitamin
D receptor is extended, similar to an aerial. This receptor
searches for available vitamin D and if not found the T cell
will not activate. These T cells, once activated, will become
either killer cells, which attack the invading virus or bacteria, or helper cells that assist the immune system (Von
Essen M, et al. Vitamin D controls T cell antigen receptor
signalling and activation of human T cells, Nature Immunology, March 2010)
Also, other recent research has underlined an important key role of vitamin D signalling in regulation of innate immunity in humans. When cells of the immune system such a macrophages sense a bacterial infection they
acquire the capacity to convert circulating 25(OD)vitD
into 1,25(OH)2 vitD. This production is a direct inducer
of expression of genes- encoding antimicrobial peptides,
in particular cathelicidin antimicrobial peptide (CAMP).
These antimicrobial peptides are vanguards of innate immune responses to bacterial infection and can act as signalling molecules to regulate immune system function
(White JH. et al. Vitamin D as an inducer of cathelicidin
antimicrobial peptide expression: Past, present and future.
J Steroid Biochem Mol Biol. 2010 Mar 17)
Adrian Gombart, Associate Professor of Biochemistry and a principal investigator with the Linus Pauling
Institute at Oregon State University, commenting on the
research conducted by OSU and the Cedars-Sinai Medical Centre stated. “The fact that this vitamin-D mediated
immune response has been retained through millions of
years of evolutionary selection, and is still found in species
ranging from squirrel monkeys to baboons and humans,
suggests that it must be critical to their survival”.
“It’s essential that we have both an innate immune response that provides an immediate and front line of defence, but we also have protection against an overreaction
JATMS
by the immune system, which is what you see in sepsis and
some autoimmune or degenerative diseases,” Gombart
said. “This is a very delicate balancing act, and without
sufficient levels of vitamin D you may not have an optimal response with either aspect of the immune system.”
(Oregon State University. “Key Feature Of Immune System Survived In Humans, Other Primates For 60 Million
Years.” Science Daily 22 August 2009)
V I TA M I N D A N D C A N C ER
A four year, population-based, double-blind, randomized placebo-controlled trial was conducted at the
Creighton University School of Medicine in Nebraska.
The study’s primary outcome was fracture incidence, and
the principal secondary outcome was cancer incidence.
The results of the study found that supplementation with
vitamin D3 1100iu and calcium 1500mg or placebo daily
after three years produced a 77 percent reduction in breast
cancer, colon cancer, skin cancer and other forms of cancer risk among the supplemented group when compared
to the placebo group. The subjects were 1179 communitydwelling women randomly selected from the population
of healthy postmenopausal women. The authors of the
study concluded that improving calcium and vitamin D
nutritional status substantially reduces all-cancer risk in
postmenopausal women. (Lappe JM, et al. Vitamin D and
calcium supplementation reduces risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91).
Vitamin D deficiency is more common in black men,
and it may be a contributor to their higher risk of cancer
when compared with whites. From 1986 and 2002, a total
of 99 out of 481 black men and 7019 out of 43,468 white
men were diagnosed with cancer. In analyses adjusted for
multiple dietary, lifestyle, and medical risk factors for cancer, black men had a 32 percent higher risk than white
men of developing any cancer and an 89 percent greater
likelihood of dying from cancer, particularly from cancer
of the digestive system cancer. This study identified vitamin D deficiency as the relevant factor in the higher cancer risk among blacks (Giovannucci E, et al. Cancer Incidence and Mortality and Vitamin D in Black and White
Male Health Professionals, Cancer Epidemiol Biomarkers
Prev 2006;15(12):2467–72).
BRE A S T C A N C ER
In a 2007 study 972 women with newly diagnosed invasive breast cancer and 1,135 randomly selected healthy
controls were evaluated to assess vitamin D / sun exposure
variables. The study found that increased exposure to sunlight during adolescence was associated with a 35 per cent
reduction in the risk of breast cancer later in life. The researches concluded that there is strong evidence to support
the hypothesis that vitamin D could help prevent breast
cancer. However, their results suggest that exposure earlier in life, particularly during breast development, maybe
most relevant (Knight J et al. “Vitamin D and Reduced
Risk of Breast Cancer: A Population-Based Case-Control
Study”Cancer Epidemiology Biomarkers & Prevention
March 2007, Volume 16, Pages 422-429)
Another study conducted by Harvard Medical School
29
ARTICLE
ARTICLE
examined data on more than 10,500 premenopausal and
21,000 postmenopausal women over 45 years of age and
the incidence of breast cancer. The study included information on supplementation and dietary sources of
vitamin D and calcium over an average of ten years. The
results reported that a high dietary intake of vitamin D
was associated with a 30 per cent reduction in the risk of
breast cancer among premenopausal women. However,
postmenopausal women didn’t experience the same reduction. This may be the result of reduced ability of vitamin
D synthesis from sun exposure with aging and its contribution to overall vitamin D status. Sunlight exposure was
not taken into account in this study. (Lin J et al. Intakes of
Calcium and Vitamin D and Breast Cancer Risk in Women Arch Intern Med. 2007;167:1050-1059).
Also, Women with breast cancer who had adequate serum vitamin D levels (72+ nmol/mL) double the survival
rate after 12 years of follow-up than vitamin D deficient
(<50 nmol/mL) women. (Fig. 3)
(Study Sees Link Between Vitamin D, Breast Cancer
Prognosis A Cancer Journal for Clinicians. 2008 Sep/Oct
;58:264-265)
C V D A N D D I A BE T E S
Recent research has found significant association between low serum levels of 25(OH)vit D and an increase in
the incidence of diabetes, CVD and metabolic syndrome.
This research examined 28 studies that included 99,745
men and women across a variety of ethnic groups. The
studies revealed a significant association between high
levels of vitamin D (25(OH)VitD) and a decreased risk of
developing cardiovascular disease (33% compared to low
levels of vitamin D), type 2 diabetes (55% reduction) and
metabolic syndrome (51% reduction) ( Levels of vitamin
D and cardiometabolic disorders: Systematic review and
meta-analysis J.Maturitas Volume 65, Issue 3, 225-236,
March 2010).
Further evidence relating to the befits of adequate vitamin D levels was presented at the American College of
Cardiology’s annual scientific session in Atlanta March
2010. Researchers from the Intermountain Medical Center Heart Institute in Murray, Utah, reviewed 31,000 of
their patients aged 50 or older found that those with the
lowest levels of serum 25(OH)vitD had a 170-per-cent
greater risk of heart attacks than those with the highest
serum levels.
Also, according to the authors of this study, the benefits of having more vitamin D were not limited to a cut in
heart-attack risk. Those with the lowest readings also had
an 80-per-cent greater risk of death, a 54-per-cent higher
risk of diabetes, a 40-per-cent higher risk of coronary artery disease, a 72-per-cent higher risk of kidney failure and
a 26-per-cent higher risk of depression.
D I A BE T E S
The incidence of diabetes in Australia is increasing and,
at the same time we are seeing a corresponding deficiency in
vitamin D levels. As the above studies show there is a strong
link between the development of diabetes type-2 and vitamin D deficiency. The following study examines the link in
30
JATMS
childhood type-1 diabetes and vitamin D supplementation.
A review and meta-analysis of the data from five trials
that included 6455 infants, of which 1429 were cases and
5026 controls was published in the Archives of Disease in
Childhood. The data from the five observational studies,
found that infants who received vitamin D supplements
were 29 per cent less likely to develop type-1 diabetes than
non-supplemented infants (Zipitis C et al. “Vitamin D
supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis” Archives of
Disease in Childhood (British Medical Journal) .2007).
Also, a study, published in the Journal of the American Medical Association, September 2007 looked at
1770 children at high risk of developing type-1 diabetes.
Their study reported that an increased intake of omega-3
fatty acids from marine sources may reduce a child’s risk of
developing type-1 diabetes by 55 per cent.
Vitamin D found in cod liver oil, a popular marine supplement, may have been a contributing factor.
C A R D I O VA S C UL A R D I S E A S E
A large case-control study (Health Professionals
Follow-up Study) was conducted in 18, 225 men. During the proceeding 10 years of follow-up, 454 men developed nonfatal myocardial infarction or fatal coronary
heart disease. After adjustment for matched variables,
men deficient in 25(OH)D less than 37.4nmol/Lt were
at increased risk for MI (heart attack) compared with
those considered to be sufficient in 25(OH)D 74nmol/
mL. And, after additional adjustment for family history of
myocardial infarction, body mass index, physical activity,
alcohol consumption, history of diabetes mellitus and hypertension, ethnicity, region, marine n-3 intake, low- and
high-density lipoprotein cholesterol levels, and triglyceride levels, this relationship remained significant. Even men
with intermediate 25(OH)D levels were at elevated risk
relative to those with sufficient 25(OH)D levels.The authors concluded that Low levels of 25(OH)D are associated with higher risk of myocardial infarction, even after
controlling for factors known to be associated with coronary artery disease (Giovannucci, E. et al. 25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men, Arch
Intern Med. 2008;168(11):1174-1180).These benefits in
part may be explained by maintaining optimal vitamin D
can slow the turnover of leukocytes by inhibiting pro-inflammatory overreaction resulting in a reduction of leukocyte telomere shortening. Shortening of leukocyte telomeres is a marker of aging and a predictor of aging-related
disease. Length of these telomeres decreases with each cell
division and with increased inflammation.
A study examined whether vitamin D levels would attenuate the rate of telomere attrition in leukocytes, such
that higher vitamin D concentrations would be associated
with longer LTL. The results of this study suggested that
higher vitamin D (25(OH)VitD) concentrations, which
can be modified through vitamin D supplementation, are
associated with longer LTL. This would explain the potentially beneficial effects of vitamin D on aging and agerelated diseases.
(Richards J, et al. Higher serum vitamin D concentra-
tions are associated with longer leukocyte telomere length
in women, American Journal of Clinical Nutrition, Vol.
86, No. 5, 1420-1425, November 2007)
V I TA M I N D S TAT I N S A N D
C H OLE S T EROL .
Studies have found that statins, medications used to
lower cholesterol, decrease the risk of CVD. However, the
dietary-heart-cholesterol hypothesis may need to be questioned as statins may reduce this risk in ways other than by
lowering cholesterol.
A study examining this hypothesis and benefits produced by statins reports that, based on published observations, the unexpected and unexplained clinical benefits
produced by statins have also been shown to be properties
of vitamin D. It seems likely that statins act as vitamin D
analogues(Grimes D, Are statins analogues of vitamin D?
The Lancet, Volume 368, Issue 9529, Pages 83 - 86, 1 July
2006).
Further evaluation of this proposed action needs to be
undertaken as it could explain in part the reduced incidence of CVD associated with an increase in serum vitamin D levels.
I MMU N E F U N C T I O N
Basically there are two types of immune functions:
our adaptive immune system, which is activated when we
mount a defence against a new invader and then retain
antibodies and memory for immunity in the future; and
our innate immune system, the almost immediate reaction
your body has, for instance, when you get a cut or a skin
infection. In primates, this action of “turning on” an optimal response to microbial attack only works properly in
the presence of adequate vitamin D.
Vitamin D is vital for the innate immune system to
function properly. T cells signal the immune systems
killer cells to activate and to do this they require vitamin
D. When T cells find an invading pathogen their vitamin
D receptor is extended, similar to an aerial. This receptor
searches for available vitamin D and if not found the T cell
will not activate. These T cells, once activated will either
become killer cells which will attack the invading virus
or bacteria or become helper cells that assist the immune
system (Von Essen M, et al. Vitamin D controls T cell antigen receptor signalling and activation of human T cells,
Nature Immunology, March 2010)
Also, other recent research has underlined an important key role of vitamin D signalling in regulation of innate immunity in humans. When cells of the immune system such a macrophages sense a bacterial infection they
acquire the capacity to convert circulating 25(OD)vitD
into 1,25(OH)2 vitD. This production is a direct inducer
of expression of genes encoding antimicrobial peptides, in
particular cathelicidin antimicrobial peptide (CAMP).
These antimicrobial peptides are vanguards of innate immune responses to bacterial infection and can act as signalling molecules to regulate immune system function
(White JH. et al. Vitamin D as an inducer of cathelicidin
antimicrobial peptide expression: Past, present and future.
J Steroid Biochem Mol Biol. 2010 Mar 17)
JATMS
Adrian Gombart, Associate Professor of Biochemistry and a principal investigator with the Linus Pauling
Institute at Oregon State University, commenting on the
research conducted by OSU and the Cedars-Sinai Medical Centre stated, “The fact that this vitamin-D mediated
immune response has been retained through millions of
years of evolutionary selection, and is still found in species
ranging from squirrel monkeys to baboons and humans,
suggests that it must be critical to their survival”.
“It’s essential that we have both an innate immune response that provides an immediate and front line of defence, but we also have protection against an overreaction
by the immune system, which is what you see in sepsis and
some autoimmune or degenerative diseases,” Gombart
said. “This is a very delicate balancing act, and without
sufficient levels of vitamin D you may not have an optimal response with either aspect of the immune system.”
(Oregon State University. “Key Feature Of Immune System Survived In Humans, Other Primates For 60 Million
Years.” Science Daily 22 August 2009)
V I TA M I N D A N D C A N C ER
A four year, population-based, double-blind, randomized placebo-controlled trial was conducted at the
Creighton University School of Medicine in Nebraska.
The study’s primary outcome was fracture incidence, and
the principal secondary outcome was cancer incidence.
The study found that supplementation with vitamin D3
1100iu and calcium 1500mg or placebo daily after three
years produced a 77 percent reduction in breast cancer, colon cancer, skin cancer and other forms of cancer
risk among the supplemented group when compared to
the placebo group. The subjects were 1179 communitydwelling women randomly selected from the population
of healthy postmenopausal women. The authors of the
study concluded that improving calcium and vitamin D
nutritional status substantially reduces all-cancer risk in
postmenopausal women. (Lappe JM, et al. Vitamin D and
calcium supplementation reduces cancer risk: results of a
randomized trial. Am J Clin Nutr. 2007 Jun;85(6):158691).
Vitamin D deficiency is more common in black men,
and it may be a contributor to their higher risk of cancer
when compared with whites. From 1986 and 2002, a total
of 99 out of 481 black men and 7019 out of 43,468 white
men were diagnosed with cancer. In analyses adjusted for
multiple dietary, lifestyle, and medical risk factors for cancer, black men had a 32 percent higher risk than white
men of developing any cancer and an 89 percent greater
likelihood of dying from cancer, particularly from cancer
of the digestive system. This study identified vitamin D
deficiency as the relevant factor in the higher cancer risk
among blacks (Giovannucci E, et al. Cancer Incidence
and Mortality and Vitamin D in Black and White Male
Health Professionals, Cancer Epidemiol Biomarkers Prev
2006;15(12):2467–72).
BRE A S T C A N C ER
A study of 972 women with newly diagnosed invasive
breast cancer and 1,135 randomly selected healthy
31
ARTICLE
ARTICLE
controls were evaluated to assess vitamin D / sun exposure
variables and found that increased exposure to sunlight
during adolescence was associated with a 35 per cent
reduction in the risk of breast cancer later in life. The
researches concluded that there is strong evidence to
support the hypothesis that vitamin D could help prevent
breast cancer. However, their results suggest that exposure
earlier in life, particularly during breast development,
maybe most relevant (Knight J et al. “Vitamin D and
Reduced Risk of Breast Cancer: A Population-Based
Case-Control Study”Cancer Epidemiology Biomarkers &
Prevention March 2007, Volume 16, Pages 422-429)
Another study conducted by Harvard Medical School
examined data on more than 10,500 premenopausal and
21,000 postmenopausal women over 45 years of age and
the incidence of breast cancer. The study included information on supplementation and dietary sources of
vitamin D and calcium over an average of ten years. The
results reported that a high dietary intake of vitamin D
was associated with a 30 per cent reduction in the risk of
breast cancer among premenopausal women. However,
postmenopausal women didn’t experience the same reduction. This may be the result of reduced ability of vitamin
D synthesis from sun exposure with aging and its contribution to overall vitamin D status. Sunlight exposure was
not taken into account in this study. (Lin J et al. Intakes of
Calcium and Vitamin D and Breast Cancer Risk in Women Arch Intern Med. 2007;167:1050-1059).
Also, women with breast cancer who had adequate
serum vitamin D levels (72+ nmol/mL) have double the
survival rate after 12 years that follow-up than vitamin D
deficient (<50 nmol/mL) women. (Fig. 3);(Study Sees
Link Between Vitamin D, Breast Cancer Prognosis A
Cancer Journal for Clinicians. 2008 Sep/Oct ;58:264265)
Figure. 3 Cancer Free Survival (RR) 12 years
Serum Vitamin D Status
These studies have found that maintaining vitamin D
levels from an early age may reduce the incidence of breast
cancer by around 35 per cent. And if breast cancer is diagnosed may increase 12 year survival by around 50 per cent.
In a recent study that evaluated dietary and supplementary vitamin D and calcium intake among 3,101
breast cancer patients and 3,471 healthy controls found
no relationship between dietary vitamin D or calcium
32
JATMS
intake and breast cancer risk. However, of women who
reported taking supplements of vitamin D, at least 400iu
daily were at 24 percent lower risk of developing breast
cancer. (Anderson L et al. American Journal of Clinical
Nutrition, online April 14, 2010).
P RO S TAT E C A N C ER
There have been a number of studies that have
reported a decrease in the incidence of prostate cancer
associated with higher sun exposure or serum vitamin D
levels.( Schwartz GG, Hulka BS. Is vitamin D deficiency
a risk factor for prostate cancer? (Hypothesis). Anticancer Res. (1990) 10(5A):1307–1311)and (Deeb KK,
Trump DL, Johnson CS. Vitamin D signalling pathways
in cancer: potential for anticancer therapeutics. Nat Rev
Cancer (2007) 7(9):684–700) However, other studies
have found non-significant difference in the incidence of
prostate cancer and vitamin D serum levels in certain age
groups.
A recent case-controlled analysis of serum vitamin D
levels and the incidence of prostate cancer, found that a
statistically significant decrease in risk of prostate cancer
was associated with high serum 25(OH)vitD levels in
men under 60 years of age( Ruth C Serum Vitamin D
and Risk of Prostate Cancer in a Case-Control Analysis
Nested Within the European Prospective Investigation
into Cancer and Nutrition (EPIC) American Journal
of Epidemiology 2009 169(10):1223-1232). However,
there was not a marked difference in incidence in men
over the age of 60 years.
Another study investigated whether serum levels of
25(OH)D are associated with the prognosis in patients
with prostate cancer. This study found that serum
25(OH)D at medium (around 50 - 70 nmol/lt) or high
levels (over 70 nmols/Lt) were significantly related to increased survival compared with the low vitamin D levels.
Also, patients receiving hormone therapy gave a stronger
association. The serum level of 25(OH)D was involved in
disease progression and is a potential marker of prognosis
in patients with prostate cancer (Tretli S, et al Association between serum 25(OH)D and death from prostate
cancer. Br J Cancer. 2009 Feb 10;100(3):450-4).
Although the data are not as conclusive as breast
cancer in women, it would appear that like breast cancer
early maintenance of vitamin D levels is the most beneficial in reduced incidence and improved prognosis.
Vitamin D Swine Flu Prevention
Studies show promise that vitamin D may be effective
in protecting against swine flu. Vitamin D promotes the
production of antimicrobial substances that have the
ability to neutralize the activity of various disease-causing
agents, including the influenza virus (Doss M et al. Journal of Immunology 2009 Jun 15; 182(12): 7878-87.
A study of 19,000 individuals and found that those
who had lowest levels of vitamin D (25OHVitD) were
about 40 percent more likely to have recent respiratory
infection, including flu, compared to those who had
higher levels of vitamin D(Ginde AA et al. Archives of
Internal Medicine 2009 Feb 23; 169(4): 384-90)
A recent randomised double-blind, placebo-con-
trolled trial among school children in Japan was conducted. The children were randomly divided into two groups:
One group received daily supplements of 1200iu daily
of vitamin D3, while the other group received a placebo.
The children were then assessed for the incidence of
influenza over the 2008 to 2009 winter period.
The study found that the incidence of influenza was
10.8 per cent in the vitamin D3 supplemented group,
compared with 18.6 per cent in the placebo group; this
reduction was even greater for those who had low vitamin D (25OHVitD), with a 74 per cent reduction in the
incidence of influenza. Also, asthma attacks were significantly reduced in asthmatic children in the vitamin D3
supplemented group. (Urashima U, et al. “Randomized
trial of vitamin D supplementation to prevent seasonal
influenza A in schoolchildren” American Journal of
Clinical Nutrition, March 10, 2010).
Given this type of information the Canadian Government Public Health Agency is investigating the use of
vitamin D as a protective measure against swine flu; just
as our grandmothers did using cod liver oil.
V I TA M I N D A N D FA LL S
Falling among the elderly is a major contributing factor to loss of enjoyment of life and increased mortality. A
meta-analysis of randomised controlled trials examined
the roll of vitamin D supplementation and the incidence
of falls. Both vitamin D2 and Vitamin D3 were investigated and the results found that 700-1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3)
reduced falls by 19% for vitamin D2 and up to 26% with
vitamin D3. To reduce the risk of falling, a daily intake
of at least 700-1000 IU supplemental vitamin D3 is
warranted in all individuals aged 65 and older. (BischoffFerrari H A et al. Fall prevention with supplemental
and active forms of vitamin D: a meta-analysis of randomised controlled trials BMJ-British Medical Journal
339:b3692, 2009).
MULT I P LE S C LERO S I S
Epidemiologic studies have shown a positive correlation of multiple sclerosis (MS) associated with latitude
(amount of sun exposure) and increased dietary intake
and increased serum levels of vitamin D. An increased
dietary intake of vitamin D and increased exposure to
UV rays was found to be protective for the development
of MS (Beretich BD et al. Explaining multiple sclerosis
prevalence by ultraviolet exposure: a geospatial analysis.
Mult Scler. 2009 Aug;15(8):891-8).
D O S A G E S A F E T Y I N M S PAT I E N T S .
A study examining high dose vitamin D supplementation was undertaken among 52 MS patients to examine
its effect on calcium metabolism. Their conclusion found
that high-dose vitamin D (approximately 10,000 IU/
day) in multiple sclerosis is safe, with evidence of immunomodulatory effects. Classification of evidence: this
trial provided class II evidence that high-dose vitamin
D use for 52 weeks in patients with multiple sclerosis
does not significantly increase serum calcium levels when
JATMS
compared to patients not on high-dose supplementation.
The study also reported that patients in the high-dose
supplementary group reported less relapse. (Burton JM et
al. A phase I/II dose-escalation trial of vitamin D3 and
calcium in multiple sclerosis Neurology. 2010 Apr 28.
[Epub ahead of print])
D O S A G E A N D T Y P E , V I TA M I N D 2 OR
V I TA M I N D 3 ?
From examination of the studies the average recommendation for vitamin D supplementation is around
1000iu daily with the majority recommending vitamin
D3. This dose is within the safety guidelines established
by the National Academy of Sciences and the National
Institute of Health, Office of Dietary Supplements, USA
state that 2,000iu of vitamin D daily is the tolerable
upper limit for adults. However, The USA Food and Nutrition Board are currently reviewing data to determine
whether updates to the DRIs (including the upper limits)
for vitamin D are needed.
Supplementary Dosage Examples include;
1. Evidence from data suggests that vitamin D3 supplements at moderate to high doses 1000iu daily may reduce CVD risk (Wang L, et al. Ann Intern Med. 2010 Mar 2;152(5):327-9).
2. The risk of falling in the elderly and vitamin
D intake was evaluated. The results found that 1000 IU supplemental vitamin D per day (vitamin D2 or vitamin D3) reduced falls by 19% and up to 26% with vitamin D3 (BMJ-
British Medical Journal 2009, October).
3. Supplementation with vitamin D3 1100iu and calcium 1500mg or placebo daily after three years produced a 77 percent reduction in breast cancer, colon cancer, skin cancer and other forms of cancer risk(Lappe JM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91).
GROUP
INFANTS 0-12
MOS
CHILDREN
FDA
REC
DOSE
200 IU
ADULTS <50
YEARS
ADULTS 5170 YEARS
400 IU
ADULTS >70
YEARS
600 IU
SAFE
HIGH
FDA
SAFE
HIGH
BEST
DOSE
1000
IU
10002000
IU
400-1000 IU
10,000
IU/
DAY
800-1000 IU
D3 every day
2000
IU
50,000 IU D2
every 2 weeks
50,000 IU D2
every month
Holick MF, Vitamin D Deficiency, N Engl J Med 357:266,
July 19, 2007
Estimate Health Care benefit of vitamin D in Dollars
A recent study in Germany found that around 45 percent
of Germans were vitamin D insufficient with around 15
33
ARTICLE
to 30 per cent being deficient. This study also pointed
out that present sun safety and dietary recommendations
would lead to vitamin D deficiency. The authors claim
that this would lead to a increased health Care cost of EU
37 billion annually(Zittermann A et al. The estimated
benefits of vitamin D for Germany. Molecular Nutrition
& Food Research, 10.1002 April 2010)
This would roughly equate to around 15 to 20 billion
dollars Australian annual saving in the health budget
expenditure, if population vitamin D levels were normalised. This would go a long way in helping improve the
budget and other problems experienced by hospitals in
Australia.
plementation and dietary changes as an effective alternative to dangerous sun exposure practises. Also, periodic
25(OH)VitD blood tests would be advisable.
TCM LIQUID EXTRACT – DISPENSARY SERVICE
traditional values & modern solutions
DISCUSSION
Although I have only included a few of the many
studies that were evaluated, the message is consistent and
clear in all of the studies. Vitamin D deficiency is a major
health issue and must be addressed. Excessive sun exposure causes skin damage and in an endeavour to curb the
incidence of skin cancer, the advice to cover up, apply sun
screen and keep out of the sun is widely being practised.
OH&S legislation has made this policy mandatory for
workplace and schools. However, this practice has in part
contributed to the vitamin D dilemma in Australia and
diseases associated with this deficiency, including melanoma are on the increase and of major concern. Governments and Health Care Professionals urgently need to
examine the role that vitamin D deficiency plays in their
disease treatment and prevention plans and consider sup-
For more information
or free samples
call 03 5956 9011
www.safflower.com.au
[email protected]
fax 03 5956 9344
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stuart hiNDs is a practising soft tissue therapist starting his journey in 1990 and continues as a lecturer
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professional levels of sport, including being a soft tissue therapist for the Geelong Football Club which
is part of the Australian Rules Football League. Stuart has also published articles both nationally and
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industry journals and mainstream publications. He was also part of the soft tissue team for the 2004
Australian Olympic Team in Athens and the 2008 Beijing Olympic Games. In 2003 Stuart presented
at the Australian Conference in Science and Medicine in Sport on the practical dynamics of soft
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JATMS
L AW R E P O R T
L AW R E P O R T
Employment law: Employee v Independent Contractor
Ingrid Pagura
BA, LLB
Ingrid is a part time teacher in the Massage Therapy department at Meadowbank College of TAFE and a
trained lawyer. She also works for a legal publishing company.
T
here are many ways that a person can be employed. Two of the major ones are as an Employee and as an Independent Contractor. This
distinction is important because each has different obligations under the law. It is a purely legal distinction.
An employee has a Contract of Service. The employee works exclusively in the business of the employer,
under their direction and control. An Independent
Contractor has a Contract for Service. They sell a service
and so they can sell this to a number of employers. They
have more flexibility and discretion as to how they carry
out their work.
Let’s imagine a Massage Therapy clinic where Mary
and Helen are both employed as massage therapists.
Mary works there full time and her boss directs how she
does her work. Her boss has asked her to update the filing and check all the patient cards when there aren’t any
massages booked in. Mary gets paid a wage at the end of
each week regardless of how many massages she has done.
Mary doesn’t need to bring her massage table or any towels and oils as they are all provided for her.
Helen works there too, but she only works Mondays
and Wednesdays and on the other days she runs her own
business. She has more discretion as to how she does
her job. If she doesn’t have any massages booked she can
relax if she wishes. At the end of the week she submits
her invoice to the boss and gets paid for each massage.
She and the boss have an understanding about using the
tables, towels and oils. Rather than Helen’s bringing her
own, the boss will charge her an amount for usage. This
comes out of her pay.
Clients book in at reception to see either Mary or
Helen and once their massage is over they pay the receptionist. As far as they can see Mary and Helen are no
different. Legally they are very different. Mary is deemed
to be an employee and Helen is deemed to be an independent contractor.
So what criteria do you use to work out which category a person falls into?
Control: how much flexibility and discretion does the employee have in doing their job? Independent contractors
have much more flexibility.
Intention of the parties: what did the parties intend the
relationship to be?
Basis of payment: how is the person paid? Do they need
to quote an ABN on their invoice? Are they paid per
task? If the answer is yes, it is likely that they are an inde-
36
JATMS
pendent contractor.
Ability to work for others: employees work exclusively for
one employer and cannot work for others. Independent
contractors can work for a number of employers. If the
person is an independent contractor then they cannot
work only for that one employer, The Australian Taxation Office will often view a person who works for one
employer more than 80% of the time, as being an employee regardless of what they call themselves.
Provision of tools of trade: the employee will have all tools
of trade provided for them but an independent contractor will need to provide their own or pay for them.
Commercial risks: an employee bears no legal risk in
respect of work done while an independent contractor
bears all the risk.
These points are guidelines only and each case must
be reviewed independently. Regardless of what an
employer has labelled you a court will always look at the
facts to decide whether you are an employee or an independent contractor.
On 1 March 2007, the Independent Contractors Act
2006 (Commonwealth) came into force setting out rules
covering independent contractors. If you’d like to read
the Act and what it contains go to www.comlaw.gov.au.
One of the main reasons it is important to categorise a worker as either an employee or an independent
contractor is the doctrine of Vicarious Liability. This is
a common law doctrine and cannot be overridden by any
employment contract.
The doctrine of Vicarious Liability states that an
employer is vicariously liable for the torts of an employee
even if they have no personal blame. An employer will
never be vicariously liable for the torts of an independent contractor. Vicarious liability doesn’t absolve the
employee from legal responsibility; it merely shifts the
burden of paying damages to the employer.
So how does this work in practice? Let’s go back to
our example.
Mary was categorised as an employee and Helen as an
independent contractor. They are both working in the
clinic. Mary performs a massage without screening her
client and ends up hurting him. Helen does screen her
client but decides to perform a contraindicated sequence
and ends up hurting her client as well. Both these clients
can sue for negligence, and if they win they will be paid
compensation.
Because Mary is an employee, her boss is vicariously
liable for her. Mary is found guilty but her boss will have
to pay for the compensation to the client. Usually bosses
are insured for this. Helen however, is not so lucky. As
she is an independent contractor, her boss isn’t vicariously
liable for her, so she’ll have to pay for the compensation
herself. Independent contractors need to have their own
insurance.
Vicarious liability is one of the major benefits of being
an employee. Your boss cannot then sue you to recover
that money either. That is part of their responsibility to
you.
Another important reason for the distinction is the
possibility of the therapist’s getting hurt at work. If
the person is an employee they are entitled to workers’
compensation, which pays benefits until the employee
can return to work. This is compulsory for all employees.
However, an independent contractor is not covered by
workers’ compensation, and if they get hurt at work they
will need to have their own insurance to cover this.
Many massage and other complementary therapists
are employed as independent contractors rather than
employees. Look at how you are employed, as there are
many implications for you. If you are unsure check with
your employer.
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JATMS
37
RECENT RESEARCH
RECENT RESEARCH
MASSAGE
Purslow PP. Muscle fascia and force transmission. Journal of
Bodywork and Movement Therapies 2010;14(4):411-7
This paper reviews the major intramuscular
extracellular matrix (IM-ECM) structures (endomysium,
perimysium and epimysium) and their possible
mechanical contributions to muscle functions. The
endomysium appears to provide an efficient mechanism
for transmission of contractile forces from adjacent
muscle fibres within fascicles. This coordinates forces
and deformations within the fascicle, protects damaged
areas of fibres against over-extension, and provides a
mechanism whereby myofibrils can be interrupted to
add new sarcomeres during muscle growth without
loss of contractile functionality of the whole column.
Good experimental evidence shows that perimysium and
epimysium are capable in some circumstances to act as
pathways for myofascial force transmission. However,
an alternative role for perimysium is reviewed, which
involves the definition of slip planes between muscle
fascicles which can slide past each other to allow large
shear displacements due to shape changes in the whole
muscle during contraction. As IM-ECM is continually
remodelled so as to be mechanically adapted for its
roles in developing and growing muscles, control of the
processes governing IM-ECM turnover and repair may
be an important avenue to explore in the reduction of
fibrosis following muscle injury.
César Fernández-de-las-Peñas PT, Hong-You Ge MD,
Cristina Alonso-Blanco PT, Javier González-Iglesias
PT and Lars Arendt-Nielsen D. Referred pain areas of
active myofascial trigger points in head, neck, and shoulder
muscles, in chronic tension type headache. Journal of
Bodywork and Movement Therapies 2010; 14(4): 391-396
Our aim was to analyze the differences in the referred
pain patterns and size of the areas of those myofascial
trigger points (TrPs) involved in chronic tension type
headache (CTTH) including a number of muscles
not investigated in previous studies. Thirteen right
handed women with CTTH (mean age: 38 ± 6 years)
were included. TrPs were bilaterally searched in upper
trapezius, sternocleidomastoid, splenius capitis, masseter,
levator scapulae, superior oblique (extra-ocular), and
suboccipital muscles. TrPs were considered active when
both local and referred pain evoked by manual palpation
reproduced total or partial pattern similar to a headache
attack. The size of the referred pain area of TrPs of each
muscle was calculated. The mean number of active TrPs
within each CTTH patient was 7 (95% CI 6.2–8.0).
A greater number (T = 2.79; p = 0.016) of active TrPs
was found at the right side (4.2 ± 1.5) when compared
to the left side (2.9 ± 1.0). TrPs in the suboccipital
muscles were most prevalent (n = 12; 92%), followed
by the superior oblique muscle (n = 11/n = 9 right/left
38
JATMS
side), the upper trapezius muscle (n = 11/n = 6) and the
masseter muscle (n = 9/n = 7). The ANOVA showed
significant differences in the size of the referred pain area
between muscles (F = 4.7, p = 0.001), but not between
sides (F = 1.1; p = 0.3): as determined by a Bonferroni
post hoc analysis the referred pain area elicited by levator
scapulae TrPs was significantly greater than the area from
the sternocleidomastoid (p = 0.02), masseter (p = 0.003)
and superior oblique (p = 0.001) muscles. Multiple active
TrPs exist in head, neck and shoulder muscles in women
with CTTH. The referred pain areas of TrPs located in
neck muscles were larger than the referred pain areas of
head muscles. Spatial summation of nociceptive inputs
from multiple active TrPs may contribute to clinical
manifestations of CTTH.
Wong CK, Coleman D, Di Persia V, Song J, Wright D. The
effects of manual treatment on rounded-shoulder posture,
and associated muscle strength. Journal of Bodywork and
Movement Therapies 2010;14(4):326-33
A relationship between pectoralis minor muscle
tightness and rounded shoulder posture (RSP)
has been suggested, but evidence demonstrating
that treatment aimed at the pectoralis minor affects
posture or muscle function such as lower trapezius
strength (LTS) remains lacking. In this randomized,
blinded, controlled study of the 56 shoulders of 28
healthy participants, the experimental treatment
consisting of pectoralis minor soft tissue mobilization
(STM) and self-stretching significantly reduced RSP
compared to the pre-treatment baseline (Friedman test,
p < .001) and the control treatment of placebo touch
and pectoralis major self-stretching (Mann–Whitney
U-test, p < .01). RSP remained significantly reduced
2 weeks after the single treatment. Both control and
experimental treatments resulted in increased LTS
(Friedman test, p < .01) with no significant difference
in LTS noted between treatments (p > .05). This
study demonstrated that STM and self-stretching of
the pectoralis minor can significantly reduce RSP.
WESTERN HERBAL MEDICINE
Lee H, Bae S, Yoon Y. The WNT/beta-catenin pathway
mediates the anti-adipogenic mechanism of SH21B, a
traditional herbal medicine for the treatment of obesity.
Journal of Ethnopharmacology 2011; 27;133(2):788-95
This study was conducted to elucidate the molecular
mechanisms of SH21B, a traditional Korean herbal
medicine commonly used for the treatment of obesity.
Materials and methods: 3T3-L1 preadipocytes were
differentiated into adipocytes in the presence or absence
of SH21B. Changes in mRNA or protein levels were
analyzed using microarray, real-time polymerase chain
reaction and western blotting analyses. Small interference
(si)RNA transfection experiments were conducted to
elucidate the essential role of β-catenin.
Results: Microarray analyses showed that components
of the WNT/β-catenin pathway including β-catenin,
cyclin D1 and dishevelled 2 were up-regulated more
than two-fold as a result of SH21B treatment during
adipogenesis, which were confirmed by real-time PCR
and western blotting. Modulation of the WNT/β-catenin
pathway by SH21B resulted in the nuclear accumulation
of β-catenin. Both intracellular lipid droplet formation
and expressions of adipogenic genes including PPARγ,
C/EBPα, FABP4 and LPL, which were inhibited by
SH21B, were significantly recovered by β-catenin siRNA
transfection.
CONCLUSIONS: SH21B modulates components
of the WNT/β-catenin pathway during adipogenesis,
and β-catenin plays a crucial role in the anti-adipogenic
mechanism of SH21B.
Gilca M, Gaman L, Panait E, Stoian I, Atanasiu V.
Chelidonium majus - an integrative review: Forschende
Komplementarmedizin und Klassische Naturheilkunde
2010;17(5):241-8
Chelidonium majus L. (family Papaveraceae),
or greater celandine, is an important plant in western
phytotherapy and in traditional Chinese medicine. Crude
extracts of C. majus as well as purified compounds
derived from it exhibit a broad spectrum of biological
activities (antiinflammatory, antimicrobial, antitumoral,
analgesic, hepatoprotective) that support some of the
traditional uses of C. majus. However, herbal medicine
also claims that this plant has several important properties
which have not yet been scientifically studied: C.
majus is supposed to have diuretic, antitussive and eyeregenerative effects. On the other hand, C. majus also
has scientifically proven effects, e.g. anti-osteoporotic
activity and radio- protection, which are not mentioned
in traditional sources. Moreover, recent controversy
about the hepatoprotective versus hepatotoxic effects
of Chelidonium majus has renewed the interest of the
medical community in this plant. This review is intended
to integrate traditional ethno-medical knowledge and
modern scientific findings about C. majus in order to
promote understanding of its therapeutic actions as well
as its toxic potential.
NUTRITION
Buiting HM, Clayton JM, Butow PN, Van Delden JJ,
Van Der Heide A. Artificial nutrition and hydration for
patients with advanced dementia: Perspectives from medical
practitioners in the Netherlands and Australia. Palliative
Medicine 2011 Jan;25(1):83-91
The appropriate use of artificial nutrition or hydration
(ANH) for patients with advanced dementia continues to
JATMS
be a subject of debate. We investigated opinions of Dutch
and Australian doctors about the use of ANH in patients
with advanced dementia. We interviewed 15 Dutch
doctors and 16 Australian doctors who care for patients
with advanced dementia. We transcribed and analysed
the interviews and held consensus meetings about the
interpretation. We found that Dutch and Australian
doctors use similar medical considerations when they
decide about the use of ANH. In general, they are reluctant
to start ANH. Disparities between the Dutch and
Australian doctors are related to the process of decisionmaking: Dutch doctors seem to put more emphasis on a
comprehensive assessment of the patient’s actual situation,
whereas Australian doctors are more inclined to use
scientific evidence and advance directives. Furthermore,
Dutch doctors take the primary responsibility themselves
whereas Australian general practitioners seem to be
more inclined to leave the decision to the family. It
seems that Dutch and Australian doctors use somewhat
different care approaches for patients with advanced
dementia. Combining the Dutch comprehensive
approach and the Australian analytic approach may
serve the interest of patients and their families best.
Fiorino S. Conti F. Fiorina, Gramenzi A. Loggi E. Cursaro
C. Di Donato R. Micco L. Gitto S. Cuppini A. Bernardi
M. Andreone P. Vitamins in the treatment of chronic viral
hepatitis. British Journal of Nutrition 2011; 105(7):982-9
Hepatitis B virus (HBV)- and hepatitis C virus
(HCV)-related chronic infections represent a major
health problem worldwide. Although the efficacy of HBV
and HCV treatment has improved, several important
problems remain. Current recommended antiviral
treatments are associated with considerable expense,
adverse effects and poor efficacy in some patients. Thus,
several alternative approaches have been attempted. To
review the clinical experiences investigating the use of
lipid- and water-soluble vitamins in the treatment of
HBV- and HCV-related chronic infections, PubMed,
the Cochrane Library, MEDLINE and EMBASE were
searched for clinical studies on the use of vitamins in the
treatment of HBV- and HCV-related hepatitis, alone or
in combination with other antiviral options. Different
randomised clinical trials and small case series have
evaluated the potential virological and/or biochemical
effects of several vitamins. The heterogeneous study
designs and populations, the small number of patients
enrolled, the weakness of endpoints and the different
treatment schedules and follow-up periods make the
results largely inconclusive. Only well-designed
randomised controlled trials with well-selected endpoints
will ascertain whether vitamins have any role in chronic
viral hepatitis. Until such time, the use of vitamins cannot
be recommended as a therapy for patients with chronic
hepatitis B or C.
39
RECENT RESEARCH
RECENT RESEARCH
TCM
Li S, Zhao J, Liu J, Xiang F, Lu D, Liu B, Xu J, Zhang H,
Zhang Q, Li X, Yu R, Chen M.
Prospective randomized controlled study of a Chinese
herbal medicine compound Tangzu Yuyang Ointment for
chronic diabetic foot ulcers: A preliminary report. Journal
of Ethnopharmacology 2011 Jan 27;133(2):543-50
The purpose of this study was to evaluate the efficacy
and safety of a topical Chinese herbal medicine (CHM)
compound Tangzu Yuyang Ointment (TYO) for
treatment of chronic diabetic foot ulcers.
Materials and methods: This multi-center,
prospective, randomized, controlled and add-on clinical
trial was conducted at seven centers in the China
mainland. Fifty-seven patients with chronic diabetic foot
ulcers of Wagner’s ulcer grade 1–3 were enrolled in
this study. Patients who were randomly assigned to the
control group (n = 28) received standard wound therapy
(SWT), whereas those randomized to the treatment
group (n = 28) received SWT plus topical TYO. Only
48 patients who finished 24 weeks of observations were
entered for data analysis.
Results: The TYO and SWT groups were comparable
for baseline characteristics. Ulcer improvement was
79.2% in the TYO group and 41.7% in the SWT group
(P = 0.017) at 12 weeks, and 91.7% vs. 62.5% (P = 0.036)
at 24 weeks. The number of ulcers that were completely
healed at 4, 12 and 24 weeks was similar in both groups,
as were the numbers of adverse events. Healing time was
96 ± 56 days (n = 19) in the TYO group and 75 ± 53 days
(n = 14) in the SWT group (P = 0.271).
CONCLUSION: TYO plus SWT is more effective
than SWT in the management of chronic diabetic foot
ulcers and has few side-effects.
Trinh K, Cui X, Wang . Chinese herbal medicine for chronic
neck pain due to cervical degenerative disc disease. Spine
2010 Nov 15;35(24):2121-7.
Study Design. Systematic review.
Objective. To assess the efficacy of Chinese herbal
medicines in treating chronic neck pain with radicular
signs or symptoms.
Summary of Background Data. Chronic neck pain
with radicular signs or symptoms is a common condition.
Many patients use complementary and alternative
medicine, including traditional Chinese medicine, to
address their symptoms.
Methods. We electronically searched CENTRAL,
MEDLINE, EMBASE, CINAHL, and AMED (up to
2009), the Chinese Biomedical Database and related
herbal medicine databases in Japan and South Korea (up
to 2007). We also contacted content experts and hand
searched a number of journals published in China.
We included randomized controlled trials with adults
with a clinical diagnosis of cervical degenerative disc
40
JATMS
disease, cervical radiculopathy, or myelopathy supported
by appropriate radiologic findings. The interventions
were Chinese herbal medicines. The primary outcome
was pain relief, measured with a visual analogue scale,
numerical scale, or other validated tool.
Results. All 4 included studies were in Chinese;
2 of which were unpublished. Effect sizes were not
clinically relevant and there was low quality evidence
for all outcomes due to study limitations and sparse
data (single studies). Two trials (680 participants) found
that Compound Qishe Tablets relieved pain better
in the short-term than either placebo or Jingfukang;
one trial (60 participants) found than an oral herbal
formula of Huangqi relieved pain better than Mobicox or
Methycobal, and another trial (360 participants) showed
that a topical herbal medicine, Compound Extractum
Nucis Vomicae, relieved pain better than Diclofenac
Diethylamine Emulgel.
CONCLUSION:. There is low quality evidence that
an oral herbal medication, Compound Qishe Tablet,
reduced pain more than placebo or Jingfukang and
a topical herbal medicine, Compound Extractum
Nucis Vomicae, reduced pain more than Diclofenac
Diethylamine Emulgel. Further research is very likely
to change both the effect size and our confidence in the
results.
Hori E. Takamoto K. Urakawa S. Ono T. Nishijo H. Effects
of acupuncture on the brain hemodynamics. Autonomic
Neuroscience-Basic & Clinical 2010; 157(1-2):74-80.
Acupuncture therapy has been applied to various
psychiatric diseases and chronic pain since acupuncture
stimulation might affect brain activity. From this point
of view, we investigated the effects of acupuncture on
autonomic nervous system and brain hemodynamics in
human subjects using ECGs, EEGs and near-infrared
spectroscopy (NIRS). Our previous studies reported
that changes in parasympathetic nervous activity were
correlated with number of de-qi sensations during
acupuncture manipulation. Furthermore, these
autonomic changes were correlated with EEG spectral
changes. These results are consistent with the suggestion
that autonomic changes induced by needle manipulation
inducing specific de-qi sensations might be mediated
through the central nervous system, especially through
the forebrain as shown in EEG changes, and are beneficial
to relieve chronic pain by inhibiting sympathetic nervous
activity. The NIRS results indicated that acupuncture
stimulation with de-qi sensation significantly decreased
activity in the supplementary motor complex (SMC)
and dorsomedial prefrontal cortex (DMPFC). Based on
these results, we review that hyperactivity in the SMC is
associated with dystonia and chronic pain, and that in the
DMPFC is associated with various psychiatric diseases
with socio-emotional disturbances such as schizophrenia,
attention deficit hyperactive disorder, etc. These findings
along with the previous studies suggest that acupuncture
with de-qi sensation might be effective to treat the
various diseases in which hyperactivity in the SMA
and DMPFC is suspected of playing a role. Copyright
Copyright 2010 Elsevier B.V. All rights reserved.
H O M O E O PAT H Y
Shaw D. Unethical aspects of homeopathic dentistry. British
Dental Journal 2010; 209(10):493-6.
In the last year there has been a great deal of public
debate about homeopathy, the system of alternative
medicine whose main principles are that like cures like and
that potency increases relative to dilution. The House of
Commons Select Committee on Science and Technology
concluded in November 2009 that there is no evidence
base for homeopathy, and agreed with some academic
commentators that homeopathy should not be funded
by the NHS. While homeopathic doctors and hospitals
are quite commonplace, some might be surprised to
learn that there are also many homeopathic dentists
practising in the UK. This paper examines the statements
made by several organisations on behalf of homeopathic
dentistry and suggests that they are not entirely ethical
and may be in breach of various professional guidelines.
Riede I. Tumor therapy with Amanita phalloides (death
cap): stabilization of B-cell chronic lymphatic leukemia.
Journal of Alternative & Complementary Medicine 2010;
16(10):1129-32.
Background: Molecular events that cause tumor
formation upregulate a number of HOX genes,
called switch genes, coding for RNA polymerase
II transcription factors. Thus, in tumor cells, RNA
polymerase II is more active than in other somatic
cells. Amanita phalloides contains amanitin, inhibiting
RNA polymerase II. Partial inhibition with amanitin
influences tumor cell--but not normal cell--activity.
Objectives: To widen the treatment spectrum,
homeopathic dilutions of Amanita phalloides,
containing amanitin, were given to a patient
with leukemia. Monitoring the leukemic cell
count, different doses of amanitin were given.
Results: The former duplication time of leukemic
cells was 21 months. Within a period of 21 months,
the cell count is stabilized to around 10(5)/L.
No leukemia-associated symptoms, liver damage,
or continuous erythrocyte deprivation occur.
Conclusions: This new principle of tumor therapy shows
high potential to provide a gentle medical treatment.
N AT U R O PAT H Y
Canaway, R. A culture of dissent: Australian naturopaths
JATMS
perspectives on practitioner, regulation. Complementary
Health Practice Review 2009 Oct;14(3):136-52
Despite the recommendations in 2006 that
naturopaths and Western herbal medicine practitioners be
more closely regulated, there have been no moves toward
state-mandated (statutory) registration or licensure of
naturopaths in any Australian state or territory. Debate
within the naturopathic profession on the appropriateness
of statutory practitioner regulation has historically
contributed to dissent and the creation of organizational
factions. In turn, the opposing factions and resulting
disunity are disincentives for government endorsement
of statutory registration. This article provides an
overview of the naturopathic profession in Australia
and the regulatory quest, highlighting how professional
marginalization and the pursuit of state protection have
fuelled the push for statutory registration. Considering
the extent of public support for complementary and
alternative medicine (CAM) practices, the unification of
the dissenting factions within the naturopathic profession
could create a powerful group, one in which current
self-regulatory mechanisms might be more effective,
so negating some of the perceived needs for statutory
regulation. However, with the increasing use of CAM
and most health professions regulated via registration
Acts, there are significant arguments to support statutory
registration for naturopaths in a manner similar to other
health care professionals.
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
41
BOOK REVIEW
BOOK REVIEW
P E N N Y R O B E R T S H AW E
LEON COWEN
Clinical Naturopathy
Clinical Hypnosis Textbook
Sarris J, Wardle J. Clinical Naturopathy, An Evidence-Based Guide to Practice. Churchill Livingstone Elsevier, 2010. ISBN 978-0-729-53926-5. $89.96. Available from Elsevier Australia, telephone 1800 263 951
or ‹http://www.elsevierhealth.com.au›.
James, U. (2010). Clinical hypnosis textbook: a guide for practical intervention. Second edition. United
Kingdom: Radcliffe Pub., 2010. ISBN 978-1-84619420-7. Soft cover. 198 pages. Available from Elsevier
Australia, telephone 1800 263 951, website: www.shop.elsevier.com.au or your local bookshop.
W
hile the authors of this book acknowledge the
role of intuition and ‘self-evolved’ diagnostics in naturopathic practice, their primary
focus is on the growing evidence-based knowledge that
is becoming ever more vital in the clinic setting. In this
endeavour, the authors have produced an easily understood text that concentrates on the most common aspects
of naturopathy—nutrition, diet, herbal medicine and
lifestyle treatments.
There are six parts to this book. In Part 1, the principles and philosophy of case taking and diagnostic
techniques are outlined. These provide readers with a
solid basis from which to understand the reasoning behind the interventions introduced in the subsequent four
parts. In Parts B to E, body systems, specialised clinical
conditions, life cycle related conditions, and conditions
in which treatment is integrated with orthodox medicine
are covered.
Each of these parts have been organised in a similar
way with case histories forming the context for the conditions. To support rationales for the suggested treatments,
tables setting out the major evidences available, and
treatment decision trees for the various suggested herbal
formulas, nutritional prescriptions and lifestyle changes
are provided. Other information such as aetiologies, risk
factors, treatment goals and conventional treatments give
an even fuller health picture. Key points, suggestions for
further reading and references complete each section.
The appendixes form Part F. They encompass a drug–
herb interaction chart, chemotherapy drugs and concurrent complementary therapies, food sources of nutrients,
factors affecting nutritional status, traditional Chinese
medicine diagnosis techniques, laboratory reference
values and more. There is also an index.
T
he author’s intention is to provide
an overview of the
topic and an indication of
the potential uses for hypnosis. This has been done
well and this book would
be suitable for a novice or
someone with a fundamental knowledge of hypnosis.
It outlines basic hypnosis
structures, including the
structure of a hypnosis
consultation rather than a
clinical hypnotherapy consultation. Whilst it still promotes scripts, it does indicate that to ‘personalise’ a script
would allow the suggestions to be more easily accepted by
the client.
The book is well written with information presented
in a succinct easy to read manner. It presents hypnosis as
an adjunct to an existing health modality and includes a
section called ‘Questions patients ask’ and ‘What to expect in the next few weeks’ which makes this an excellent
guide for the inexperienced practitioner.
The best aspect of the book is that it covers many
topics, some of which are unusual to see in a book of this
type, e.g. ‘Past Life Regression’ - it is rare to see a book
which promotes a medical viewpoint and acknowledges
Past life Regression as this one does.
The appendices are also well constructed. Although
short, Appendix I and Appendix II provide a good summary of the history of hypnosis and a glossary of terms
respectively.
To summarise, this book would be of interest to
health practitioners who want a basic understanding of
hypnosis/hypnotherapy. It would however be of limited
benefit to practitioners who want to use hypnosis or
clinical hypnotherapy within their practice – for that, as
the book suggests, training in the discipline is required.
It follows the standard format of many clinical hypnotherapy text books.
Oncology Massage (OM) Training ...
Dispelling myths
Eleanor Oyston
02 6236 3008 | 0417 259 026
[email protected]
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needs mindful touch.This can be given to everyone by a trained
massage therapist who knows the adjustments needed for each person’s
unique situation. A powerful tool for wellbeing in our hands.
Oncology Massage offers a moment when peace and relaxation can
blossom. It provides an opportunity for the individual to reconnect with
their physical, emotional and spiritual self.
Do you have Clients living with Cancer?
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For enrolments contact Kylie Ochsenbein
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www.oncologymassagetraining.com.au
42
JATMS
JATMS
43
ARTICLE
BOOK REVIEW
Reflecting On Relaxation
P E N N Y R O B E R T S H AW E
Fundamentals of Complementary and Alternative Medicine
Micozzi MS. Fundamentals of Complementary and Alternative Medicine. 4th Edition. Saunders Elsevier,
2011. ISBN 978-1-437-70577-5. $89.96. Available from Elsevier Australia, telephone 1800 263 951 or
‹http://www.elsevierhealth.com.au›.
T
his book, now in its fourth edition, takes a broadbased approach to covering complementary and
alternative medicine. It not only looks at its place
from a biological point of view, but also uncovers its
origins in social history and medical anthropology. As
a result, various health traditions are viewed from the
perspective of how people have adapted to their natural
environments and from that, built empirical knowledge
that provides them with the means to deal with illnesses
and diseases.
The text is arranged into six sections. The first section
describes the foundations of complementary and alternative medicine—its characteristics, its integrative role
with conventional medicine, its pharmacological basis,
its social and cultural factors, and its energetic traits
(vitalism). This is followed in Section 2 with a discussion of modalities concerned primarily with the connec-
tion between mind, body and spirit. Its subjects include
psychoneuroimmunology, energy medicine, biophysical
devices, art and other creative therapies, as well as the role
of humour in wellbeing.
After a general examination of the principles of manual and manipulative therapies, Section 3 details massage
and other touch therapies, shiatsu, reflexology, osteopathy and chiropractic. In Sections 4 and 5, the discussions
move on to focus on the ethnomedical systems of Asia,
Africa and the Americas.
The text is jam-packed and features like break-out
boxes summarising important points, diagrams, blackand-white photographs and an index. Additionally,
readers are invited to access the ‘Evolve’ website for a
chapter on Tibetan medicine, a complete list of chapter
references, an image collection, herb appendixes and
discussion questions.
ATMS & VETAB Accredited Courses
Introductory & Advanced Training
Continuing Education Courses
Online and in-house available
“The True Specialists in Clinical Hypnotherapy Training”
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Advanced Practitioner Certificate in Clinical Hypnotherapy
Certificate IV in Clinical Hypnotherapy (Reg: 91524NSW)
Diploma of Clinical Hypnotherapy (Reg: 91525NSW)
Adv. Diploma of Clinical Hypnotherapy (Reg: 91526NSW)
For Information: Ring (02) 9415 6500 or
Email: [email protected] for information.
1st Flr 302 Pacific Hwy Lindfield NSW 2070 Tel: (02) 9415 6500 Fax: (02) 9415 6588 Web: www.aah.edu.au
Executive Director: Leon W. Cowen AdvDipCH, DipHypMast(USA), GradDipAppHyp, MastCH, FAHA, MATMS
44
JATMS
Sandra Sebelis
I
t is quite amazing to consider that we human beings
now need to attend classes to be taught such natural
processes as relaxation and meditation. Unfortunately in the busy over-stressed lives that we lead no time or
space has been allocated for these functions. But then if
we look at another indispensible function, that of preparing, eating and digesting food, and see how we have also
almost eliminated these processes with the advent of fast
foods, take-aways, microwave cooking, half-hour lunch
breaks and commercial breaks on television, we can better understand the un-natural, fast tempo that we are living at. And what does this dehumanizing existence do to
our physiology? It creates stress, stress that manifests in
the first instance as headaches, migraines, muscular disorders, insomnia, back aches, anxiety, repetition strain
injuries, boredom, restlessness, addictions and dependencies on alcohol, tobacco and drugs. If the stress continues
and undermines the body’s natural defences and immune
system without any permanent relief, then we are faced
with ulcers, high blood pressure, heart problems, cancer
and AIDS.
Although it is necessary that we experience certain
tensions or pressures to exist it is equally important to
know how to let go, to switch off, and simply be in the
here and now. The practice of awareness will tell us when
this is necessary, when it is time to change our state or attitude. When we relax totally, we let go of all tension in
the mind and body. The regular daily practice of relaxation
will improve health and vitality, and provide protection
against stress and psychosomatic disorders. It will slow
down our physiological processes and increase our brain’s
alpha waves. It will improve digestion, provide a natural
state for healing processes to take place, improve efficiency
in work and sport, and enhance our creativity and spontaneity. It will free us from unrealistic fears and anxieties and
increase our courage and inner poise and sense of wellbeing. We will feel more alive, more stable and calm and our
perceptions and awareness will be enhanced. It will help
us get to sleep more quickly and induce a more refreshing and peaceful sleep. Daily relaxation will also improve
our concentration powers, and our spiritual awareness and
self-actualization. We will feel more in harmony with nature and negative emotions will be discarded in favour of
positive ones.
Ideally we practice relaxation daily, before and after an
exercise programme, in the middle of the day or before an
evening meal. Wear loose comfortable clothing and ensure
that you will not be disturbed. The ideal position is lying
on a flat firm surface (a bed is out) with a rug or mat under your body and a rug to cover yourself if the weather is
cold. Relaxation may also be practised sitting up, for five
to ten minutes sitting behind the wheel of your stationary car, at the office desk, or even on a closed toilet seat if
no other quiet places are available; even this is preferable
JATMS
to no break in your work routine at all. When sitting, ensure that your spine is aligned correctly and relaxed, legs
are slightly apart with feet resting flat on the floor, arms
supported by the arms of the chair, palms up or hands
cupped in your lap. Shoulders are rounded and neck and
head bent gently forward. It is essential that your weight is
evenly distributed throughout the whole body, eyes lightly
closed. If you are lying down for your practice, make sure
your sine is as straight and flat as possible, legs slightly
apart, feet falling opening out naturally. If you have a back
problem lie with legs slightly flexed using a cushion under the knees. This ensures that the lower spine is brought
into the floor and totally supported. Arms are out from
the sides, palms up. Extend the back of your neck, chin
down, shoulders expanding to give a feeling of space. This
position is known as Savasana, the corpse posture in yoga,
and is one of total acceptance and openness, where physical tension is reduced to a minimum. A small cushion or
a book may be placed under the back of the neck if necessary.
Probably the most well-known and widely used relaxation technique is progressive muscular relaxation, established by an American doctor, Edmund Jacobsen in 1910.
This technique is highly favoured by doctors and psychiatrists and has been described as a physiological and clinical
investigation of muscular states. Breathing rhythm is observed and then attention is rotated around different muscles groups of the body, tensing and then releasing them.
The whole process takes about 20 minutes. The disadvantage that I see with this technique is that you are never totally switched off but constantly working with the tensing
and releasing, and there may be negative consequences of
repeatedly hearing “tense” in a relaxation session, with no
positive thoughts or images introduced.
More recently Dr Herbert Benson introduced his relaxation response to combat stress. This technique is similar to mantra meditation and involves sitting in a quiet
comfortable position, choosing a word or short phrase
that is firmly rooted in our own belief system, closing your
eyes, relaxing the muscles and then with a slow breath repeating the focus word or phrase on each exhalation. The
attitude assumed is passive and the technique is practised
once or twice daily for 20 minutes each time.
Yoga classes have always included relaxation or yoga
nidra, either at the beginning or end of a sequence of postures. Students lie in Savasana, the corpse posture, and rotate their awareness through the sounds they hear around
them to physical feelings and sensations, then to awareness
of their thoughts and feelings, always without becoming
attached or hooked into them but simply learning to observe or witness only. Sensations are then turned inwards
or withdrawn and awareness is then rotated over the individual parts of the body. Full diaphragmatic breathing and
the use of symbolic visualisation are practised to change
45
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ARTICLE
awareness and physical conditions and to increase self actualisation.
Autogenic training has been described as the Western
answer to Eastern techniques such as yoga or zen meditation. It is a phycho-physiological self-training or hypnosis procedure (autogenic means self-originated or generated from within) that was developed experimentally in
Germany in the 1920s by Dr Johannes Schultz. There
are more than 3000 medical and scientific references and
work on Shultz’s autogenic training but barely ten percent
have been translated into English and consequently autogenic training is not widely known in English-speaking
countries. Dr Schultz based his method on observations
made by Dr Oskar Vogt and his students from their work
with patients in hypnosis and the physiological and psychological sensations they experienced (e.g. heaviness and
warmth, changes in heartbeat and respiration, all induced
by relaxation). Schultz also developed a series of mental
exercises based on his study of hallucinations, and these
formulas were introduced in an advanced stage of training for therapeutic purposes and are similar to the techniques proposed by Emile Coue in his book Self-mastery
Through Conscious Auto-suggestion, first published in
1922. Schultz’s autogenic training became widely known
in Europe in the 1950’s and was then introduced into
North and South America, Canada and Japan, mainly
through the influence of Dr Wolfgang Luthe, who has
published books on the subject with Dr Schultz.
Sensational
Homeopathy
Seminar 1
Byron Bay
19, 20, 21 August 2011
Lord Byron Resort
Practitioner $420 / $390 early bird
Student $300 / $270 early bird
Sensational
Homeopathy
Seminar 2
Byron Bay
28, 29, 30 October 2011
Lord Byron Resort
Practitioner $420 / $390 early bird
Student $300 / $270 early bird
Dr Mahesh Gandhi - Sensational Psychiatrist
Dr Mahesh Gandhi has been closely associated with Dr. Rajan Sankaran for more
than 15 years. Dr. Gandhi’s background in Psychiatry, has given him tremendous
insight into the homeopathic treatment of psychiatry related cases.
Dr. Mahesh Gandhi uses the methods pioneered by Sankaran. He will show how
patients can be guided to talk about the source of the remedy they require,
using tools such as kingdom, levels and miasms.
J
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$8 RD
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21 CPE points
Dr Frans Vermeulen - Plant Kingdom Series
World authority on Materia Medica, author and lecturer
Each of the many books he has authored makes a contribution of major significance
to our understanding of substances. His lectures are inspiring and appreciated for
their liveliness, depth of knowledge and breadth of factual information.
Bo
EA Sept ok b
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aware of the vital life force energy (prana, chi or ki) that
we absorb with each inhalation, aware of the releasing or
letting go of all negativity, stress, tiredness, worry, pain or
disease with each exhalation, and consciously introduce
the idea that with each inhalation from now on we will go
deeper and deeper into the state of relaxation. Awareness
then moves to the physical body lying on the mat and the
clothes that cover us. We become aware of odours, taste
sensations, images or coloured lights behind our closed
eyes, then rotate our awareness to the sounds around us
and then to our thoughts and feelings, simply witnessing or observing them and not allowing ourselves to get
caught up by them. The senses are then withdrawn and
turned inwards and students allow only the sound of my
voice to reach them so that I can continue to guide them
deeper and deeper into the relaxed state. Then we being
to practise rotating awareness through different parts of
the body with students repeating instructions mentally to
themselves while generating an image of the specific parts
we are working on, and feelings of heaviness and warmth.
They repeat instructions, emphasising the personal pronouns “I” or “My”. It is important that a dependency on
my voice is not built up but that in their daily practice,
students are able to substitute their own inner voice while
repeating the commands that I have taught them. We then
become aware of our hearts beating, strong and steady,
and of our breath, calm and comfortable, and feel deep
Homeopathic clinician for 25 years, combined with Frans they will incorporate the clinical
experience gathered from some of the greatest homeopaths of the last 140 years.
21 CPE points
JATMS
Many thanks to our generous Sponsors
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B O O K S
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peace as we continue deeper and deeper in relaxation. We
imagine we are lying in the shade and that our foreheads
are cool, then we move down the body to discover the
warmth of the solar plexus and the specific systems in the
body and how well each functions during the relaxation
process. Affirmations and positive thoughts are then introduced into the subconscious, which becomes accessible
in the relaxed state, and I draw on my own inspirations
and experiences and those from the teachings of Kahlil
Gibran, Gerard Jampolsky, Louise Hay, Virginia Satir, the
Bhagavad Gita, Leo Tzu, Buddha, Jung and Jesus. The final
part of the relaxation, which lasts 20-25, minutes is given
over to visualisations, either of single objects or images, or
of a connected theme or a story. Students are given the opportunity to repeat their own affirmations or goals before
they are gently and slowly brought out of the hypnotic and
deeply relaxed state, by flexing and stretching the whole
body, opening the eyes, breathing deeply, then gently massaging the lower part of the body. Because of the altered
state of consciousness that is induced during such deep
relaxation it is vital that there is a gentle readjustment and
that students do not leap up and immediately begin another activity. In my yoga classes I employ relaxation right
at the beginning of the class and by retaining this feeling
of relaxation and working deeply with the breath we are
able to achieve extremely good results with the postures
that follow, without any artificial forcing or straining.

Dr Linda Johnston
Reine DuBois Naturopath / Classical Homeopath
For enquiries or bookings call 0423 581 198
www.naturopathbyronbay.com.au
[email protected]
46
The purpose of autogenic training is to promote adequate and healthy responses of body and mind and to
eliminate inadequate and unhealthy reactions. It also promotes greater personal and social effectiveness. Three postures area suggested for the practice: lying on your back,
lying back in an easy chair or leaning forward while sitting ain a hard chair. During the first two weeks students
practise 2-3 times a day, 5 minutes at a time and for no
more than 15 minutes a day. The six exercises that compose the standard formula are heaviness (e.g. my right arm
is heavy), warmth (e.g. “my right arm is warm”), cardiac
formula (e.g. “my heartbeat is calm and regular”), respiratory formula (e.g. “my breathing is calm and regular” or
“my breathing breathes me”), abdominal formula (e.g. “my
solar plexus is warm”) and forehead formula (e.g. “my forehead is cool”). The more advanced stages include suggestions like, “my throat is cool” and meditative formula (the
visulization of spontaneous or colours, selected colours,
concrete or abstract objects, feeling states, other people,
and dialoguing with the subconscious).
In my yoga and relaxation classes I teach a combination of autogenic training and yoga nidra, combining the
wisdom of traditional practices and emphasis on awareness with the modern scientific and medical findings on
the profound effects of the hypnotic trance states being
currently taught with neurolinquistic programming. We
begin with an introduction to the concept and practice
of the diaphragmatic breathing technique, becoming
JATMS

47
ALRETTITCELR
ES
TO THE EDITOR: I was pleased to read Alan Jansson’s
reply ( JATMS 17(1) p.52) to the research article on post
menopausal women which regarded shallow needling as
placebo acupuncture. I too am constantly disappointed in
the level of knowledge professed to be had by practitioners of our art. I have been practicing Japanese meridian
style acupuncture for nearly 10 years now and the use of
shallow and deeper needling are both utilised effectively in
our style. Those who would suggest that shallow needling
can be used for placebo acupuncture, in my mind, know
little of its therapeutic strength. I would not hesitate to say
that they would generally have a poor working knowledge
of the meridian systems as well, an integral part of our
practice as well as part of how the body is understood in
the traditional oriental paradigm. Disappointed but still
hanging in there.
Caleb Mortensen,
Carlton, VIC
TO THE EDITOR: As a practicing naturopath I have
been following the issue of registration of naturopaths and
herbalists closely. I have to say that I am a supporter of registration. Although the main reason for registration is to
ensure public safety, I feel that an incidental benefit is the
recognition of tertiary qualifications and the promotion
of credibility amongst consumers and other health professionals particularly those in regulated professions such as
medicine.
This point was emphasised to me when I contacted the
PCOS Australian Alliance (PCOSAA) with feedback in
relation to the Clinical Guidelines for the Management
of PCOS. Within the guidelines, lifestyle intervention is
recommended as first-line treatment for all women with
PCOS. Lifestyle intervention, delivered by a multidisciplinary team, enables women with PCOS to access professional lifestyle advice including dietary, exercise and
behaviours that promote wellness. It is an excellent document that acknowledges women as whole beings, and
encourages personal involvement in the management of
a complex condition. The PCOSAA is about to be nationally and internationally recognised as pioneering and
cutting-edge. It is internationally acknowledged that Australia is leading the world with this amalgamated, multidisciplinary approach.
Lifestyle advice is underpinned by holistic principles,
which is a prominent feature of naturopathic philosophy
and practice. My colleagues and I have treated women
with PCOS in this way for the past 14 years (30 years +
for one)! Collectively we have successfully treated many
women with PCOS, using naturopathy and herbal medicine. I’m sure many other naturopaths and herbalists have
too. So, I sent feedback to the PCOS Alliance explaining
the frequent use of complementary medicine by women
with PCOS, along with evidence based research references, hoping that naturopaths and herbalists could be in-
48
JATMS
cluded in the dialogue, instead of sidelined and disregarded as usual. You can imagine my disappointment when the
reply to me from the PCOS Alliance came which stated,
quote: “Currently, there are no national accreditation and
registration processes for CAM practitioners and the level
of qualification varies significantly. The GDG determined
that, currently, the qualifications of CAM practitioners in
the provision of lifestyle advice cannot be advocated in an
evidence based guideline as there is no evidence currently
to support this role in PCOS and the consistency and
quality of CAM practitioner training in this field cannot
be confirmed”.
This means that naturopaths will not be included as
part of the multidisciplinary team involved in the management of women with PCOS. It means that our clients
will (hopefully) continue their covert use of naturopathy
(not telling their doctor), and it means that many women
will not consult a naturopath or herbalist at all. It means
that a doctor, dietician, nurse, psychologist or exercise
physiologist will not openly refer women with PCOS to
naturopaths or herbalists. It means that members of the
‘multidisciplinary team’ be meeting the needs for women
with PCOS.
I can’t see how non-registration of naturopaths helps
our practice. There is ample evidence that non-registration
isolates us from the wider health community, limits the
number of clients we see and severely limits our income
potential and professional esteem. Many advanced diploma or bachelor trained naturopaths work in retail, practice part-time and live below the poverty line.
In relation to the discussions about self regulation,
it is obviously biased towards the interests of the profession. Self regulation clearly represents the interests of the
profession rather than the consume. Are our interests
not already represented by our professional bodies? Selfregulation is not objective and not respected enough for
interdisciplinary inclusion. In light of the recent reports
of the self regulated fast food industry, self regulation is
not rigorous and poorly considered within professional
communities. Whilst I understand that many practicing
naturopaths or herbalsists did not acquire a diploma or
bachelor due to the historical unavailability, and therefore
registration may threaten their practice, can’t we accommodate this need with recognition of long term practice in
so-called ‘grandmothering’? Diplomas and Bachelors have
been available now for approximately the past 17 years –
doesn’t the cost for obtaining such a qualification warrant
postgraduate security and a viable, stable career path?
The recent debate in relation to statutory registration
of naturopaths and herbalists presents an opportunity for
recognition of naturopaths and herbalists. I strongly hope
that the ATM chooses to represent our interests and to not
pass it up.
Susan Arentz
Sydney, NSW
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S TAT E N E W S
S TAT E N E W S
From South Australia
SANDRA SEBELIS
I
n between my Shiatsu Clinic and my Yoga Classes,
I am lucky still finding time to read and this time,
would like to recommend to you the latest book
on wellknown and prolific Australian author,
Stephanie Dowrick, entitled Seeking The Sacred which
seeks to transform our view of ourselves and one another
The book is published by Allen & Unwin 2010 and is
very much a followon from previous titles which include,
Intimacy And the Solitude, Forgiveness And The Other
Acts Of Love and Choosing Happiness. Quoting from
the introduction: “Our search for the sacred may be as
individual as our fingerprints yet it connects us effortlessly
to all human beings ... [it is] inspiration for profound
inner transformation, for waking up”.
On
behalf
of
all
our
members,
may
I
offer
congratulations
to
Belle
McCaleb
on
her
recent
Australia
Day
2011 Achievement Award from the Unley City
Council. The award was in recognition of Belle’s work
with cancer patients at our Cancer Care Centre in her
role as naturopath, herbalist and counsellor, and in her
founding of the Cancer Support Alliance. Bravo Belle.
We have just heard our first PES for the year
which was very well attended and enjoyed by all.
The seminar, entitled Healthy Heart got off to a real
giggle with a morning workshop lead by David Cronin,
joyologist, life coach, entertainer and author of Healing
and Humour. We practised laughter and learned that we
can get humoroids if we don’t laugh. To say we had fun
would be putting it mildly. I found it incredible to watch
a roomful of therapists, normally very serious, walking
around the room, laughing so much at themselves and
each other that tears were rolling down their faces.
After lunch Dora Mackereth from our
local branch of the Heart Foundation spoke
on the warning signs of a heart attack and actions to take,
which I have summarized as follows:
• Discomfort or pain in the centre of the chest which may feel like heaviness, tightness or pressure
• Discomfort in arms, shoulders, neck jaw and back. Arms may feel heavy and useless. There may be choking in the throat.
• Shortness of breath, nausea, cold sweats, dizziness or light-headedness.
Get help quickly and dial 000.
Jesse Sleeman, naturopath and herbalist, affectionately
known as the court jester of natural therapies, presented
a talk called Getting to the heart of the matter, which
explored the impacts of diet, exercise, breathing, the
50
JATMS
mind, electromagnetic radiation, social isolation and
environmental disconnection on the cardiovascular
system.
Two final quotes:
From the Jain Kritanya Sutra:
Treat all creatures in the world as you want to be treated.
And from Zoroastrianism:
Do not do to others whatever is injurious to your own self.
From Victoria
PAT R I C I A O A K L E Y
A
TMS started the year 2011 in Victoria with
our Sports Nutrition Seminar, held at the
Dandenong Sports Club on February 20.
The presenter, Kira Sutherland BHSc, ND, Grad Dip
Sports Nutrition (IOC), provided A.T.M.S. members
and visitors with interesting facts about the types of
nutrients needed by competitive athletes to improve
their performance, with the basics of energy production
through to sports supplements, protein powders and case
studies. Kira was invited back again for future seminars
and attendees were happy with their certificates, provided
by A.T.M.S. at the completion of the day.
In March Bill Pearson, A.T.M.S. Vice President,
presented an interesting Seminar on Traditional
Chinese Medicine, also at the Dandenong Sports Club.
Unfortunately I was unable to attend but Bill’s seminars
are always very popular in Melbourne and it was great to
have him over from Tasmania.
The second meeting of the Integrative Medicine
Education and Research Group Journal Club was held
on April 6th at the Alfred Hospital, Commercial Road,
Prahran A.M.R.E.P. Education Centre, Seminar Room.
A well attended evening began with light refreshments,
compliments of Swisse, providing a social side to the
evening in the company of like-minded people while
enjoying some tasty sustenance before sitting down for the
meeting.
After the welcome Professor Andrew Scholey from the
Brain Science Institute spoke on studies into “The Effects
of Herbal Supplements on Mood and Cognition: issues
and challenges” which had been conducted over the past
twelve months at the Burwood Campus and sponsored
by N.I.C.M, the National Institute of Complementary
Medicine. Dr Andrew Pipingas reported on measuring
and ameliorating neurocognitive decline and how his
group had measured age-relative cognitive decline,
e.g. crystallized intelligence, general knowledge and
vocabulary, and fluid intelligence – the time needed for
performing tasks and processing information, recognition
memory, episodic memory, spatial memory, working
memory etc. He was followed by Tania Wells, naturopath
and experienced integrative medicine practitioner who
presented her case study of safe drug withdrawal. These
meetings are held monthly at the moment with various
speakers. For members interested in attending, please get
in touch and I will gladly provide more details.
ATMS’s submission to the Australian Health
Ministers’ Advisory Council (AHMAC) on the
preferred option for regulation of unregistered health
care practitioners was the main discussion on the agenda
for our breakfast meeting on April 13th, 2011 at 134
Durham Road, Sunshine. Dr Sandi Rogers, A.T.M.S.
National President, was able to explain about the
submission of this important document and had a copy
for attendees to read.
Andrea Hepner had been
able to attend John Wardell’s ARMAC meeting held in
Melbourne and reported on the event, as Ann Vlass and
Ben Greening had hoped to attend but had been unable
to, mostly due to Friday night traffic and a busy schedule.
We then moved on to discussions about our A.G.M. to
be held in Melbourne this September and Sandi was able
to tell us about her new social media networking website
and preventative health, on which she is publish four
articles providing more awareness of current topics in our
industry.
We are looking forward to our next breakfast meeting on
13th July and welcome all members to come along.
• Outstanding Naturopathy Graduate – Christine Barnes
• Outstanding Western Herbal Medicine Graduate – Michelle Beech
• Outstanding Nutrition Graduate – Kim Holmes
Upcoming Seminars: (please check ATMS website for
dates in your area)
• Heart Health
• Lower Back Pain
• Business
• Homeopathic
• Naturopathy
• Mental Health
• Alzheimers
I look forward to catching up with you at the next seminar.
From New South Wales
A N T O I N E T T E B A L N AV E
T
he first 3 months of 2011 have been extremely
busy and exciting for NSW. The Optimising
Hormones using Natural Medicine seminar series
were so well attended that people came on the day
looking for a place (please book early as there are only
limited numbers available). Presenters Stephen Eddey and
Teresa Mitchell-Paterson created a fast-paced, informative
and clinically relevant seminar and attendees left with
fantastic knowledge to take back to their clinics and
students. What a bonus to your learning experience.
The Natural Health Expo was fantastic with Matthew
Boylan and me flying the ATMS flag on Friday, and on
Saturday Patrick de Permentier and Allan Hudson were
there to meet and greet. Our FREE Student Membership
was very well received.
I was then given the honour of attending the
Australasian College of Natural Therapies (ACNT)
Graduation Ceremony. Wow! What a professional
ceremony with students in cap and gown and faculty in
their robes. I think other colleges could do the same. We
only graduate once and what a memory these students will
take with them for the rest of their lives. ATMS presented
one-year memberships to the following:
JATMS
51
S TAT E N E W S
From Tasmania
BILL PEARSON
T
his year I am looking forward to travelling
around the state talking with and listening to our
members. Wherever you are in Tasmania there
will be a date and a venue for you. It is imperative that
you confirm your attendance with Meadowbank or the
meeting could be cancelled.
• Sunday April 17th. Launceston.
• Sunday May 29. Hobart
• Sunday July 24. Burnie
• Sunday September 4. New Norfolk
• Sunday October 9. Huonville
As one of your Vice Presidents I am happy to report
that I am representing our association as follows:
• Sitting on two committees which are looking at the pending registration of TCM in 2012. I will share further news as it comes to hand.
• I am approaching the 7th meeting, along with President Sandi Rogers and Company Secretary 52
JATMS
•
•
Matthew Boylan, with the Inter Association Regulatory Forum. This exciting initiative initiated by ATMS has brought together 15 professional natural medicine associations to create a regulatory pathway for natural medicine practitioners.
Have attended the non registered health practitioner meetings.
Have presented the ATMS perspective at the ARONAH meetings.
At the same time the second edition of the ATMS
Newspaper is soon to appear in your mail boxes.
Negotiations with the China Academy of Chinese
Medical Sciences continues which will create an exciting
opportunity for all our practitioners. As I write this I
am preparing to see as many members as possible at the
International Summit in Sydney in a few weeks.
It continues to be busy which can only mean one
thing: that your Directors are working tirelessly for you.
And this is how it should be.
Until next time my wishes to you all.
H E A LT H F U N D N E W S
AUSTRALIAN
(AHM)
H E A LT H
H E A LT H F U N D N E W S
MANAGEMENT
Names of eligible ATMS members will be automatically sent to AHM each month. ATMS members can check
their eligibility by telephoning the ATMS on 1800 456
855.
A U S T R A L I A N R E G I O N A L H E A LT H G R O U P
(ARHG)
This group consists of the following health funds:
•
ACA Health Benefits Fund
•
Cessnock District Health
•
CUA Health (Credicare)
•
Defence Health Partners
•
GMF Health (Goldfields Medical Fund)
•
GMHBA (Geelong Medical)
•
Health Care Insurance Limited
•
Health Partners
•
HIF (Heath Insurance Fund of WA)
•
Latrobe Health Services
•
Lysaught Peoplecare
•
MDHF (Mildura District Health Fund)
•
Navy Health Fund
•
Onemedifund
•
Phoenix Welfare
•
Police Health Fund
•
Queensland Country Health
•
Railway and Transport
•
Teachers Union Health
•
St Lukes
•
Teachers Federation
•
Transport Health
•
Westfund
When you join ATMS, or when you upgrade your
qualifications, details of eligible members are automatically sent to ARHG by ATMS monthly. The details sent
to ARHG are your name, address, telephone and accredited discipline(s). These details will appear on the AHHG
websites. If you do not wish your details to be sent to
ARHG, please advise the ATMS office on 1800 456 855.
Remedial massage therapists who graduated after
March 2002 must hold a Certificate IV or higher from a
registered training organisation. Please ensure that ATMS
has a copy of your current professional indemnity insurance and first aid certificate.
The ARHG provider number is based on your ATMS
number with additional lettering. To work out your
ARHG provider number please follow these steps:
1. Add the letters AT to the front of your ATMS member number
2. If your ATMS number has five digits go
to step 3. If it has two, three or four digits,
you need to add enough zeros to the
front to make it a five digit number
54
JATMS
3.
(e.g. 123 becomes 00123).
Add the letter that corresponds to your
accredited modality at the end of the
provider number.
AAcupuncture
C Chinese herb al medicine
HHomoeopathy
M Remedial massage
NNaturopathy
OAromatherapy
R Remedial therapies
W Western herbal medicine
If ATMS member 123 is accredited in Western herbal medicine, the ARHG provider number will be
AT00123W.
4. If you are accredited in several modalities,
you will need a different provider
number for each modality (e.g. if ATMS member 123 is accredited for Western
herbal medicine and remedial massage, the
ARHG provider numbers are AT00123W and
AT00123M.
AUSTRALIAN UNITY
Names of eligible ATMS members will be automatically sent to Australian Unity each month. ATMS members
can check their eligibility by telephoning ATMS on 1800
456 855.
B U PA (including HBA and Mutual Community)
Names of eligible ATMS members will be automatically sent to BUPA each month. ATMS members can check
their eligibility by telephoning ATMS on 1800 456 855.
directly to Grand United on 1800 249 966.
HBF
To register with HBF, please contact the fund directly
on 13 34 23.
HCF AND MANCHESTER UNITY
Names of eligible ATMS members will be automatically sent to HCF and Manchester Unity each fortnight.
ATMS members can check their eligibility by telephoning
ATMS on 1800 456 855.
MBF ALLIANCES
Names of eligible ATMS members will be automatically sent to MBF Alliances each month. ATMS members
can check their eligibility by telephoning ATMS on 1800
456 855.
M E D I B A N K P R I VAT E
Names of eligible ATMS members will be automatically sent to Medibank Private each month. ATMS members can check their eligibility by telephoning ATMS on
1800 456 855.
NIB
NIB require Health Training Package qualifications
for naturopathy, Western herbal medicine, homoeopathy,
nutrition, remedial massage, shiatsu and Chinese massage.
Australian HLT Advanced Diploma qualifications are the
minimum requirements for acupuncture and Chinese
herbal medicine. Names of eligible ATMS members will
be sent to NIB each week. NIB accept overseas qualifications which have been assessed as equivalent to the Austra-
C B H S H E A LT H F U N D L I M I T E D
On joining ATMS, or when you upgrade your qualifications, the details of eligible members are automatically
sent to CBHS each month. The details sent to CBHS are
your name, address, telephone and accredited discipline(s).
These details will appear on the CBHS website. If you do
not want your details to be sent to CBHS, please advise
the ATMS office on 1800 456 855.
Please ensure that ATMS has a copy of your current
professional indemnity insurance and first aid certificate.
D O C T O R S H E A LT H F U N D
Names of eligible ATMS members will be automatically sent to Doctors Health Fund each fortnight. ATMS
members can check their eligibility by telephoning ATMS
on 1800 456 855.
G R A N D U N I T E D C O R P O R AT E
To register with Grand United Corporate, please apply
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lian qualification by Vetassess or and RTO college.
All recognised provides must agree to the NIB Provider Requirements, Terms and Conditions as a condition of NIB provider status. The document is available
at http://providers.nib.com.au. Alternatively, a copy can
be obtained by emailing [email protected] or calling
NIB Provider Hotline on 1800 175 377. It is not necessary for ATMS members to complete the application form
attached to NIB Provider Requirements, Terms and Conditions.
ATMS members currently recognised by NIB and who
have not submitted their renewed professional indemnity
insurance and/or first aid certificate to ATMS must do so
immediately, or they will be removed from the NIB list.
Documents needed for members to remain on the
health fund list
To remain on the health funds list, members must have
a copy of their current professional indemnity insurance
and first aid certificate on file at the ATMS office and must
meet the CPE requirements. Please ensure that you forward copies of these documents to the ATMS office when
you receive your renewed certificates.
Lapsed membership, insurance or first aid will result in a member being removed from the health
funds list. Upgrading qualifications may be required to be re-instated for some health funds.
C H A N G E O F D E TA I L S
The ATMS office will forward your change of details
to your approved health funds on the next available list.
Health funds can take up to one month to process change
of details.
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✔ Allergy-free organic meals
✔ Children friendly dishes
✔ Organic food without added sugar, pesticides,
artiﬁcial ﬂavours, colours, preservatives,
texturisers, hormones, trans fats or GMO’s
✔ Dishes specially made without added nuts,
gluten, eggs, soy, amines or any MSG.
The Peasants Feast
Organic Restaurant
121A King Street, Newtown 9516 5998
www.peasantsfeast.com.au
OPEN TUES-SAT 6 til 10PM
Chinese massage
Hypnotherapy
Counselling
19
20
21
Iridology
Myofascial technique
18
23
Alexander technique
17
* Australian Regional Health
Group
Touch for health
Kinesiology
16
Shiatsu
14
15
Integration therapy
Deep tissue massage
Reflexology
11
13
Aromatherapy
10
12
Sports massage
Remedial massage
7
Remedial therapies
Nutrition
6
9
Chinese herbal med
5
8
Homoeopathy
Naturopathy
4
Herbal medicine
3
Acupuncture
2
√
1
C
√
√
√
√
√
√
√
√
√
√
56
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Teachers Union*
Transport Health*
Westfund Health Fund*
√
√
√
√
√
Teachers Federation*
√
√
√
√
√
St Lukes*
√
√
√
Railway and Transport*
√
√
√
Qld Country Health*
√
√
√
√
Police Health Fund*
√
√
√
√
√
Phoenix Welfare*
√
√
√
√
Onemedifund*
√
√
√
NIB Health Fund
√
√
√
√
Naval Health Fund
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Medibank Private
Mildura Health Fund*
√
√
√
√
√
MBF Alliances
√
√
√
√
√
Manchester Unity
√
√
√
Lysaght Peoplecare*
√
√
√
Latrobe*
√
√
√
HIF*
√
√
√
√
Health Partners*
√
√
√
√
Health Care Insurance*
JATMS
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
HCF
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Grand United Corporate
√
√
√
√
√
√
GMHBA (Geelong Med)*
Goldfields Med Fund*
√
√
√
√
Defence Health*
Doctors Health Fund
√
√
√
√
CUA Health (Credcare)*
HBF
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Cessnock Dist Health*
CBHS Health Fund Ltd
√
√
√
√
√
√
√
√
√
√
√
Aust Unity Health Ltd
BUPA/HBA/Mutual Com
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
ACA*
Aust Heath Managemt
√
√
√
√
8
7
6
5
4
3
2
1
Fund
H E A LT H F U N D U P D AT E J U N E 2 0 11
9
10
11
12
√
√
√
√
√
√
13
14
√
15
√
16
√
17
18
19
√
20
√
21
√
22
√
Rebates do not usually cover medicines.
This table is a guide. For rebate terms and conditions, patients
should contact the health fund. Policies may change without prior
notice.
√ Therapy covered by fund
23
C O N T I N U I N G P R O F E S S I O N A L E D U C AT I O N
ontinuing professional education (CPE) is a
structured program of further education for
practitioners in the professional occupations.
The ATMS CPE policy is designed to ensure its practitioners regularly update their clinical skills and professional knowledge. One of the main aims of CPE is keep
members abreast of current research and new developments which inform contemporary clinical practice.
The ATMS CPE Policy is based on the following principles:
•
Easily accessible to all members, regardless of
geographic location
•
Members should not be given broad latitude in
the selection and design of their individual
learning programs
•
Applicable to not only the disciplines in which
a member has ATMS accreditation, but also to
other practices that are relevant to clinical
practice which ATMS does not accredit
(e.g. Ayurveda, yoga)
•
Applicable to not only clinical practice, but also to all activities associated with managing a small business (e.g.bookkeeping, advertising)
•
Seminars, workshops and conferences that
qualify for CPE points must be of a high
standard and encompass both broad based topics
as well as discipline-specific topics
•
Financially viable, so that costs will not inhibit participation by members, especially those in
remote areas
•
Relevant to the learning needs of practitioners, taking into account different learning styles and
needs
•
Collaborative prSetocess between professional complementary medicine associations, teaching institutions, suppliers of therapeutic goods and
devices and government agencies to offer
members the widest possible choice in CPE
activities
•
Emphasis on consultation and co-operation
with ATMS members in the development and implementation of the CPE program
ATMS members can gain CPE points through a wide
range of professional activities in accordance with the
ATMS CPE policy. CPE activities are described in the
CPE policy document as well as the CPE Record. These
documents can be obtained from the ATMS office (telephone 1800 456 855, fax (02) 9809 7570, or email info@
atms.com.au) or downloaded from the ATMS website at
www.atms.com.au.
It is a mandatory requirement of ATMS membership
that members accumulate 20 CPE points per financial
year.
Five 5 CPE points can be gained from each issue of
JATMS
this journal. To gain five CPE points from this issue, se
lect any three of the following articles, read them carefully
and critically reflect how the information in the article
may influence your own practice and/or understanding of
complementary medicine practice:
•
Luchau T, Ward B. and Koliha L. Myofascial techniques: musculoskeletal headache
•
Connelly, P. Nutritional advantages and disad
vantages of dietary phytates: Part 2
•
de Permentier, P. Effective research: a discussion of essential elements
•
Medhurst, R. Homeopathy and its role in the management of headaches
•
Pagura, I. Employment law: employee v indepen
dent contractor
As part of your critical reflection and analysis, answer
in approximately 100 words the following questions for
each of the three articles:
1. What new information did I learn from this
article?
2. In what ways will this information affect my
clinical prescribing/techniques and/or my
understanding of complementary medicine
practice?
3. In what ways has my attitude to this topic changed?
Record your answers on a separate sheet of paper for
each question. Date and sign the sheets and attach to your
ATMS CPE Record. As a condition of membership, the
CPE Record must be kept in a safe place, and be produced
on request from ATMS.
FREE ELECTRONIC JOURNALS
T
he following list of free electronic journals and
good websites has been recommended by the
ATMS Heads of Department. Subscription to a
free Journal will accrue 2 ATMS CPE points. As there
is no way to accurately and fairly measure visits to a web
site, visiting a website will not attract any CPE points.
Nutrition:
http://www.nafwa.org/fulltextarticles.php
•
•
http://www.nutritionj.com/
•
http://www.gfmer.ch/Medical_journals/Nutrition_food_
obesity.htm
•
http://highwire.stanford.edu/lists/freeart.dtl
Chinese Medicine:
http://www.worldscinet.com/ajcm/ajcm.shtml
•
Herbal:
http://cpb.pharm.or.jp/
•
•
http://www.ethnobotanyjournal.org/
Homoeopathy:
•
http://www.Hpathy.com
57
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affecting your clients?
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Acceptance and Clinical Evidence
Over 11,000 instruments in use worldwide.
Over 400 in Chinese Government hospitals.
Environmental stressors can play a significant
role in many chronic conditions. Hundreds of
thousands of clients have been helped by BICOM
Therapy over the past 20 years and clinical
evidence is available to practitioners on request.
CODE OF CONDUCT
PREAMBLE
C
omplementary medicine is a holistic approach to
the prevention, diagnosis and therapeutic management of a wide range of disorders in the community. Complementary medicine practice is founded on
the development of a therapeutic relationship and the
implementation of therapeutic strategies based on holistic principles. Complementary medicine encompasses a
diversity of practices to improve the health status of the
individual and community for the common good.
The aim of the Code of Conduct is to make it easier
for members to understand the conduct which is acceptable to ATMS, the complementary medicine profession
and to the wider community, and to identify unacceptable
behaviour. The Ethical Principles underpin the standards
of professional conduct as set out in the Code of Conduct.
The intention of the Code of Conduct is to identify
ethical dilemmas and assist ATMS members in resolving
them. ATMS members are accountable for their clinical
decision making and have moral and legal obligations for
the provision of safe and competent practice.
Where an ATMS member encounters an ethial quandary, it is advisable to seek appropriate advice. If this action does not solve the matter, the advice of ATMS should
be sought. The purpose of the Code of Conduct is to:
Identify the minimum requirements for practice in the
complementary medicine profession
Identify the fundamental professional commitments of
ATMS members
Act as a guide for ethical practice
Clarify what constitutes unprofessional behaviour
Indicate to the community the values which are expected of ATMS members
The Code of Conduct was established as the basis for
ethical and professional conduct in order to meet community expectations and justify community trust in the
judgement and integrity of ATMS members.
While the Code of Conduct is not underpinned in statute, adoption and adherence to it by ATMS members is a
condition of ATMS membership. A breach of the Code of
Conduct may render an ATMS member liable for removal
from the Register of Members.
ETHICAL PRINCIPLES
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all with a full set of accessories.
Price range $30,000 -$45,000.
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Start up support with treatment advice, client referral
and your listing as a practitioner on our website
24-month parts and labour warranty (factory-trained engineer in NSW)
German manufactured to ISO 9001 quality standard
Included on TGA Register (ARTG No. 138918)
For more information and to discuss how BICOM can help build your practice, contact:
BIOMED Australia Pty Ltd Ph/Fax (03) 6229 1114 www.bicomaustralia.com.au
Practitioners conduct themselves ethically and professionally at all times.
Practitioners render their professional services in accordance with holistic principles for the benefit and wellbeing of patients.
Practitioners do no harm to patients.
Practitioners have a commitment to continuing professional education to maintain and improve their professional knowledge, skills and attitudes.
Practitioners respect an individual’s autonomy, needs,
values, culture and vulnerability in the provision of com-
JATMS
plementary medicine treatment.
Practitioners accept the rights of individuals and encourage them to make informed choices in relation to
their healthcare, and support patients in their search for
solutions to their health problems.
Practitioner treat all patients with respect, and do not
engage in any form of exploitation for personal advantage
whether financial, physical, sexual, emotional, religious or
for any other reason.
DUTY OF CARE
The highest level of professional and ethical care shall
be given to patients.
The practitioner will exercise utmost care to avoid unconscionable behaviour.
The patient has the right to receive treatment that is
provided with skill, competence, diligence and care.
In the exercise of care of the patient, the practitioner
shall not misrepresent or misuse their skill, ability or qualifications.
PROFESSIONAL CONDUCT
Practitioner members must adhere to all of the requirements of this Code of Conduct and State, Territory and
Federal law within the scope of their practice.
The title of Doctor or Dr will not be used, unless registered with an Australian medical registration board.
Under no circumstances may a student, staff member
or another practitioner use someone else’s membership
number or tax invoice book for the purposes of issuing a
health fund rebate tax invoice. The member is responsible
for the issue of their own tax invoices.
The practitioner shall not provide false, misleading
or incorrect information regarding health fund rebates,
WorkCover, ATMS or any other documents.
The practitioner shall not advertise under the ATMS
logo any discipline(s) for which they are not accredited
with ATMS.
The practitioner shall not denigrate other members of
the healthcare profession.
The practitioner shall be responsible for the actions of
all persons under their employ, whether under contract or
not.
The practitioner shall not engage in activity, whether
written or verbal, that will reflect improperly on the profession of ATMS.
In the conveying of scientific or empirical knowledge
to a patient, the practitioner shall act responsibly, and all
personal opinions shall be highlighted as such.
Students shall not engage in clinical practice other than
as part of supervised training. In all other student obligations, students must identify themselves as such and not
charge a fee.
In the clinical setting, the practitioner shall not be under the influence of any substance capable of impairing
59
CODE OF CONDUCT
professional judgement.
The medicines and medical devices used by the practitioner must be in accordance with therapeutic goods law.
Telephone or Internet consultations, without a prior
face-to-face consultation, must not be conducted.
The fee for ser vice and medicines charged by the practitioner must be reasonable, avoiding any excess or exploitation,
Patient records must be properly maintained with adequate information of a professional standard
The practitioner must act with due care and obtain
consent when conveying a patient’s information to another healthcare professional.
The patient has a right to be adequately informed as to
their treatment plan and medicines, and access to their information as far as the law permits.
R E L AT I O N S H I P B E T W E E N
N E R A N D PAT I E N T
ADVERTISING
PRACTITIO-
The practitioner shall not discriminate on the basis of
race, age, religion, gender, ethnicity,
sexual preference, political views, medical condition,
socioeconomic status, culture, marital status, physical or
mental disability.
The practitioner must behave with courtesy, respect,
dignity and discretion towards the
Patient, at all times respecting the diversity of individuals and honouring the trust in the therapeutic relationship.
The practitioner should assist the patient find another
healthcare professional if required.
Should a conflict of interest or bias arise, the practitioner shall declare it to the patient, whether the conflict or
bias is actual or potential, financial or personal.
Advertisements, in any form of printed or electronic
media must not:
Be false, misleading or deceptive
Abuse the trust or exploit the lack of knowledge of consumers
Make claims of treatment that cannot be substantiated
Make claims of cure
Use the title of Doctor, unless registered with an Australian medical registration board
Encourage excessive or inappropriate use of medicines
or services
List therapies for which the practitioner foes not have
ATMS accreditation if the ATMS logo or name is used.
PROFESSIONAL BOUNDARY
The practitioner will not enter into an intimate or sexual relationship with a patient.
The practitioner will not engage in contact or gestures
of a sexual nature to a patient.
Mammary glands and genitalia of a patient will not be
touched or massaged and only professional techniques
applied to surrounding tissue.
Any internal examination of a patient, even with the
consent of the patient, is regarded as indecent assault
which is a criminal offence.
Any approaches of a sexual nature by a patient must be
declined and a note made in the patient’s record.
P E R S O N A L I N F O R M AT I O N A N D C O N F I DENTIALITY
The practitioner will abide by the requirements of State,
Territory and Federal privacy and patient record law.
The practitioner shall honour the information given by
a person in the therapeutic relationship.
The practitioner shall ensure that there will be no
wrongful disclosure, either directly or indirectly, of a patient’s personal information.
Patient records must be securely stored, archived,
passed on or disposed of in accordance with State, Territory and Federal patient record law.
Appropriate measures shall be in place to ensure that
patient information provided by facsimile, email, mobile
telephone or other media shall be secure.
60
JATMS
Australian College of
Chi-Reflexology
Advanced Clinical Reflexology
and Chi-Reflexology Training
Add clinical skills including balancing
the whole system through the feet in minutes!
Also, Post-Graduate (CPD/CPE) programme:
• Advanced Reflexology theory and practice,
including all of the systems of the body
accurately reflected in the feet and the
Anatomical Reflection Theory.
• Chi-Reflexology is a unique approach
developed by Moss Arnold, principal and
founder of the College & more.
Chi-Reflexology Book, Chart and DVD also available
NEW REFLEXOLOGY BOOK now available.
See www.chi-reflexology.com.au or
phone 02 4754 5500
A NEW Benchmark in
Herbal Medicine
Quality unsurpassed
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n
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Mullein
Verbascum thapsus
Free Website and Email
Entries in ATMS Internet
Directory
I
n an average month, the ATMS website receives
300,000 hits. To take advantage of this large public exposure, members can now have their websites and/or
email addresses included in the ATMS Internet Directory.
Viburnum opulus
When a consumer searches for a practitioner on the
ATMS Internet Directory, the search search result page
currently shows your name, membership number, suburb or town, telephone number(s), qualifications and
language(s) spoken. With this free service, your website
and/or email address(es) will also be shown.
It is a free service to have your email address included
in the ATMS Internet Directory but we need your written permission to release your information into the public
domain.
WEBSITE AND EMAIL ADDRESSES
Calendula
Calendula officinalis
W E B S I T E A N D E M A I L R E G I S T R AT I O N
To obtain a copy of the registration form, telephone
the ATMS office on 1800 456 855, send an email to:
[email protected] or send a fax to (02) 9809 7570 and
request a copy of the registration form.



INTENSIVE
HOW DOES IT WORK?
E M A I L A D D R E S S O N LY
Cramp Bark
required change can be made.
It is also a free service to have both your website and
email addresses included in the ATMS Internet Directory,
and your written permission is also required. As it is a requirement of the Code of Conduct that website information conforms to certain standards, your website will be
assessed to ensure conformity with the Code before it is
posted in the Directory. If there is an aspect of the website that needs modifying, we will advise you so that the
Weekend Workshops

Conducted By Master Zhang Hao
B.Phy.Ed. D. TCM (China)
Found/Director of Chi-Chinese
Healing College














       
       




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 
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