Sandra Robertson on What does “Processed food” really mean?

Sandra Robertson is a Practitioner of Chinese Medicine in Victoria, B.C., Canada. She is the author of Treating Children with Chinese Dietary Therapy. You can find more information at Nourishlifemedicine.com.

Food awareness

I recently spoke on a podcast and the subject of “processed food” came up frequently during the interview. After we had concluded I realized that I could have elaborated on the different levels and methods that are utilized in the processing of food. Not all processed food is unhealthy and in our often-busy lives, it’s helpful to make a distinction so we can choose efficiently and wisely for our health. Nowadays our grocery store aisles contain food products that have been hugely altered from their original states in ways that would have been unimaginable 100 years ago. Many staples such as bread, yoghurt, cereal, and baked goods have gone from being just simple processed food items to becoming ultra-processed food (UPF). Awareness and education of what we think we are eating and what we are actually eating is crucial not only to our own health but for the health of our children and grandchildren born into this world of quick, easy and addictive food products.

Processing foods

The processing of foods means any alteration from their original state such as cooking eggs, baking bread, freezing meat, grinding grain, or roasting vegetables. These are common ways in which we process our food on a day-to-day basis. There’s also fermenting, drying, and salt preservation; these methods were used in the past to help feed our ancestors through the winter and during times of food scarcity. Processing foods in these ways is still be considered natural and, in most cases, healthful.

Processing was taken a step further in the early 1900s. Napoleon’s government in France needed to figure out a way to preserve food for the sustenance of French troops. Napoleon devised a contest- whoever could come up with the best preservation method would win a cash prize. Canning came out as the winner, and this was the beginning of processing foods for the masses. Over the next 100-plus years, mass production of foods has ballooned. The addition of sugar, salt, and preservatives have made it possible to significantly increase the shelf life of packaged foods. These products now number in the thousands and line our grocery store shelves, cafeterias and vending machines. Essential vitamins and minerals are stripped from the original foods through harsh processing and restructuring while unpronounceable and unrecognizable ingredients are added in. The final product of this processing can hardly be called food anymore.

The Nova food classification system

I came across the NOVA food classification system that divides all food into four separate groups. It was pioneered by public health nutritionist Carlos Monteiro from Brazil to better help us understand the different levels of processing so that we can make better meal choices. Optimally, children and adults would only be eating foods from groups 1-3 and very occasionally or never have items from group 4.

The 4 classifications:

  1. Unprocessed or minimally processed foods. Unprocessed foods are obtained directly from plants or animals with no alteration done to them such as a raw carrot or apple. Minimally processed comes from food that is unprocessed and might include drying, crushing, grinding, freezing, pasteurization, roasting, non-alcoholic fermentation, etc. such as dried apples, frozen peas, etc.
  2. Processed culinary ingredients. Ingredients such as oils, fats, sugar, and salt that come from the first group of unprocessed or minimally processed foods. They are used to help cook and season foods in group 1. The products are extracted by grinding, pressing, refining, milling, and drying. Examples are honey, maple syrup, butter, olive oil, white sugar, and coconut fat.
  3. Processed foods. Manufactured with the use of salt, sugar, oil, or products from group 1 or 2. They do not contain a lot of ingredients (unlike the ultra-processed products below), anywhere from 2-4. Examples of these foods are freshly made breads and cheeses, tomato paste, salted nuts, canned fish, etc.
  4. Ultra-processed foods (UPF’s). These are the “foods” (food should not be in the name of these products as they are far removed from the original group 1 and 2 foods) to be wary of and optimally “ultra-avoided”. They are industrial formulations that do not contain ingredients you would use when cooking at home. They often utilize chemical processes in the manufacturing and use flavour enhancers, food additives, and colours to make the food hyper-palatable. Hyper-palatable foods by-pass your body’s full signal and are overeaten. These non-foods are made to be branded, highly profitable, and convenient. They are marketed to children with the use of cartoon characters, bright colours and advertising. They fill us with empty calories that not only replace fresh unprocessed foods but are deleterious to our health.

Labels

The companies that produce UPF’s are allowed to use words like “natural”, “healthy”, and “organic” in their marketing and on the packaging which can be misleading to consumers. The ingredients may have started out as natural or healthy, but after stripping the fiber, bleaching the flour, and adding in high amounts of sugar and preservatives, it is nothing of its original nature. Organic Doritos™ does not suddenly make Doritos good for you because they are organic! Smart bread™ is not a wise choice and fits into group 4 above. Reading labels is the only way to find out what is mostly living inside the package. “Mostly” since ingredients such as “spices”, or “natural flavours” do not require any further explanation.

Gut microbiome health

When we eat, we are not only feeding ourselves, but we are also feeding the trillions of different bacteria that reside in our gastrointestinal tract. Since the role gut microbiota have on our health has been discovered (1) many studies have been done linking how our diet affects our microbiome. (2) (3) (4) (5) Dysbiosis-an imbalance in the gut microbiome- has been found to be indicated in chronic diseases such as obesity, diabetes, cardiovascular disease, and more recently mounting evidence to increased COVID-19 severity. (6). Dysbiosis occurs when there is a decrease in microbial diversity. The good bacteria in our gut help us to digest our food, produce vitamins, regulate our immune system, and protect against the bacteria that cause disease, so we want to keep them happy.

Eating a varied diet is one of the ways we can increase our microbial diversity. Lots of fiber, probiotic, and prebiotic-rich foods will feed the “good” bacteria. Ultra-processed foods that are basically sugar, refined wheat, corn, oil, and soy, feed the “bad” bacteria. Diversity is severely lacking in these products as they are all essentially made of similar ingredients. The “bad” bacteria then take over and can cause cravings for sugar and more of the same unwholesome foods. Young children are particularly vulnerable as the assembly of microbial communities is taking place in their guts from the time they are born and is established by the age of three. They acquire a taste for UPF’s, and it can be challenging to introduce new flavours and textures into their meals. Over time, our guts and tastebuds become hijacked by these unnatural foods.

Ultra-processed food concerns

There are real consequences to eating UPF’s aside from the obvious lack of nutrients, minerals, and fiber. A recent study done at the Hebrew University of Jerusalem discovered that eating UPF’s (even in reduced amounts) may harm young children’s skeletal development. They found that UPF’s can cause reduced bone quality. This is especially concerning for children as their bones are in the developing stages and are continually growing and reshaping themselves. (7)

UPF consumption has also been linked to rising childhood obesity rates into adolescence and early adulthood. (8). Obese children face complications such as breathing difficulties, increased risk of fractures, hypertension, insulin resistance, early markers of cardiovascular disease, and psychological effects. [i]

Insulin resistance- one of the complications of obesity- leads to type 2 diabetes. This disease used to only be seen in adults but is now on the rise in children. It is much worse for a child to develop Type 2 diabetes than for an adult. Diabetes-related complications- eye disease, kidney disease, nerve disease, strokes, heart disease, toe, and foot amputations- develop rapidly in children and will negatively affect their quality of life into adulthood. (9)

[i] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Awareness for better health

As they say, knowledge is power. Becoming more mindful of what we are buying and which companies we choose to support will be a huge step in the direction of wellness. Reading labels will help guide us to avoid and minimize group 4 UPF’s in the diet. Even if the packaging states it is natural and healthy, the ingredients might prove otherwise. If the list of ingredients is long, this is another clue to its increased processed nature.

There is no arguing that processed foods have made cooking easier, more efficient and extended the shelf life of many different foods for us. UPF’s on the other hand are unnecessary, insidious dietary additions that only seek to create profit for the food giants, leaving us and our children sick and malnourished.

You can learn more about and get your copy of Treating Children with Chinese Dietary Therapy, here.


References

  1. Sekirov I, R. S. (2010 Jul). Gut microbiota in health and disease. Physiol Rev., 90(3):859-904.
  2. De Filippo C, C. D. (2010). Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. doi:10.1073/pnas.1005963107. Proc Natl Acad Sci U S A., 107(33):14691-14696.
  3. Mokkala K, H. N. (2020 Apr;). Interactions of dietary fat with the gut microbiota: Evaluation of mechanisms and metabolic consequences. Clin Nutr, 39(4):994-1018.
  4. Ruiz-Ojeda FJ, P.-D. J.-L. (2020). Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Adv Nutr, S31-S48.
  5. Zmora N, S. J. (2019). You are what you eat: diet, health, and the gut microbiota. Nat Rev Gastroenterol Hepatol., (1):35-56.
  6. Yeoh YK, Z. T. (2021). Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut, 70:698-706.
  7. Zaretsky, J. G.-F. (2021). Ultra-processed food targets bone quality via endochondral ossification. Bone Res, 9-14.
  8. Chang K, K. N. (Published online June 14, 2021). Association Between Childhood Consumption of Ultra processed Food and Adiposity Trajectories in the Avon Longitudinal Study of Parents and Children Birth Cohort. JAMA Pediatrics.
  9. University of Colorado Anschutz Medical Campus. (2021, July 28). New study reveals serious long-term complications in youth-onset type 2 diabetes. ScienceDaily. www.sciencedaily.com/releases/2021/07/210728201347.htm

Breath Hygiene: Keeping the Mind and Body Healthy Through COVID-19

Robin Rothenberg, author of Restoring Prana and forthcoming Svadhyaya Breath Journal: A Companion Workbook to Restoring Prana (June 2020), served for six years on the IAYT Accreditation Committee in addition to running a busy yoga therapy practice. Her yoga therapist training program was one of the first to be accredited by IAYT in 2014 and she has been a yoga therapist for over 20 years. You can find out more about Robin at Essential Yoga TherapyBelow she shares tips for keeping the mind and body healthy through COVID-19.

Over the past few weeks I’ve seen numerous social media posts counseling people to stay calm and stay clean. In my experience, employing good breath hygiene is the most effective way to both remain grounded and support immune and respiratory health. The breath is our greatest inner resource and with a little breath education, you too can develop the capacity to settle yourself, even when fear is gnawing at your gut!  Initially, breath hygiene may feel unfamiliar or awkward (much like learning to wipe down everything you touch with disinfectant) but the more you work with it, the easier it gets.

Here are five valuable tips for how you can use the breath as a powerful BFF to enhance emotional regulation, while simultaneously giving your immune system a boost.

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Learning How to Tailor Treatment to a Patient’s Needs with Nora Franglen

Nora Franglen has been a Five Element Acupuncturist for many years and has refined her profession over a lifetime.

We have an extract from her latest book, A Five Element Legacy, where she provides guidance to other practitioners on how to tailor treatment to a patient’s needs, the difficulty of a fixed diagnosis and how to measure if treatment has been successful.

In A Five Element Legacy, Nora Franglen reflects on a lifetime of practising five element acupuncture, and offers advice and insights into developing patient-practitioner relationships, tailoring treatments to individual patient’s needs and the importance of taking your time and trusting your feelings. Read more about the book here.

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What Role Does Mitochondria Play in Fatigue?

Fatigue can be a debilitating experience for many, and the impact on the physical and mental health of those affected can be immense.

Ray Griffiths, author of Mitochondria in Health and Disease, discusses fatigue in this extract, including an in depth exploration of the causes of fatigue and the mitochondrial nutrients that can assist with resolving cases of fatigue to improve the quality of life of your patients.

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Introducing the ‘Personalized Nutrition and Lifestyle Medicine for Healthcare Practitioners’ Series

We are pleased to announce our new series, ‘Personalized Nutrition and Lifestyle Medicine for Healthcare Practitioners’. Written and edited by healthcare practitioners, this series aims to help practitioners and students of clinical nutrition facilitate new levels of success with individuals striving for optimal health and peak performance. Accessible and evidence-based, this innovative new series will provide essential guidance for professionals in this fast growing area of healthcare.

Sign up to our mailing list here to keep up to date with the books in the series.

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Acupuncture Without Needles?

I have spent a lot of time developing my technique with an acupuncture needle. First as a practitioner of Traditional Chinese Medicine (TCM) and then as a teacher of needle technique, and now as the author of The Living Needle, a book on the subject. I have a lot of friends who aren’t acupuncturists that ask me if there is anything in all that work for them, other than just getting treatments from me. The answer is a resounding yes! While the needle is certainly the most well-known tool of the TCM practitioner and a very useful one as well, it is not the most important thing at my disposal, or even completely necessary to my trade.

As I discuss in The Living Needle, what is most important is that the body is engaged, and not simply engaged in a passive way, but really meaningfully engaged. This can be accomplished with or without a needle. While it is wonderful to be able to make direct contact with the deeper tissues, the fact that is so often forgotten by providers and patients alike is that all the body’s tissues are interconnected into one vast network. This means that contact with any tissue will necessarily affect all the others. Because of this, as any good massage therapist knows fingers can be just as powerful as needles. This reality is perfectly clear not only in massage, but in trigger point therapy and any number of other manual techniques using nothing more than a finger or an external tool to create pressure.

Am I suggesting that you don’t need to see an acupuncturist? Not necessarily because there is a wealth of diagnostic and other skills we bring to the table, I’m just suggesting you might not be stuck waiting on your appointment to start seeing benefits. You don’t even have to go to a massage or physical therapist to start reaping some rewards (though in a lot of cases you should go see them too). What I’m suggesting more than anything, is that your health and well-being are your business first and there are some simple tools and tricks close to hand that you can start using right now!

All around your house are implements that you can bring to bear on your aches, pains, and even internal medicine issues; from the handle of a spoon, to a toothpick, or a rolling pin, almost anything can be used to apply targeted pressure to the body. And of course you always have fingers. Here are a couple specific things that you can try.

  • Digestive Rolling: Get a round implement, a dough roller, stiff cardboard tube, or even the side of a pencil. Find the front edge of your shin bone just under your knee. Place the tool just below the knee and about half an inch outside the edge of your shin bone. It shouldn’t be pressing on the bone, but it should be pretty close. From here, with strong pressure (it shouldn’t be painful, but you should know you’re doing it) roll whatever you’re using down the front of your leg to your ankle. Come back to the start and do it again. Roll down nine times and then do the other leg. This area of the body has a strong effect on the digestion and rolling it like this will bolster stomach function and up-regulate peristalsis. This is a big deal, because with the chronic stress most of us live under our digestive system is underfunctioning most of the time, and chronic underfunction in the digestive system can lead to all sorts of long term illnesses!
  • Morning Wake-Up Call: Get that same item you used to roll your shin and put it on the floor. You’re going to sit down and put your foot on it so that the inside edge of your foot, just behind your big toe is pressing against it. Put some pressure on it and roll it back and forth from just behind the big toe to the heel, keeping the pressure focused mostly on the inside edge of the foot. This will again stimulate digestive function, but will also help with adrenal function and cortisol, which can help you feel brighter eyed on those draggy mornings!
  • Stress Buster: Feeling stressed? Especially that kind of stress where it feels like someone is squeezing the middle of your chest and refuses to let go? Grab the handle of a spoon or a toothpick if you like a little bit of a sharper sensation, or even just use your finger if you don’t have anything else close to hand. On the underside of your wrist, find the two tendons that run down from your hand. About an inch and a half below the crease of your wrist you’ll find a little tender spot between those two tendons. Press and hold there, making little counter-clockwise circles. On the top of your foot, between the bones behind the big and second toe, slide back toward the top of your foot until you feel where those bones almost meet and then move back toward your toes just a little. You should find another tender spot there where you can repeat the same procedure. While you’re rubbing either of these spots try to slow your breathing down and take nice long breaths. Within a minute or two you should feel a lot better!

The most important thing to remember with any of this is that the real treatment, the fundamental improvement isn’t about the tool that you use, it’s about the meaningful engagement with the body. Most of us live a life where we are largely separated from our bodies as far as awareness goes. The adage I often share with students and patients alike is that most of us don’t know we have feet until we stub our toe. So while you’re doing any of these practices, really get involved. Don’t simply poke away at the body while you make a mental grocery list of other things you have to do. Be aware of the sensations you feel under your fingers and in your tissues. After all, it’s your body, you might as well get to know it!

This more than anything is the real art to medicine, the ability to actively connect with a body and respond to it in the moment. This is also where real health lives. If you want to learn more about engaging the body feel free to pick up The Living Needle: Modern Acupuncture Technique.

 

Justin Phillips, LAc teaches needle technique and advanced needle technique at AOMA. He also runs a private acupuncture practice in Texas. His new book, The Living Needle: Modern Acupuncture Technique explains the fundamental principles of the art of needle technique for acupuncturists.

Challenging Stress, Burnout and Rust-Out: Finding Balance in Busy Lives Extract

Are the holiday’s amping up the stress in your already busy professional life? A balanced lifestyle enhances health, happiness and wellbeing. This practical resource provides professionals with techniques to achieve all of the above. Challenging Stress, Burnout and Rust-Out explores how balance can be found and how stress and anxiety, which are linked to being overworked and over busy, may be alleviated.

Read an extract of Clouston-Challenging-Stress-Burnout-and-Rust-Out-Ch-5-PRESS.pdf

For more information on Challenging Stress, Burnout and Rust, please visit our website.

How can reflexology help children?

Susan Quayle, author of the ‘Mouse’ series, spoke to us to discuss her background in reflexology, the concept behind her books and how the practice of reflexology can help children.

 

Susan, you’ve been a reflexologist for a number of years. How did you discover reflexology?

I actually believe that reflexology discovered me, despite my resistance to it.

I first came across it at a green festival in Dorset. I tried it and found it extremely relaxing. At the time I was a hardcore horticulturalist, plants were my passion, but I did buy Laura Norman’s book and was fascinated with the whole idea.

Shortly after this my sister-in-law became pregnant and suffered very badly with Hyperemisis Gravidarum and my first step on the road to becoming a maternity reflexologist, unbeknownst to me, was when I would visit her and give her the treatment for morning sickness from Laura’s book. It always made her feel better.

 

It was another ten years before I retrained in massage therapy and followed this training with sports massage. Unfortunately, the sports massage tutor wasn’t very good and we all felt that we would never get through the exam or have the required knowledge to work in this field so we left en-mass. The only other course that was running was the reflexology diploma, which I was very unsure about joining. Fortunately I did and came to realise very quickly what an incredible therapy it is. I have trained in many therapies but reflexology has been the focus of my career followed closely by aromatherapy.

 

What do you think it is about reflexology that is so beneficial for children’s physical and mental well-being?

I have seen reflexology totally relax children, almost instantly; their eyes glaze and have a far away look in them and it happens very quickly if the child is in need of the treatment.

Reflexology promotes a profoundly deep relaxation that often feels like a switch being flicked and a part of you just sinks into a deep restfulness. It is during this deep rest and quiet space that the body is able to begin a healing response.

Children are open to new experiences and engage fully, when they feel safe and comfortable, which enables them to reach this place of healing and relaxation very quickly. As they are so young and untainted by life-long indulgences their body can rebalance quickly and often does.

Every day our children are put under more and more pressure to perform, conform and do well. Their physical and mental health is constantly under threat and children with supportive families are just as likely as those without to be prescribed drugs for depression now.

Complementary therapies are an important part of family life. In so many cultures around the world, where appropriate, nurturing touch is shared by the whole family not just given to the babies and young children.

Touch helps children to be more accepting of their body and the changes taking place, touch is an important part of being human and I think is particularly important for teenagers, who would accept it more readily if it had been part of their every day life delivered within the safety of a loving family.

 

Your new book (and the other books in your series) focuses around characters and a story to accompany a reflexology exercise. How did you find this process?

As with all processes that appear to arrive from nowhere, my first book had actually been many years in the making; deep inside my head where all the creativity is happening without me even really knowing about it.

Both my children were brought up with a love of books; we read to them every day and sang songs, our favourites were always the rhyming stories and songs. So it all began with Slinky Malinky, The Gruffalo, The Snail and the Whale, Green Eggs and Ham and all those wonderful books for children. I have always been pretty good at putting little rhymes together for children’s cards and things so the rhyming was fixed a long time ago.

The actual ‘Eureka’ moment, like Archimedes, occurred in the bath, a great place for parents to get a moment’s peace and actually lose themselves in thoughts. I jumped out and wrote the first draft instantly, that was the effect of all those years of preparation in the hidden corners of my brain! Many months’ work followed but that very first draft took place on October 12th 2012. I have never been so excited or bewildered!

Once I had the idea it was only really a matter of allowing the story to develop in my head. I think I could come up with them forever!

 

What reaction have you had to your books so far?

The reaction to the books has been wonderful. They have been embraced by the reflexology community and have even won awards, along with The Children’s Reflexology Programme, (the teaching programme that now goes with them). I think it was such a unique and novel idea to put reflexology to a story and also to make this lovely, gentle complementary therapy available to children. Children have embraced it whole heartedly; they love the animal characters, finding the animals on their own feet but also sharing such healthy, positive touch with family and friends. Complementary therapy made accessible through play offers a positive understanding of issues relating to health, self care and nurturing, positive touch within families but also within communities.

 

How is Mouse and the Storm different from the other books in your series?

My latest book Mouse and the Storm differs from the first two in that it contains hand reflexology. The first two books use foot reflexology so are more about giving and receiving reflexology. Book three is about giving and receiving too, but it also focuses on self treatment. Mouse and the Storm was written specifically to support parents of children with additional needs and to go with our courses for these parents.

Being able to self treat offers many children who have challenges with day-to-day transitions, between places and activities, strategies to help them. It also allows children with sensitivity issues to take control of the pressure and touch that is used on them. We have seen some wonderful results with both the book and the course, and with these children loving and engaging with the animal characters too. We have had reports of children coming home from school and telling their parents how many times they visited Mouse that day.

 

Are there any challenges you have encountered when using reflexology with children?

Using reflexology with children can be as challenging as trying to get them to engage in anything else. It can take time to build a relationship with them, which can create some awkward moments! If a child doesn’t want reflexology the chances are that today you won’t be giving any. However if you are careful you may well sow the seeds that will allow you to treat them next time. Children are naturally curious and once they have made a connection with you they will put their trust in you and love to learn. You can’t force a child so really it is about releasing your own ego and making it all about the child. I had one little boy whose mum used to come to me for reflexology and I always gave him a bit too. He wouldn’t allow anyone to give him reflexology except me – he grew out of it soon enough and now gives his baby sister reflexology as well as his parents; he’s only five.

 

Lastly, what do you hope readers take away from your book?

My passion is reflexology. I wrote my books so that I could share the huge benefits of reflexology with as many families as I could. I hope that the next generation will grow up not only knowing what reflexology is but what it feels like to receive and what it feels like to give, and value it as a resource available to them with little cost or effort. Hopefully these children will grow up wanting to share these books with their own children and so pass their knowledge on to the next generation.

Reflexology is an experience, a powerful human connection on a deeply personal and nurturing level that I hope will resonate with every child that encounters it through my books at a young age. To value connection and humanity through our basic human need, touch, is a value worth instilling from as early an age as possible. Complementary therapies are a gentle way of bringing communities together in health, well being, nurture and caring. Our children need to grow up in the warm embrace of these life skills for their own good health and that of each other. Our families and communities need to reconnect on the most basic level. This is a part of what I hope my books can bring about.

 

If you would like to read more articles like this and hear the latest news and offers on our books, why not join our mailing list? We can send information by email or post as you prefer, and please also tell us about your areas of interest so we can send the most relevant information. You can unsubscribe at any time.


To view the whole series by Susan Quayle, please click here.

Mouse and the Storm

A hand reflexology programme designed to relieve anxiety in children, accompanied by a soothing story about dealing with unexpected disruptions

 

Mouse’s Best Day Ever

A charming story about Mouse and her friends as they find fun on a stormy day with an accompanying simple reflexology treatment to help relieve discomfort from teething, constipation and colic

 

The Mouse’s House

An enchanting story about a mouse’s mission to make a cosy home for Winter with an accompanying simple reflexology massage for parents or carers to perform on a child

Why is the advice for treatment of the menopause so confusing?

menopause

In the midst of conflicting information surrounding HRT and the best ways to treat the symptoms of the menopause, author of The Menopause Maze, Liz Efiong – inspired by recent media inspection of the issue – weighs in.

Last year, Dr Megan Arroll and I published a book for women approaching and experiencing menopause entitled The Menopause Maze: The Complete Guide to Conventional, Complementary and Self-Help Options. We set out to write a book which would inform and empower women to visit their GPs and seek the help they needed. Our book was published after the National Institute for Health and Care Excellence’s (NICE) new guidelines at the end of 2015 and presents the very latest advice from menopause experts.

On the 23rd of February 2017, an hour long documentary called The Insiders’ Guide to the Menopause, became available on BBC iPlayer*. The programme was presented by Kirsty Wark, who herself went through the menopause following a hysterectomy and took HRT for 3 years until stopping abruptly in 2002, when the health scares surrounding the study called the Women’s Health Initiative (WHI) were published. The results showed an increased risk of breast cancer for women taking HRT, which caused many women to stop taking HRT suddenly, often going cold-turkey without even consulting a medical professional. Women stopped asking their GPs for HRT, whilst GPs were also caught up in the safety issues and became less familiar with HRT.

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