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: Zac Bobrov Technical Director, InterClinical Laboratories Brad McEwen MHSc, BHSc Naturopath, Herbalist, Lecturer and Researcher SEMINAR DATES & VENUES: Adelaide: Melbourne: Perth: Sydney: Brisbane: Auckland: 21st & 22nd May 2011 28th & 29th May 2011 11th & 12th June 2011 18th & 19th June 2011 25th & 26th June 2011 6th & 7th August 2011 Crowne Plaza Park View Hotel Seasons of Perth Vibe Hotel Diana Plaza Mercure Hotel Don’t miss this seminar. Book Now! (Special price for group bookings) For full seminar program details and ticket prices, please contact InterClinical Laboratories or register on-line. Phone: (02) 9693 2888 Fax: (02) 9693 1888 On-line registrations: www.interclinical.com.au/events W Hair Tissue Mineral Analysis 2011 Practitioner Seminar Series NE PRESIDENT S TAT E R E P R E S E N TAT I V E S NSW, Antoinette Balnave PO Box 126 Cooranbong NSW 2265 T 0418 294 055 HEAVY METAL AND FREE RADICAL IN-HOUSE TEST KITS Osumex in-house test kits allow you a simple and straight forward way to instantly monitor your patient’s levels of free radicals and heavy metals using an easy to read colour chart. ® WORKSHOPS : July-October 2011 Mt Martha: Sydney: Byron Bay: Noosa: Sydney: 16 & 17 July • Level 2 (ATMS CPE Approved) 0414 766 425 • [email protected] 30 & 31 July • Level 2 (ATMS CPE Approved) 02 9450 1388 • [email protected] 30 & 31 July • Level 1 (ATMS CPE Approved) 0403 816 484 • [email protected] 12 to 14 August • Level 3 (ATMS CPE Approved) 07 3878 9371 • [email protected] 27 & 28 August • White Light Essences 02 9450 1388 • [email protected] Murwillumbah: 3 September • Astrology & ABFE 02 6672 7985 • [email protected] Coffs Harbour: 17 September • Women’s Wellbeing & ABFE 18 September • Children & ABFE (both ATMS CPE Approved) 02 6644 9869 • [email protected] Sydney: 1 to 3 October • Level 3 (ATMS CPE Approved) 02 9450 1388 • [email protected] ABFE College Course (ATMS CPE Approved) throughout Australia ABFE Correspondence Course (ATMS CPE Approved) See our website for details on these courses: www.ausflowers.com.au • Ph (02) 9450 1388 Thai Massage & Spa Tour 2011 The professional & personal experience of a lifetime! 17-25th September call 02 9713 9256 for a flyer & more information Specialising in massage workshops & products mostlymassage.com email: [email protected] phone 02 9713 9256 TEST KITS AVAILABLE: • General Heavy Metal Test Kit: Tests for the presence of 8 elements in solution. Elements tested in this kit include; cadmium, cobalt, copper, lead, manganese, mercury, nickel and zinc.* • Specific Heavy Metal Test Kits: Tests for the presence and approximate levels of specific elements including; aluminium, arsenic, cadmium, chlorine, chromium, cobalt, copper, iron, lead, manganese, mercury, molybdenum, silver, tin and zinc.* *The above tests can be applied to detect the presence of heavy metals in mediums including saliva, urine, water, dust, soil, food and drink. • Free Radical Test Kit: A simple and reliable test to measure the level of free radicals or “oxidative stress” within the body. This test measures malondialdehydes as a marker of free radical stress. The lighter the colour, the less free radical stress in the body. For more information please contact: www.heavymetalstest.com.au 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 Ask us for FREE samples! 1300 797 668 16 Now you can confidently treat stubborn skin conditions 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 Patrick de Permentier 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 0800 100 482 1300 138 815 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 HELIO SUPPLY COMPANY HERBS FOR HEALTH NATURAL REMEDIES GROUP OBORNE HEALTH SUPPLIES SUN HERBAL PAGLE HEALTH SOLUTIONS RENER HEALTH PRODUCTS TRADITIONAL MEDICINE SUPPLIES 43 Russell Setright Your Sun Herbal distributors: 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 ACUPUNCTURE SUPPLIES 07 3852 2288 FAR NORTH QUEENSLAND NUTRITIONALS TOWNSVILLE 07 4728 7555 CAIRNS 07 4051 3319 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. . Volume 17 Number 2 . June 2011 SIBO Advertisement.indd 2 JATMS . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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. . Volume 17 Number 2 . June 2011 9 ARTICLE Myofascial Techniques: Working with Musculoskeletal Headaches Free Needle Trial Worth $50.00 CALL TODAY! 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). ATMS Journal Specials* 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. 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 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, . Volume 17 Number 2 . June 2011 11 ARTICLE ARTICLE 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. . Volume 17 Number 2 . June 2011 13 ARTICLE JOURNAL OF THE AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY 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 condence in prescribing during pregnancy for common complaints 14 JATMS . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 9/05/2011 2:50:09 PM 15 ARTICLE ARTICLE 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 . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 17 ARTICLE ARTICLE 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- . Volume 17 Number 2 . June 2011 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. 47. 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. 53. 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. RE F ERE N C E S 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. 61. 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 19 ARTICLE 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. Owned Be amazed by what you discover about yourself in this journey of self discovery! Emotional interpretation of physical iris signs Psycho-neuro-immuno-iridology Up to 80% of all illness is triggered by emotional stress. Discover the emotional links between health and disease identified from the iris Discover how your iris pattern reveals your personality Learn how variations between your left and right eye each reveal different facets of your character. Enhance your clinical effectiveness using birth order principles Are you closer to one parent than the other? Do you know siblings that look similar but behave very differently? These disparities are fundamentally linked to dynamics of the family tree. Linking this information to your iridology profile often fills gaps, enabling you to see the whole person. Identifying and resolving Time Risk Discover how to identify unresolved trauma and methods to help release trapped emotional conflicts. Building Bridges Learn how to heal the wounds of the past so you can embrace the life you are living now. 20 www.iridologyonline.com JATMS BOOKINGS AND ENQUIRIES: . Volume 17 Number 2 . June 2011 Toni Miller and Edith Cuffe are coming to Adelaide, Melbourne, Coolangatta and Sydney. Iridology Research & Integrated Subjects 07 55595252 USB Iridology Camera Designed Made 82. Lestienne, I., et al., Effects of soaking whole cereal and legume seeds on iron, zinc and phytate contents. Food Chemistry, 2004. 89(3): p. 421-425. www.iridology.nl EyeSpy - Pebble 8 80. Bohn, T., et al., Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorp tion in humans. 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Volume 17 Number 2 . June 2011 21 JOURNAL OF THE AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY ARTICLE Effective Research: A Discussion of Essential Elements Patrick de Permentier 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. . Volume 17 Number 2 . June 2011 Become a Certified Infant Massage Educator with Infant Massage Australia The Infant Massage Educator training enables you to develop skills in strengthening family relationships through the nurturing touch of infant massage. Certification includes: • 4-day workshop, theoretical and experiential • Self-paced study module • Extensive handouts including 2 books • Infant Massage Australia membership Early bird package for early fee payment Our facilitators have many years commitment in promoting infant massage and in other health professional roles. They are active local members of Infant Massage Australia, a nonprofit group supporting and promoting nurturing touch in Australian families. For training details and application form please contact your local trainer. QLD & NT: Amanda Buckmaster 0409 614 467, (07) 3352 7884 [email protected] www.nurturingconnection.com.au WA: Sydel Weinstein 0414 636 459 [email protected] www.thefamilynurturingcentre.org SA: Kellie Thomas 0412 195 349, (08) 8562 2863 [email protected] www.infantmassage.org.au VIC & NSW: Clare Thorp (03) 9728 8667 [email protected] www.firstconnections.com.au Empowering parents. Enriching families. See www.infantmassage.org.au for more information on workshops and trainers. JATMS . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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. NOW AVAILABLE FROM CHINA BOOKS $39.95 The Clinical Handbook of Chinese Herbs: Desk Reference by Will MACLEAN Distilled from the major herb reference texts used in China and the West, the Desk Reference is quick and easy to use, with clear and accurate tables comparing all the herbs used in the modern clinic. Designed to help students master the formidable task of learning the materia medica, and to enhance the dexterity of experienced practitioners, the desk reference is an essential guide to the intricate logic of Chinese herbal prescription. Pangolin Press, 2011, 160pp, ISBN 9780957972025 * 2nd Floor, 234 Swanston Street, Melbourne Vic 3000 ( (03) 9663 8822 : [email protected] w www.chinabooks.com.au * Shop F7, 1st. Floor, 683-689 George Street, Sydney NSW ( (02) 9280 1885 : [email protected] JATMS . Volume 17 Number 2 . June 2011 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- . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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- . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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- . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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- . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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 PurChase Our latest release DVDs saVe as a full set and save OveR $50! 12 CPe Points a members (3 pply for atMs points per D VD) Master Class series 20% WAS $2 nOw $ 76 220 (1) Live Case Study: Knee pain incorporating hip & thigh (2) Live Case Study: Leg pain incorporating Foot and Ankle (3) Live Case Study: Lumbo-pelvic pain (4) Live Case Study: Shoulder Girdle Pain incorporating arm & forearm Our Masterclass DVD series systemically follows a clinical scenario starting with client history taking and documenting presenting symptoms to final outcomes of the assessment and treatment of the condition, including an overview of biomechanics dysfunction which brought about the condition. shot from a number of camera angles and on-screen PowerPoint slides makes these new DVDs a ‘must see’ production for any therapist who’s serious about their craft. abOut the PreseNter iN Our Master Class DVD series stuart hiNDs is a practising soft tissue therapist starting his journey in 1990 and continues as a lecturer in remedial soft tissue techniques at Victoria University in Melbourne while maintaining a busy private practice in Geelong. Stuart has worked with elite road cyclists and a range of athletes from all 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 internationally relating to soft tissue treatment and its relationship to musculoskeletal dysfunction in 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 tissue treatment of adductor strains and keynote speaker at the 2005 Joint Sportex Sports Massage Association Conference in the UK. More recently he presented at the 2009 Australian Association of Massage Therapists National Conference in Hobart, Tasmania. aCt NOW! 34 Complete your order tODaY online at www.comphs.com.au (under DVDs & CDrOMs bundles category) or call our office on (03) 9481 6724 JATMS . Volume 17 Number 2 . June 2011 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. . Volume 17 Number 2 . June 2011 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. Sydney Institute of Traditional Chinese Medicine CRICOS 01768k NTIS 5143 Nowadays alternative medicine practitioners are all learning Acupuncture and Chinese Herbal Medicine Enrol into Sydney Institute of Traditional Chinese Medicine (SITCM) 2012 New semester commences on 20th Feb 2012 Open days: 23 July, 17 Sep and 19th Nov 2011 from 10am to 2pm VET FEE HELP Delivering practical courses: Delivering practical courses: Advanced Diploma of Traditional Advanced Diploma of Traditional Chinese Chinese Medicine – 91133NSW Medicine – 91133NSW (double modalities of acupuncture and (double modalities of acupuncture and Chinese Chinese herbal medicine) herbal medicine) by VETAB Accredited by Accredited VETAB, Approved by AUSTUDY, Approved byHealth AUSTUDY, Recognized by major Funds and TCM professional Recognized by majorassociations. Health Funds and TCM professional associations. ◇ ◇ ◇ ◇ 28 years since establishment with graduates successfully practicing nationally and abroad with employment rate over 90%. TCM national registration on 1 July 2012. Government support TCM & WM integrated medical centre will be opening in Sydney. Limited seat for international students. We are in the city: Level 5, 545 Kent St., Sydney NSW 2000 Tel: 02 92612289 Email: [email protected] Level 5, Harbor Plaza, 25 sitcm.edu.au Dixon St. Sydney 2000 Web: WWW. Tel: (02) 9281 1173 | Email:[email protected] www.sitcm.edu.au A comprehensive Practice Management Solution ASSIST© is a computer software solution developed for the alternative & complementary medicine practitioner. ASSIST© is a must for every practice, implementing ASSIST© will increase your productivity and enhance your professional image. With ASSIST© information is at your fingertips. Easily create, access and update; ASSIST© incorporates an easy to use electronic library, including the capability to add or update references. Employ ASSIST© to help take care of your business and patients. Appointments Patient History Clinical Notes Photographs / Images Prescriptions Invoices Taking Care of Business & Patients. ASSIST© by escientia email [email protected] phone 1300 729 866 www.esci.com.au JATMS . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 (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. . Volume 17 Number 2 . June 2011 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, . Volume 17 Number 2 . June 2011 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. . Volume 17 Number 2 . June 2011 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] Massage for a person with cancer, or a history of cancer, 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? Oncology Massage Training gives you the knowledge and skills to work safely with clients who are challenged with issues that arise from cancer, and the treatment of it. There is always a way to apply skilful, mindful touch! Course dates, minimum qualification requirements, module content and registration information are posted on our website. For enrolments contact Kylie Ochsenbein 07 3378 3220 | 0410 486 767 [email protected] www.oncologymassagetraining.com.au 42 JATMS . Volume 17 Number 2 . June 2011 JATMS . Volume 17 Number 2 . June 2011 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” Enhance your modality – Learn hypnosis Increase your clients with your additional skills 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 . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 45 ARTICLE 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 Bo uly B th 15 ook se EA b mi R efo na LY rs BI re $8 RD 0 dis RAT co E un t 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 RL em efo Y BI ber re RD 3 RA 0 TE 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 H O M E O PAT H I C B O O K S Archibel Homeopathic Software Interclinical Laboratories Wellbeing Magazine . Volume 17 Number 2 . June 2011 Homeopathic Books Mipureorganics The Remedy Room 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 . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 Fed up with your website? Don’t know how to get a website? Looking for a reliable company who understands the business of being in private practice? Let Wellsites help you. At Wellsites we are here to guide you, share our knowledge & give you support to help you have a professional and affordable website for your practice. Wellsites can assist in developing a long term website strategy. As your practice grows, your website can grow & change to match your needs. We offer individual solutions tailored to match your practice & budget requirements. “We have been overjoyed with our practice’s new website from Wellsites. Thank you for supporting us every step of the way. We love how easy it is to update giving it the flexibility to grow and expand. We highly recommend using Wellsites” Dr. P Jones, Sydney Grow your practice with a website from Wellsites SPECIAL OFFER FREE 1 hour website consultation: we will work with you to understand your needs, answer any questions you have and discuss a plan to move your practice forward. Contact us today & book your FREE website consultation - 02 9410 1507 www.wellsites.com.au PHONE: 02 9410 1507 | FAX: 02 9412 2508 | Email: [email protected] 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 well- known 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 . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 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. . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 Your Source for Massage DVD We have the largest & best collection of massage books & DVDs Advance Your Knowledge! Approved CPE Points More than 200 DVD titles in stock Myofascial Release, Deep Tissue Massage, Anatomy, Trail Guide to the Body, Neuromuscular Therapy, Anatomy Trains, Myoskeletal Alignment, OrthoBionomy, Positional Release, Craniosacral, Polarity Therapy, BodyReading, Visceral Manipulation, Stretching, Orthopedic, Lymphatic Drainage, Sports, Esalen, Pregnancy, Infant, Nerve Mobilization, Stone, Pregnanc Reiki, Lomi Lomi, Equine, Canine, Fibromyalgia, Chair, Ayurvedic, Shirodara,Shiatsu, Acupressure, Thai Massage, TuiNa,QiGong, Tai Chi, Reflexology, Zen Shiatsu, Yoga, Spa, Beauty Therapy and more Visit www.terrarosa.com.au Or Call 0402 059570 for a free catalog 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. HAVING TROUBLE FINDING HEALTHY CHEMICAL-FREE FOOD? ✔ 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 . Volume 17 Number 2 . June 2011 √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ 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 . Volume 17 Number 2 . June 2011 57 Environmental Stressors affecting your clients? BICOM® Therapy can help 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 What We Offer Choice of models, treatment only or with EAV testing, all with a full set of accessories. Price range $30,000 -$45,000. Introductory and advanced training in Australia 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 . Volume 17 Number 2 . June 2011 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 . Volume 17 Number 2 . June 2011 A NEW Benchmark in Herbal Medicine Quality unsurpassed g n i t c extra e r o m . . . h Shhh IN STOCK NOW Mullein Verbascum thapsus JOURNAL OF THE AUSTRALIAN TRADITIONAL-MEDICINE SOCIETY 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 Chi-Chinese Healing College www.chihealing.com.au 9629 1688 it Comprehensive monographs of selected extracts. 5 year evidence based studies as well as extensive historical information. Essential reading for the well informed practitioner. Isn’t time you discover the Benefits of Craniosacral Therapy · Treats a wide variety of health issues · Reduces strain on your body yet provides effective light-touch techniques · Increases your earning power · Combines well with other therapies Craniosacral Therapy I Sydney : September 26 - 30 REGISTER ON WWW.OPTIMALRX.COM NOW FOR YOUR FREE MONOGRAPHS Bettalife Oborne Health Supplies Traditional Medicine Supplies Rener Health Products Natural Remedies Group Queensland South Australia & NSW/ACT/Sthn Qld Western Australia Victoria/Tasmania P 1300 138 815 Northern Territory Sydney 1300 882 849 P 1300 883 716 & South Australia P 1300 553 223 Sthn Qld 1300 889 786 P 1300 88 71 88 Melbourne: please refer to our website for dates Call 1800 101 105 www.craniosacraltherapy.com.au ACADEMY OF AUSTRALIA Important News For New South Wales Members T he NSW Government Commission for Children and Young People requires that from 1 May 2011 all self employed persons who have direct unsupervised contact with children in their employment must hold a Certificate for Self Employed People issued by the Commission. To hold a Certificate for Self Employed People, a self employed person needs to first undergo a police check. This requirement applies to all NSW ATMS members who have unsupervised contact with children in their practice. In order to gain the Certificate, the Commission’s application form must be lodged with a police sta- tion. There is an application fee of $80. The police check may take some time, so do not delay lodging the application. Fines and other penalties may apply if after 1 May 2011 a self employed person has unsupervised contact with a child while undertaking their employment,but does not hold the Certificate. Information about applying for the Certificate may be found on the Commission’s website: https://check.kids.nsw.gov.au/#self-employed If you require further information after checking the Commission’s website, please telephone Matthew Boylan on 1800 456 855. SUBSCRIBE! $36.95 1 YR - 4 ISSUES • informs AND educates • RELEVANT issues • independent • QUALITY not quantity • FOR people • BY people • ABOUT people • DIFFERENT from other media $66.00 2YRS - 8 ISSUES Approved for CPE Points YOUR GUIDE TO HEALTH AND HEALING ALTERNATIVES The Art of YOUR GUIDE TO HEALTH AND HEALING ALTERNATIVES The Art of AUST. $8.95 NZ $9.95 AUST. $8.95 NZ $9.95 Shop for your healthcare needs in our NEW Online Shopping area for some of the best supplements in Austraila, along with our magazine, Back Issues, Books, CDs, and DVDs www.theartofhealing.com.au Subscribe for 4 issues (1 yr) Subscribe for 8 issues (2 yrs) AUS $36.95 Outside Australia $46.00 AUS $66.00 Outside Australia $72.00 Name ___________________________________________________________________ Address _________________________________________________________________ Phone _____________________________ Email ________________________________ I enclose my cheque/money order or debit my Bankcard M/card Visa Cardholder’s name _______________________________________________ Expires _____ / _____ / _____ Card no: SUBSCRIPTIONS CAN BE POSTED TO: PO Box 1598 Byron Bay NSW 2481 PHONED TO: Ph: (02) 6685 5723 EMAILED TO: [email protected] OR ORDER ONLINE AT” www.theartofhealing.com.au
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