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What are heart rate zones, and how can you incorporate them into your exercise routine?

<a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537749/">Heart rate zones</a> reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute. But what are the different heart rate zones, and how can you use these zones to optimise your workout? <h2>The three-zone model</h2> While there are several models used to describe heart rate zones, the most common model in the scientific literature is the <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">three-zone model</a>, where the zones may be categorised as follows: <ul> <li> zone 1: 55%–82% of maximum heart rate </li> <li> zone 2: 82%–87% of maximum heart rate </li> <li> zone 3: 87%–97% of maximum heart rate. </li> </ul> If you’re not sure what your maximum heart rate is, it can be calculated using <a href="https://www.jacc.org/doi/full/10.1016/S0735-1097%2800%2901054-8">this equation</a>: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute. There are also other models used to describe heart rate zones, such as the <a href="https://journals.humankinetics.com/view/journals/ijspp/14/8/article-p1151.xml">five-zone model</a> (as its name implies, this one has five distinct zones). These <a href="https://journals.humankinetics.com/view/journals/ijspp/9/1/article-p100.xml">models</a> largely describe the same thing and can mostly be used interchangeably. <h2>What do the different zones involve?</h2> The three zones are based around a person’s <a href="https://link.springer.com/article/10.2165/00007256-200939060-00003">lactate threshold</a>, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic. Aerobic exercise <a href="https://www.healthline.com/health/fitness-exercise/difference-between-aerobic-and-anaerobic">uses oxygen</a> to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time. On average your lactate threshold tends to sit around <a href="https://www.tandfonline.com/doi/full/10.2147/OAJSM.S141657">85% of your maximum heart rate</a>, although this varies from person to person, and can be <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00043.2013">higher in athletes</a>. In the three-zone model, each zone loosely describes <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2015.00295/full">one of three types of training</a>. Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace. Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences. Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3. <h2>Striking a balance</h2> To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout. While zone 3 is thought to produce the largest improvements in <a href="https://www.sciencedirect.com/science/article/pii/S1440244018309198">maximal oxygen uptake</a> – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much. Training in different heart rate zones improves <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=38c07018c0636422d9d5a77316216efb3c10164f">slightly different physiological qualities</a>, and so by spending time in each zone, you ensure a <a href="https://link.springer.com/article/10.1007/bf00426304">variety of benefits</a> for performance and health. <h2>So how much time should you spend in each zone?</h2> Most <a href="https://www.frontiersin.org/articles/10.3389/fspor.2023.1258585/full">elite endurance athletes</a>, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3. Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate <a href="https://journals.humankinetics.com/view/journals/ijsnem/22/5/article-p392.xml?content=pdf">more than 250 kilometres per week</a>, which would be impossible to recover from if it was all performed in zone 2 or 3. Of course, most people are not professional athletes. The <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">World Health Organization</a> recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week. If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines. <h2>What if I don’t have a heart rate monitor?</h2> If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training. The three heart rate zones discussed in this article can also be prescribed based on feel using a simple <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2004.00418.x">10-point scale</a>, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce. With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10. Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228520/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hunter-bennett-1053061">Hunter Bennett</a>, Lecturer in Exercise Science, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-heart-rate-zones-and-how-can-you-incorporate-them-into-your-exercise-routine-228520">original article</a>.

Body

How extreme dieting can affect bone health

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> In a recent Instagram post, the actor Jameela Jamil revealed she has poor bone density, despite only being in her 30s. Jamil blamed this finding on 20 years of dieting – urging her followers to be aware of the harms diet culture can do to your health. Bone density is important for many reasons, primarily because it acts as a reservoir for many of the important minerals our bones need to function well. Many factors can affect your bone density – and as Jamil has pointed out, diet is one component that has a significant effect on bone health. Bone is a living tissue. This means our skeleton <a href="https://www.sciencedirect.com/science/article/abs/pii/S1521690X08000869">grows and remodels itself</a> according to the stresses and strains it’s put under. Everything from fractures to exercise require our bones to change their shape or density. This is why a weightlifter’s skeleton is <a href="https://link.springer.com/article/10.1007/BF00298721">much denser</a> than a marathon runner’s. The biggest skeletal changes we experience happen in our younger years. But bones keep changing throughout our lives depending on how active we are, what our diet consists of, and if we’ve suffered an injury or disease. Bones are <a href="https://www.niams.nih.gov/health-topics/what-bone">made of proteins</a>, such as collagen, as well as minerals – largely calcium. This is a <a href="https://www.ncbi.nlm.nih.gov/books/NBK430714/">key mineral</a> for us, as it keeps our bones and teeth strong and helps repair and rebuild any injured bones. But other minerals and vitamins are also important. For example, vitamin D supports calcium, playing a key role in <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2761808">bone mineralisation</a>. This is where calcium <a href="https://www.ncbi.nlm.nih.gov/books/NBK279023/">combines with phosphate</a> in our bones to create the mineral crystal <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264100/">hydroxyapatite</a>. This crystal is crucial to our bone mineral density (also known as “bone mass”), as it helps bones remodel and maintain their structural strength. <a href="https://www.nhs.uk/conditions/dexa-scan/">Dexa scans</a> – the type of scan Jamil referred to in her post – can measure the density of these crystals in bones. The <a href="https://theros.org.uk/information-and-support/osteoporosis/scans-tests-and-results/bone-density-scan-dxa/">more hydroxyapatite crystals</a> detected, the healthier the bones are. <figure class="align-center "><img src="https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="The interior of bones, showing four depictions of bone density – from healthy to severe osteoporosis." /><figcaption>The more crystals detected, the better your bone density. <a class="source" href="https://www.shutterstock.com/image-illustration/osteoporosis-4-stages-one-picture-3d-524364046">Crevis/ Shutterstock</a></figcaption></figure> We hit peak bone mineral density in our <a href="https://pubmed.ncbi.nlm.nih.gov/35869910/">late teens and early 20s</a>, when our body has grown to full size and our metabolism is working its best. From here, it’s possible to maintain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684300/">stable bone mass</a> into your late 30s for women and early 40s for men, with the right diet and activity. But after this point, it begins to decline. <h2>Bone density</h2> We accrue calcium over many years. It initially comes from our mother, then later from our diet. Our body accrues calcium so it can adapt to times when calcium demand is greater than what we can get from our diet – such as during pregnancy, when the foetus needs calcium to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355895/">build its own bones</a>. However, relying solely on this skeletal calcium reserve can’t be sustained for lengthy or repeated periods, because of how long it takes to be replenished. This is why diet is so important for bone density – and why a poor diet can cause extreme damage, especially when certain food groups or minerals are consistently left out. For instance, studies have shown consuming soft drinks, (<a href="https://pubmed.ncbi.nlm.nih.gov/17023723/">particularly cola</a>), more than four times a week is linked with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071508/">lower bone density</a> and increased fracture risk. This is true even after adjusting for many other variables that affect bone density. These carbonated and energy drinks contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966367/">varying levels of vitamins</a> – often with none of the minerals, including calcium, that the body needs to function optimally. This causes the body to draw on its reserves if calcium isn’t being delivered elsewhere in the diet. Diets high in added sugar can also have a detrimental affect on the skeleton. Excess sugar causes inflammation and other physiological changes, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9471313/">obesity</a>. Consuming high amounts of sugar is linked with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748414/">reduced calcium intake</a>, especially in children who substitute milk for sugary drinks. Excess sugar consumption also causes the body to <a href="https://jps.biomedcentral.com/articles/10.1007/s12576-016-0487-7">excrete excess calcium</a>, instead of reabsorbing it in the kidney as the body normally would. <a href="https://pubmed.ncbi.nlm.nih.gov/25491765/">Low- and high-fat diets</a> have also been associated with increased risk of <a href="https://www.nhs.uk/conditions/osteoporosis/">osteoporosis</a> (a condition that weakens bones) in women – though larger studies are needed to better understand the effects of removing whole food groups on bone health. <a href="https://www.nhs.uk/mental-health/conditions/anorexia/overview/">Anorexia nervosa</a> also has a significant affect on <a href="https://pubmed.ncbi.nlm.nih.gov/30817009">bone density</a> – affecting a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959847/">majority of people</a> with the condition. Low bone mineral density – especially in the spine – puts people with anorexia at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959847/">increased risk of fractures</a> because their bone thickness is reduced, increasing the likelihood of developing osteoporosis, which is associated with increased fractures. Anorexia in young adulthood is particularly challenging. This is the stage where the skeleton is building itself to reach peak <a href="https://pubmed.ncbi.nlm.nih.gov/15574617/">bone mass</a>, so it’s depositing calcium at a record pace. When diet is insufficient and the body already starts drawing on its mineral reserves, there’s a potential that the bone density or calcium reserves in the body will never be optimal – increasing fracture risk for the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746661/">rest of that person’s life</a>. <h2>Can bone health be fixed?</h2> Optimal bone health starts in utero, but our prepubescent years are key to <a href="https://pubmed.ncbi.nlm.nih.gov/26884506/">setting our skeleton up</a> for later life. People who are behind the curve in early life may have difficulty achieving their peak, as poor bone mineral density can affect everything from our appetite to how efficient our gastrointestinal tract is at absorbing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971894/">important nutrients</a> (including calcium). Supplements have a limited effect because our body can only absorb a set amount of any <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8746734/">vitamin or mineral at a time</a>. While it’s possible to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684300/">limit some of the decline</a> in bone density that naturally happens as we age, some of the choices we make – such as not consuming enough calcium – can accelerate the decline. Biological sex also has a significant impact on our bone health in old age – with post-menopausal women at greater risk of osteoporosis because they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/">produce less oestrogen</a>, which helps keep the cells that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424385">degrade bone</a> in check.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228321/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-extreme-dieting-can-affect-bone-health-228321">original article</a>. </div>

Body

If you have money anxiety, knowing your financial attachment style can help

<a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> The number of people struggling with money in Britain is at a <a href="https://www.theguardian.com/money/2024/mar/18/record-numbers-of-uk-people-in-debt-warns-charity">record high</a>. Financial charities say that people are contacting them for help with debt, paying bills and insolvency. The campaign group Debt Justice found in a <a href="https://debtjustice.org.uk/wp-content/uploads/2024/03/WalnutOmnibus-Debt-Justice-Policy-Development-Weighted.xlsx">survey</a> that 29% of 18- to 24-year-olds and 25% of 25- to 34-year-olds had missed three or more bill payments in the last six months. A majority (65%) of people don’t think they can survive on their savings for three months without <a href="https://www.money.co.uk/savings-accounts/savings-statistics">borrowing money</a>. Statistics from the UK’s financial markets regulator show that more than one-third of UK adults have less than £1,000 in savings. And a survey by Money.co.uk found that 30% of Brits aged 25-64 do not save at all <a href="https://www.pensionsage.com/pa/Nearly-one-third-of-Brits-are-not-saving-for-retirement.php">for retirement</a>. With figures like that, is it any wonder that 75% of people in the UK feel <a href="https://www.mentalhealth.org.uk/about-us/news/financial-strain-driving-uks-anxiety#:%7E:text=Almost%20three%2Dquarters%20of%20the,cited%20job%20insecurity%20or%20unemployment">anxious about money</a>? The current state of the economy is particularly scary for young people. Unless you were born with a trust fund (not most people), you are likely part of the first generation to be financially worse off than <a href="https://edition.cnn.com/2020/01/11/politics/millennials-income-stalled-upward-mobility-us/index.html">your parents</a>. Retirement seems like an impossibility, and you’re unlikely to own your own home. Eighty percent of people in their early 20s worry about <a href="https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/money-and-mental-health/#Thelinksbetweenmoneyandmentalhealth">not earning enough</a>. It is important to start planning for your financial future early in your career, but you may find it overwhelming. The good news is, there are ways to overcome this. <h2>Finding your financial attachment style</h2> As a psychotherapist and finance researcher, I work with people to help them to increase their financial confidence and find the motivation to start planning. This often starts with understanding what influences their relationship with money. <a href="https://www.cambridge.org/core/journals/behavioral-and-brain-sciences/article/bowlbyainsworth-attachment-theory/6D35C7A344107195D97FD7ADAE06C807">Attachment theory</a> is a psychological concept introduced in the late 1950s. Your attachment style – which can be, for example, secure, anxious or avoidant – explains how you approach creating emotionally intimate relationships with other people. Some people feel secure building relationships, while others are extremely anxious. Some avoid close relationships altogether. Attachment style can also apply to your finances. If you feel confident and safe when it comes to money, you are secure in your relationship to saving and spending. But if the thought of opening an ISA or filling out a tax return, let alone planning for retirement, fills you with dread and panic, you may be anxiously attached. And if you if you push money worries to the back of your mind, you are likely avoidant. Attachment theorists and psychotherapists like me think that attachment styles are shaped by childhood experiences – for example, how well you were looked after by your parents or carers, and how safe and loved you felt. The way money was handled in your family growing up is likely to have set the blueprint for your <a href="https://www.sciencedaily.com/releases/2020/02/200225114410.htm">financial attachment style</a>. Outside influences like education or work experiences may shape this too. Although financial education is part of the <a href="https://maps.org.uk/en/work-with-us/financial-education-in-schools">school curriculum</a> in the UK, 76% of children leave school without sufficient <a href="https://maps.org.uk/en/media-centre/press-releases/2024/hundreds-of-thousands-leaving-school-without-money-skills#:%7E:text=In%20its%20poll%20of%201%2C012,knowledge%20they%20need%20for%20adulthood">financial knowledge</a> to manage their lives. Similarly, financial services like banks have done a poor job helping people establish secure financial relationships. Complex and <a href="https://www.pwmnet.com/private-view-blog-time-for-the-financial-industry-to-jettison-the-jargon">off-putting language</a> has placed a barrier between those who know about money and those who need to learn. If you feel unable to keep up with financial terms, or that you don’t understand money, this is likely to hurt your confidence in your financial planning abilities and fuel a more avoidant attachment style. Identifying your attachment style can help you nurture a better relationship with money. You will be able to understand and predict how and why you react to finances in certain ways. And, it can provide confidence by reminding you that money struggles are not necessarily your fault. <h2>Getting over financial anxiety</h2> Some of the recent financial trends spreading on social media may give an insight into your attachment style. Are you <a href="https://www.cnbc.com/select/what-is-loud-budgeting-trend-can-it-work/">“loud budgeting”</a> (being vocal about why you aren’t spending money)? This could be a sign of financial confidence and that you have secure financial attachment. Or are you “doom spending” (spending money you don’t have instead of creating a <a href="https://www.theguardian.com/lifeandstyle/2024/jan/31/are-you-loud-budgeting-or-doom-spending-finance-according-to-gen-z">nest egg</a> for the future)? You may be avoidant. Healthy relationships with <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/maintaining-healthy-relationships-and-mental-wellbeing/#:%7E:text=People%20with%20healthy%2C%20positive%20and,such%20as%20stress%20and%20anxiety">people</a> and <a href="https://www.nhs.uk/every-mind-matters/lifes-challenges/money-worries-mental-health/#:%7E:text=Our%20mental%20health%20might%20be,earning%20enough%20or%20currently%20unemployed">money</a> are both critical for our survival and mental health. As an adult, you have the power to improve these relationships. But because attachment patterns were formed early on, they are difficult to change. Therapy and other support can help you adopt healthier habits, as can increasing your financial knowledge. If you want to change your relationship with money, you should try to be mindful of what may be influencing you. While financial advice on social media may be useful and help young people feel more empowered to <a href="https://www.forbes.com/advisor/investing/financial-advisor/adults-financial-advice-social-media/">talk about money</a>, it can also <a href="https://www.mcleanhospital.org/essential/it-or-not-social-medias-affecting-your-mental-health">increase anxiety further</a> and be <a href="https://theconversation.com/if-you-get-your-financial-advice-on-social-media-watch-out-for-misinformation-222196">full of misinformation</a>. A good place to start for accurate and helpful information is the government’s <a href="https://www.moneyhelper.org.uk/en">Money Helper website</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225243/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ylva-baeckstrom-1463175">Ylva Baeckstrom</a>, Senior Lecturer in Finance, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-you-have-money-anxiety-knowing-your-financial-attachment-style-can-help-225243">original article</a>.

Money & Banking

How tracking menopause symptoms can give women more control over their health

<a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them. People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important. <a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry. There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” <h2>Why does monitoring symptoms help?</h2> One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms. Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209004/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">original article</a>.

Body

Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can’t be cleaned away? Eye infections may seem like a relatively minor – if unsightly and inconvenient – complaint, but they can also be far more serious. Take the deadly outbreak of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022785/">antibiotic resistant</a> bacteria <a href="https://www.cff.org/managing-cf/burkholderia-cepacia-complex-b-cepacia">Burkholderia cepacia</a> in 2023-24, for example. Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. <a href="https://www.independent.co.uk/news/health/contaminated-eye-gel-outbreak-death-b2523446.html">One person died</a> and at least 25 others suffered serious infections. The outbreak has now subsided and products are <a href="https://www.gov.uk/drug-device-alerts/specific-brands-of-carbomer-eye-gel-recall-of-aacarb-eye-gel-aacomer-eye-gel-and-puroptics-eye-gel-potential-risk-of-infection-dsi-slash-2023-slash-11#update-2-april-2024">back on the shelves</a> but it isn’t the first time that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335909/">medicinal products</a> have led to outbreaks of B cepacia. The bacterium is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing <a href="https://erj.ersjournals.com/content/17/2/295">death in days</a>. But it’s not just B cepacia that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death. Bacteria account for up to <a href="https://pubmed.ncbi.nlm.nih.gov/16148850/">70% of eye infections</a> and globally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032492/">over 6 million people</a> have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at <a href="https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections">increased risk</a>. <figure><iframe src="https://www.youtube.com/embed/pWsx8i1kaxs?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about <a href="https://www.ncbi.nlm.nih.gov/books/NBK11556/">6 million cones and 120 million rods</a> which detect colour and light. Eye cells have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775779/">no ability to regenerate</a> so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a <a href="https://www.ncbi.nlm.nih.gov/books/NBK531490/">bony protective frame</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK482428/">limiting exposure</a> having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated. Despite our bodies’ best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes. <h2>Conjunctivitis</h2> The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the <a href="https://my.clevelandclinic.org/health/body/24329-conjunctiva">conjunctiva</a>. <figure><iframe src="https://www.youtube.com/embed/RZ4danuJwd0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> The conjunctiva is <a href="https://innovations.bmj.com/content/9/4/253">highly vascularised</a>, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328962/">blood vessels to dilate</a> in the conjunctiva. This results in <a href="https://www.cdc.gov/conjunctivitis/about/symptoms.html">“pink eye”</a>, a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself. <h2>Blepharitis</h2> Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It’s most commonly caused by <a href="https://www.tandfonline.com/doi/pdf/10.3109/09273948.2013.870214">Staphylococcus bacteria</a>, or the <a href="https://cks.nice.org.uk/topics/blepharitis/background-information/causes/">dysfunction of the glands</a> of the eyelids. It can be treated by <a href="https://www.nhs.uk/conditions/blepharitis/">cleaning the eyes</a> regularly. <h2>Stye</h2> A stye (also called <a href="https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/hordeolum">hordeolum</a>) is a painful infection of the upper or lower eyelid. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370090/">Internal styes</a> are caused by infection of an oil-producing gland inside the eyelid, whereas <a href="https://pubmed.ncbi.nlm.nih.gov/28723014/">external styes</a> develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1874715">the S aureus form of the Staphylococcus species</a>. <figure><iframe src="https://www.youtube.com/embed/INKrGOdy824?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes – this could spread the infection. <h2>Keratitis</h2> Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye’s main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness. The most common type is bacterial keratitis; however, it can also be caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998329/">amoeba</a>, which can migrate to other parts of the body – including the brain – and cause infection and <a href="https://theconversation.com/nasal-rinsing-why-flushing-the-nasal-passages-with-tap-water-to-tackle-hay-fever-could-be-fatal-225811">even death</a>. Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation. <h2>Uveitis</h2> <a href="https://www.nhs.uk/conditions/uveitis/">Uveitis</a> is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501150/">herpes simplex</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29023181/">herpes zoster</a> or <a href="https://link.springer.com/chapter/10.1007/978-3-319-09126-6_40">trauma</a>. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772296/">partial blindness</a>. <h2>Exogenous endophthalmitis</h2> This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286045/">many other sources</a>. <h2>Dacryocystitis</h2> Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be <a href="https://pubmed.ncbi.nlm.nih.gov/8443113/">acute</a>, <a href="https://www.nature.com/articles/6700662">chronic</a> or <a href="https://www.jebmh.com/articles/a-study-of-congenital-dacryocystitis.pdf.pdf">acquired at birth</a>. Most cases are caused by <a href="https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01792-4">Streptococcus pneumoniae and Staphylococcus aureus</a> bacteria. The condition mainly affects newborns and those over 40. Seventy-five per cent of cases are women and it’s most commonly found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039673/">white adults</a>. It can lead to the stagnation of tears, creating a breeding ground for microbes. <h2>Careful with contacts</h2> Proper eye hygiene reduces the risk of all these conditions – and this is even more important for contact lens wearers. <figure><iframe src="https://www.youtube.com/embed/uENHAntJOIA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Appropriate hygienic cleaning of lenses is paramount. <a href="https://pubmed.ncbi.nlm.nih.gov/30789440/">Non-sterile water</a>, <a href="https://www.aao.org/eye-health/glasses-contacts/contact-lens-care">spit</a> and other fluids can transfer <a href="https://www.science.org/content/article/bacteria-living-your-contact-lens-solution">potentially dangerous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482476/">microbes</a> into the eye – a warm, moist environment that makes an ideal breeding ground for bacteria – leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356/">localised infection</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/">blindness</a> or progress to a more serious <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835757/">systemic infection or death</a>. Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227252/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eye-infections-might-seem-like-a-minor-complaint-but-in-some-cases-they-can-cause-blindness-and-even-death-227252">original article</a>. </div>

Body

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

<a href="https://theconversation.com/profiles/martin-hewison-1494746">Martin Hewison</a>, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> Most of us don’t worry about getting vitamin D when the weather’s warm and the sun is shining. But as winter approaches, accompanied by overcast days and long nights, you may be wondering if it could be useful to take a vitamin D supplement – and what benefit it might have. During the summer, the best way to get vitamin D is by getting a bit of sunshine. Ultraviolet rays (specifically UVB, which have a shorter wavelength) interact with a form of cholesterol called <a href="https://www.ncbi.nlm.nih.gov/books/NBK278935/">7-dehydrocholesterol</a> in the skin, which is then converted into vitamin D. Because vitamin D production is dependent on UVB, this means our ability to make it <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/#:%7E:text=From%20about%20late%20March%2Fearly,enough%20vitamin%20D%20from%20sunlight.">declines in the winter months</a>. Vitamin D production also <a href="https://pubmed.ncbi.nlm.nih.gov/24494042/">depends on where you live</a>, with people living nearer to the equator making more vitamin D than those living nearer the poles. Vitamin D deficiency is a <a href="https://assets.publishing.service.gov.uk/media/5a804e36ed915d74e622dafa/SACN_Vitamin_D_and_Health_report.pdf">problem in the UK</a> during the winter months. This is due to its northerly position and cloudy weather, and lack of time spent outdoors. One study of over 440,000 people in the UK found that <a href="https://pubmed.ncbi.nlm.nih.gov/33309415/">18% were vitamin D deficient</a> during the winter months. Vitamin D deficiency was even higher in certain ethnic groups – with the data showing 57% of Asian participants and 38% of black participants were vitamin D deficient. This is because the melanin content of skin determines a person’s ability to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/#:%7E:text=Skin%20pigmentation%2C%20i.e.%2C%20melanin%2C,%5B7%5D%20and%20more%20generally.">make UVB into vitamin D</a>. Given the prevalence of vitamin D deficiency in the UK, and the importance it has for our health, in 2016 the UK’s Science Advisory Council on Nutrition outlined recommendations for the <a href="https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report#:%7E:text=In%20a%20change%20to%20previous,aged%204%20years%20and%20older">amount of vitamin D</a> people should aim to get in the winter. They recommend people aim to get ten micrograms (or 400 IU – international units) of vitamin D per day. This would help people avoid severe deficiency. This can be achieved either by taking a supplement, or eating <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/ask-the-expert/foods-high-in-vitamin-d">certain foods</a> that are rich in vitamin D – including fatty fish such as herring, mackerel and wild salmon. A 100 gram serving of fresh herring, for example, would have approximately five micrograms of vitamin D. The clearest benefit of taking a vitamin D supplement is for <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/">bone health</a>. In fact, vitamin D was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899558/">first discovered</a> 100 years ago because of its ability to prevent the disease rickets, which causes weak bones that bend. Although rickets <a href="https://www.nhs.uk/conditions/rickets-and-osteomalacia/#:%7E:text=The%20number%20of%20rickets%20cases,from%20sunlight%2C%20can%20develop%20rickets.">isn’t very common</a> in the UK today, it can still occur in children if they lack vitamin D. In adults, vitamin D deficiency can cause bone pain, tenderness and muscles weakness, as well as increased risk of osteomalacia – often called “soft bone disease” – which leads to weakening or softening bones. The reason a lack of vitamin D can have such an effect on bone health is due to the vitamin’s relationship with <a href="https://pubmed.ncbi.nlm.nih.gov/18844850/">calcium and phosphate</a>. Both of these minerals help keep our bones strong – but they require vitamin D in order to be able to reinforce and strengthen bones. <h2>Other health benefits</h2> In addition to its effects on the skeleton, a growing body of research is beginning to indicate that vitamin D supplements may have additional benefits to our health. For example, <a href="https://ar.iiarjournals.org/content/42/10/5009.long">research shows</a> there’s a link between vitamin D deficiency and increased risk of catching certain viral illnesses, including the <a href="https://pubmed.ncbi.nlm.nih.gov/19237723/">common cold</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231123/">flu</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385774/">COVID</a>. Similarly, several studies – <a href="https://pubmed.ncbi.nlm.nih.gov/32904944/">including my own</a> – have demonstrated in cell models that vitamin D promotes immunity against microbes, such as the bacteria which causes tuberculosis. This means vitamin D may potentially prevent some types of infections. Vitamin D may also dampen inflammatory immune responses, which could potentially protect against autoimmune diseases, such as <a href="https://pubmed.ncbi.nlm.nih.gov/29243029/">multiple sclerosis</a> and <a href="https://www.frontiersin.org/articles/10.3389/fmed.2020.596007/full">rheumatoid arthritis</a>. One 2022 trial, which looked at over 25,000 people over the age of 50, found taking a 2,000 IU (50 micrograms) vitamin D supplement each day was associated with an <a href="https://www.bmj.com/content/376/bmj-2021-066452">18% lower risk</a> of autoimmune disease – notably rheumatoid arthritis. Vitamin D supplements may also be linked with lower risk of cardiovascular disease. A <a href="https://www.bmj.com/content/381/bmj-2023-075230">major Australian study</a>, which looked at over 21,000 people aged 60-84, found that participants who took a 2,000 IU vitamin D supplement a day for five years had a lower risk of suffering a major cardiovascular event (such as stroke or heart attack) compared to those who didn’t take a supplement. It’s currently not known why vitamin D may have these benefits on these other areas of our health. It’s also worth noting that in many of these trials, very few of the participants were actually vitamin D deficient. While we might speculate the observed health benefits may be even greater in people with vitamin D deficiency, it will be important for future research to study these factors. While it’s too early to say whether vitamin D supplements have broad health benefits, it’s clear it’s beneficial for bone health. It may be worthwhile to take a supplement in the winter months, especially if you’re over 65, have darker skin or spent a lot of time indoors as these factors can put you at <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-deficiency/faq-20058397#:%7E:text=However%2C%20some%20groups%20%E2%80%94%20particularly%20people,sun%20exposure%20or%20other%20factors.">increased risk of vitamin D deficiency</a>. The research also shows us that we should be rethinking vitamin D supplementation advice. While in the UK it’s recommended people get 400 IU of vitamin D a day, many trials have shown 2,000 IU a day is associated with health benefits.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219521/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/martin-hewison-1494746">Martin Hewison</a>, Professor of Molecular Endocrinology, <a href="https://theconversation.com/institutions/university-of-birmingham-1138">University of Birmingham</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/vitamin-d-supplements-can-keep-bones-strong-but-they-may-also-have-other-benefits-to-your-health-219521">original article</a>.

Body

What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

Here’s why having chocolate can make you feel great or a bit sick – plus 4 tips for better eating

<a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Australians are <a href="https://www.retail.org.au/media/sweet-spending-boon-predicted-for-easter-retail">predicted</a> to spend around A$1.7 billion on chocolates, hot cross buns and other special foods this Easter season. Chocolate has a long history of production and consumption. It is made from cacao beans that go through processes including fermentation, drying, roasting and grounding. What is left is a rich and fatty liquor that is pressed to remove the fat (cocoa butter) and the cacao (or “cocoa”) powder which will then be mixed with different ingredients to produce dark, milk, white and other types of chocolates. There are several health benefits and potential problems that come in these sweet chocolatey packages. <h2>The good news</h2> Cacao beans contain <a href="https://foodstruct.com/food/cocoa-bean">minerals</a> like iron, potassium, magnesium, zinc and phosphorus and some vitamins. They are also rich in beneficial chemicals called <a href="https://pubmed.ncbi.nlm.nih.gov/23150750/">polyphenols</a>. These are great antioxidants, with the potential to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465250/">improve heart health</a>, increase <a href="https://pubmed.ncbi.nlm.nih.gov/25164923/">nitric oxide</a> (which dilates blood vessels) and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488419/">reduce blood pressure</a>, provide food for gut microbiota and <a href="https://www.mdpi.com/2072-6643/12/7/1908">promote gut health</a>, boost the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465250/">immune system</a> and reduce inflammation. However, the concentration of polyphenols in the chocolate we eat depends largely on the cocoa solid amounts used in the final product. In general terms, the darker the chocolate, the more cocoa solids, minerals and polyphenols it has. For example, dark chocolates may have around <a href="https://www.tandfonline.com/doi/full/10.1080/10942912.2011.614984">seven times more polyphenols</a> compared to white chocolates and <a href="https://www.tandfonline.com/doi/full/10.1080/10942912.2011.614984">three times more polyphenols</a> compared to milk chocolates. <h2>But also some bad news</h2> Unfortunately, the <a href="https://theconversation.com/treat-or-treatment-chocolate-is-good-but-cocoa-is-better-for-your-heart-3084">health benefits of cocoa solids</a> are easily offset by the high sugar and fat content of modern-day chocolates. For example, milk and white chocolate eggs are on average 50% sugar, 40% fat (mostly saturated fats) – which means a lot of added kilojoules (calories). Also, there may be some side effects that come with ingesting chocolate. Cocoa beans include a compound called theobromine. While it has the anti-inflammatory properties responsible for some of the health benefits of chocolate, it is also a mild brain stimulant that acts in a similar way to caffeine. The mood boost it offers may also be partly responsible for how much we <a href="https://www.frontiersin.org/articles/10.3389/fphar.2015.00030/full?crsi=662496658&cicada_org_src=healthwebmagazine.com&cicada_org_mdm=direct">like chocolate</a>. Dark chocolate has higher theobromine compared to milk and white chocolate. But accordingly, overindulging in chocolate (and therefore theobromine) may lead to feeling restless, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">headaches</a> and nausea. <h2>What else is in your chocolate?</h2> Milk and dairy-based chocolates may also cause stomach upset, abdominal pain and bloating in people with <a href="https://dietitiansaustralia.org.au/health-advice/lactose-intolerance">lactose intolerance</a>. This happens when we don’t produce enough lactase enzymes to digest milk sugar (lactose). People with lactose intolerance can usually tolerate up to 6 grams of lactose without showing symptoms. Milk chocolate can have around <a href="https://www.ncbi.nlm.nih.gov/books/NBK310258/">3 grams of lactose</a> per 40 grams (the size of a standard chocolate bar). So two chocolate bars (or the equivalent in milk chocolate eggs or bunnies) may be enough to cause symptoms. It’s worth noting that lactase enzyme activity dramatically declines as we age, with the highest activity in newborns and children. So lactose sensitivity or intolerance may not be such an issue for your kids and your symptoms may increase over time. Genetics also plays a major role in how sensitive people are to lactose. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815241/">Allergic reactions</a> to chocolate are usually due to the added ingredients or cross-contamination with potential allergens such as nuts, milk, soy, and some sweeteners used in the production of chocolate. Symptoms can be mild (acne, rashes and stomach pain) or more severe (swelling of the throat and tongue and shortness of breath). If you or your family members have known allergic reactions, make sure you read the label before indulging – especially in a whole block or basket of the stuff. And if you or your family members do experience symptoms of an allergic reaction after eating chocolate, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/allergic-reactions-emergency-first-aid">seek medical attention</a> immediately. <h2>4 take home tips</h2> So, if you are like me and have a weakness for chocolate there are a few things you can do to make the experience a good one.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/202848/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <ol> <li>keep an eye out for the darker chocolate varieties with higher cocoa solids. You may notice a percentage on labelling, which refers to how much of its weight is from cocoa beans. In general, the higher this percentage, the lower the sugar. White chocolate has almost no cocoa solid, and mostly cocoa butter, sugar and other ingredients. Dark chocolate has 50–100% cocoa beans, and less sugar. Aim for at least 70% cocoa</li> <li>read the fine print for additives and possible cross-contamination, especially if allergies might be an issue</li> <li>the ingredients list and nutrition information panel should tell you all about the chocolate you choosing. Go for varieties with lower sugar and less saturated fat. Nuts, seeds and dried fruits are better ingredients to have in your chocolate than sugar, creme, syrup, and caramel</li> <li>finally, treat yourself – but keep the amount you have within sensible limits!</li> </ol> <a href="https://theconversation.com/profiles/saman-khalesi-366871">Saman Khalesi</a>, Postdoctoral Fellow of the National Heart Foundation & Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/heres-why-having-chocolate-can-make-you-feel-great-or-a-bit-sick-plus-4-tips-for-better-eating-202848">original article</a>.

Food & Wine

Summer’s over, so how much sun can (and should) I get?

<a href="https://theconversation.com/profiles/katie-lee-228942">Katie Lee</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/rachel-neale-891731">Rachel Neale</a>, <a href="https://theconversation.com/institutions/qimr-berghofer-medical-research-institute-1811">QIMR Berghofer Medical Research Institute</a> As we slide of out summer, you might be wondering how careful you need to be about sun exposure. Excessive exposure causes <a href="https://www.cancer.org.au/about-us/policy-and-advocacy/prevention-policy/national-cancer-prevention-policy/skin-cancer-statistics-and-issues/uv-radiation">skin cancer</a>, but sun exposure also has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">benefits</a>. How do you balance the two? A new <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">position statement</a> from cancer, bone health and other experts <a href="https://www.assc.org.au/wp-content/uploads/2023/01/Sun-Exposure-Summit-PositionStatement_V1.9.pdf">aims to help</a> Australians balance the good and bad effects of sun exposure by taking into account their skin colour, risk of skin cancer, and where they live. <h2>What are the benefits of sunlight?</h2> Ultraviolet (UV) radiation (the wavelengths in sunlight that cause skin cancer) also leads to vitamin D production. <a href="https://dermnetnz.org/topics/vitamin-d">Vitamin D</a> is very important for maintaining strong bones, and is likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">multiple other health benefits</a>. But vitamin D probably isn’t the whole story. Sunshine, including UV radiation, is thought to affect health in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">other ways</a> such as improving our mood and reducing the risk of autoimmune diseases and infections. So for many people, avoiding the sun and taking a vitamin D supplement may not be the best approach. <h2>How much time does it take to make vitamin D?</h2> It’s complicated, but for most people and most of the year across most of Australia, it’s a lot less than you think. The <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">amount of time needed</a> depends on the amount of skin covered by clothing and the intensity of UV radiation (indicated by the UV index). More skin exposed and higher UV index equate to less time needed. Both the UV index and the amount of the year that UV radiation is high increase as you get closer to the equator. In summer, all of Australia is bathed in sunshine. But in winter, opposite ends of the country have <a href="https://onlinelibrary.wiley.com/doi/10.1111/php.13854">very different exposures</a>. In summer, everybody except those with deeply pigmented skin can make enough vitamin D in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">just five minutes</a> between 9am and 3pm, anywhere in Australia, provided they are wearing shorts and a T-shirt. In winter it’s a different story. In <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Darwin and Brisbane</a>, 5–10 minutes between 10am and 3pm will do the trick, but in <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">Hobart</a>, factoring in winter clothing, it will take nearly an hour in the middle of the day. Hover your mouse over the lines below to see the length of exposure needed at specific times of day. <iframe id="X5szQ" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/X5szQ/" width="100%" height="400px" frameborder="0"></iframe> Staying out for longer than needed doesn’t necessarily make more vitamin D, but it <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib25">does cause skin damage</a>. <h2>Hang on, what about those with darker skin?</h2> People with deeply pigmented, brown to black skin accumulate both vitamin D and DNA damage at a much slower rate than people with lighter skin tones. When UV radiation hits a DNA strand, it causes the DNA to become distorted. If the distortion isn’t fixed, it will cause a mistake when the DNA is copied for a new cell, causing a permanent mutation that sometimes leads to cancer. Melanin, the brown pigment in the skin, absorbs UV photons before that can happen, and the high melanin content in the darkest skin tones provides <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.201701472R">60 times</a> as much UV protection as the small amount in very fair skin. The flip side is the risk of vitamin D deficiency is much higher than the risk of skin cancer. The new statement accounts for this by putting people into <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">three groups</a> based on their risk of skin cancer, with specialised advice for each group. <h2>Highest skin cancer risk</h2> This includes people with very pale skin that burns easily and tans minimally, but also people with darker white or olive skin who can tan easily but have extra skin cancer risk factors because they: <ul> <li>have had skin cancer before</li> <li>have a family history of melanomas</li> <li>have many moles</li> <li>are taking immunosuppressant medications.</li> </ul> For these people, the harms of sun exposure almost certainly <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub">outweigh the benefits</a>. These people should wear sunscreen every day the <a href="https://www.arpansa.gov.au/our-services/monitoring/ultraviolet-radiation-monitoring/ultraviolet-radiation-index">UV index</a> is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, and use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">five sunsmart steps</a> whenever the UV index is above three: <ul> <li>slip on clothing covering as much of the body as possible</li> <li>slop on SPF30+ sunscreen on areas that can’t be covered up</li> <li>slap on a hat</li> <li>seek shade</li> <li>slide on sunglasses.</li> </ul> They shouldn’t spend time outdoors deliberately to make vitamin D, but should discuss vitamin D supplements with their doctor. <h2>Intermediate skin cancer risk</h2> This means people with dark white/olive skin that sometimes burns but tans easily, and who don’t have other skin cancer risk factors. These people should still apply sunscreen as part of their usual routine on all days when the UV index is forecast to get to <a href="https://www.assc.org.au/peak-health-bodies-recommend-new-approach-to-sunscreen-use/">three or more</a>, but they can spend enough time outdoors to get a “dose” of vitamin D on most days of the week. Once the time needed for their vitamin D dose is up, they should also use the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> steps to avoid accumulating DNA damage. If they’re unable to do this because of health or lifestyle factors, like being housebound, working night shifts, or always covering up with clothing, they should see their doctor about whether they need vitamin D supplements. <h2>Lowest skin cancer risk</h2> This covers people with deeply pigmented brown to black skin that rarely or never burns. These people can <a href="https://www.sciencedirect.com/science/article/pii/S1326020023052949?via%3Dihub#bib14">safely spend enough time outdoors</a> to make vitamin D and get the other benefits of sunshine. But because more time is needed, it can be difficult, particularly when the weather is cold. Vitamin D supplements might be needed. They don’t need to routinely protect their skin, but might need to <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">slip-slop-slap-seek-slide</a> if they are outdoors for more than two hours. <h2>How do I get the feel-good effects of sunshine?</h2> Spending time outdoors in the early morning is the best way to get the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976694/">feel-good effects</a> of sunshine. An early morning walk is a great idea for all of us, but it won’t make vitamin D.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224144/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/katie-lee-228942">Katie Lee</a>, PhD Candidate, Dermatology Research Centre, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/rachel-neale-891731">Rachel Neale</a>, Principal research fellow, <a href="https://theconversation.com/institutions/qimr-berghofer-medical-research-institute-1811">QIMR Berghofer Medical Research Institute</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/summers-over-so-how-much-sun-can-and-should-i-get-224144">original article</a>.

Body

Altitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare

<a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above. Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey. As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way. <h2>The science behind altitude sickness</h2> Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">most severe forms of altitude sickness</a>. Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level. <figure><iframe src="https://www.youtube.com/embed/iv1vQPIdX_k?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Tips for preventing or reducing the risk of altitude sickness.</figcaption></figure> <h2>The importance of gradual ascent</h2> High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">severe forms of altitude sickness</a>. <h2>Effective medications</h2> For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma">treatment of glaucoma</a>, a condition that causes increased pressure within the eye. If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent. Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize. <h2>Unproven therapies and remedies are common</h2> As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend. Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective. <a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. <a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness. Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness. The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222057/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, Senior Instructor in Emergency Medicine, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/altitude-sickness-is-typically-mild-but-can-sometimes-turn-very-serious-a-high-altitude-medicine-physician-explains-how-to-safely-prepare-222057">original article</a>.

Travel Trouble

MH370 disappearance 10 years on: can we still find it

<a href="https://theconversation.com/profiles/charitha-pattiaratchi-110101">Charitha Pattiaratchi</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> It has been ten years since Malaysia Airlines passenger flight MH370 <a href="https://theconversation.com/lessons-to-learn-despite-another-report-on-missing-flight-mh370-and-still-no-explanation-100764">disappeared on March 8 2014</a>. To this day it remains one of the biggest aviation mysteries globally. It’s unthinkable that a modern Boeing 777-200ER jetliner with 239 people on board can simply vanish without any explanation. Yet multiple searches in the past decade have still not yielded the main wreckage or the bodies of the victims. At a remembrance event held earlier this week, the Malaysian transport minister announced <a href="https://www.reuters.com/world/asia-pacific/malaysia-says-mh370-search-must-go-10-years-after-plane-vanished-2024-03-03/">a renewed push for another search</a>. If approved by the Malaysian government, the survey will be conducted by United States seabed exploration firm Ocean Infinity, whose efforts were unsuccessful in 2018. <h2>What happened to MH370?</h2> The flight was scheduled to fly from Kuala Lumpur to Beijing. Air traffic control lost contact with the aircraft within 60 minutes into the flight over the South China Sea. Subsequently, it was tracked by military radar crossing the Malay Peninsula and was last located by radar over the Andaman Sea in the northeastern Indian Ocean. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579774/original/file-20240305-18-vdbysn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" alt="A map of the region showing the initial search areas on 8-16 March." /></a><figcaption>The planned route, final route and initial search area for MH370 in Southeast Asia. <a class="source" href="https://en.wikipedia.org/wiki/Timeline_of_Malaysia_Airlines_Flight_370#/media/File:MH370_initial_search_Southeast_Asia.svg">Andrew Heenen/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> Later, automated satellite communications between the aircraft and British firm’s Inmarsat telecommunications satellite indicated that the plane ended up in the southeast Indian Ocean <a href="https://hub.arcgis.com/datasets/4c94d33cfc144f7d8b78943dee56e29b/explore">along the 7th arc</a> (an arc is a series of coordinates). This became the basis for defining the initial search areas by the Australian Air Transport Safety Bureau. Initial air searches were conducted in the South China Sea and the Andaman Sea. To date, we still don’t know what caused the aircraft’s change of course and disappearance. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579749/original/file-20240305-25-p456o1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Location of the 7th arc and the origin of debris locations for simulations undertaken by the University of Western Australia. Google Earth/Author provided</figcaption></figure> <h2>What have searches for MH370 found so far?</h2> On March 18 2014, ten days after the disappearance of MH370, a search in the southern Indian Ocean <a href="https://www.atsb.gov.au/publications/2014/considerations-on-defining-the-search-area-mh370">was led by Australia</a>, with participation of aircraft from several countries. This search continued until April 28 and covered an area of 4,500,000 square kilometres of ocean. No debris was found. Two underwater searches of the Indian Ocean, 2,800km off the coast of Western Australia, have also failed to find any evidence of the main crash site. The initial seabed search, led by Australia, covered 120,000 square kilometres and extended 50 nautical miles across the 7th arc. It took 1,046 days and was suspended on January 17 2017. A second search by Ocean Infinity in 2018 <a href="https://oceaninfinity.com/conclusion-of-current-search-for-malaysian-airlines-flight-mh370/">covered over 112,000 square kilometres</a>. It was completed in just over three months but also didn’t locate the wreckage. <h2>What about debris?</h2> While the main crash site still hasn’t been found, several pieces of debris have washed up in the years since the flight’s disappearance. In fact, in June 2015 officials from the Australian Air Transport Safety Bureau determined that debris might arrive in Sumatra, contrary to the ocean currents in the region. The strongest current in the Indian Ocean is the South Equatorial Current. It flows east to west between northern Australia and Madagascar, and debris would be able to cross it. Indeed, on July 30 2015 a large piece of debris – a <a href="https://en.wikipedia.org/wiki/Flaperon">flaperon</a> (moving part of a plane wing) – washed up on Reunion Island in the western Indian Ocean. It was later confirmed to belong to MH370. Twelve months earlier, using an oceanographic drift model, our University of Western Australia (UWA) modelling team had predicted that any debris originating from the 7th arc would end up in the western Indian Ocean. In subsequent months, additional aircraft debris was found in the western Indian Ocean in Mauritius, Tanzania, Rodrigues, Madagascar, Mozambique and South Africa. The UWA drift analysis accurately predicted where floating debris from MH370 would beach in the western Indian Ocean. It also guided American adventurer Blaine Gibson and others to directly recover several dozen pieces of debris, three of which <a href="https://www.newsweek.com/where-blaine-gibson-now-malaysia-airlines-mh370-debris-hunter-1787369">have been confirmed</a> to be from MH370, while several others <a href="https://www.airlineratings.com/news/mh370-debris-now-for-the-facts/">are deemed likely</a>. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=602&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=602&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=602&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=757&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=757&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579756/original/file-20240305-22-q62h9n.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=757&fit=crop&dpr=3 2262w" alt="A detailed satellite map showing locations of debris found on the shores of Africa and Madagascar." /></a><figcaption>Predicted locations of landfall from results of University of Western Australia drift modelling. The white dots indicate predicted landfall of the debris. The aggregation of many dots, particularly close to land, is an indication of the density of particles – higher probability of debris making landfall. These are highlighted by red circles. Charitha Pattiaratchi/UWA, Author provided</figcaption></figure> To date, these debris finds in the western Indian ocean are the only physical evidence found related to MH370. It is also independent verification that the crash occurred close to the 7th arc, as any debris would initially flow northwards and then to the west, transported by the prevailing ocean currents. These results are consistent with other drift studies undertaken by independent researchers globally. <h2>Why a new search for MH370 now?</h2> Unfortunately, the ocean is a chaotic place, and even oceanographic drift models cannot pinpoint the exact location of the crash site. The proposed new search by Ocean Infinity has significantly narrowed down the target area within latitudes 36°S and 33°S. This is approximately 50km to the south of the locations where UWA modelling indicated the release of debris along the 7th arc. If the search does not locate the wreckage, it could be extended north. Since the initial underwater searches, technology has tremendously improved. Ocean Infinity is using a fleet of autonomous underwater vehicles with improved resolution. The proposed search will also use remotely controlled surface vessels. In the area where the search is to take place, the ocean is around 4,000 metres deep. The water temperatures are 1–2°C, with low currents. This means that even after ten years, the debris field would be relatively intact. Therefore, there is a high probability that the wreckage can still be found. If a future search is successful, this would bring closure not just to the families of those who perished, but also the thousands of people who have been involved in the search efforts.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224954/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/charitha-pattiaratchi-110101">Charitha Pattiaratchi</a>, Professor of Coastal Oceanography, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/mh370-disappearance-10-years-on-can-we-still-find-it-224954">original article</a>.

Travel Trouble

How can I stop overthinking everything? A clinical psychologist offers solutions

<a href="https://theconversation.com/profiles/kirsty-ross-1513078">Kirsty Ross</a>, <a href="https://theconversation.com/institutions/massey-university-806">Massey University</a> As a clinical psychologist, I often have clients say they are having trouble with thoughts “on a loop” in their head, which they find difficult to manage. While rumination and overthinking are often considered the same thing, they are slightly different (though linked). <a href="https://www.apa.org/monitor/nov05/cycle">Rumination</a> is having thoughts on repeat in our minds. This can lead to overthinking – analysing those thoughts without finding solutions or solving the problem. It’s like a vinyl record playing the same part of the song over and over. With a record, this is usually because of a scratch. Why we overthink is a little more complicated. <h2>We’re on the lookout for threats</h2> Our brains are hardwired to look for threats, to make a plan to address those threats and keep us safe. Those perceived threats may be based on past experiences, or may be the “what ifs” we imagine could happen in the future. Our “what ifs” are usually negative outcomes. These are what we call “<a href="https://ccbhc.org/hot-thoughts-what-are-they-and-how-can-you-handle-them/">hot thoughts</a>” – they bring up a lot of emotion (particularly sadness, worry or anger), which means we can easily get stuck on those thoughts and keep going over them. However, because they are about things that have either already happened or might happen in the future (but are not happening now), we cannot fix the problem, so we keep going over the same thoughts. <h2>Who overthinks?</h2> Most people find themselves in situations at one time or another when they overthink. Some people are <a href="https://www.apa.org/monitor/nov05/cycle">more likely</a> to ruminate. People who have had prior challenges or experienced trauma may have come to expect threats and look for them more than people who have not had adversities. Deep thinkers, people who are prone to anxiety or low mood, and those who are sensitive or feel emotions deeply are also more likely to ruminate and overthink. Also, when we are stressed, our emotions tend to be stronger and last longer, and our thoughts can be less accurate, which means we can get stuck on thoughts more than we would usually. Being run down or physically unwell can also mean our thoughts are <a href="https://healthify.nz/hauora-wellbeing/m/mental-health-and-your-body/">harder to tackle</a> and manage. <h2>Acknowledge your feelings</h2> When thoughts go on repeat, it is helpful to use both emotion-focused and problem-focused <a href="https://link.springer.com/referencework/10.1007/978-1-4419-1005-9">strategies</a>. Being emotion-focused means figuring out how we feel about something and addressing those feelings. For example, we might feel regret, anger or sadness about something that has happened, or worry about something that might happen. Acknowledging those emotions, using self-care techniques and accessing social support to talk about and manage your feelings will be helpful. The second part is being problem-focused. Looking at what you would do differently (if the thoughts are about something from your past) and making a plan for dealing with future possibilities your thoughts are raising. But it is difficult to plan for all eventualities, so this strategy has limited usefulness. What is more helpful is to make a plan for one or two of the more likely possibilities and accept there may be things that happen you haven’t thought of. <h2>Think about why these thoughts are showing up</h2> Our feelings and experiences are information; it is important to ask what this information is telling you and why these thoughts are showing up now. For example, university has just started again. Parents of high school leavers might be lying awake at night (which is when rumination and overthinking is common) worrying about their young person. Knowing how you would respond to some more likely possibilities (such as they will need money, they might be lonely or homesick) might be helpful. But overthinking is also a sign of a new stage in both your lives, and needing to accept less control over your child’s choices and lives, while wanting the best for them. Recognising this means you can also talk about those feelings with others. <h2>Let the thoughts go</h2> A useful way to manage rumination or overthinking is “<a href="https://www.getselfhelp.co.uk/docs/Options.pdf">change, accept, and let go</a>”. Challenge and change aspects of your thoughts where you can. For example, the chance that your young person will run out of money and have no food and starve (overthinking tends to lead to your brain coming up with catastrophic outcomes!) is not likely. You could plan to check in with your child regularly about how they are coping financially and encourage them to access budgeting support from university services. Your thoughts are just ideas. They are not necessarily true or accurate, but when we overthink and have them on repeat, they can start to feel true because they become familiar. Coming up with a more realistic thought can help stop the loop of the unhelpful thought. Accepting your emotions and finding ways to manage those (good self-care, social support, communication with those close to you) will also be helpful. As will accepting that life inevitably involves a lack of complete control over outcomes and possibilities life may throw at us. What we do have control over is our reactions and behaviours. Remember, you have a 100% success rate of getting through challenges up until this point. You might have wanted to do things differently (and can plan to do that) but nevertheless, you coped and got through. So, the last part is letting go of the need to know exactly how things will turn out, and believing in your ability (and sometimes others’) to cope. <h2>What else can you do?</h2> A stressed out and tired brain will be <a href="https://mentalhealth.org.nz/resources/resource/stress-and-how-to-manage-it">more likely</a> to overthink, leading to more stress and creating a cycle that can affect your wellbeing. So it’s important to manage your stress levels by eating and sleeping well, moving your body, doing things you enjoy, seeing people you care about, and doing things that fuel your soul and spirit. Distraction – with pleasurable activities and people who bring you joy – can also get your thoughts off repeat. If you do find overthinking is affecting your life, and your levels of anxiety are rising or your mood is dropping (your sleep, appetite and enjoyment of life and people is being negatively affected), it might be time to talk to someone and get some strategies to manage. When things become too difficult to manage yourself (or with the help of those close to you), a therapist can provide tools that have been proven to be helpful. Some helpful tools to manage worry and your thoughts can also be found <a href="https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Anxiety">here</a>. When you find yourself overthinking, think about why you are having “hot thoughts”, acknowledge your feelings and do some future-focused problem solving. But also accept life can be unpredictable and focus on having faith in your ability to cope. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223973/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kirsty-ross-1513078">Kirsty Ross</a>, Associate Professor and Senior Clinical Psychologist, <a href="https://theconversation.com/institutions/massey-university-806">Massey University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-can-i-stop-overthinking-everything-a-clinical-psychologist-offers-solutions-223973">original article</a>.

Mind

Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one

<a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness. Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as <a href="https://link.springer.com/referenceworkentry/10.1007/978-3-319-69892-2_1006-1">anticipatory grief</a>. While not experienced by everyone, anticipatory grief is a <a href="https://spcare.bmj.com/content/bmjspcare/early/2022/02/10/bmjspcare-2021-003338.full.pdf?casa_token=IWNMDFN5SoIAAAAA:2EybwyPcKu73VdrACTNk7jITor-mMIXK8rv76arXgdjV9cA2Y0MV0LyZLLwcYe1rZUAQymOzFYo">common</a> part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die. <h2>Difficult to define, distressing to experience</h2> Anticipatory grief has proved <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">challenging to define</a>. A <a href="https://journals.sagepub.com/doi/full/10.1177/02692163221074540#bibr13-02692163221074540">systematic review</a> of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief. Therese Rando, a <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315800806-9/grief-mourning-accommodating-loss-therese-rando">prominent theorist</a>, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of <a href="https://www.cruse.org.uk/understanding-grief/effects-of-grief/complicated-grief/">“complicated grief”</a>, a term that describes persistent and debilitating emotional distress. <figure><iframe src="https://www.youtube.com/embed/AapGn60DZSA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other <a href="https://www.sciencedirect.com/science/article/pii/S0277953621005724?casa_token=I9mbdSv3d3gAAAAA:MqxN5X_iWbcqa6BYj7IXmImUviheOQWAVA4UBy6795UDuS1uOHG9b245qMkyOiLcvjv_SU6yVA">research evidence</a> shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death. <h2>Carers should seek support</h2> Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience. It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life <a href="https://www.mind.org.uk/information-support/helping-someone-else/carers-friends-family-coping-support/your-mental-health/">can be an isolating time</a>. Where possible, it can also be beneficial for carers to offer their loved one <a href="https://compassionatecommunitiesni.com/our-programs/dying-to-talk/">opportunities to reflect</a> on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an <a href="https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/">advance care plan</a>. <figure><iframe src="https://www.youtube.com/embed/wrJaTXW1Xvk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Talking is key</h2> Living with altered family dynamics, multiple losses, transition and uncertainty can be <a href="https://www.tandfonline.com/doi/full/10.1080/07481187.2021.1998935">distressing for all family members</a>. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to <a href="https://hospicefoundation.ie/i-need-help/i-am-seriously-ill/how-to-talk-to-those-you-care-about/">talk about dying</a>. However, talking is key in <a href="https://www.cruse.org.uk/about/blog/important-conversations-death/">preparing for an impending death</a>. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including <a href="https://www.mariecurie.org.uk/help/support/diagnosed/talking-children/children">talking to children</a> about death and dying. Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends. Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221629/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lisa-graham-wisener-1247893">Lisa Graham-Wisener</a>, Lecturer of Health Psychology, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> and <a href="https://theconversation.com/profiles/audrey-roulston-1512057">Audrey Roulston</a>, Professor of Social Work in Palliative Care, <a href="https://theconversation.com/institutions/queens-university-belfast-687">Queen's University Belfast</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/not-all-mourning-happens-after-bereavement-for-some-grief-can-start-years-before-the-death-of-a-loved-one-221629">original article</a>.

Caring

How long does back pain last? And how can learning about pain increase the chance of recovery?

<a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>. Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain. Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access. <h2>More pain doesn’t mean a more serious injury</h2> Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease. There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system. The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. <h2>Reduce your chance of lasting pain</h2> Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain: <ul> <li> understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </li> <li> reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal. </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover. But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>.

Body

Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like

<a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> At least <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.665019/full">one in ten people</a> have depression at some point in their lives, with some estimates <a href="https://www.sciencedirect.com/science/article/pii/S0749379720301793">closer to one in four</a>. It’s one of the worst things for someone’s wellbeing – worse than <a href="https://www.happinessresearchinstitute.com/_files/ugd/928487_4a99b6e23f014f85b38495b7ab1ac24b.pdf">debt, divorce or diabetes</a>. <a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">One in seven</a> Australians take antidepressants. Psychologists are in <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">high demand</a>. Still, only <a href="http://dx.doi.org/10.1371/journal.pmed.1003901">half</a> of people with depression in high-income countries get treatment. Our <a href="https://www.bmj.com/content/384/bmj-2023-075847">new research</a> shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it. <h2>Walk, run, lift, or dance away depression</h2> We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together. We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> – one of the <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00004/full">gold-standard treatments</a> for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them. Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants. But of these exercises, people were most likely to stick with strength training and yoga. <iframe id="cZaWb" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/cZaWb/2/" width="100%" height="400px" frameborder="0"></iframe> Antidepressants certainly help <a href="https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext">some people</a>. And of course, anyone getting treatment for depression should talk to their doctor <a href="https://australia.cochrane.org/news/new-cochrane-review-explores-latest-evidence-approaches-stopping-long-term-antidepressants">before changing</a> what they are doing. Still, our evidence shows that if you have depression, you should get a psychologist and an exercise plan, whether or not you’re taking antidepressants. <h2>Join a program and go hard (with support)</h2> Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, <a href="https://www.who.int/initiatives/behealthy/physical-activity">such as</a> “some physical activity is better than doing none.” But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression. We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results. <h2>Yes, it’s hard to keep motivated</h2> We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results. Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free. We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression. Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result. Other reviews found it’s important to have a <a href="https://pubmed.ncbi.nlm.nih.gov/31923898/">clear action plan</a> (for example, putting exercise in your calendar) and to <a href="https://pubmed.ncbi.nlm.nih.gov/19916637/">track your progress</a> (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult. A <a href="https://www.nature.com/articles/s41586-021-04128-4">2021 mega-study</a> of more than 60,000 gym-goers <a href="https://www.nature.com/articles/s41586-021-04128-4/figures/1">found</a> experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted. Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it. So, when starting out, it seems wise to avoid going it alone. Instead: <ul> <li> join a fitness group or yoga studio </li> <li> get a trainer or an exercise physiologist </li> <li> ask a friend or family member to go for a walk with you. </li> </ul> Taking a few steps towards getting that support makes it more likely you’ll keep exercising. <h2>Let’s make this official</h2> Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only <a href="https://www.apa.org/depression-guideline/">conditionally recommends</a> exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”. Based on our research, this recommendation is withholding a potent treatment from many people who need it. In contrast, The Royal Australian and New Zealand College of Psychiatrists <a href="https://www.ranzcp.org/getmedia/a4678cf4-91f5-4746-99d4-03dc7379ae51/mood-disorders-clinical-practice-guideline-2020.pdf">recommends</a> vigorous aerobic activity at least two to three times a week for all people with depression. Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression. I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223441/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, Senior Lecturer in Psychology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/running-or-yoga-can-help-beat-depression-research-shows-even-if-exercise-is-the-last-thing-you-feel-like-223441">original article</a>.

Body

What ‘psychological warfare’ tactics do scammers use, and how can you protect yourself?

<a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Not a day goes by without a headline <a href="https://www.vice.com/en/article/qjvaym/people-share-worst-scam-stories">about a victim being scammed</a> and losing money. We are constantly warned about new scams and staying safe from cybercriminals. Scamwatch has <a href="https://www.scamwatch.gov.au/research-and-resources/tools-resources/online-resources/spot-the-scam-signs">no shortage of resources</a>, too. So why are people still getting scammed, and sometimes spectacularly so? Scammers use sophisticated psychological techniques. They exploit our deepest human vulnerabilities and bypass rational thought to tap into our emotional responses. This “<a href="https://www.thecut.com/article/amazon-scam-call-ftc-arrest-warrants.html">psychological warfare</a>” coerces victims into making impulsive decisions. Sometimes scammers spread their methods around many potential victims to see who is vulnerable. Other times, criminals focus on a specific person. Let’s unpack some of these psychological techniques, and how you can defend against them. <h2>1. Random phone calls</h2> Scammers start with small requests to establish a sense of commitment. After agreeing to these minor requests, we are more likely to comply with larger demands, driven by a desire to act consistently. The call won’t come from a number in your contacts or one you recognise, but the scammer may pretend to be someone you’ve engaged to work on your house, or perhaps one of your children using a friend’s phone to call you. If it is a scammer, maybe keeping you on the phone for a long time gives them an opportunity to find out things about you or people you know. They can use this info either immediately or at a later date. <h2>2. Creating a sense of urgency</h2> Scammers fabricate scenarios that require immediate action, like claiming a bank account is at risk of closure or an offer is about to expire. This tactic aims to prevent victims from assessing the situation logically or seeking advice, pressuring them into rushed decisions. The scammer creates an artificial situation in which you are frightened into doing something you wouldn’t ordinarily do. Scam calls <a href="https://theconversation.com/we-have-filed-a-case-under-your-name-beware-of-tax-scams-theyll-be-everywhere-this-eofy-162171">alleging to be from the Australian Tax Office</a> (ATO) are a great example. You have a debt to pay (apparently) and things will go badly if you don’t pay right now. Scammers play on your emotions to provoke reactions that cloud judgement. They may threaten legal trouble to instil fear, promise high investment returns to exploit greed, or share fabricated distressing stories to elicit sympathy and financial assistance. <h2>3. Building rapport with casual talk</h2> Through extended conversation, scammers build a psychological commitment to their scheme. No one gets very far by just demanding your password, but it’s natural to be friendly with people who are friendly towards us. After staying on the line for long periods of time, the victim also becomes cognitively fatigued. This not only makes the victim more open to suggestions, but also isolates them from friends or family who might recognise and counteract the scam. <h2>4. Help me to help you</h2> In this case, the scammer creates a situation where they help you to solve a real or imaginary problem (that they actually created). They work their “IT magic” and the problem goes away. Later, they ask you for something you wouldn’t normally do, and you do it because of the “social debt”: they helped you first. For example, a hacker might attack a corporate network, causing it to slow down. Then they call you, pretending to be from your organisation, perhaps as a recent hire not yet on the company’s contact list. They “help” you by turning off the attack, leaving you suitably grateful. Perhaps a week later, they call again and ask for sensitive information, such as the CEO’s password. You know company policy is to not divulge it, but the scammer will ask if you remember them (of course you do) and come up with an excuse for why they really need this password. The balance of the social debt says you will help them. <h2>5. Appealing to authority</h2> By posing as line managers, officials from government agencies, banks, or other authoritative bodies, scammers exploit our natural tendency to obey authority. Such scams operate at varying levels of sophistication. The simple version: your manager messages you with an urgent request to purchase some gift cards and send through their numbers. The complex version: your manager calls and asks to urgently transfer a large sum of money to an account you don’t recognise. You do this because <a href="https://www.wsj.com/articles/fraudsters-use-ai-to-mimic-ceos-voice-in-unusual-cybercrime-case-11567157402">it sounds exactly</a> like your manager on the phone – but the scammer <a href="https://www.forbes.com/sites/thomasbrewster/2021/10/14/huge-bank-fraud-uses-deep-fake-voice-tech-to-steal-millions/?sh=1329b80e7559">is using a voice deepfake</a>. In a recent major case in Hong Kong, such a scam even involved a <a href="https://edition.cnn.com/2024/02/04/asia/deepfake-cfo-scam-hong-kong-intl-hnk/index.html">deepfake video call</a>. This is deeply challenging because artificial intelligence tools, such as Microsoft’s VALL-E, can create <a href="https://arstechnica.com/information-technology/2023/01/microsofts-new-ai-can-simulate-anyones-voice-with-3-seconds-of-audio/">a voice deepfake</a> using just three seconds of sampled audio from a real person. <h2>How can you defend against a scam?</h2> First and foremost, verify identity. Find another way to contact the person to verify who they are. For example, you can call a generic number for the business and ask to be connected. In the face of rampant voice deepfakes, it can be helpful to agree on a “safe word” with your family members. If they call from an unrecognised number and you don’t hear the safe word just hang up. Watch out for pressure tactics. If the conversation is moving too fast, remember that someone else’s problem is not yours to solve. Stop and run the problem past a colleague or family member for a sanity check. A legitimate business will have no problem with you doing this. Lastly, if you are not sure about even the slightest detail, the simplest thing is to hang up or not respond. If you really owe a tax debt, the ATO will write to you.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223959/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mike-johnstone-106590">Mike Johnstone</a>, Security Researcher, Associate Professor in Resilient Systems, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> and <a href="https://theconversation.com/profiles/georgia-psaroulis-1513050">Georgia Psaroulis</a>, Postdoctoral research fellow, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-psychological-warfare-tactics-do-scammers-use-and-how-can-you-protect-yourself-223959">original article</a>.

Money & Banking

The art of ‘getting lost’: how re-discovering your city can be an antidote to capitalism

<a href="https://theconversation.com/profiles/stephen-dobson-1093706">Stephen Dobson</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Do you remember what it was like to discover the magic of a city for the first time? Do you remember the noises, smells, flashing lights and pulsating crowds? Or do you mostly remember cities through the screen of your phone? In 1967, French philosopher and filmmaker Guy Debord <a href="https://files.libcom.org/files/The%20Society%20of%20the%20Spectacle%20Annotated%20Edition.pdf">publicised the need</a> to move away from living our lives as bystanders continually tempted by the power of images. Today, we might see this in a young person flicking from one TikTok to the next – echoing the hold images have on us. But adults aren’t adverse to this window-shopping experience, either. Debord notes we have a tendency to observe rather than engage. And this is to our detriment. Continually topping-up our image consumption leaves no space for the unplanned – the reveries to break the pattern of an ordered life. Debord was a member of a group called the <a href="https://www.britannica.com/topic/Situationist-International">Situationist International</a>, dedicated to new ways we could reflect upon and experience our cities. Active for about 15 years, they believed we should experience our cities as an act of resistance, in direct opposition to the (profit-motivated) capitalistic structures that demand our attention and productivity every waking hour. More than 50 years since the group dissolved, the Situationists’ philosophy points us to a continued need to attune ourselves – through our thoughts and senses – to the world we live in. We might consider them as early eco-warriors. And through better understanding their philosophy, we can develop a new relationship with our cities today. <h2>Understanding the ‘situation’</h2> The Situationist International movement was <a href="https://www.jstor.org/stable/j.ctt183p61x">formed</a> in 1957 in Cosio di Arroscia, Italy, and became active in several European countries. It brought together radical artists inspired by spontaneity, experimentalism, intellectualism, protest and hedonism. Central figures included Danish artist <a href="https://museumjorn.dk/en/">Asger Jorn</a>, French novelist <a href="https://mitpress.mit.edu/author/michele-bernstein-10219/">Michèle Bernstein</a> and Italian musician and composer <a href="https://en.wikipedia.org/wiki/Walter_Olmo">Walter Olmo</a>. The Situationists were driven by a <a href="https://encyclopedia.pub/entry/34141">libertarian form of Marxism</a> that resisted mass consumerism. One of the group’s early terms was “unitary urbanism”, which sought to join avant-garde art with the critique of mass production and technology. They rejected “urbanism’s” conventional emphasis on function, and instead thought about art and the environment as inexorably interrelated. By rebelling against the invasiveness of consumption, the Situationists proposed a turn towards artistically-inspired individuality and creativity. <h2>Think on your own two feet</h2> According to the 1960 <a href="https://hts3.files.wordpress.com/2010/12/situationist-international-manifesto.pdf">Situationist Manifesto</a> we are all to be artists of our own “situations”, crafting independent identities as we stand on our own two feet. They believed this could be achieved, in part, through “<a href="https://www.tate.org.uk/art/art-terms/p/psychogeography#:%7E:text=Psychogeography%20describes%20the%20effect%20of,emotions%20and%20behaviour%20of%20individuals">psychogeography</a>”: the idea that geographical locations exert a unique psychological effect on us. For instance, when you walk down a street, the architecture around you may be deliberately designed to encourage a certain kind of experience. Crossing a vibrant city square on a sunny morning evokes joy and a feeling of connection with others. There’s also usually a public event taking place. The Situationists valued drift, or dérive in French. This alludes to unplanned movement through a landscape during journeys on foot. By drifting aimlessly, we unintentionally redefine the traditional rules imposed by private or public land owners and property developers. We make ourselves open to the new unexpected and, in doing so, are liberated from the shackles of everyday routine. In <a href="https://link.springer.com/book/10.1007/978-981-10-8100-2">our research</a>, my colleagues and I consider cities as places in which “getting lost” means exposing yourself to discovering the new and taken-for-granted. <h2>Forge your own path</h2> By understanding the Situationists – by looking away from our phones and allowing ourselves to get lost – we can rediscover our cities. We can see them for what they are beneath the blankets of posters, billboards and advertisements. How might we take back the image and make it work for us? The practise of geo-tagging images on social media, and sharing our location with others, could be considered close to the spirit of the Situationists. Although it’s often met with claims of <a href="https://www.nationalgeographic.com/travel/article/when-why-not-to-use-geotagging-overtourism-security">over-fuelling tourism</a> (especially regarding idyllic or otherwise protected sites), geo-tagging could <a href="https://www.melaninbasecamp.com/trip-reports/2019/5/1/five-reasons-why-you-should-keep-geotagging">inspire us</a> to actively seek out new places through visiting the source of an image. This could lead to culturally respectful engagement, and new-found respect for the rights of traditional custodians as we experience their lands in real life, rather than just through images on our phones. Then there are uniquely personal and anarchistic forms of resistance, wherein we can learn about the world around us by interweaving ourselves with our histories. In doing so we offer a new meaning to a historical message, and a new purpose. The Situationists called this process <a href="https://www.theartstory.org/movement/situationist-international/">détournement</a>, or hijacking. For instance, from my grandfather I inherited a biscuit tin of black and white photographs I believe were taken in the 1960s. They showed images of parks and wildlife, perhaps even of the same park, and cityscapes of London with people, streets and buildings. I have spent many hours wandering the London streets tracking down the exact places these images were snapped. I was juxtaposing past with present, and experiencing both continuity and change in the dialogues I had with my grandfather. In this way, I used images to augment (rather than replace) my lived experience of the material world. Urban art installations can also be examples of detournment as they make us re-think everyday conceptions. <a href="https://www.cityartsydney.com.au/artwork/forgotten-songs/">Forgotten Songs</a> by Michael Hill is one such example. A canopy of empty birdcages commemorates the songs of 50 different birds once heard in central Sydney, but which are now lost due to habitat removal as a result of urban development. There are also a number of groups, often with a strong environmental or civic rights focus, that partake in detournment. <a href="https://popularresistance.org/dancing-revolution-how-90s-protests-used-rave-culture-to-reclaim-the-streets/">Reclaim the Streets</a> is a movement with a long history in Australia. The group advocates for communities having ownership of and agency within public spaces. They may, for instance, “invade” a highway to throw a “<a href="https://pasttenseblog.files.wordpress.com/2022/02/road-rave.pdf">road rave</a>” as an act of reclamation. <figure><iframe src="https://www.youtube.com/embed/bUL0C_T-Sqk?wmode=transparent&start=999" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> As French avant-garde philosopher <a href="https://www.themarginalian.org/2014/07/24/the-poetics-of-reverie-gaston-bachelard/">Gaston Bachelard</a> might have put it, when we’re bombarded by images there is no space left to daydream. We lose the opportunity to explore and question the world capitalism serves us through images. Perhaps now is a good time to set down the phone and follow in the Situationists’ footsteps. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221606/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/stephen-dobson-1093706">Stephen Dobson</a>, Professor and Dean of Education and the Arts, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-art-of-getting-lost-how-re-discovering-your-city-can-be-an-antidote-to-capitalism-221606">original article</a>.

Travel Tips

Out of the rabbit hole: new research shows people can change their minds about conspiracy theories

<a href="https://theconversation.com/profiles/matt-williams-666794">Matt Williams</a>, <a href="https://theconversation.com/institutions/massey-university-806">Massey University</a>; <a href="https://theconversation.com/profiles/john-kerr-1073102">John Kerr</a>, <a href="https://theconversation.com/institutions/university-of-otago-1304">University of Otago</a>, and <a href="https://theconversation.com/profiles/mathew-marques-14884">Mathew Marques</a>, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> Many people <a href="https://theconversation.com/was-phar-lap-killed-by-gangsters-new-research-shows-which-conspiracies-people-believe-in-and-why-158610">believe at least one</a> conspiracy theory. And that isn’t necessarily a bad thing – conspiracies do happen. To take just one example, the CIA really did engage in <a href="https://www.politico.com/story/2019/04/13/cia-mind-control-1266649">illegal experiments</a> in the 1950s to identify drugs and procedures that might produce confessions from captured spies. However, many conspiracy theories are not supported by evidence, yet still attract believers. For example, in a <a href="https://doi.org/10.1111/pops.12746">previous study</a>, we found about 7% of New Zealanders and Australians agreed with the theory that <a href="https://www.earthdata.nasa.gov/learn/sensing-our-planet/on-the-trail-of-contrails">visible trails behind aircraft</a> are “chemtrails” of chemical agents sprayed as part of a secret government program. That’s despite the theory being <a href="https://iopscience.iop.org/article/10.1088/1748-9326/11/8/084011">roundly rejected</a> by the scientific community. The fact that conspiracy theories attract believers despite a lack of credible evidence remains a puzzle for researchers in psychology and other academic disciplines. Indeed, there has been a great deal of research on conspiracy theories published in the past few years. We now know more about how many people believe them, as well as the psychological and political factors that <a href="https://www.nature.com/articles/s41598-022-25617-0">correlate with that belief</a>. But we know much less about how often people change their minds. Do they do so frequently, or do they to stick tenaciously to their beliefs, regardless of what evidence they come across? <h2>From 9/11 to COVID</h2> We set out to answer this question using a <a href="https://doi.org/10.1038/s41598-024-51653-z">longitudinal survey</a>. We recruited 498 Australians and New Zealanders (using the <a href="http://prolific.com">Prolific</a> website, which recruits people to take part in paid research). Each month from March to September 2021, we presented our sample group with a survey, including ten conspiracy theories, and asked them how much they agreed with each one. All of these theories related to claims about events that are either ongoing, or occurred this millennium: the September 11 attacks, the rollout of 5G telecommunications technology, and COVID-19, among others. While there were definitely some believers in our sample, most participants disagreed with each of the theories. The most popular theory was that “pharmaceutical companies (‘Big Pharma’) have suppressed a cure for cancer to protect their profits”. Some 18% of the sample group agreed when first asked. The least popular was the theory that “COVID-19 ‘vaccines’ contain microchips to monitor and control people”. Only 2% agreed. <h2>Conspiracy beliefs probably aren’t increasing</h2> Despite contemporary concerns about a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320252/">pandemic of misinformation</a>” or “<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30461-X/fulltext">infodemic</a>”, we found no evidence that individual beliefs in conspiracy theories increased on average over time. This was despite our data collection happening during the tumultuous second year of the COVID-19 pandemic. Lockdowns were still happening occasionally in both <a href="https://www.timeout.com/melbourne/things-to-do/a-timeline-of-covid-19-in-australia-two-years-on">Australia</a> and <a href="https://covid19.govt.nz/about-our-covid-19-response/history-of-the-covid-19-alert-system/">New Zealand</a>, and anti-government sentiment was building. While we only tracked participants for six months, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270429">other studies</a> over much longer time frames have also found little evidence that beliefs in conspiracy theories are increasing over time. <hr /> <iframe class="flourish-embed-iframe" style="width: 100%; height: 600px;" title="Interactive or visual content" src="https://flo.uri.sh/visualisation/16665395/embed" width="100%" height="400" frameborder="0" scrolling="no" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation"></iframe> <div style="width: 100%!; margin-top: 4px!important; text-align: right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/16665395/?utm_source=embed&utm_campaign=visualisation/16665395" target="_top"><img src="https://public.flourish.studio/resources/made_with_flourish.svg" alt="Made with Flourish" /></a></div> <hr /> Finally, we found that beliefs (or non-beliefs) in conspiracy theories were stable – but not completely fixed. For any given theory, the vast majority of participants were “consistent sceptics” – not agreeing with the theory at any point. There were also some “consistent believers” who agreed at every point in the survey they responded to. For most theories, this was the second-largest group. Yet for every conspiracy theory, there was also a small proportion of converts. They disagreed with the theory at the start of the study, but agreed with it by the end. There was also a small proportion of “apostates” who agreed with the theory at the start, but disagreed by the end. Nevertheless, the percentages of converts and apostates tended to balance each other pretty closely, leaving the percentage of believers fairly stable over time. <h2>Inside the ‘rabbit hole’</h2> This relative stability is interesting, because <a href="https://www.jstor.org/stable/2564659">one criticism</a> of conspiracy theories is that they may not be “<a href="https://www.britannica.com/topic/criterion-of-falsifiability">falsifiable</a>”: what seems like evidence against a conspiracy theory can just be written off by believers as part of the cover up. Yet people clearly do sometimes decide to reject conspiracy theories they previously believed. Our findings bring into question the popular notion of the “rabbit hole” – that people rapidly develop beliefs in a succession of conspiracy theories, much as Alice tumbles down into Wonderland in Lewis Carroll’s <a href="https://www.gutenberg.org/ebooks/11">famous story</a>. While it’s possible this does happen for a small number of people, our results suggest it isn’t a typical experience. For most, the <a href="https://www.latrobe.edu.au/news/articles/2023/opinion/how-to-talk-to-someone-about-conspiracy-theories">journey into</a> conspiracy theory belief might involve a more gradual slope – a bit like a <a href="https://zslpublications.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1469-7998.1985.tb05649.x">real rabbit burrow</a>, from which one can also emerge. <hr /> Mathew Ling (<a href="https://www.neaminational.org.au/">Neami National</a>), Stephen Hill (Massey University) and Edward Clarke (Philipps-Universität Marburg) contributed to the research referred to in this article.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222507/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <hr /> <a href="https://theconversation.com/profiles/matt-williams-666794">Matt Williams</a>, Senior Lecturer in Psychology, <a href="https://theconversation.com/institutions/massey-university-806">Massey University</a>; <a href="https://theconversation.com/profiles/john-kerr-1073102">John Kerr</a>, Senior Research Fellow, <a href="https://theconversation.com/institutions/university-of-otago-1304">University of Otago</a>, and <a href="https://theconversation.com/profiles/mathew-marques-14884">Mathew Marques</a>, Senior Lecturer in Social Psychology, <a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/out-of-the-rabbit-hole-new-research-shows-people-can-change-their-minds-about-conspiracy-theories-222507">original article</a>.

Mind

Your unique smell can provide clues about how healthy you are

<a href="https://theconversation.com/profiles/aoife-morrin-1478132">Aoife Morrin</a>, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Hundreds of chemicals stream from our bodies into the air every second. These chemicals release into the air easily as they have high vapour pressures, meaning they boil and turn into gases at room temperature. They give clues about who we are, and how healthy we are. Since ancient Greek times, we’ve known that we smell differently when we are unwell. While we rely on blood analysis today, ancient Greek physicians used smell to diagnose maladies. If they took a whiff of your breath and described it as fetor hepaticus (meaning bad liver), it meant you could be headed for liver failure. If a person’s whiff was sweet or fruity, physicians thought this meant that sugars in the digestive system were not being broken down, and that person had probably diabetes. Science has since shown the ancient Greeks were right – liver failure and <a href="https://tisserandinstitute.org/human-volatilome/">diabetes</a> and many <a href="https://link.springer.com/article/10.1007/s00216-023-04986-z">other diseases</a> including infectious diseases give your breath a distinctive smell. In 1971, <a href="https://www.nobelprize.org/prizes/peace/1962/pauling/facts/">Nobel Laureate chemist Linus Pauling</a> <a href="https://edu.rsc.org/feature/breath-analysis/2020106.article#:%7E:text=The%20'modern%20era'%20of%20breath,in%20an%20average%20breath%20sample.">counted 250 different</a> gaseous chemicals in breath. These gaseous chemicals are called volatile organic compounds or VOCs. <figure><iframe src="https://www.youtube.com/embed/RzozmYPfCmM?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Since Pauling’s discovery, other scientists have <a href="https://link.springer.com/article/10.1007/s40291-023-00640-7">discovered hundreds more VOCs</a> in our breath. We have learned that many of these VOCs have distinctive odours, but some have no odour that our noses can perceive. Scientists believe that whether a VOC <a href="https://tisserandinstitute.org/human-volatilome/">has an odour</a> that our noses can detect or not, they can reveal information about how healthy someone is. A Scottish man’s Parkinson’s disease onset was <a href="https://www.bbc.co.uk/news/uk-scotland-47627179">identified by his wife</a>, retired nurse Joy Milner, after she was convinced the way he smelled had changed, years before he was diagnosed in 2005. This discovery has <a href="https://www.manchester.ac.uk/discover/news/smell-of-skin-could-lead-to-early-diagnosis-for-parkinsons/">led to research programmes</a> involving Joy Milner to identify <a href="https://www.scientificamerican.com/article/a-supersmeller-can-detect-the-scent-of-parkinsons-leading-to-an-experimental-test-for-the-illness/">the precise smell</a> of this disease. Dogs can <a href="https://www.nature.com/articles/d41586-022-01629-8">sniff out more diseases</a> than humans because of their more <a href="https://www.understandinganimalresearch.org.uk/news/the-science-of-sniffs-disease-smelling-dogs%20-%20I%20think%20the%20previous%20nature%20link%20has%20more%20credibility%20for%20here%20also">sophisticated olfactory talents</a>. But technological techniques, like <a href="https://www.britannica.com/science/mass-spectrometry">analytical tool mass spectrometry</a>, picks up even more subtle changes in VOC profiles that are being linked to <a href="https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(20)30100-6/fulltext">gut</a>, <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S0165993618305168">skin</a> and <a href="https://err.ersjournals.com/content/28/152/190011">respiratory</a> diseases as well as neurological diseases like Parkinson’s. Researchers believe that one day some diseases will be diagnosed simply by breathing into a device. <figure><iframe src="https://www.youtube.com/embed/Xjo2M-XMYfs?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Where do VOCs come from?</h2> Breath is not the only source of VOCs in the body. They are also emitted from skin, urine and faeces. VOCs from skin are the result of millions of skin glands removing metabolic waste from the body, as well as waste generated by bacteria and other microbes that live on our skin. Sweating produces extra nutrients for these bacteria to metabolise which can result in particularly odorous VOCs. Odour from sweat only makes up a fraction of the scents from VOCs though. <a href="https://www.nature.com/articles/nrmicro.2017.157">Our skin</a> and also our gut microbiomes are made up from a delicate balance of these microbes. Scientists think <a href="https://journals.lww.com/co-gastroenterology/abstract/2015/01000/the_gut_microbiome_in_health_and_in_disease.12.aspx">they influence our health</a>, but we don’t yet understand a lot about how this relationship works. Unlike the gut, the skin is relatively easy to study – you can collect skin samples from living humans without having to go deep into the body. <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S1471492221002087">Scientists think</a> skin VOCs can offer insights into how the microbiome’s bacteria and the human body work together to maintain our health and protect us from disease. In my team’s laboratory, <a href="https://iopscience.iop.org/article/10.1088/1752-7163/abf20a">we are investigating</a> whether the skin VOC signature can reveal different attributes of the person it belongs to. These signals in skin VOC signatures are probably how dogs distinguish between people by smell. We are at a relatively early stage in this research area but we have shown that you can tell males from females based on how acidic the VOCs from skin are. We use mass spectrometry to see this as the average human nose is not sophisticated enough to detect these VOCs. We can also predict a person’s age with reasonable accuracy to within a few years from their skin VOC profile. This is not surprising considering that oxidative stress in our bodies increases as we age. <a href="https://www.metabolismjournal.com/article/S0026-0495(00)80077-3/pdf">Oxidative stress</a> happens when your antioxidant levels are low and causes irreversible damage to our cells and organs. <a href="https://pubs.acs.org/doi/10.1021/jasms.3c00315">Our recent research</a> found by-products of this oxidative damage in skin VOC profiles. Not only are these VOCs responsible for personal scent – they are used by plants, insects and animals as a communication channel. Plants are in a <a href="https://www.nature.com/articles/s41598-017-10975-x">constant VOC dialogue</a> with other organisms including pollinators, herbivores, other plants and their natural enemies such as harmful bacteria and insects. VOCs used for this back and forth dialogue are known as pheromones. <h2>What has science shown about love pheromones?</h2> In the animal kingdom, there is good evidence VOCs can act as aphrodisiacs. Mice for example have microbes which contribute to a particularly <a href="https://www.sciencedirect.com/science/article/pii/S0960982212012687">smelly compound called trimethylamine</a>, which allows mice to verify the species of a potential mate. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0093691X21003083">Pigs</a> and <a href="https://www.nature.com/articles/4381097a">elephants</a> have sex pheromones too. It is possible that humans also produce VOCs for attracting the perfect mate. Scientists have yet to fully decode skin – or other VOCs that are released from our bodies. But evidence for human love pheromones so far is <a href="https://www.science.org/content/article/do-human-pheromones-actually-exist">controversial at best</a>. <a href="https://www.newscientist.com/article/dn3835-colour-vision-ended-human-pheromone-use/">One theory suggests</a> that they were lost about 23 million years ago when primates developed full colour vision and started relying on their enhanced vision to choose a mate. However, we believe that whether human pheromones exist or not, skin VOCs can reveal who and how we are, in terms of things like ageing, nutrition and fitness, fertility and even stress levels. This signature probably contains markers we can use to monitor our health and diagnose disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215311/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/aoife-morrin-1478132">Aoife Morrin</a>, Associate Professor of Analytical Chemistry, <a href="https://theconversation.com/institutions/dublin-city-university-1528">Dublin City University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/your-unique-smell-can-provide-clues-about-how-healthy-you-are-215311">original article</a>.

Body

What is doxing, and how can you protect yourself?

<a href="https://theconversation.com/profiles/rob-cover-13135">Rob Cover</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> The Australian government has brought forward <a href="https://www.theguardian.com/australia-news/2024/feb/12/albanese-government-to-propose-legislation-to-crack-down-on-doxing">plans to criminalise doxing</a>, bringing nationwide attention to the harms of releasing people’s private information to the wider public. The government response comes after the <a href="https://www.smh.com.au/national/hundreds-of-jewish-creatives-have-names-details-taken-in-leak-published-online-20240208-p5f3if.html">public release of almost 600 names</a> and private chat logs of a WhatsApp group of Australian Jewish creative artists discussing the Israel-Hamas war. As a result, some of the people whose details were leaked claim they were harassed, <a href="https://www.theguardian.com/australia-news/2024/feb/09/josh-burns-jewish-whatsapp-group-channel-publication-israel-palestine-clementine-ford">received death threats</a> and even had to go into hiding. While we wait for <a href="https://www.smh.com.au/national/australia-news-live-federal-laws-on-doxxing-to-be-brought-forward-anniversary-of-stolen-generations-apology-20240213-p5f4eh.html?post=p55nen#p55nen">new penalties</a> for doxers under the federal Privacy Act review, understanding doxing and its harms can help. And there are also steps we can all take to minimise the risk. <h2>What is doxing?</h2> <a href="https://www.kaspersky.com/resource-center/definitions/what-is-doxing">Doxing</a> (or doxxing) is releasing private information — or “docs”, short for documents — online to the wider public without the user’s consent. This includes information that may put users at risk of harm, especially names, addresses, employment details, medical or financial records, and names of family members. The Australian government <a href="https://ministers.ag.gov.au/media-centre/transcripts/media-conference-parliament-house-13-02-2024">currently defines doxing</a> as the “malicious release” of people’s private information without their consent. Doxing began as a form of unmasking anonymous users, trolls and those using hate speech while <a href="https://www.theatlantic.com/technology/archive/2022/04/doxxing-meaning-libs-of-tiktok/629643/">hiding behind a pseudonym</a>. Recently, it has become a weapon for online abuse, harassment, hate speech and adversarial politics. It is often the outcome of online arguments or polarised public views. It is also becoming more common. Although there is no data for Australia yet, according to media company <a href="https://www.safehome.org/family-safety/doxxing-online-harassment-research/">SafeHome.org</a>, about 4% of Americans report having been doxed, with about half saying their private emails or home addresses have been made public. Doxing is a crime in some countries such as the Netherlands and South Korea. In other places, including Australia, privacy laws haven’t yet caught up. <h2>Why is doxing harmful?</h2> In the context of the <a href="https://theconversation.com/au/topics/israel-hamas-war-146714">Israel-Hamas war</a>, doxing has affected <a href="https://www.haaretz.com/world-news/asia-and-australia/2024-02-06/ty-article/death-threats-boycotts-target-jewish-creatives-in-australia/0000018d-7e43-d636-adef-7eefae580000">both Jewish</a> and <a href="https://edition.cnn.com/2023/10/15/business/palestinian-americans-activists-doxxing/index.html">pro-Palestinian communities and activists</a> in Australia and abroad. Doxing is harmful because it treats a user as an object and takes away their agency to decide what, and how much, personal information they want shared with the wider public. This puts people at very real risk of physical threats and violence, particularly when public disagreement becomes heated. From a broader perspective, doxing also damages the digital ecology, reducing people’s ability to freely participate in public or even private debate through social media. Although doxing is sometimes just inconvenient, it is often used to publicly shame or humiliate someone for their private views. This can take a toll on a person’s mental health and wellbeing. It can also affect a person’s employment, especially for people whose employers require them to keep their attitudes, politics, affiliations and views to themselves. Studies have shown doxing particularly impacts <a href="https://journals.sagepub.com/doi/full/10.1177/0306422015605714">women</a>, including those using dating apps or experiencing family violence. In some cases, children and family members have been threatened because a high-profile relative has been doxed. Doxing is also harmful because it oversimplifies a person’s affiliations or attitudes. For example, releasing the names of people who have joined a private online community to navigate complex views can represent them as only like-minded stereotypes or as participants in a group conspiracy. <h2>What can you do to protect yourself from doxing?</h2> Stronger laws and better platform intervention are necessary to reduce doxing. Some experts believe that the fear of <a href="https://dl.acm.org/doi/abs/10.1145/3476075">punishment</a> can help shape better online behaviours. These punishments may include criminal <a href="https://www.esafety.gov.au/report/what-you-can-report-to-esafety">penalties</a> for perpetrators and <a href="https://www.theaustralian.com.au/breaking-news/doxxing-attack-on-jewish-australians-prompts-call-for-legislative-change/news-story/9a2f3615dbf5594fb521a8959739e1f8#:%7E:text=Alongside%20legislative%20reform%2C%20the%20ECAJ,information%2C%E2%80%9D%20Mr%20Aghion%20said.">deactivating social media accounts</a> for repeat offenders. But better education about the risks and harms is often the best treatment. And you can also protect yourself without needing to entirely withdraw from social media: <ol> <li> never share a home or workplace address, phone number or location, including among a private online group or forum with trusted people </li> <li> restrict your geo-location settings </li> <li> avoid giving details of workplaces, roles or employment on public sites not related to your work </li> <li> avoid adding friends or connections on social media services of people you do not know </li> <li> if you suspect you risk being doxed due to a heated online argument, temporarily shut down or lock any public profiles </li> <li> avoid becoming a target by pursuing haters when it reaches a certain point. Professional and courteous engagement can help avoid the anger of those who might disagree and try to harm you. </li> </ol> Additionally, hosts of private online groups must be very vigilant about who joins a group. They should avoid the trap of accepting members just to increase the group’s size, and appropriately check new members (for example, with a short survey or key questions that keep out people who may be there to gather information for malicious purposes). Employers who require their staff to have online profiles or engage with the public should provide information and strategies for doing so safely. They should also provide immediate support for staff who have been doxed.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223428/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rob-cover-13135">Rob Cover</a>, Professor of Digital Communication and Co-Director of the RMIT Digital Ethnography Research Centre, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-doxing-and-how-can-you-protect-yourself-223428">original article</a>.

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Your unique smell can provide clues about how healthy you are

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What are heart rate zones, and how can you incorporate them into your exercise routine?

How extreme dieting can affect bone health

If you have money anxiety, knowing your financial attachment style can help

How tracking menopause symptoms can give women more control over their health

Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

What are the most common symptoms of menopause? And which can hormone therapy treat?

Here’s why having chocolate can make you feel great or a bit sick – plus 4 tips for better eating

Summer’s over, so how much sun can (and should) I get?

Altitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare

MH370 disappearance 10 years on: can we still find it

How can I stop overthinking everything? A clinical psychologist offers solutions

Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one

How long does back pain last? And how can learning about pain increase the chance of recovery?

Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like

What ‘psychological warfare’ tactics do scammers use, and how can you protect yourself?

The art of ‘getting lost’: how re-discovering your city can be an antidote to capitalism

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Your unique smell can provide clues about how healthy you are

What is doxing, and how can you protect yourself?

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