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

<p><em><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></em></p> <p>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.</p> <p><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.</p> <p>But what are the different heart rate zones, and how can you use these zones to optimise your workout?</p> <h2>The three-zone model</h2> <p>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:</p> <ul> <li> <p>zone 1: 55%–82% of maximum heart rate</p> </li> <li> <p>zone 2: 82%–87% of maximum heart rate</p> </li> <li> <p>zone 3: 87%–97% of maximum heart rate.</p> </li> </ul> <p>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.</p> <p>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.</p> <h2>What do the different zones involve?</h2> <p>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.</p> <p>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.</p> <p>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>.</p> <p>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>.</p> <p><strong>Zone 1</strong> 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.</p> <p><strong>Zone 2</strong> 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.</p> <p><strong>Zone 3</strong> 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.</p> <h2>Striking a balance</h2> <p>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.</p> <p>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.</p> <p>Training in different heart rate zones improves <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&amp;type=pdf&amp;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.</p> <h2>So how much time should you spend in each zone?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <h2>What if I don’t have a heart rate monitor?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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" /></p> <p><em><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></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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>.</em></p>

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How extreme dieting can affect bone health

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p><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.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;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&amp;q=45&amp;auto=format&amp;w=600&amp;h=338&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=338&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=338&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=424&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=424&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/591182/original/file-20240430-18-u30byz.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=424&amp;fit=crop&amp;dpr=3 2262w" alt="The interior of bones, showing four depictions of bone density – from healthy to severe osteoporosis." /><figcaption><span class="caption">The more crystals detected, the better your bone density.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/osteoporosis-4-stages-one-picture-3d-524364046">Crevis/ Shutterstock</a></span></figcaption></figure> <p>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.</p> <h2>Bone density</h2> <p>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>.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p><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.</p> <p><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.</p> <p>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.</p> <p>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>.</p> <h2>Can bone health be fixed?</h2> <p>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>.</p> <p>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.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><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></em></p> <p><em>Image credits: Getty </em><em>Images</em></p> <p><em>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>.</em></p> </div>

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What is childhood dementia? And how could new research help?

<p><em><a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p>“Childhood” and “dementia” are two words we wish we didn’t have to use together. But sadly, around <a href="https://doi.org/10.1093/brain/awad242">1,400 Australian children and young people</a> live with currently untreatable childhood dementia.</p> <p>Broadly speaking, childhood dementia is caused by any one of <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">more than 100</a> rare genetic disorders. Although the causes differ from dementia acquired later in life, the progressive nature of the illness is the same.</p> <p><a href="https://doi.org/10.1093/brain/awad242">Half</a> of infants and children diagnosed with childhood dementia will not reach their tenth birthday, and most will die <a href="https://www.childhooddementia.org/what-is-childhood-dementia#what">before turning 18</a>.</p> <p>Yet this devastating condition has lacked awareness, and importantly, the research attention needed to work towards treatments and a cure.</p> <h2>More about the causes</h2> <p>Most types of childhood dementia are <a href="https://academic.oup.com/brain/article/146/11/4446/7226999">caused</a> by <a href="https://www.genome.gov/genetics-glossary/Mutation">mutations</a> (or mistakes) in our <a href="https://www.genome.gov/genetics-glossary/Deoxyribonucleic-Acid">DNA</a>. These mistakes lead to a range of rare genetic disorders, which in turn cause childhood dementia.</p> <p><a href="https://doi.org/10.1093/brain/awad242">Two-thirds</a> of childhood dementia disorders are caused by “<a href="https://www.ncbi.nlm.nih.gov/books/NBK459183/">inborn errors of metabolism</a>”. This means the metabolic pathways involved in the breakdown of carbohydrates, lipids, fatty acids and proteins in the body fail.</p> <p>As a result, nerve pathways fail to function, neurons (nerve cells that send messages around the body) die, and progressive cognitive decline occurs.</p> <h2>What happens to children with childhood dementia?</h2> <p>Most children initially appear unaffected. But after a period of apparently normal development, children with childhood dementia <a href="https://doi.org/10.1016/j.pediatrneurol.2023.09.006">progressively lose</a> all previously acquired skills and abilities, such as talking, walking, learning, remembering and reasoning.</p> <p>Childhood dementia also leads to significant changes in behaviour, such as aggression and hyperactivity. Severe sleep disturbance is common and vision and hearing can also be affected. Many children have seizures.</p> <p>The age when symptoms start can vary, depending partly on the particular genetic disorder causing the dementia, but the average is around <a href="https://doi.org/10.1093%2Fbrain%2Fawad242">two years old</a>. The symptoms are caused by significant, progressive brain damage.</p> <h2>Are there any treatments available?</h2> <p>Childhood dementia treatments currently <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">under evaluation</a> or approved are for a very limited number of disorders, and are only available in some parts of the world. These include gene replacement, <a href="https://doi.org/10.1002/jmd2.12378">gene-modified cell therapy</a> and protein or <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1712649">enzyme replacement therapy</a>. Enzyme replacement therapy is available in Australia for <a href="https://australianprescriber.tg.org.au/articles/cerliponase-alfa-for-neuronal-ceroid-lipofuscinosis-type-2-disease.html">one form of childhood dementia</a>. These therapies attempt to “fix” the problems causing the disease, and have shown promising results.</p> <p>Other experimental therapies include ones that <a href="https://doi.org/10.3390/life12050608">target</a> faulty protein production or <a href="https://doi.org/10.1056/nejmoa2310151">reduce inflammation</a> in the brain.</p> <h2>Research attention is lacking</h2> <p>Death rates for Australian children with cancer <a href="http://www.childhooddementia.org/getasset/2WX39O">nearly halved</a> between <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">1997 and 2017</a> thanks to research that has enabled the development of multiple treatments. But over recent decades, <a href="http://www.childhooddementia.org/getasset/2WX39O">nothing has changed</a> for children with dementia.</p> <p>In 2017–2023, research for childhood cancer received over four times more funding per patient compared to funding for <a href="https://www.childhooddementia.org/getasset/2WX39O">childhood dementia</a>. This is despite childhood dementia causing a <a href="https://doi.org/10.1093/brain/awad242">similar number of deaths</a> each year as childhood cancer.</p> <p>The success <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-survival">for childhood cancer sufferers</a> in recent decades demonstrates how adequately funding medical research can lead to improvements in patient outcomes.</p> <p>Another bottleneck for childhood dementia patients in Australia is the lack of access to clinical trials. An <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">analysis</a> published in March this year showed that in December 2023, only two clinical trials were recruiting patients with childhood dementia in Australia.</p> <p>Worldwide however, 54 trials were recruiting, meaning Australian patients and their families are left watching patients in other parts of the world receive potentially lifesaving treatments, with no recourse themselves.</p> <p>That said, we’ve seen a slowing in the establishment of <a href="https://www.childhooddementia.org/news/report-reveals-global-research-inequity">clinical trials</a> for childhood dementia across the world in recent years.</p> <p>In addition, we know from <a href="https://www.childhooddementia.org/join-us/professionals/impacts">consultation with families</a> that current care and support systems <a href="https://www.childhooddementia.org/getasset/44MLP8">are not meeting the needs</a> of children with dementia and their families.</p> <h2>New research</h2> <p>Recently, we were awarded <a href="https://www.premier.sa.gov.au/media-releases/news-items/major-funding-boost-for-research-into-childhood-dementia">new funding</a> for <a href="https://www.flinders.edu.au/giving/our-donors/impact-of-giving/improving-the-lives-of-children-with-dementia">our research</a> on childhood dementia. This will help us continue and expand studies that seek to develop lifesaving treatments.</p> <p>More broadly, we need to see increased funding in Australia and around the world for research to develop and translate treatments for the broad spectrum of childhood dementia conditions.</p> <p><em>Dr Kristina Elvidge, head of research at the <a href="https://www.childhooddementia.org/our-people">Childhood Dementia Initiative</a>, and Megan Maack, director and CEO, contributed to this article.</em><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/228508/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/kim-hemsley-1529322">Kim Hemsley</a>, Head, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/nicholas-smith-1529324">Nicholas Smith</a>, Head, Paediatric Neurodegenerative Diseases Research Group, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a>, and <a href="https://theconversation.com/profiles/siti-mubarokah-1529323">Siti Mubarokah</a>, Research Associate, Childhood Dementia Research Group, Flinders Health and Medical Research Institute, College of Medicine and Public Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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-childhood-dementia-and-how-could-new-research-help-228508">original article</a>.</em></p>

Mind

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King Charles returns to public duties for the first time since diagnosis

<p>King Charles has made his first official public appearance since being diagnosed with cancer in February. </p> <p>In a symbolic appearance on Tuesday morning, the royal visited the Macmillan Cancer Centre at the University College Hospital donning a navy pinstripe suit with a light blue shirt and a pink dinosaur tie.</p> <p>The monarch was joined by his wife, Queen Camilla, with the couple sporting huge smiles as they waved to the crowd outside of the London hospital. </p> <p>The royal couple met with clinicians, patients and families of patients during the visit, and when asked by one patient how his treatment was going, Charles replied: "I'm alright, thank you".</p> <p>In one photo Charles can be seen tenderly placing his hand on the arms of a patient as he spoke with them. </p> <p>One patient discussed her chemotherapy with Charles, who who told her: “I’ve got to have my treatment this afternoon as well,” according to the <em>Mirror</em>.</p> <p>He also shared his reaction to finding out about his diagnosis for the first time, telling one patient: “It’s always a bit of a shock, isn’t it, when they tell you?”</p> <p>The King's hospital visit comes just days after the Palace released a statement confirming that he was showing progress with his treatment and would be resuming official duties. </p> <p>“His Majesty The King will shortly return to public-facing duties after a period of treatment and recuperation following his recent cancer diagnosis,”  it read, before announcing the visit to the cancer centre. </p> <p>“This visit will be the first in a number of external engagements His Majesty will undertake in the weeks ahead.”</p> <p>Despite this, his upcoming summer schedule would not be a full one, with events like the King's Birthday parade, known as Trooping the Colour, and the Royal Ascot, being undertaken on a case-by-case basis. </p> <p>He also plans to host the Emperor and Empress of Japan in late June. </p> <p>“As the first anniversary of the Coronation approaches, Their Majesties remain deeply grateful for the many kindnesses and good wishes they have received from around the world throughout the joys and challenges of the past year,” the statement concluded. </p> <p><em>Image: Getty</em></p>

Caring

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What’s the difference between ADD and ADHD?

<p><em><a href="https://theconversation.com/profiles/kathy-gibbs-1392051">Kathy Gibbs</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p>Around <a href="https://www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd#:%7E:text=Around%201%20in%20every%2020,have%20symptoms%20as%20an%20adult.">one in 20 people</a> has attention-deficit hyperactivity disorder (ADHD). It’s one of the most common neurodevelopmental disorders in childhood and often continues into adulthood.</p> <p>ADHD is <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">diagnosed</a> when people experience problems with inattention and/or hyperactivity and impulsivity that negatively impacts them at school or work, in social settings and at home.</p> <p>Some people call the condition attention-deficit disorder, or ADD. So what’s the difference?</p> <p>In short, what was previously called ADD is now known as ADHD. So how did we get here?</p> <h2>Let’s start with some history</h2> <p>The <a href="https://www.guilford.com/books/Attention-Deficit-Hyperactivity-Disorder/Russell-Barkley/9781462538874">first clinical description</a> of children with inattention, hyperactivity and impulsivity was in 1902. British paediatrician Professor George Still <a href="https://pubmed.ncbi.nlm.nih.gov/26740929/">presented</a> a series of lectures about his observations of 43 children who were defiant, aggressive, undisciplined and extremely emotional or passionate.</p> <p>Since then, our understanding of the condition evolved and made its way into the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. Clinicians use the DSM to diagnose mental health and neurodevelopmental conditions.</p> <p>The first DSM, published in 1952, did not include a specific related child or adolescent category. But the <a href="https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890420355.dsm-ii">second edition</a>, published in 1968, <a href="https://www.tandfonline.com/doi/full/10.1080/00207411.2015.1009310">included a section</a> on behaviour disorders in young people. It referred to ADHD-type characteristics as “hyperkinetic reaction of childhood or adolescence”. This described the excessive, involuntary movement of children with the disorder.</p> <p>In the early 1980s, the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm">third DSM</a> added a condition it called “attention deficit disorder”, listing two types: attention deficit disorder <em>with</em> hyperactivity (ADDH) and attention deficit disorder as the subtype <em>without</em> the hyperactivity.</p> <p>However, seven years later, a revised DSM (DSM-III-R) replaced ADD (and its two sub-types) with ADHD and three sub-types we have today:</p> <ul> <li>predominantly inattentive</li> <li>predominantly hyperactive-impulsive</li> <li>combined.</li> </ul> <h2>Why change ADD to ADHD?</h2> <p>ADHD replaced ADD in the DSM-III-R in 1987 for a number of reasons.</p> <p>First was the controversy and debate over the presence or absence of hyperactivity: the “H” in ADHD. When ADD was <a href="https://www.guilford.com/books/Attention-Deficit-Hyperactivity-Disorder/Russell-Barkley/9781462538874">initially named</a>, little research had been done to determine the similarities and differences between the two sub-types.</p> <p>The next issue was around the term “attention-deficit” and whether these deficits were similar or different across both sub-types. Questions also arose about the extent of these differences: if these sub-types were so different, were they actually different conditions?</p> <p>Meanwhile, a new focus on inattention (an “attention deficit”) recognised that children with inattentive behaviours <a href="https://academic.oup.com/shm/article/30/4/767/2919401">may not necessarily be</a> disruptive and challenging but are more likely to be forgetful and daydreamers.</p> <h2>Why do some people use the term ADD?</h2> <p>There was a <a href="https://academic.oup.com/shm/article/30/4/767/2919401">surge of diagnoses</a> in the 1980s. So it’s understandable that some people still hold onto the term ADD.</p> <p>Some may identify as having ADD because out of habit, because this is what they were originally diagnosed with or because they don’t have hyperactivity/impulsivity traits.</p> <p>Others who don’t have ADHD may use the term they came across in the 80s or 90s, not knowing the terminology has changed.</p> <h2>How is ADHD currently diagnosed?</h2> <p>The three sub-types of ADHD, outlined in the DSM-5 are:</p> <ul> <li> <p>predominantly inattentive. People with the inattentive sub-type have difficulty sustaining concentration, are easily distracted and forgetful, lose things frequently, and are unable to follow detailed instructions</p> </li> <li> <p>predominantly hyperactive-impulsive. Those with this sub-type find it hard to be still, need to move constantly in structured situations, frequently interrupt others, talk non-stop and struggle with self control</p> </li> <li> <p>combined. Those with the combined sub-type experience the characteristics of those who are inattentive and hyperactive-impulsive.</p> </li> </ul> <p>ADHD diagnoses <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/children-mental-illness">continue to rise</a> among children and adults. And while ADHD was commonly diagnosed in boys, more recently we have seen growing numbers of girls and women seeking diagnoses.</p> <p>However, some international experts <a href="https://academic.oup.com/shm/article/30/4/767/2919401">contest</a> the expanded definition of ADHD, driven by clinical practice in the United States. They argue the challenges of unwanted behaviours and educational outcomes for young people with the condition are uniquely shaped by each country’s cultural, political and local factors.</p> <p>Regardless of the name change to reflect what we know about the condition, ADHD continues to impact educational, social and life situations of many children, adolescents and adults.<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/225162/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/kathy-gibbs-1392051">Kathy Gibbs</a>, Program Director for the Bachelor of Education, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/whats-the-difference-between-add-and-adhd-225162">original article</a>.</em></p>

Mind

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Christina Applegate details bout of Covid and Sapovirus amid MS battle

<p>Christina Applegate has detailed her latest health battle amid her multiple sclerosis (MS).</p> <p>Speaking on her <em>MesSy</em> podcast with co-host Jamie-Lynn Sigler, the actress revealed her rough experience after contracting Covid for the first time, which then turned into long Covid, and to make matters worse, she then contracted Sapovirus from contaminated food. </p> <p>Sapoviruses can cause acute gastroenteritis, and the actress candidly shared that she had been wearing diapers in recent weeks because of how often she has had to go to the bathroom. </p> <p>"I finally got the Covies.. someone real close to me dropped the ball and came home with the stuff and it spread all over the house," she began.</p> <p>"I had one day when I had a headache and chills and I thought I was making it through this."</p> <p>"It turned into long covid and it turned into a chest infection and then my heart was doing weird stuff, where it just speeds up... so I was like mother f--ker!"</p> <p>She then continued, saying that after contracting the virus she was "p---ing out of her a** for a few days".</p> <p>"I was so dizzy. I was so sick. I couldn't eat... Someone else's poop went into my mouth and I ate it."</p> <p>The actress recently revealed that she has 30 lesions on her brain from her MS,  a condition where the body's own immune system mistakenly attacks and damages the fatty material around the nerves, which can cause a range of symptoms. </p> <p>It is the most common acquired chronic neurological disease affecting young adults, according to MS Australia. </p> <p><em>Image: Getty</em></p>

Caring

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

<p><a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <em><a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a></em></p> <p>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.</p> <p>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.</p> <p>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.</p> <p><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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.”</p> <h2>Why does monitoring symptoms help?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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" /></p> <p><em><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></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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>.</em></p>

Body

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Good news: midlife health is about more than a waist measurement. Here’s why

<p><em><a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p>You’re not in your 20s or 30s anymore and you know regular health checks are important. So you go to your GP. During the appointment they measure your waist. They might also check your weight. Looking concerned, they recommend some lifestyle changes.</p> <p>GPs and health professionals commonly <a href="https://theconversation.com/the-body-mass-index-cant-tell-us-if-were-healthy-heres-what-we-should-use-instead-211190">measure waist circumference</a> as a vital sign for health. This is a better indicator than body mass index (BMI) of the amount of intra-abdominal fat. This is the really risky fat around and within the organs that can drive heart disease and metabolic disorders such as type 2 diabetes.</p> <p>Men are at greatly increased risk of health issues if their waist circumference is <a href="https://www.bmj.com/content/311/7017/1401">greater than 102 centimetres</a>. Women are considered to be at greater risk with a waist circumference of <a href="https://www.bmj.com/content/311/7017/1401">88 centimetres or more</a>. More than <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/waist-circumference-and-bmi/latest-release">two-thirds of Australian adults</a> have waist measurements that put them at an increased risk of disease. An even better indicator is waist circumference divided by height or <a href="https://www.baker.edu.au/news/in-the-media/waist-height-ratio#:%7E:text=According%20to%20research%2C%20a%20healthy,the%20highest%20risk%20of%20disease.">waist-to-height ratio</a>.</p> <p>But we know people (especially women) have a propensity to <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/abstract">gain weight around their middle during midlife</a>, which can be very hard to control. Are they doomed to ill health? It turns out that, although such measurements are important, they are not the whole story when it comes to your risk of disease and death.</p> <h2>How much is too much?</h2> <p>Having a waist circumference to height ratio larger than 0.5 is associated with greater risk of chronic disease as well as premature death and this applies in adults of any age. A healthy waist-to-height ratio is between 0.4 to 0.49. A ratio of 0.6 or more <a href="https://www.baker.edu.au/news/in-the-media/waist-height-ratio#:%7E:text=According%20to%20research%2C%20a%20healthy,the%20highest%20risk%20of%20disease">places a person at the highest risk of disease</a>.</p> <p>Some experts recommend <a href="https://www.nature.com/articles/s41574-019-0310-7">waist circumference be routinely measured in patients during health appointments</a>. This can kick off a discussion about their risk of chronic diseases and how they might address this.</p> <p>Excessive body fat and the associated health problems manifest more strongly during midlife. A range of social, personal and physiological factors come together to make it more difficult to control waist circumference as we age. Metabolism tends to slow down mainly due to decreasing muscle mass because people do <a href="https://onlinelibrary.wiley.com/doi/10.1002/jcb.25077">less vigorous physical activity, in particular resistance exercise</a>.</p> <p>For women, hormone levels begin changing in mid-life and this also <a href="https://www.tandfonline.com/doi/full/10.3109/13697137.2012.707385">stimulates increased fat levels particularly around the abdomen</a>. At the same time, this life phase (often involving job responsibilities, parenting and caring for ageing parents) is when elevated stress can lead to <a href="https://journals.lww.com/psychosomaticmedicine/abstract/2000/09000/stress_and_body_shape__stress_induced_cortisol.5.aspx">increased cortisol which causes fat gain in the abdominal region</a>.</p> <p>Midlife can also bring poorer sleep patterns. These contribute to fat gain with <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0010062">disruption to the hormones that control appetite</a>.</p> <p>Finally, your family history and genetics can <a href="https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1002695">make you predisposed to gaining more abdominal fat</a>.</p> <h2>Why the waist?</h2> <p>This intra-abdominal or visceral fat is much more metabolically active (it has a greater impact on body organs and systems) than the fat under the skin (subcutaneous fat).</p> <p>Visceral fat surrounds and infiltrates major organs such as the liver, pancreas and intestines, releasing a variety of chemicals (hormones, inflammatory signals, and fatty acids). These affect inflammation, lipid metabolism, cholesterol levels and insulin resistance, <a href="https://academic.oup.com/eurheartjsupp/article/8/suppl_B/B4/461962">contributing to the development of chronic illnesses</a>.</p> <p>The issue is particularly evident <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/abstract">during menopause</a>. In addition to the direct effects of hormone changes, <a href="https://www.sciencedirect.com/science/article/pii/S0960076013001118?via%3Dihub">declining levels of oestrogen change brain function, mood and motivation</a>. These psychological alterations can result in reduced physical activity and increased eating – often of comfort foods high in sugar and fat.</p> <p>But these outcomes are not inevitable. Diet, exercise and managing mental health can limit visceral fat gains in mid-life. And importantly, the waist circumference (and ratio to height) is just one measure of human health. There are so many other aspects of body composition, exercise and diet. These can have much larger influence on a person’s health.</p> <h2>Muscle matters</h2> <p>The quantity and quality of skeletal muscle (attached to bones to produce movement) a person has makes a <a href="https://www.nature.com/articles/nrendo.2012.49">big difference</a> to their heart, lung, metabolic, immune, neurological and mental health as well as their physical function.</p> <p>On current evidence, it is equally or more important for health and longevity to <a href="https://www.bmj.com/content/345/bmj.e7279">have</a> higher muscle mass and better cardiorespiratory (aerobic) fitness than waist circumference within the healthy range.</p> <p>So, if a person does have an excessive waist circumference, but they are also sedentary and have less muscle mass and aerobic fitness, then the recommendation would be to focus on an appropriate exercise program. The fitness deficits should be addressed as priority rather than worry about fat loss.</p> <p>Conversely, a person with low visceral fat levels is not necessarily fit and healthy and may have quite poor aerobic fitness, muscle mass, and strength. <a href="https://bjsm.bmj.com/content/45/6/504">The research evidence</a> is that these vital signs of health – how strong a person is, the quality of their diet and how well their heart, circulation and lungs are working – are more predictive of risk of disease and death than how thin or fat a person is.</p> <p>For example, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510687/">2017 Dutch study</a> followed overweight and obese people for 15 years and found people who were very physically active had no increased heart disease risk than “normal weight” participants.</p> <h2>Getting moving is important advice</h2> <p>Physical activity has many benefits. Exercise can counter a lot of the negative behavioural and physiological changes that are occurring during midlife including for people going through menopause.</p> <p>And regular exercise reduces the tendency to use food and drink to help manage what can be a <a href="https://journals.lww.com/acsm-msse/fulltext/2008/05000/physical_activity,_sedentary_index,_and_mental.7.aspx">quite difficult time in life</a>.</p> <p>Measuring your waist circumference and monitoring your weight remains important. If the measures exceed the values listed above, then it is certainly a good idea to make some changes. Exercise is effective for fat loss and in particular <a href="https://bjsm.bmj.com/content/57/16/1035">decreasing visceral fat</a> with greater effectiveness when <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0864-5">combined with dietary restriction of energy intake</a>. Importantly, any fat loss program – whether through drugs, diet or surgery – is also a muscle loss program unless resistance exercise is part of the program. Talking about your overall health with a doctor is a great place to start.</p> <p><a href="https://www.essa.org.au/Public/Public/Searches/find-aep-withdistance.aspx">Accredited exercise physiologists</a> and <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitians</a> are the most appropriate allied health professionals to assess your physical structure, fitness and diet and work with you to get a plan in place to improve your health, fitness and reduce your current and future health risks.<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/226019/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/rob-newton-12124"><em>Rob Newton</em></a><em>, Professor of Exercise Medicine, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/good-news-midlife-health-is-about-more-than-a-waist-measurement-heres-why-226019">original article</a>.</em></p>

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What happens when I stop taking a drug like Ozempic or Mounjaro?

<p><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.</p> <p>But does weight come back when you stop using it?</p> <p>The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people.</p> <p>So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.</p> <h2>It’s a long-term treatment, not a short course</h2> <p>If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.</p> <p>For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.</p> <p>Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)</p> <p>Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.</p> <h2>Why do people stop?</h2> <p>Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>.</p> <p>But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons.</p> <p>Understanding what stopping does to the body is therefore important.</p> <h2>So what happens when you stop?</h2> <p>When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen:</p> <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> <p>blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars</p> </li> <li> <p>over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back</p> </li> <li> <p>weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.</p> </li> </ul> <p>While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.</p> <h2>Is stopping and starting the medications a problem?</h2> <p>People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>.</p> <p>When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.</p> <p>Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.</p> <h2>How can you avoid gaining weight when you stop?</h2> <p>Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:</p> <ul> <li> <p>getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a></p> </li> <li> <p>exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it</p> </li> </ul> <ul> <li> <p>addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies</p> </li> <li> <p>eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.</p> </li> </ul> <p>Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<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/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>.</em></p>

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Surgery won’t fix my chronic back pain, so what will?

<p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p>This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.</p> <p>The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.</p> <p><a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs.</p> <p>The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?</p> <h2>Opioids and invasive procedures</h2> <p>Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.</p> <p><a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.</p> <h2>Addressing the contributors to pain</h2> <p>Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:</p> <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> <p>Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.</p> <p>The interventions have minimal side effects and are cost-effective.</p> <p>In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.</p> <p>In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.</p> <h2>Why isn’t everyone with chronic pain getting this care?</h2> <p>While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150.</p> <p>In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.</p> <p>Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.</p> <p>Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.</p> <p>Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.</p> <h2>So what can we do about it?</h2> <p>We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.</p> <p>Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.</p> <p>Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<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/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/christine-lin-346821"><em>Christine Lin</em></a><em>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.</em></p>

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Do optimists really live longer? Here’s what the research says

<p><em><a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, <a href="https://theconversation.com/institutions/durham-university-867">Durham University</a></em></p> <p>Do you tend to see the glass as half full, rather than half empty? Are you always looking on the bright side of life? If so, you may be surprised to learn that this tendency could actually be good for your health.</p> <p>A <a href="https://content.apa.org/record/2020-71981-001">number of studies</a> have shown that optimists enjoy higher levels of wellbeing, better sleep, lower stress and even better cardiovascular health and immune function. And now, <a href="https://pubmed.ncbi.nlm.nih.gov/35674052/">a recent study</a> has shown that being an optimist is linked to longer life.</p> <p>To conduct their study, researchers tracked the lifespan of nearly 160,000 women aged between 50 to 79 for a period of 26 years. At the beginning of the study, the women completed a <a href="https://local.psy.miami.edu/people/faculty/ccarver/availbale-self-report-instruments/lot-r/">self-report measure of optimism</a>. Women with the highest scores on the measure were categorised as optimists. Those with the lowest scores were considered pessimists.</p> <p>Then, in 2019, the researchers followed up with the participants who were still living. They also looked at the lifespan of participants who had died. What they found was that those who had the highest levels of optimism were more likely to live longer. More importantly, the optimists were also more likely than those who were pessimists to live into their nineties. Researchers refer to this as “exceptional longevity”, considering the average lifespan for women is about 83 years in developed countries.</p> <p>What makes these findings especially impressive is that the results remained even after accounting for other factors known to predict a long life – including education level and economic status, ethnicity, and whether a person suffered from depression or other chronic health conditions.</p> <p>But given this study only looked at women, it’s uncertain whether the same would be true for men. However, <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1900712116">another study</a> which looked at both men and women also found that people with the highest levels of optimism enjoyed a lifespan that was between 11% and 15% longer than those who were the least optimistic.</p> <h2>The fountain of youth?</h2> <p>So why is it that optimists live longer? At first glance it would seem that it may have to do with their healthier lifestyle.</p> <p>For example, <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.310828">research from several studies</a> has found that optimism is linked to eating a healthy diet, staying physically active, and being less likely to smoke cigarettes. These healthy behaviours are well known to improve heart health and <a href="https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases">reduce the risk</a> for cardiovascular disease, which is a <a href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">leading cause of death</a> globally. Adopting a healthy lifestyle is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857242/">important for reducing the risk</a> of other potentially deadly diseases, such as diabetes and cancer.</p> <p>But having a healthy lifestyle may only be part of the reason optimists live a longer than average life. This latest study found that lifestyle only accounted for 24% of the link between optimism and longevity. This suggests a number of other factors affect longevity for optimists.</p> <p>Another possible reason could be due to the way optimists manage stress. When faced with a stressful situation, optimists tend to deal with it head-on. They <a href="https://pubmed.ncbi.nlm.nih.gov/16859439/">use adaptive coping strategies</a> that help them resolve the source of the stress, or view the situation in a less stressful way. For example, optimists will problem-solve and plan ways to deal with the stressor, call on others for support, or try to find a “silver lining” in the stressful situation.</p> <p>All of these approaches are well-known to reduce feelings of stress, as well as the biological reactions that occur when we feel stressed. It’s these <a href="https://www.apa.org/topics/stress/body">biological reactions to stress</a> –- such as elevated cortisol (sometimes called the “stress hormone”), increased heart rate and blood pressure, and impaired immune system functioning –- that can take a toll on health over time and increase the risk for developing <a href="https://www.sciencedirect.com/science/article/pii/S0889159115004316?via%3Dihub">life-threatening diseases</a>, such as cardiovascular disease. In short, the way optimists cope with stress may help protect them somewhat against its harmful effects.</p> <h2>Looking on the bright side</h2> <p>Optimism is typically viewed by researchers as a relatively stable personality trait that is determined by both <a href="https://www.cambridge.org/core/journals/twin-research-and-human-genetics/article/sex-differences-in-the-genetic-architecture-of-optimism-and-health-and-their-interrelation-a-study-of-australian-and-swedish-twins/58F21AA11943D44B4BA4C63A966E6AC7">genetic</a> and early childhood influences (such as having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541423/">secure and warm relationship</a> with your parents or caregivers). But if you’re not naturally prone to seeing the glass as half full, there are some ways you can increase your <a href="https://www.tandfonline.com/doi/abs/10.1080/17439760.2016.1221122?journalCode=rpos20">capacity to be optimistic</a>.</p> <p>Research shows optimism can change over time, and can be cultivated by engaging in simple exercises. For example, visualising and then writing about your “<a href="https://www.psychologytoday.com/us/blog/what-matters-most/201303/what-is-your-best-possible-self">best possible self</a>” (a future version of yourself who has accomplished your goals) is a technique that studies have found can <a href="https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221122">significantly increase optimism</a>, at least temporarily. But for best results, the goals need to be both positive and reasonable, rather than just wishful thinking. Similarly, simply <a href="https://www.tandfonline.com/doi/abs/10.3200/SOCP.149.3.349-364">thinking about positive future events</a> can also be effective for boosting optimism.</p> <p>It’s also crucial to temper any expectations for success with an accurate view of what you can and can’t control. Optimism is reinforced when we experience the positive outcomes that we expect, and <a href="https://psycnet.apa.org/record/1970-20680-001">can decrease</a> when these outcomes aren’t as we want them to be. Although more research is needed, it’s possible that regularly envisioning yourself as having the best possible outcomes, and taking realistic steps towards achieving them, can help develop an optimistic mindset.</p> <p>Of course, this might be easier said than done for some. If you’re someone who isn’t naturally optimistic, the best chances to improve your longevity is by <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003332">living a healthy lifestyle</a> by staying physically active, eating a healthy diet, managing stress, and getting a good night’s sleep. Add to this cultivating a more optimistic mindset and you might further increase your chances for a long life.<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/184785/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/fuschia-sirois-331254">Fuschia Sirois</a>, Professor in Social &amp; Health Psychology, <a href="https://theconversation.com/institutions/durham-university-867">Durham University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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/do-optimists-really-live-longer-heres-what-the-research-says-184785">original article</a>.</em></p>

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Asking ChatGPT a health-related question? Better keep it simple

<p>It’s tempting to <a href="https://cosmosmagazine.com/news/chatgpt-and-dr-google/">turn to search engines</a> to seek out health information, but with the rise of large language models, like ChatGPT, people are becoming more and more likely to depend on AI for answers too.</p> <div class="copy"> <p>Concerningly, an Australian study has now found that the more evidence given to <a href="https://cosmosmagazine.com/technology/chatgpt-an-intimate-companion/">ChatGPT</a> when asked a health-related question, the less reliable it becomes.</p> <p>Large language models (LLM) and artificial intelligence use in health care is still developing, creating a  a critical gap when providing incorrect answers can have serious consequences for people’s health.</p> <p>To address this, scientists from Australia’s national science agency, CSIRO, and the University of Queensland (UQ) explored a hypothetical scenario: an average person asking ChatGPT if ‘X’ treatment has a positive effect on condition ‘Y’.</p> <p>They presented ChatGPT with 100 questions sourced from the <a href="https://trec-health-misinfo.github.io/" target="_blank" rel="noopener">TREC Health Misinformation track</a> – ranging from ‘Can zinc help treat the common cold?’ to ‘Will drinking vinegar dissolve a stuck fish bone?’</p> <p>Because queries to search engines are typically shorter, while prompts to a LLM can be far longer, they posed the questions in 2 different formats: the first as a simple question and the second as a question biased with supporting or contrary evidence.</p> <p>By comparing ChatGPT’s response to the known correct response based on existing medical knowledge, they found that ChatGPT was 80% accurate at giving accurate answers in a question-only format. However, when given an evidence-biased prompt, this accuracy reduced to 63%, which was reduced again to 28% when an “unsure” answer was allowed. </p> <p>“We’re not sure why this happens,” says CSIRO Principal Research Scientist and Associate Professor at UQ, Dr Bevan Koopman, who is co-author of the paper.</p> <p>“But given this occurs whether the evidence given is correct or not, perhaps the evidence adds too much noise, thus lowering accuracy.”</p> <p>Study co-author Guido Zuccon, Director of AI for the Queensland Digital Health Centre at UQ says that major search engines are now integrating LLMs and search technologies in a process called Retrieval Augmented Generation.</p> <p>“We demonstrate that the interaction between the LLM and the search component is still poorly understood, resulting in the generation of inaccurate health information,” says Zuccon.</p> <p>Given the widespread popularity of using LLMs online for answers on people’s health, Koopman adds, we need continued research to inform the public about risks and to help them optimise the accuracy of their answers.</p> <p>“While LLMs have the potential to greatly improve the way people access information, we need more research to understand where they are effective and where they are not.”</p> <p><em>Image credits: Getty Images</em></p> <div> <p align="center"> </p> </div> <p><em><img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=301406&amp;title=Asking+ChatGPT+a+health-related+question%3F+Better+keep+it+simple" width="1" height="1" loading="lazy" aria-label="Syndication Tracker" data-spai-target="src" data-spai-orig="" data-spai-exclude="nocdn" /></em><em><a href="https://cosmosmagazine.com/technology/ai/asking-chatgpt-a-health-related-question-better-keep-it-simple/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/imma-perfetto/">Imma Perfetto</a>. </em></div>

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Christina Applegate's devastating health update

<p>Christina Applegate has shared a heart-wrenching health update, sharing that she is currently unable to walk or use her shower. </p> <p>The actress, who has been battling multiple sclerosis (MS) since 2021, spoke candidly on her <em>MeSsy</em> podcast that she is going through a difficult relapse of her chronic illness, which is getting in the way of being able to complete basic tasks. </p> <p>“I’m gonna be honest with you, I need to buy stock in Cottonelle because I haven’t taken a shower in three weeks,” Applegate told podcast co-host Jamie Lynn-Sigler, who also suffers from MS.</p> <p>She continued, “Because I can’t stand in my shower. There’s no f****** way I can use my shower.”</p> <p>“I have such a small bench and my a** is so huge these days that I can’t sit on it, it’s like I slip right off of it,” she added. “So, I’ve been Cottonelle-ing my body.”</p> <p>At the beginning of the episode, Applegate detailed the severity of her symptoms and how they were impacting different areas of her body.</p> <p>"Intense pain in my legs, not being able to walk to the bathroom without feeling like I'm going to fall, insane tingling, spurts of tingles," she said of the pain she's currently experiencing.</p> <p>"I haven't slept for 24 hours because my eye is doing something weird, where every time I close my eye to go to sleep, my right eye starts to shift like this."</p> <p>Applegate noted how unusual the symptoms in her legs were, saying, "My legs have never been this bad... so I don't know what's going on, like, no energy."</p> <p>"[My] Legs are just done. I can't get circulation, I can't get them to stop hurting."</p> <p dir="ltr">Christina first revealed her diagnosis in August 2021, sharing the news on Twitter and thanking everyone for their support. </p> <p dir="ltr">“Hi friends. A few months ago I was diagnosed with MS. It’s been a strange journey. But I have been so supported by people that I know who also have this condition. It’s been a tough road. But as we all know, the road keeps going. Unless some a**hole blocks it,” her tweet reads.</p> <p dir="ltr">According to MS Australia, MS is the most common acquired chronic neurological disease in young adults with diagnosis occurring between the ages of 20 to 40.</p> <p dir="ltr"><em>Image credits: Getty Images </em></p>

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Silent cancers: here’s what you need to know when there are no obvious symptoms

<p><em><a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a></em></p> <p>The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature.</p> <p>Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment.</p> <p>Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>.</p> <p>While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area.</p> <p>Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example.</p> <h2>The importance of early diagnosis</h2> <p>Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge.</p> <p>Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment.</p> <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses.</p> <p>Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures.</p> <p>Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells.</p> <p>Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>.</p> <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease.</p> <h2>Biomarker discovery</h2> <p>The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine.</p> <p>For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK.</p> <p>Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.</em></p>

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<p><em><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p>Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people.</p> <p>Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020.</p> <p>It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year.</p> <p>Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>.</p> <h2>What goes into a flu vaccine?</h2> <p>Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus.</p> <p>Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains.</p> <p>All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future.</p> <h2>What’s different about new flu vaccines?</h2> <p>There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad).</p> <p>Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely.</p> <p>However, there have been several enhancements to influenza vaccines in recent years.</p> <p>Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people.</p> <p>An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people.</p> <p>Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future.</p> <h2>What should I do this year?</h2> <p>Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life.</p> <p>Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>.</p> <p>In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need.</p> <h2>Are there side effects?</h2> <p>All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines.</p> <p>As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines.</p> <p>Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<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/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.</em></p>

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12 best yoga poses to strengthen bones

<p><strong>A bone-health doctor lists the 12 best yoga poses to strengthen bones</strong></p> <p>If you’re like many yoga lovers, you appreciate how this one physical activity can be so beneficial, while simultaneously so gentle. Few other practises stretch your body, calm your mind or help regulate vitals, such as your heart rate and blood pressure, in quite the way a regular yoga session can do.</p> <p>Researcher and rehabilitation doctor, Dr Loren Fishman has also been a practitioner of yoga for 50 years and is the creator of ‘the Fishman method’ of yoga for osteoporosis. In a conversation with Reader’s Digest, Dr Fishman points out that for all its advantages, yoga can also provide a powerful boost to your long-term bone density. In particular, Dr Fishman published 12 yoga poses in Orthopedic Nursing that are particularly great for strengthening your bones.</p> <p>Of these 12 poses Dr Fishman says: “They all work by putting pressure on the bones of sufficient magnitude and duration.” He says this can “stimulate the osteoblasts to make more bone”, thanks to their placement of “maximum torque, compression or pressure” on particular body parts, as outlined below.</p> <p>So, while a good yoga session is a helpful tool to help you get through the week, its effects are longer-lasting than you realised.</p> <p>Keep reading for the 12 best yoga poses to strengthen your bones. (“With all poses, remember not to round the spine as you go into and out of the poses, and within the poses themselves,” Dr Fishman advises.)</p> <p><strong>1. Tree pose (Vriksasana)</strong></p> <p>Tree pose has a special way of calling you to stillness. Dr Fishman says tree pose also adds pressure that can strengthen the upper femur and hip. He adds that a study at the University of Southern California (USC) showed a 60 per cent increase in pressure, even with the foot placed three-quarters down the calf.</p> <p>Dr Fishman says tree pose is “also extremely valuable for improving balance and avoiding falls,” although he reminds us that the raised foot should always go above or below the knee – never directly on the knee joint.</p> <p><strong>2. Triangle pose (Trikonasana)</strong></p> <p>Triangle pose “puts torque on the lumbar spine, the neck of the femur, the hips and ribs,” Dr Fishman says, adding that this is another pose that will help improve balance.</p> <p><strong>3. Reverse Triangle Pose (Parivrtta Trikonasan) </strong></p> <p>Dr Fishman says great pressures develop on the proximal femurs (very top of the femur bone that connects with the hip joint) in this pose, as well as the hip and lower back. Reverse triangle also puts helpful pressure in the ribs and wrists and is “a very powerful balance-improver.”</p> <p><strong>4. Warrior 2 (Virabhadrasana II)</strong></p> <p>“Fabulous mechanical disadvantage means great pressure on the entire forward (bent leg) femur,” Dr Fishman says of full warrior pose. He explains that “the straight leg’s rotation works on the head of femur and hip,” helping to strengthen the upper leg and hip. This is yet another pose that he says helps with balance.</p> <p><strong>5. Side angle pose (Parsvakonasana)</strong></p> <p>Another boon for balance, Dr Fishman says side angle pose torques the lower back and the top of the femur – all good things – and stimulates the bone-making cells of the hip, too.</p> <p><strong>6. Locust pose (Salabhasana)</strong></p> <p>Locust pose “raises pressures, which stimulate bone-making in the posterior elements of the spine,” Dr Fishman says, while it also helps balance some the forward focus on the ribs of the earlier poses. Locust pose also strengthens extensor muscles of the back to improve posture and reverse curvature of the spine in the upper back, which can lead to fractures.</p> <p><strong>7. Bridge pose (Setu Bandhasana)</strong></p> <p>Dr Fishman says bridge pose can help strengthen the ribs and lower regions of the spine.</p> <p><strong>8. Reclining hand to big toe (Supta Padangusthasana I)</strong></p> <p>Also known to be a good hamstring stretch, this pose facilitates “extreme pressure brought to bear on relevant sections” of the femur, hip, pelvis (specifically the sitz bones) and spine.</p> <p>Seated versions of this and the following pose offer less intensity, but Dr Fishman cautions for both: “The seated versions have the potential to be dangerous. Keep the spine straight and against the back of the chair. Do not round the back.”</p> <p><strong>9. Supine hand to big toe 2 (Supta Padangusthasana II)</strong></p> <p>In the side extension variation of this pose, there is “extreme pressure brought to bear” on the upper femur, hip, pubis, ribs, and spine, he says.</p> <p><strong>10. Straight-legged twist (Marichyasana)</strong></p> <p>This “puts great pressure” on the sitz bones and pelvis, as well as “great but safe pressure” on the spine.</p> <p><strong>11. Bent-leg twist (Matsyendrasana)</strong></p> <p>The bent-leg twist “puts great pressure” on the upper femur and pelvis, plus “great but safe pressure” on the vertebra. Dr Fishman suggests you should hug the leg to ensure a straight spine.</p> <p><strong>12. Corpse pose (Savasana)</strong></p> <p>Truthfully, Dr Fishman says, Savasana is “of little value for the bones per se, but truly important at the end of the session for mental and general physiological health.” That’s good enough for us.</p> <p><em><span id="docs-internal-guid-68140ce3-7fff-bd62-dea6-7b47a6dfe42b">Written by Jennifer Huizen and Kristine Gasbarre. This article first appeared in <a href="https://www.readersdigest.co.nz/healthsmart/12-best-yoga-poses-to-strengthen-bones" target="_blank" rel="noopener">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRA87V" target="_blank" rel="noopener">here’s our best subscription offer.</a></span></em></p> <p><em>Image: Getty Images</em></p>

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How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

<p>It’s 3am and you’re suddenly wide awake. Try these seven science-backed strategies to fall back to sleep fast.</p> <p><strong>Give meditation a try </strong></p> <p>As a mindfulness coach, I’m very aware of the day-to-day anxieties and worries that can interfere with a good night’s sleep. One of the most effective natural sleep aids is a quick meditation session to ease yourself out of those stresses. If you’ve never meditated before, you’ll likely find the meditation interrupted by thoughts flashing through your mind.</p> <p>It’s important for you to know that this isn’t a failure on your part, and that you aren’t doing anything wrong. Thinking is just what the brain does, as naturally as lungs take in air. The point is to be non-judgmental yet aware of your thoughts, bodily experiences and breath, moment by moment.</p> <p><strong>Stop wanting to fall asleep</strong></p> <p>It’s counterintuitive, isn’t it? Sometimes trying too hard to do something is the very thing that prevents us from achieving it – and that’s never more true than when it comes to falling asleep. Desperately wanting to sleep will only stoke anxieties that will further stress your brain, essentially feeding it the message that it’s not safe to sleep.</p> <p>Throw in those worries about your to-do list at work the following day, and the whole thing can snowball into a panic attack. Try letting go of that feeling that you absolutely must sleep now, and observe your own anxieties for what they are without judgment. When you stop looking at sleep as a goal, you’ll find it easier to fall asleep.</p> <p><strong>Start a journal </strong></p> <p>If you find yourself struggling to fall asleep, pick up a pen and paper (not your phone!), and start writing: simply scribble down an account of what’s going on inside your head. Although there’s no “right” way to journal, you might start by listing the events of your day, and from there, how those events and encounters made you feel.</p> <p>Building this structured picture of your thoughts may help you see that the problem that’s keeping you up at night, and is likely less overwhelming than you thought. Why my insistence on a pen and paper? First off, studies show the simple motor action that’s involved in the act of handwriting has a calming effect. Secondly, the light emitted by laptops and phones isn’t conducive to falling asleep.</p> <p><strong>Find yourself a "3am friend"</strong></p> <p>Some of us are lucky to have a ‘3am friend’, that close confidant you can call up in the wee hours knowing that they won’t hold it against you in the morning. Although it’s great to have someone to talk to when you want to fall asleep, it’s important that the conversation doesn’t just rehash the anxieties that are preventing you from catching shut-eye in the first place.</p> <p>Rather than using the call to seek solutions for those issues, talk about things that calm your nerves, or even have them assist you in deep breathing. It may sound silly, but doing a series of deep, relaxing breaths can help you let go of the troubles that are keeping you wide awake.</p> <p><strong>Take a warm shower</strong></p> <p>Taking a warm shower not only relaxes your muscles and soothes minor aches and pains, but it also raises your core body temperature. As soon as you step out of the shower, your body starts working at lowering that temperature, which is something that normally happens when you’re falling asleep naturally.</p> <p>(That’s why we always feel the need for a blanket when we sleep, no matter how warm it is!) By kick-starting that temperature-lowering process, you’re tricking your body into falling asleep fast.</p> <p><strong>Stretch yourself to sleep </strong></p> <p>Anxiety keeping you up? Research suggests mild stretching can help take the edge off and relax muscles that have become stiff and sore after a long day. We’re not talking intricate yoga poses or acrobatics here, either: Simple stretches like an overhead arm stretch and bending over to touch your toes should do the trick. Ramp up the relaxation potential with a soundtrack of ambient noise at a volume that’s just barely audible.</p> <p>There are plenty of white noise apps that are free to download, but soft music can work as well (so long as there are no lyrics). Just remember, if you’re using an electronic device to play these sleep-promoting sounds, make sure it’s placed screen-down so you’re not distracted by the light it emits.</p> <p><strong>Read (or listen!) to something new</strong></p> <p>When you’re struggling with insomnia, it might be tempting to pull an old favourite off the bookshelf. In reality, it’s better to read or listen to an audio book that covers a topic on which you know absolutely nothing. New information, while taking attention away from the stressors that are keeping you up at night, gives your brain enough of a workout to make it tire more quickly than when it’s engaged with familiar subjects and concepts.</p> <p>Again, if it’s an audio book or podcast you’re listening to, make sure the light-emitting side of the device is face down to keep the room as dark as possible. Darkness and warmth play an essential part in the production and maintenance of melatonin, the hormone that plays the central role falling asleep.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article by Deepak Kashyap </em><em>originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/conditions/sleep/how-to-fall-asleep-without-sleeping-pills-7-natural-sleep-aids-that-actually-work" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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How to look after your mental health while packing up Mum or Dad’s home

<p><em><a href="https://theconversation.com/profiles/erika-penney-1416241">Erika Penney</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a>; <a href="https://theconversation.com/profiles/alice-norton-1516505">Alice Norton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/avalon-tissue-1515840">Avalon Tissue</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>So Mum or Dad has died, or moved to aged care, and now you’ve got to pack up their house. It’s a huge job and you’re dreading it.</p> <p>It’s normal to feel grief, loss, guilt, exhaustion or even resentment at being left with this job.</p> <p>So how can you look after your mental health while tackling the task?</p> <h2>It’s OK to feel a lot of feelings</h2> <p>Research has documented how this task can exert an intense <a href="https://www.tandfonline.com/doi/full/10.1080/15267431.2021.1943399">physical and emotional toll</a>.</p> <p>This can be more intense for those who had strained – or even <a href="https://journals.sagepub.com/doi/epub/10.1177/0030222819868107">traumatic</a> – relationships with the person whose house they’re packing up.</p> <p>Decisions around distributing or discarding items can, in some families, bring up painful reminders of the past or end up <a href="https://journals.sagepub.com/doi/10.1177/1074840711428451">replaying strained dynamics</a>.</p> <p>Family members who were carers for the deceased may feel exhaustion, overwhelm, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.1512?sid=vendor%3Adatabase">burnout</a> or a sense of injustice they must now continue to be responsible for their loved one’s affairs. Grief can be compounded by the practical challenges of deciding how to <a href="https://doi.org/10.1016/0148-2963(94)00054-I">store or discard belongings</a>, <a href="https://www.jstor.org/stable/30000385">arrange the funeral</a>, execute the will, deal with the aged care place or, in some cases, navigate legal disputes.</p> <p>But packing up the house may also be cathartic or helpful. <a href="https://www.tandfonline.com/doi/full/10.1080/15267431.2021.1943399">Research</a> has shown how the task of cleaning out a loved one’s belongings can provide an opportunity for family and friends to talk, share memories, and make sense of what has just happened.</p> <p>It’s also normal to grieve before someone dies. What psychologists call “<a href="https://pubmed.ncbi.nlm.nih.gov/29206700/">anticipatory</a> grief” can happen to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615888/">relatives packing up the house</a> of a parent who has moved to aged care or palliative care.</p> <h2>What to do with all this stuff?</h2> <p><a href="https://doi.org/10.1016/0148-2963(94)00054-I">Some</a> treat their loved one’s items with sanctity, holding onto as many of their belongings as possible and creating “shrines” in their honour.</p> <p>Others alleviate the weight of grief by clearing out a loved one’s house as soon as possible, giving away, selling or discarding as much as they can.</p> <p>But if you experience a mix of these – enthusiastically getting rid of some stuff, while desperately wanting to hold onto other things – that’s OK too.</p> <p>One <a href="https://www.tandfonline.com/doi/abs/10.1080/10253866.2017.1367677">study</a> identified a process punctuated by four key periods:</p> <ol> <li> <p>numbness and overwhelm at the task of packing the house</p> </li> <li> <p>yearning to maintain a link to the loved through their belongings</p> </li> <li> <p>working through grief, anger and guilt regarding the loved one and the task of managing their belongings, and</p> </li> <li> <p>healing and making sense of the relationship with the deceased and their belongings.</p> </li> </ol> <p>However, it is important to note everyone’s approach is different and there is no “right” way to do the clean out, or “right” way to feel.</p> <h2>Caring for your mental health during the clean out</h2> <p>To care for your mental health during these difficult times, you might try to:</p> <ul> <li> <p>make space for your feelings, whether it’s sadness, loss, resentment, anger, relief or all the above. There is no right or wrong way to feel. <a href="https://guilfordjournals.com/doi/abs/10.1521/jscp.2011.30.2.163">Accepting</a> your emotions is healthier than suppressing them</p> </li> <li> <p>share the load. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2648.1999.01220.x">Research</a> has shown practical support from close friends and family can help a lot with grief. Accept help with packing, planning, dealing with removalists, selling or donating items and cleaning. Don’t be afraid to reduce your mental load by delegating tasks to friends, who are likely wondering how they can help</p> </li> <li> <p>take a systematic approach. Break tasks into their smallest component. For example, aim to clean out a drawer instead of an entire bedroom. This can help the mental and physical task feel more manageable</p> </li> <li> <p>reflect on what’s meaningful to you. Some belongings will have <a href="https://doi.org/10.1016/0148-2963(94)00054-I">meaning</a>, while others will not. What was valuable to the deceased may not be valuable to you. Things they probably saw as pretty worthless (a handwritten shopping list, an old sewing kit) may be very meaningful to you. Ask yourself whether retaining a small number of meaningful possessions would allow you to maintain a connection with your loved one, or if clearing out the space and discarding the items is what you need</p> </li> <li> <p>share your story. When you feel ready, share your “<a href="https://www.tandfonline.com/doi/full/10.1080/15267431.2021.1943399">cleaning out the closet</a>” story with trusted friends and family. Storytelling allows the deceased to live on in memory. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2648.1999.01220.x">Research</a> also suggests we cope better with bereavement when friends and relatives make time to hear our feelings</p> </li> <li> <p>remember that professional help is available. Just as a solicitor can help with legal disputes, a mental health professional can help you process your feelings.</p> </li> </ul> <p>The home of your loved one is not merely a place where they lived, but a space filled with meaning and stories.</p> <p>Packing up the house of a loved one can be incredibly daunting and challenging, but it can also be an important part of your grieving process.</p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em><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/223956/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/erika-penney-1416241">E<em>rika Penney</em></a><em>, Lecturer in Clinical Psychology, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a>; <a href="https://theconversation.com/profiles/alice-norton-1516505">Alice Norton</a>, Lecturer in Psychology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/avalon-tissue-1515840">Avalon Tissue</a>, Associate Lecturer in Clinical Psychology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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-to-look-after-your-mental-health-while-packing-up-mum-or-dads-home-223956">original article</a>.</em></p>

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Eating some chocolate really might be good for you – here’s what the research says

<p><em><a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p>Although it always makes me scoff slightly to see Easter eggs making their first appearance in supermarkets at the end of December, there are few people who aren’t delighted to receive a bit of chocolate every year.</p> <p>It makes sense that too much chocolate would be bad for you because of the high fat and sugar content in most products. But what should we make of common claims that eating some chocolate is actually good for you?</p> <p>Happily, there is a fair amount of evidence that shows, in the right circumstances, chocolate may be both beneficial for your heart and good for your mental state.</p> <p>In fact, chocolate – or more specifically cacao, the raw, unrefined bean – is a medicinal wonder. It contains many different active compounds which can evoke pharmacological effects within the body, like medicines or drugs.</p> <p>Compounds that lead to neurological effects in the brain have to be able to cross the <a href="https://link.springer.com/chapter/10.1007/978-3-642-13443-2_7">blood-brain barrier</a>, the protective shield which prevents harmful substances – like toxins and bacteria – entering the delicate nervous tissue.</p> <p>One of these is the compound <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">theobromine</a>, which is also found in tea and contributes towards its bitter taste. Tea and chocolate also contain caffeine, which theobromine is related to as part of the purine family of chemicals.</p> <p>These chemicals, among others, contribute to chocolate’s addictive nature. They have the ability to cross the blood-brain barrier, where they can influence the nervous system. They are therefore known as <a href="https://pubmed.ncbi.nlm.nih.gov/15549276/">psychoactive</a> chemicals.</p> <figure><iframe src="https://www.youtube.com/embed/HloqayQdR6M?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>What effects can chocolate have on mood? Well, <a href="https://academic.oup.com/nutritionreviews/article/71/10/665/1931144?login=false">a systematic review</a> looked at a group of studies which examined the feelings and emotions associated with consuming chocolate. Most demonstrated improvements in mood, anxiety, energy and states of arousal.</p> <p>Some noted the feeling of guilt, which is perhaps something we’ve all felt after one too many Dairy Milks.</p> <h2>Health benefits of cocoa</h2> <p>There are other organs, aside from the brain, that might benefit from the medicinal effects of cocoa. For centuries, chocolate has been used as a medicine to treat a <a href="https://pubmed.ncbi.nlm.nih.gov/10917925/">long list of diseases</a> including anaemia, tuberculosis, gout and even low libido.</p> <p>These might be spurious claims but there is evidence to suggest that eating cacao has a positive effect on the cardiovascular system. First, it can prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068178/">endothelial dysfunction</a>. This is the process through which arteries harden and get laden down with fatty plaques, which can in turn lead to heart attacks and strokes.</p> <p>Eating dark chocolate may also reduce <a href="https://www.sciencedirect.com/science/article/pii/S1537189115001135?via%3Dihub">blood pressure</a>, which is another risk factor for developing arterial disease, and prevent formation of clots which block up blood vessels.</p> <figure><iframe src="https://www.youtube.com/embed/8VUcPCbSSCY?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Some studies have suggested that dark chocolate might be useful in adjusting ratios of <a href="https://pubmed.ncbi.nlm.nih.gov/20968113/">high-density lipoprotein cholesterol</a>, which can help protect the heart.</p> <p>Others have examined insulin resistance, the phenomenon associated with Type 2 diabetes and weight gain. They suggest that the <a href="https://www.sciencedirect.com/science/article/pii/S0963996900000697#:%7E:text=Cocoa%20is%20rich%20in%20polyphenols%20particularly%20in%20catechins,and%20cocoa%20powder%20have%20been%20published%20only%20recently.">polyphenols</a> – chemical compounds present in plants – found in foodstuffs like chocolate may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29993262/">improved control of blood sugars</a>.</p> <h2>Chocolate toxicity</h2> <p>As much as chocolate might be considered a medicine for some, it can be a poison for others.</p> <p>It’s well documented that the ingestion of caffeine and theobromine is highly toxic for domestic animals. Dogs are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801869/">particularly affected</a> because of their often voracious appetites and generally unfussy natures.</p> <p>The culprit is often dark chocolate, which can provoke symptoms of agitation, rigid muscles and even seizures. In certain cases, if ingested in high enough quantities, it can lead to comas and abnormal, even fatal heart rhythms.</p> <p>Some of the compounds found in chocolate have also been found to have potentially negative effects in humans. Chocolate is a source of oxalate which, along with calcium, is one of the main components of <a href="https://pubmed.ncbi.nlm.nih.gov/20301742/">kidney stones</a>.</p> <p>Some clinical groups have advised against consuming oxalate rich foods, such as spinach and rhubarb – and chocolate, for those who suffer from recurrent kidney stones.</p> <p>So, what should all this mean for our chocolate consumption habits? Science points in the direction of chocolate that has as high a cocoa solid content as possible, and the minimum of extras. The potentially harmful effects of chocolate are more related to fat and sugar, and may counteract any possible benefits.</p> <p>A daily dose of 20g-30g of plain or dark chocolate with cocoa solids above 70% – rather than milk chocolate, which contains fewer solids and white chocolate, which contains none – could lead to a greater health benefit, as well as a greater high.</p> <p>But whatever chocolate you go for, please don’t share it with the dog.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/226759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/dan-baumgardt-1451396"><em>Dan Baumgardt</em></a><em>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/eating-some-chocolate-really-might-be-good-for-you-heres-what-the-research-says-226759">original article</a>.</em></p>

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How much stress is too much? A psychiatrist explains the links between toxic stress and poor health − and how to get help

<p><a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655">La<em>wson R. Wulsin</em></a><em>, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati </a></em></p> <p>COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others.</p> <p>So how much stress is too much, and what can you do about it?</p> <p>I’m a <a href="https://researchdirectory.uc.edu/p/wulsinlr">psychiatrist specializing in psychosomatic medicine</a>, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues.</p> <p>I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My <a href="https://www.cambridge.org/core/books/toxic-stress/677FA62B741540DBDB53E2F0A52A74B1">forthcoming book</a> is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.”</p> <p>A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the <a href="https://doi.org/10.1097/PSY.0000000000001197">effects of smoking and low socioeconomic status</a>, two well-established risk factors for accelerated aging.</p> <figure><iframe src="https://www.youtube.com/embed/yiglpsqv5ik?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.</span></figcaption></figure> <h2>The difference between good stress and the toxic kind</h2> <p>Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit.</p> <p>Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “<a href="https://www.penguinrandomhouse.com/books/313183/the-body-%20keeps-the-score-by-bessel-van-der-kolk-md/">The Body Keeps the Score</a>.”</p> <p>The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface.</p> <p>When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions.</p> <p>For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors.</p> <h2>‘Treating’ stress</h2> <p>Though stress neuroscience in recent years has given researchers like me <a href="https://doi.org/10.1097/PSY.0000000000001051">new ways to measure and understand stress</a>, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan.</p> <p>Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure.</p> <p>Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during <a href="https://www.cdc.gov/violenceprevention/aces/ace-brfss.html">vulnerable periods such as childhood</a>.</p> <p>Over the past 40 years in the U.S., the alarming rise in <a href="https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html">rates of diabetes</a>, <a href="https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf">obesity</a>, depression, PTSD, <a href="https://www.cdc.gov/nchs/products/databriefs/db433.htm">suicide</a> and addictions points to one contributing factor that these different illnesses share: toxic stress.</p> <p>Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses.</p> <h2>Suffering from toxic stress</h2> <p>Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html">four or more adverse events in childhood</a>. This is the threshold for higher risk for illnesses in adulthood.</p> <p>Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have <a href="https://doi.org/10.7249/TL221">four or more chronic illnesses</a>. If you have even one chronic illness, you can imagine how stressful four must be.</p> <p>And about 12% of the U.S. population <a href="https://blogs.worldbank.org/opendata/introducing-second-edition-world-banks-global-subnational-atlas-poverty">lives in poverty</a>, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all.</p> <p>Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress.</p> <figure><iframe src="https://www.youtube.com/embed/WuyPuH9ojCE?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Exercise, meditation and a healthy diet help fight toxic stress.</span></figcaption></figure> <h2>Recognizing and managing stress and its associated conditions</h2> <p>The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a <a href="https://doi.org/10.1097/PSY.0000000000001051">self-reported measure of stress</a>.</p> <p>The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, <a href="https://lifestylemedicine.org/">called “lifestyle medicine</a>,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate.</p> <p>Adopting these lifestyle changes is not quick or easy, but it works.</p> <p>The <a href="https://www.cdc.gov/diabetes/prevention/index.html">National Diabetes Prevention Program</a>, the <a href="https://www.ornish.com/">Ornish “UnDo” heart disease program</a> and the <a href="https://www.ptsd.va.gov/understand_tx/tx_basics.asp">U.S. Department of Veterans Affairs PTSD program</a>, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits.</p> <p>There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/222245/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/lawson-r-wulsin-1493655"><em>Lawson R. Wulsin</em></a><em>, Professor of Psychiatry and Family Medicine, <a href="https://theconversation.com/institutions/university-of-cincinnati-1717">University of Cincinnati</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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-much-stress-is-too-much-a-psychiatrist-explains-the-links-between-toxic-stress-and-poor-health-and-how-to-get-help-222245">original article</a>.</em></p>

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