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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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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<p><em><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p>Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”.</p> <p>As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”.</p> <p>We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.</p> <p>Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.</p> <h2>How does it work?</h2> <p>Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better.</p> <p>GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars.</p> <p>GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.</p> <p><iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe></p> <p>GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.</p> <p>Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.</p> <p>GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection.</p> <h2>What can users expect? What does the research say?</h2> <p>Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).</p> <p>A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.</p> <p>Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.</p> <p>Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>.</p> <p>Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.</p> <h2>Who is eligible for semaglutide?</h2> <p>Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes.</p> <p>However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.</p> <p>The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia.</p> <p>When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.</p> <h2>What else do you need to do during Ozempic treatment?</h2> <p>Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.</p> <p>Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week.</p> <p>STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.</p> <p>A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>.</p> <h2>But what are the side effects?</h2> <p>Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.</p> <p>In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.</p> <p>More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.</p> <p>To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term.</p> <p>Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.</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.</em><!-- 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/219116/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/clare-collins-7316"><em>Clare Collins</em></a><em>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: </em><em>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/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.</em></p>

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.</p> <p>When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.</p> <p>The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>.</p> <h2>Not the first ‘miracle’ weight-loss drug</h2> <p>This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>.</p> <p>Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame.</p> <h2>Ozempic doesn’t work the same for everyone</h2> <p>When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5%</p> <p>What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits.</p> <p>When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon.</p> <p>But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate.</p> <h2>Treatment needs to be ongoing. What will this mean?</h2> <p>When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment.</p> <p>Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods.</p> <p>Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&amp;text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies.</p> <h2>Biology is only part of the story</h2> <p>For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures.</p> <p>But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved.</p> <p>Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants.</p> <h2>A weight-centred approach misses the rest of the story</h2> <p>The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health.</p> <p>Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>.</p> <h2>Obesity isn’t an issue detached from people</h2> <p>Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma.</p> <p>The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum.</p> <p>Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication.</p> <h2>Drugs are tools, not silver bullets</h2> <p>The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is.</p> <p>Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment.</p> <p>Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself.</p> <p>Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way.</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/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics &amp; Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW 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/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.</em></p>

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Could my glasses be making my eyesight worse?

<p><em><a href="https://theconversation.com/profiles/james-armitage-399647">James Armitage</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/nick-hockley-1517162">Nick Hockley</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a></em></p> <p>So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?</p> <p>Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them <a href="https://www.bbc.com/future/article/20140513-do-glasses-weaken-your-eyesight#:%7E:text=A%20study%20from,they%20are%20right%3F">less likely to wear their glasses</a>.</p> <p>But what they are noticing is how much better the world appears through the glasses. They become <a href="https://www.tandfonline.com/doi/full/10.1080/2576117X.2022.2033588">less tolerant</a> of a blurry world when they remove them.</p> <p>Here are some other things you might notice about eyesight and wearing glasses.</p> <h2>Lazy eyes?</h2> <p>Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.</p> <p>Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us <a href="https://www.aao.org/museum-eye-openers/how-does-eye-focus">focus on objects</a> in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).</p> <p>From the age of about 40, the lens in our eye <a href="https://theconversation.com/why-we-lose-our-hearing-and-vision-as-we-age-67930">progressively hardens</a> and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “<a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/presbyopia">presbyopia</a>” and at the moment there are no treatments for this lens hardening.</p> <p>Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.</p> <p>Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.</p> <h2>The wrong glasses?</h2> <p>Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause <a href="https://headaches.org/readers-mail-glasses-causing-headache/">eyestrain and headaches</a>.</p> <p>Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children <a href="https://iovs.arvojournals.org/article.aspx?articleid=2126392">as their visual system is still in development</a>.</p> <p>But it is more common for kids to develop long-term vision problems as a result of <a href="https://www.cera.org.au/wp-content/uploads/2021/08/Healthy-Young-Eyes-Guide-ACC.pdf">not wearing glasses when they need them</a>.</p> <p>By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in <a href="https://www.cera.org.au/wp-content/uploads/2021/08/Healthy-Young-Eyes-Guide-ACC.pdf">blurry or uncomfortable vision</a> during daily wear.</p> <p><a href="https://goodvisionforlife.com.au/">Registered optometrists in Australia</a> are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.</p> <h2>What about dirty glasses?</h2> <p>Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. <a href="https://www.optometry.org.au/wp-content/uploads/GVFL/Brochure_PDFs/Care-for-Glasses-2018-A4-single-page-final.pdf">Cleaning glasses regularly</a> with a microfibre lens cloth will help.</p> <p>While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207238">harbour bacteria</a> with the remote but theoretical <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628431/#:%7E:text=59%2C60%5D.-,S.,39%2C40%2C41%5D.">potential to cause eye infection</a>.</p> <p>To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207238">reduce bacterial contamination by 96%</a> – but care should be taken as alcohol can damage some frames, depending on what they are made of.</p> <h2>When should I get my eyes checked?</h2> <p><a href="https://goodvisionforlife.com.au/faqs/">Regular eye exams</a>, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD16%2F20156&amp;dbid=AP&amp;chksum=676U2aH1QM4XJ6ICVAVaKg%3D%3D">expire within two years</a> and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.</p> <p>Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as <a href="https://goodvisionforlife.com.au/vision-problems/glaucoma/">glaucoma</a>, will be recommended more frequent checks.</p> <p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706420/">online prescription estimator</a> is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.</p> <p>Conditions such as <a href="https://www.cdc.gov/diabetes/managing/diabetes-vision-loss.html#:%7E:text=Diabetic%20retinopathy%20is%20caused%20when,vision%20or%20stopping%20blood%20flow.">diabetes</a> or <a href="https://www.ncbi.nlm.nih.gov/books/NBK525980/">high blood pressure</a>, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.<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/225169/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/james-armitage-399647">James Armitage</a>, Associate Professor in Vision Science, Optometry Course Director, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/nick-hockley-1517162">Nick Hockley</a>, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin 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/could-my-glasses-be-making-my-eyesight-worse-225169">original article</a>.</em></p>

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Days are getting shorter and colder. 6 tips for sticking to your fitness goal

<p><em><a href="https://theconversation.com/profiles/juliana-s-oliveira-709434">Juliana S. Oliveira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/anne-tiedemann-409380">Anne Tiedemann</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/cathie-sherrington-561141">Cathie Sherrington</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/leanne-hassett-1497197">Leanne Hassett</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Daylight saving ends this weekend. The days are shorter and getting colder. It’s less appealing to cycle to work, walk after dinner, or wake up early to hit the gym. But we all know daily physical activity is essential for our health and wellbeing.</p> <p>Physical activity releases feel-good neurotransmitters in our brains, which help to alleviate <a href="https://bjsm.bmj.com/content/57/18/1203">stress, anxiety, and depression</a>. It also helps <a href="https://www.cdc.gov/chronicdisease/resources/infographic/physical-activity.htm#:%7E:text=Regular%20physical%20activity%20helps%20improve,depression%20and%20anxiety%2C%20and%20dementia.">prevent diseases</a> such as diabetes, heart disease and some cancers. Regular physical activity can prolong life and improve overall quality of life.</p> <p>However, many of us find it difficult to achieve the <a href="https://bjsm.bmj.com/content/54/24/1451">recommended 150 minutes of moderate intensity physical activity</a> each week. In fact, three out of ten Australians and half of Australians aged 65 and over are <a href="https://www.aihw.gov.au/reports/physical-activity/physical-activity">inactive</a>.</p> <p>So, what can you do to stay motivated and keep moving regularly through the darker months? Here are some tips.</p> <h2>1. Nail those goals</h2> <p>Goals can provide us with a sense of purpose, meaning and direction. But just aiming to “get fit” is less likely to cut it than goals that are SMART: specific, measurable, achievable, realistic and time-bound.</p> <p><strong>Specific</strong> goals are based on an observable behaviour or activity, such as step count, yoga, or competing in an event.</p> <p><strong>Measurable</strong> goals can be tracked, so you can easily tell whether you have ticked them off.</p> <p><strong>Achievable</strong> goals are realistic and based on your current fitness and abilities. But they can and should still be challenging. If you’ve only ever run 5 kilometres, it won’t be realistic to aim for a half marathon in the next month. But you could aim for 10 kilometres.</p> <p><strong>Relevant</strong> goals hold personal meaning for you. Articulating why it’s important will help motivate you to do it.</p> <p><strong>Time-bound</strong> goals include a target date for achieving them. You can always revisit your deadline if you’re ahead of schedule or if it’s too unrealistic.</p> <p>An example of a SMART goal could be: “I will walk 10,000 steps every weekday within a month.” Then you can break it down into short-term goals to make it more achievable. If you currently walk 6,000 steps each day, you can increase steps by 1,000 every week to reach 10,000 by the end of the month.</p> <h2>2. Keep track</h2> <p>More than <a href="https://www.deloitte.com/au/en/Industries/tmt/blogs/digital-consumer-trends-who-is-purchasing-what-now.html">90% of Australians own a smartphone</a> and more than <a href="https://www.deloitte.com/au/en/Industries/telecom-media-entertainment/blogs/digital-consumer-trends-touch-less-healthier-wiser.html">two in ten own a fitness tracker or a smartwatch</a>. These devices can help you track your goals and activity, keep you accountable and increase your motivation.</p> <p>A 2021 systematic review suggests fitness trackers and smartphone apps <a href="https://bjsm.bmj.com/content/55/8/422">can assist people</a> to increase their step count by up to 2,000 steps per day. <a href="https://bjsm.bmj.com/content/54/20/1188">Our research</a> demonstrated fitness trackers can also be helpful in increasing physical activity among older people. If you don’t have a fitness tracker, you can buy low-cost pedometers or track your activity times using paper and pen.</p> <h2>3. Plan for success but prepare for barriers</h2> <p>Take some time to think about the potential barriers that could prevent you from being active and plan solutions to overcome them.</p> <p>For example, if the cost of physical activity is too high for you, try to find options that are free, such as walking or running. You can also consider free online programs or streaming videos.</p> <p>If you find it difficult to fit exercise into your busy schedule, try exercising early in the morning before you start your day and laying out your workout clothes the night before. You could consider joining a gym with flexible timetables. A good strategy is to try to fit physical activity into your daily routine, such as walking or cycling to work.</p> <p>If you are living with a chronic health condition or disability, consider seeking guidance from a health professional such as an <a href="https://www.essa.org.au/Public/SearchAEP.aspx?WebsiteKey=44cfee74-3fc3-444e-bb5f-77729c390872">exercise physiologist</a> or <a href="https://choose.physio/find-a-physio">physiotherapist</a>. Start slow and gradually increase your activity and find something you enjoy so you are more likely to keep doing it.</p> <h2>4. Team up with a workout friend</h2> <p>Physical activity can be more fun when you do it with someone else. Studies show <a href="https://www.sciencedirect.com/science/article/abs/pii/S0167494322002953?via%253Dihub&amp;sa=D&amp;source=docs&amp;ust=1712015093947627&amp;usg=AOvVaw1XGQBMDMFspL5YrQtKo3h">working out with friends can be more motivating and enjoyable</a>. It can also help with accountability, as some people are more likely to show up when they have a workout partner. So, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60407-9/fulltext">find a friend</a> who supports your goal of being more active or maintaining your current activity levels.</p> <h2>5. Plan yourself a little treat</h2> <p>Make an appointment with yourself in your diary to exercise. Approach it as just as important as meeting a friend or colleague. One idea is to delay something you’d rather do and make it a reward for sticking to your activity appointment. If you really want to go out for coffee, do a hobby, or watch something, go for a walk first.</p> <p>Research shows <a href="https://www.nature.com/articles/s41746-019-0164-3">incentives can dramatically increase physical activity levels</a>.</p> <h2>6. Find a coach</h2> <p>If you want more support, <a href="https://bjsm.bmj.com/content/51/19/1425">health coaching</a> might be an option.</p> <p>Trained professionals work one-on-one with people, sometimes via telehealth, to find out what’s reducing their motivation to make healthier choices, such as exercise. Then they employ behaviour change techniques to help them meet their health goals.</p> <p>Our recent research suggests health coaching can improve physical activity in <a href="https://bjsm.bmj.com/content/58/7/382">older people</a> and those with <a href="https://www.sciencedirect.com/science/article/pii/S183695532400002X">chronic pain</a>. In <a href="https://www.gethealthynsw.com.au/#:%7E:text=About%20the%20Get%20Healthy%20Service&amp;text=Delivered%20by%20NSW%20Health%2C%20the,and%20achieve%20your%20health%20goals">New South Wales</a>, <a href="https://lifeprogram.org.au/">Victoria</a> and <a href="https://www.myhealthforlife.com.au/">Queensland</a>, these sessions are government-subsidised or free.<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/226619/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/juliana-s-oliveira-709434">Juliana S. Oliveira</a>, Postdoctoral Research Fellow, Physical Activity, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/anne-tiedemann-409380">Anne Tiedemann</a>, Professor of Physical Activity and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/cathie-sherrington-561141">Cathie Sherrington</a>, Professor, Institute for Musculoskeletal Health, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/leanne-hassett-1497197">Leanne Hassett</a>, Associate Professor in Physiotherapy, <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/days-are-getting-shorter-and-colder-6-tips-for-sticking-to-your-fitness-goals-226619">original article</a>.</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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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<p><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <em><a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <em><a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p>After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs.</p> <p>As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns.</p> <p>But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug.</p> <h2>Potential benefits</h2> <p><strong>1) It’s likely to help you lose weight</strong></p> <p>The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity.</p> <p>The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight).</p> <p>In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg.</p> <p>Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication.</p> <p><strong>2) It may reduce your chronic disease risk factors</strong></p> <p>When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases.</p> <p>In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels.</p> <p>In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels.</p> <p><strong>3) It might improve your quality of life, emotional wellbeing or sense of achievement</strong></p> <p>The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health.</p> <p>Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image.</p> <h2>What about the risks?</h2> <p><strong>1) You may experience gastrointestinal symptoms</strong></p> <p>In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%).</p> <p>In the UK study, nausea and diarrhoea were also commonly reported.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living.</p> <p>Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study.</p> <p><strong>2) You might feel fatigued</strong></p> <p>Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants.</p> <p><strong>3) You might be among the minority who don’t tolerate the drug</strong></p> <p>Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia.</p> <p>In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing.</p> <p>More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period.</p> <p>A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period.</p> <p>Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions.</p> <p><strong>4) It might be difficult to access</strong></p> <p>Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024.</p> <p>To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication.</p> <p><strong>5) You might not always get clear information from vested interests</strong></p> <p>Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>.</p> <p>Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications.</p> <h2>Bottom line</h2> <p>Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.</em><!-- 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/219312/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/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross 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/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.</em></p>

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Rebel Wilson's shocking weight loss confession

<p>Rebel Wilson has confessed to using Ozempic to maintain her weight after dropping almost 40kgs in her "year of health" in 2020. </p> <p>While speaking to the <em>Sunday Times </em>about the release of her memoir, <em>Rebel Rising</em>, the Aussie actress confessed to using the drug, which is used to treat type 2 diabetes. </p> <p>The 44-year-old has previously referred to 2020 as her "year of health" after she lost a staggering amount of weight, and has now finally admitted to using Ozempic, but only to maintain her weight. </p> <p>She said, "Someone like me could have a bottomless appetite for sweets, so I think those drugs can be good."</p> <p>Rebel went on to clarify that she is no longer taking the drug, and is happy with her weight. </p> <p>The actress shared how wanting to have a baby kick-started her dramatic weight loss in 2020, but not everyone was happy about her plans for a drastic transformation.</p> <p>"Basically no one apart from my mum wanted me to lose weight," Wilson recalled.</p> <p>"People thought I'd lose my pigeonhole in my career, playing the fat funny character, and they wanted me to continue in that."</p> <p>Over the past four years, Wilson has admitted to gaining some of it back including 20lbs from "stress eating" leading up to the release of her book, with Covid lockdowns also playing a part in her fluctuating weight.</p> <p>"I know that my relationship with food is complicated," she said. </p> <p>"I feel strongly that young women shouldn't try to obsess over looking like Victoria's Secret models — they should just look like themselves."</p> <p><em>Image credits: Getty Images </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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Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

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

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

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

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

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

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Only walking for exercise? Here’s how to get the most out of it

<p><em><a href="https://theconversation.com/profiles/ken-nosaka-169021">Ken Nosaka</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a></em></p> <p>We’re living longer than in previous generations, with <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/demographic-profile">one in eight</a> elderly Australians now aged over 85. But the current <a href="https://pubmed.ncbi.nlm.nih.gov/26561272/">gap</a> between life expectancy (“lifespan”) and health-adjusted life expectancy (“healthspan”) is about ten years. This means many of us live with significant health problems in our later years.</p> <p>To increase our healthspan, we need planned, structured and regular physical activity (or exercise). The <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">World Health Organization recommends</a> 150–300 minutes of moderate-intensity exercise – such as brisk walking, cycling and swimming – per week and muscle strengthening twice a week.</p> <p>Yet few of us meet these recommendations. <a href="https://doi.org/10.1186/s12966-019-0797-2">Only 10%</a> meet the strength-training recommendations. <a href="https://pubmed.ncbi.nlm.nih.gov/32488898/">Lack of time</a> is one of the most common reasons.</p> <p>Walking is cost-effective, doesn’t require any special equipment or training, and can be done with small pockets of time. <a href="https://link.springer.com/epdf/10.1007/s00421-024-05453-y?sharing_token=1vDsDJTN5WzPxi5YmSEkOfe4RwlQNchNByi7wbcMAY5hnPeFvF3FY4v2z1P9M2M0oiR78kXv1Yzj0ODMgckqhKOGHUABEd9UOPOfV5kPAj1jf1IYMIYkdIBv-DUEcKCOiDdNyj6MFypeDhSyeYQrWu_bvlAYtPUmOSaldFpmycA%3D">Our preliminary research</a>, published this week, shows there are ways to incorporate strength-training components into walking to improve your muscle strength and balance.</p> <h2>Why walking isn’t usually enough</h2> <p>Regular walking <a href="http://theconversation.com/health-check-in-terms-of-exercise-is-walking-enough-78604">does not appear</a> to work as muscle-strengthening exercise.</p> <p>In contrast, exercises consisting of “eccentric” or muscle-lengthening contractions <a href="http://theconversation.com/its-ok-to-aim%20lower-with-your-new-years-exercise-resolutions-a-few-minutes-a-day-can-improve-your-muscle-strength-193713">improve</a> muscle strength, <a href="https://pubmed.ncbi.nlm.nih.gov/31130877/">prevent muscle wasting</a> and improve other functions such as balance and flexibility.</p> <p>Typical eccentric contractions are seen, for example, when we sit on a chair slowly. The front thigh muscles lengthen with force generation.</p> <h2>Our research</h2> <p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/31055678/">previous research</a> found body-weight-based eccentric exercise training, such as sitting down on a chair slowly, improved lower limb muscle strength and balance in healthy older adults.</p> <p>We also <a href="https://pubmed.ncbi.nlm.nih.gov/28291022/">showed</a> walking down stairs, with the front thigh muscles undergoing eccentric contractions, increased leg muscle strength and balance in older women more than walking up stairs. When climbing stairs, the front thigh muscles undergo “concentric” contractions, with the muscles shortening.</p> <p>It can be difficult to find stairs or slopes suitable for eccentric exercises. But if they could be incorporated into daily walking, lower limb muscle strength and balance function could be improved.</p> <p>This is where the idea of “eccentric walking” comes into play. This means inserting lunges in conventional walking, in addition to downstairs and downhill walking.</p> <figure><iframe src="https://www.youtube.com/embed/wAI7z3XdY9o?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Eccentric walking means incorporating deep lunges into your movement.</span></figcaption></figure> <p>In our <a href="https://link.springer.com/epdf/10.1007/s00421-024-05453-y?sharing_token=1vDsDJTN5WzPxi5YmSEkOfe4RwlQNchNByi7wbcMAY5hnPeFvF3FY4v2z1P9M2M0oiR78kXv1Yzj0ODMgckqhKOGHUABEd9UOPOfV5kPAj1jf1IYMIYkdIBv-DUEcKCOiDdNyj6MFypeDhSyeYQrWu_bvlAYtPUmOSaldFpmycA%3D">new research</a>, published in the European Journal of Applied Physiology, we investigated the effects of eccentric walking on lower limb muscle strength and balance in 11 regular walkers aged 54 to 88 years.</p> <p>The intervention period was 12 weeks. It consisted of four weeks of normal walking followed by eight weeks of eccentric walking.</p> <p>The number of eccentric steps in the eccentric walking period gradually increased over eight weeks from 100 to 1,000 steps (including lunges, downhill and downstairs steps). Participants took a total of 3,900 eccentric steps over the eight-week eccentric walking period while the total number of steps was the same as the previous four weeks.</p> <p>We measured the thickness of the participants’ front thigh muscles, muscle strength in their knee, their balance and endurance, including how many times they could go from a sitting position to standing in 30 seconds without using their arms. We took these measurements before the study started, at four weeks, after the conventional walking period, and at four and eight weeks into the eccentric walking period.</p> <p>We also tested their cognitive function using a digit symbol-substitution test at the same time points of other tests. And we asked participants to complete a questionnaire relating to their activities of daily living, such as dressing and moving around at home.</p> <p>Finally, we tested participants’ blood sugar, cholesterol levels and complement component 1q (C1q) concentrations, a potential <a href="https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fj.14-262154">marker of sarcopenia</a> (muscle wasting with ageing).</p> <h2>What did we find?</h2> <p>We found no significant changes in any of the outcomes in the first four weeks when participants walked conventionally.</p> <p>From week four to 12, we found significant improvements in muscle strength (19%), chair-stand ability (24%), balance (45%) and a cognitive function test (21%).</p> <p>Serum C1q concentration decreased by 10% after the eccentric walking intervention, indicating participants’ muscles were effectively stimulated.</p> <p>The sample size of the study was small, so we need larger and more comprehensive studies to verify our findings and investigate whether eccentric walking is effective for sedentary people, older people, how the different types of eccentric exercise compare and the potential cognitive and mental health benefits.</p> <p>But, in the meantime, “eccentric walking” appears to be a beneficial exercise that will extend your healthspan. It may look a bit eccentric if we insert lunges while walking on the street, but the more people do it and benefit from it, the less eccentric it will become. <!-- 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/224159/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/ken-nosaka-169021">Ken Nosaka</a>, Professor of Exercise and Sports Science, <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/only-walking-for-exercise-heres-how-to-get-the-most-out-of-it-224159">original article</a>.</em></p>

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Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

<p><a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, <em><a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”</p> <p>“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.</p> <p>No further details have been released about the Princess of Wales’ treatment.</p> <p>But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.</p> <h2>It’s not the same as preventing cancer</h2> <p>To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>.</p> <p>Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>.</p> <p>Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers.</p> <h2>How can chemotherapy be used as preventive therapy?</h2> <p>In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.</p> <p>If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.</p> <p>If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> .</p> <p>The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.</p> <p>With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.</p> <p>If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.</p> <h2>How effective is preventive therapy?</h2> <p>The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.</p> <p>Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.</p> <p>Preventive chemotherapy is usually given for three to six months.</p> <h2>How does chemotherapy work?</h2> <p>Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.</p> <p>Chemotherapy is not selective for cancer cells. It kills any dividing cells.</p> <p>But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy.</p> <p>Normal cells can recover between courses, which are usually given three to four weeks apart.</p> <h2>What are the side effects?</h2> <p>The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.</p> <p>The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.</p> <p>Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.</p> <p>Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.</p> <p>There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>.</p> <p>Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.<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/226461/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</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/kate-middleton-is-having-preventive-chemotherapy-for-cancer-what-does-this-mean-226461">original article</a>.</em></p>

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6 major benefits of doing yoga every day, from experts

<h2>Positive effects of yoga</h2> <p style="font-size: medium; font-weight: 400;">Sometimes it’s the simplest daily practice that can have the biggest impact on your health, and yoga is proof of that. Although most forms of yoga aren’t considered to be as intense as other workout regimens (think your average cycling class!), practising yoga on a daily basis has been scientifically demonstrated to help you mentally and physically. Through breath work, meditation and holding poses that increase strength and flexibility, the body and mind reap benefits from yoga that positively impact your long-term health. It’s no wonder people have been practising yoga for over 5000 years, and that the number of Australians practising yoga doubled between 2008 and 2017 to over two million, according to the Australian Bureau of Statistics.</p> <p style="font-size: medium; font-weight: 400;">In order to get the full scope of what practising yoga daily can really do for your body, we spoke with several experts who have seen the ways yoga has positively benefited their students, patients… and even themselves.</p> <p style="font-size: medium; font-weight: 400;"><a href="https://gaiam.innovations.co.nz/p/gaiam-yoga/mats?affiliate=GAIAM60" target="_blank" rel="noopener">Keen to try? You’ll need a mat. There’s a range of mats to suit every yoga level, check out these we recommend.</a></p> <h2>Yoga assists with mood regulation</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_getty2.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">Yoga teacher, Jenni Tarma, shares, “We have a wealth of research demonstrating that a regular mindfulness practice – the act of paying attention to the sensation in the body, thoughts and emotions without judgment – can reduce stress and help us to feel calmer, more productive, and generally more even-keeled in our daily lives.”</p> <p style="font-size: medium; font-weight: 400;">After evaluating yoga history and research, one 2014 review published in Frontiers in Human Neouroscience concluded that regular yoga practice can help facilitate self-regulation (the ability to understand and manage your behaviour and reactions). Another study of adolescents between the ages of 13 and 18 found that practising yoga positively benefited emotional regulation and self-esteem. “Movement releases beneficial neurotransmitters in the brain, which helps us feel good as well as assist in mood regulation,” says yoga instructor, Evan Lawrence. “One of the things that I like about yoga specifically is that there is simultaneously a focus on physical movement and breathing.”</p> <p style="font-size: medium; font-weight: 400;"><a href="https://www.readersdigest.co.nz/culture/23-instant-mood-boosters-you-wont-want-to-live-without" target="_blank" rel="noopener">Don’t miss these instant mood boosters you won’t want to live without.</a></p> <h2>Yoga builds up your core strength</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_shutterstock3.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">Personal trainer and yoga teacher, Gina Newton, says, “From a physical perspective, yoga is so great for increasing our core strength, which should be a non-negotiable part of every human’s workout.” Newton adds, “We all need our core – and especially women who have been pregnant or had children, our core strength is something we need to care for and nurture to hold us up.”</p> <p style="font-size: medium; font-weight: 400;">According to Harvard Medical School, a stronger core benefits the body in multiple ways, including providing better posture, balance, stability, relief for lower back pain, and support through daily tasks like cleaning, working, and athletic activities or exercise.</p> <p style="font-size: medium; font-weight: 400;">Wearing comfortable yoga gear will help you get the most out of your workout. <a href="https://gaiam.innovations.co.nz/p/gaiam-apparel/apparel?affiliate=GAIAM60" target="_blank" rel="noopener">Check out these yoga clothes from Gaiam.</a></p> <h2>Yoga reduces stress</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_getty4.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">“Yoga and meditation are powerful tools for stress resilience and strengthening mental health,” says holistic healthcare practitioner and yoga instructor, Nicole Renée Matthews.  “Doing yoga regularly promotes mental clarity and calmness, centres and relaxes the mind, helps to relieve stress patterns and anxiety, and boosts concentration and focus.”</p> <p style="font-size: medium; font-weight: 400;">One 2010 study from the Journal of Alternative and Complementary Medicine concluded that practising yoga can improve mood and decrease anxiety even more than a regular walking practice after participants finished a 12-week program. Researchers have also found that the breath-taking techniques involved with yoga can be part of what benefits decreased anxiety during practice.</p> <p style="font-size: medium; font-weight: 400;">“Breath awareness, another key component of yoga, has been shown to reduce physiological markers of stress, especially when using techniques such as ‘belly breathing’ – breathing deeply so that the abdomen expands, rather than exclusively using a shallow chest breath – and elongating the exhalation,” says Tarma. “These techniques help to activate the parasympathetic nervous system, which in turn leads to less anxiety, jitteriness, and improved sleep; all things that can improve our mental health on a day-to-day basis.”</p> <p style="font-size: medium; font-weight: 400;"><a href="https://www.readersdigest.co.nz/healthsmart/conditions/mental-health/10-science-backed-ways-to-lower-your-stress-this-instant-really" target="_blank" rel="noopener">Don’t miss these science-backed ways to lower your stress this instant (really!).</a></p> <h2>Yoga improves brain health</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_getty5.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">According to associate professor of psychiatry, Dr Gail Saltz, practising yoga “improves overall blood flow to the body, including the brain, [which is] helpful for cognition and memory.”</p> <p style="font-size: medium; font-weight: 400;">One 2019 review published in Brain Plasticity concluded that behavioural interventions like yoga can help “mitigate age-related and neurodegenerative decline” due to the positive effects a daily practice has on different parts of the functioning brain, like the hippocampus (which plays a major role in learning and memory) and the prefrontal cortex (cognitive control functions).</p> <p style="font-size: medium; font-weight: 400;">Staying hydrated is key to maintaining optimum brain health. <a href="https://gaiam.innovations.co.nz/p/takeya/water-bottles-actives-range?affiliate=GAIAM60" target="_blank" rel="noopener">These drink bottles can help you keep your water intake up throughout the day.</a></p> <h2>Yoga improves flexibility and mobility</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_shutterstock6.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">“Physically, daily yoga practice allows us to engage our muscles and move through larger ranges of joint motion than we do typically moving through life,” says Lawrence. “This helps to keep us limber and flexible.”</p> <p style="font-size: medium; font-weight: 400;">“Dedicated, daily yoga practice helps with flexibility and strength, which can help improve your posture, as well as balance,” says yoga instructor, Samantha Hoff. “On the physical side, it also helps with joint mobility since you’ll take your joints through most – or all – of their ranges of motion.”</p> <p style="font-size: medium; font-weight: 400;"><a href="https://www.readersdigest.co.nz/healthsmart/12-best-yoga-poses-to-strengthen-bones" target="_blank" rel="noopener">Here are the best yoga poses to strengthen bones.</a></p> <h2>Yoga strengthens muscle and endurance</h2> <p style="font-size: medium; font-weight: 400;"><img src="https://oversixtydev.blob.core.windows.net/media/2024/03/6benefitsyoga_getty7.jpg" alt="" width="1280" height="720" /></p> <p style="font-size: medium; font-weight: 400;">“From a musculoskeletal perspective,” says Tarma, “yoga loads our bodies and joints in a wide variety of positions and scenarios: think longer static holds in poses that challenge our tissues’ endurance, or controlled transitions between shapes that develop strength, control and coordination. These different facets of our movement capabilities all contribute to better overall function and load-tolerance capacity. As an added bonus, because most styles of yoga are bodyweight only and move at a very moderate speed, yoga is also a generally very accessible and safe movement modality.”</p> <p style="font-size: medium; font-weight: 400;">Yoga is the ultimate self-care activity. <a href="https://gaiam.innovations.co.nz/p/gaiam-yoga/accessories/27-73312-gaiam-performance-hold-everything-yoga-backpack-bag?affiliate=GAIAM60" target="_blank" rel="noopener">Whether you do it at a studio or in the park, this handy yoga backpack bag stores everything you need for a calm yoga workout.</a></p> <p style="font-size: medium; font-weight: 400;"><strong>This article, written by </strong><span style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif; font-size: medium;"><strong>Kiersten Hickman,</strong> </span><strong style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;">originally appeared on <a href="https://www.readersdigest.co.nz/culture/6-major-benefits-of-doing-yoga-every-day-from-experts" target="_blank" rel="noopener">Reader's Digest</a>.</strong></p> <p style="font-size: medium; font-weight: 400;"><em>Images: Shutterstock | Getty</em></p>

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William Shatner shocks hosts simply by revealing his age

<p>In a world where time ticks mercilessly onward, one man has defied the very essence of ageing: the legendary William Shatner, the man who boldly went where no nonagenarian has gone before.</p> <p>As Shatner prepares to celebrate his 93rd trip around the sun, fans worldwide are scratching their heads in disbelief. The reason? Well, it seems that Captain Kirk himself has stumbled upon the fountain of youth and decided to keep it all to himself. </p> <p>The commotion started when Shatner made a <a href="https://www.tiktok.com/@todayshow/video/7347749279865490734?_r=1&_t=8koli3bKC49" target="_blank" rel="noopener">guest appearance</a> on the <em>US Today Show</em>, looking fresher than a daisy in springtime. Fans took to social media to express their shock, with one incredulous viewer commenting, "Damn, he's still sharp and has his hair. I would never have guessed 93." And another chimed in with, "I would've guessed 67 or 68."</p> <p>Forget "live long and prosper"; it seems the new motto is "live long and confound the heck out of everyone".</p> <p>Even the hosts of the<em> Today Show</em> were left flabbergasted by Shatner's youthful glow. They couldn't resist asking the man himself for his secret to longevity. And what pearls of wisdom did he impart? "Don't tell anybody [your age]." Ah, sage advice indeed. It seems the real secret to ageing gracefully is to maintain an air of mystery.</p> <p>But let's rewind to 2021 when Shatner was grilled by a journalist about whether he'd had any "serious work" done. His response? A witty comeback, of course. "No, have you?" Touché, Shatner, touché. And when pressed further, he simply attributed his youthful appearance to good genes, lots of horseback riding and a healthy dose of bewilderment about the world. </p> <p>Despite his apparent disdain for the number 90 ("It's disgusting," he once declared in an interview), Shatner finds himself hurtling towards the ripe old age of 93 with all the grace and poise of a starship navigating through a meteor shower. And if his recent TV appearance is anything to go by, he's showing no signs of slowing down.</p> <p>So let's all take a leaf out of Shatner's playbook, shall we? If anyone asks for the secret to your eternal youth, just give them that trademark Shatner smirk and say: "It's classified."</p> <p><em>Images: NBC | Wikimedia | Tik Tok</em></p>

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Does intermittent fasting have benefits for our brain?

<p><a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, <em><a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Intermittent fasting has become a popular dietary approach to help people lose or manage their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683964/">weight</a>. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and <a href="https://pubmed.ncbi.nlm.nih.gov/27810402">improve overall health</a>.</p> <p>Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like <a href="https://link.springer.com/article/10.1007/s11011-023-01288-2">Alzheimer’s disease</a>.</p> <p>This is not a new idea – the ancient Greeks believed fasting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839325/">enhanced thinking</a>. But what does the modern-day evidence say?</p> <h2>First, what is intermittent fasting?</h2> <p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/35487190/">diets</a> – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.</p> <p>Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast.</p> <p>Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.</p> <h2>4 ways fasting works and how it might affect the brain</h2> <p>The brain accounts for about <a href="https://theconversation.com/how-much-energy-do-we-expend-thinking-and-using-our-brain-197990">20% of the body’s energy consumption</a>.</p> <p>Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.</p> <p><strong>1. Ketosis</strong></p> <p>The goal of many intermittent fasting routines is to flip a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">metabolic switch</a>” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. <a href="https://www.ncbi.nlm.nih.gov/books/NBK493179/">Ketones</a> – chemicals produced by this metabolic process – become the preferred energy source for the brain.</p> <p>Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10844723/">cause symptoms</a> of hunger, fatigue, nausea, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/">low mood</a>, irritability, constipation, headaches, and brain “fog”.</p> <p>At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to <a href="https://www.science.org/doi/10.1126/science.aau2095">preserve brain function</a> and prevent <a href="https://pubmed.ncbi.nlm.nih.gov/32709961/">age-related neurodegeneration disorders and cognitive decline</a>.</p> <p>Consistent with this, increasing ketones through <a href="https://pubmed.ncbi.nlm.nih.gov/31027873/">supplementation</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/31757576/">diet</a> has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively.</p> <p><strong>2. Circadian syncing</strong></p> <p>Eating at times that <a href="https://pubmed.ncbi.nlm.nih.gov/32480126/">don’t match our body’s natural daily rhythms</a> can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to <a href="https://pubmed.ncbi.nlm.nih.gov/22010477/">chronic disease</a>.</p> <p>Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in <a href="https://pubmed.ncbi.nlm.nih.gov/36599299/">expression of genes in tissue</a> and helps the body during rest and activity.</p> <p>A 2021 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827225/">study of 883 adults</a> in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions.</p> <p><strong>3. Mitochondria</strong></p> <p>Intermittent fasting may provide <a href="https://pubmed.ncbi.nlm.nih.gov/35218914/">brain protection</a> through improving mitochondrial function, metabolism and reducing oxidants.</p> <p>Mitochondria’s <a href="https://www.genome.gov/genetics-glossary/Mitochondria">main role is to produce energy</a> and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to <a href="https://www.nature.com/articles/s41574-021-00626-7">mitochondrial dysfunction during ageing</a>.</p> <p>Rodent studies suggest alternate day fasting or reducing calories <a href="https://journals.sagepub.com/doi/10.1038/jcbfm.2014.114">by up to 40%</a> might protect or improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/21861096">brain mitochondrial function</a>. But not all studies support this theory.</p> <p><strong>4. The gut-brain axis</strong></p> <p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/">gut and the brain communicate with each other</a> via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.</p> <p>In mice, intermittent fasting has shown promise for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">improving brain health</a> by increasing survival and <a href="https://pubmed.ncbi.nlm.nih.gov/12354284/">formation of neurons</a> (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion.</p> <p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470960/">no clear evidence</a> on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646955/">lower meal frequency</a> (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.</p> <p>Some research has suggested calorie restriction may have a protective effect against <a href="https://academic.oup.com/nutritionreviews/article/81/9/1225/7116310">Alzheimer’s disease</a> by reducing oxidative stress and inflammation and promoting vascular health.</p> <p>When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed <a href="https://pubmed.ncbi.nlm.nih.gov/26713821/">cognitive improvement</a> when participants followed a calorie restricted diet for 12 months.</p> <p>Another study found a 25% calorie restriction was associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30968820">slightly improved working memory</a> in healthy adults. But a <a href="https://www.sciencedirect.com/science/article/pii/S0022316623025221?via%3Dihub">recent study</a>, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.</p> <h2>Bottom line</h2> <p>Studies in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740746/">mice</a> support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.</p> <p>Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749464/">older adults</a> whose nutritional needs may be higher.</p> <p>Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314618/">prolonged fasting</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042193/">severe calorie restriction</a> may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions.</p> <p>If you’re considering <a href="https://www.nejm.org/doi/10.1056/NEJMra1905136?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">intermittent fasting</a>, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.<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/223181/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, Assistant Professor, Faculty of Health Sciences and Medicine, <em><a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></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/does-intermittent-fasting-have-benefits-for-our-brain-223181">original article</a>.</em></p> <p><em>Image: Getty </em></p>

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