Monthly Archives: November 2021

Concerned about overeating? Here’s what you need to know about food addiction

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Concerned about overeating? Here’s what you need to know about food addiction

November 25, 2021 6.05am AEDT

Authors

  1. Tracy Burrows Professor Nutrition and Dietetics, University of Newcastle
  2. Megan Whatnall Post-Doctoral Researcher in Nutrition and Dietetics, University of Newcastle

Disclosure statement

Tracy Burrows is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, and Hunter Medical Research Institute, NSW. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Bill and Melinda Gates Foundation, nib foundation, The National Heart Foundation. She has also consulted to the Sax Institute.

Megan Whatnall is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She has received research grants from Hunter Medical Research Institute, The National Heart Foundation of Australia, and nib foundation.

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For many of us, eating particular foods can be comforting: a pick-me-up during a hard task; a reward after a long day at work; a satiating end to a lovely dinner.

But some people have a compulsive and uncontrolled urge to eat particular foods, especially hyper-palatable “junk” foods. This can impact on their day-to-day functioning, and their ability to fulfil social, work or family roles.

People who struggle with addictive eating may have intense cravings, which don’t relate to hunger, as well as increased levels of tolerance for large quantities of food, and feelings of withdrawal.

Rather than hunger, these cravings may be prompted by low mood, mental illness (depression and anxiety), high levels of stress, or heightened emotions.

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Read more: Explainer: can you be addicted to food?


“Food addiction” or “addictive eating” is not yet a disorder that can be diagnosed in a clinical setting. Yet patients often ask health professionals about how to manage their addictive eating.

These health providers generally acknowledge their patients’ addictive eating behaviours but may be unsure of suitable treatments.

Food addiction is commonly assessed using the Yale Food Addiction Scale.

The science of addictive eating is still emerging, but researchers are increasingly noting addiction and reward pathways in the brain triggered by stress, heightened emotions and mental illness are associated with the urge to overeat.

How common is it?

Many factors contribute to overeating. The abundance of fast food, junk food advertising, and the highly palatable ingredients of many processed foods can prompt us to eat whether we are hungry or not.

However, some people report a lack of control over their eating, beyond liking and wanting, and are seeking help for this.

Around one in six people (15-20%) report addictive patterns of eating or addictive behaviours around food.

While food addiction is higher among people with obesity and mental health conditions, it only affects a subset of these groups.

How can you tell if you have a problem?

Typically, food addiction occurs with foods that are highly palatable, processed, and high in combinations of energy, fat, salt and/or sugar while being low in nutritional value. This might include chocolates, confectionery, takeaway foods, and baked products.

These foods may be associated with high levels of reward and may therefore preoccupy your thoughts. They might elevate your mood or provide a distraction from anxious or traumatic thoughts, and over time, you may need to eat more to get the same feelings of reward.

Anxious man looks out the window.
For some people with addictive eating, food preoccupies their thoughts. Shutterstock

However, for others, it could be an addiction to feelings of fullness or a sense of reward or satisfaction.

There is ongoing debate about whether it is components of food that are addictive or the behaviour of eating itself that is addictive, or a combination of the two.

Given people consume foods for a wide range of reasons, and people can form habits around particular foods, it could be different for different people.


Read more: Foods high in added fats and refined carbs are like cigarettes – addictive and unhealthy


It often starts in childhood

Through our research exploring the experiences of adults, we found many people with addictive eating attribute their behaviours to experiences that occurred in childhood.

These events are highly varied. They range from traumatic events, to the use of dieting or restrictive eating practices, or are related to poor body image or body dissatisfaction.

Our latest research found addictive eating in teenage years is associated with poorer quality of life and lower self-esteem, and it appears to increase in severity over time.

Children and adolescents tend to have fewer addictive eating behaviours, or symptoms, than adults. Of the 11 symptoms of the Yale Food Addiction Scale, children and adolescents generally have only two or three, while adults often have six or more, which is classified as severe food addiction.


Read more: In a virtual universe of ‘perfect’ bodies, Instagram’s new policy offers important protection for young users


The associations we observed in adolescents are also seen in adults: increased weight and poorer mental health is associated with a greater number of symptoms and prevalence of food addiction.

This highlights that some adolescents will need mental health, eating disorder and obesity services, in a combined treatment approach.

We also need to identify early risk factors to enable targeted, preventative interventions in younger age groups.

How is it treated?

The underlying causes of addictive eating are diverse so treatments can’t be one-size-fits-all.

A large range of treatments are being trialled. These include:

  • passive approaches such as self-help support groups
  • trials of medications such as naltrexone and bupropion, which targets hormones involved in hunger and appetite and works to reduce energy intake
  • bariatric surgery to assist with weight loss. The most common procedure in Australia is gastric banding, where an adjustable band is placed around the top part of the stomach to apply pressure and reduce appetite.

However, few of the available self-help support groups include involvement or input from qualified health professionals. While providing peer support, these may not be based on the best available evidence, with few evaluated for effectiveness.

Medications and bariatric surgery do involve health professional input and have been shown to be effective in achieving weight loss and reducing symptoms of food addiction in some people.

However, these may not be suitable for some people, such as those in the healthy weight range or with complex underlying health conditions. It’s also critical people receiving medications and surgery are counselled to make diet and other lifestyle changes.


Read more: Your brain on sugar: What the science actually says


Other holistic, personalised lifestyle approaches that include diet, physical activity, as well as mindfulness, show promising results, especially when co-designed with consumers and health professionals.

Person ties orange laces on their runners.
Personalised approaches which include diet and physical activity are showing promising results. Shutterstock

Our emerging treatment program

We’re also creating new holistic approaches to manage addictive eating. We recently trialled an online intervention tailored to individuals’ personalities.

Delivered by dietitians and based on behaviour change research, participants in the trial received personalised feedback about their symptoms of addictive eating, diet, physical activity and sleep, and formulated goals, distraction lists, and plans for mindfulness, contributing to an overall action plan.

After three months, participants reported the program as acceptable and feasible. The next step in our research is to trial the treatment for effectiveness. We’re conducting a research trial to determine the effectiveness of the treatment on decreasing symptoms of food addiction and improving mental health.

This is the first study of its kind and if found to be effective will be translated to clinical practice

COVID-19 research: Fact, fiction or something in-between

COVID-19 research: Fact, fiction or something in-between

Mayo Clinic|November 19, 2021

Q: There are so many studies out there regarding COVID-19 and vaccinations for people to read and react to. How do we know/decide which study is accurate and worthwhile for patients and which studies aren’t when it comes to COVID-19?

A: “There is more information on the internet than anyone can digest,” says Melanie Swift, MD, infectious disease physician at Mayo Clinic. “It can be difficult to know what to believe. Depending on who is running the website or sharing their interpretation of the medical studies, it may be reliable, but it might be a misinterpretation of the data or completely falsified information.”

Here are some tips:

  • Studies that are indexed in PubMed, are published in reputable journals, and have undergone scientific peer review are reputable.
  • Studies that are searchable in Google Scholar may have undergone peer review as well, but might be a “preprint” that has not yet undergone peer review or been accepted by a reputable scientific journal. Preprints are labelled as such and should be interpreted with caution.
  • Use trusted sources like:

Beware of:

  • Websites that feature medical experts who are not trained in a relevant specialty or endorsed by a reputable medical center or legitimate medical society. “Infectious diseases or pulmonary and critical care medicine specialists are ideal sources for COVID-19 information. If the website or organization features just one or two doctors from unrelated specialties, be skeptical,” says Swift.
  • Social media postings from individuals sharing opinion, anecdotes, or their interpretation of medical studies. “People will commonly state they have done their own “research” but this may mean they only searched for studies that support their bias. These individuals may not have the expertise to judge the validity of a medical study, may be justifying their personal beliefs or promoting a political agenda,” Swift adds.
  • Claims for alternative or “miracle” drugs that sound unrealistic, without studies published in reputable medical journals. When highly effective treatments are confirmed through valid scientific studies, they are publicized by the CDC, medical centers, medical societies, and reliable media outlets.

The National Library of Medicine provides a helpful tutorial on how to evaluate a health-related website while the Surgeon General recommends a quick health misinformation checklist,” says Swift.

Some of the tips they offer include:

  • Did you check with the CDC or local public health department to see whether there is any information about the claim being made?
  • Did you ask a credible health care professional such as your doctor or nurse if they have any additional information?
  • Did you type the claim into a search engine to see if it has been verified by a credible source?
  • Did you look at the “About Us” page on the website to see if you can trust the source?
  • If you’re not sure, don’t share!

Salt intake and the Brain.

Researchers reveal surprising findings on how salt affects blood flow in the brain

MedicalXpress Breaking News-and-Events|November 12, 2021

A first-of-its-kind study led by researchers at Georgia State reveals surprising new information about the relationship between neuron activity and blood flow deep in the brain, as well as how the brain is affected by salt consumption.

When neurons are activated, this typically produces a rapid increase of blood flow to the area. This relationship is known as neurovascular coupling, or functional hyperemia, and it occurs via dilation of blood vessels in the brain called arterioles. Functional magnetic resource imaging (fMRI) is based on the concept of neurovascular coupling: Experts look for areas of weak blood flow to diagnose brain disorders.

However, previous studies of neurovascular coupling have been limited to superficial areas of the brain (such as the cerebral cortex) and scientists have mostly examined how blood flow changes in response to sensory stimuli coming from the environment (such as visual or auditory stimuli). Little is known about whether the same principles apply to deeper brain regions attuned to stimuli produced by the body itself, known as interoceptive signals.

To study this relationship in deep brain regions, an interdisciplinary team of scientists led by Dr. Javier Stern, professor of neuroscience at Georgia State and director of the university’s Center for Neuroinflammation and Cardiometabolic Diseases, developed a novel approach that combines surgical techniques and state-of-the-art neuroimaging. The team focused on the hypothalamus, a deep brain region involved in critical body functions including drinking, eating, body temperature regulation and reproduction. The study, published in the journal Cell Reports, examined how blood flow to the hypothalamus changed in response to salt intake.

“We chose salt because the body needs to control sodium levels very precisely. We even have specific cells that detect how much salt is in your blood,” said Stern. “When you ingest salty food, the brain senses it and activates a series of compensatory mechanisms to bring sodium levels back down.”

The body does this in part by activating neurons that trigger the release of vasopressin, an antidiuretic hormone that plays a key role in maintaining the proper concentration of salt. In contrast to previous studies that have observed a positive link between neuron activity and increased blood flow, the researchers found a decrease in blood flow as the neurons became activated in the hypothalamus.

“The findings took us by surprise because we saw vasoconstriction, which is the opposite of what most people described in the cortex in response to a sensory stimulus,” said Stern. “Reduced blood flow is normally observed in the cortex in the case of diseases like Alzheimer’s or after a stroke or ischemia.”

The team dubbed the phenomenon “inverse neurovascular coupling,” or a decrease in blood flow that produces hypoxia. They also observed other differences: In the cortex, vascular responses to stimuli are very localized and the dilation occurs rapidly. In the hypothalamus, the response was diffuse and took place slowly, over a long period of time.

“When we eat a lot of salt, our sodium levels stay elevated for a long time,” said Stern. “We believe the hypoxia is a mechanism that strengthens the neurons’ ability to respond to the sustained salt stimulation, allowing them to remain active for a prolonged period.”

The findings raise interesting questions about how hypertension may affect the brain. Between 50 and 60% of hypertension is believed to be salt-dependent—triggered by excess salt consumption. The research team plans to study this inverse neurovascular coupling mechanism in animal models to determine whether it contributes to the pathology of salt-dependent hypertension. In addition, they hope to use their approach to study other brain regions and diseases, including depression, obesity and neurodegenerative conditions.

“If you chronically ingest a lot of salt, you’ll have hyperactivation of vasopressin neurons. This mechanism can then induce excessive hypoxia, which could lead to tissue damage in the brain,” said Stern. “If we can better understand this process, we can devise novel targets to stop this hypoxia-dependent activation and perhaps improve the outcomes of people with salt-dependent high blood pressure.”

The study authors include Ranjan Roy and Ferdinand Althammer, postdoctoral researchers in the Center for Neuroinflammation and Cardiometabolic Diseases, Jordan Hamm, assistant professor of neuroscience at Georgia State, and colleagues at the University of Otago in New Zealand, Augusta University and Auburn University. The research was supported by the National Institute of Neurological Disorders and Stroke.

Seaweed as ‘superfood’? Here’s what the research says

Seaweed as ‘superfood’? Here’s what the research says

Many of my patients are aware that I have been promoting seaweed as a health benefit to all, especially those with thyroid problems. My wife and I have been consuming seaweed for some years now. It is obtainable from any Asian food store, and also Coles and Woollies in the Asian section. The Korean seasoned seaweed is best.

Alistair Gardiner |November 17, 2021

It may sound like another food fad, but a growing body of evidence suggests that edible seaweed has health benefits for humans. Those slimy sea plants—actually a type of marine algae—are packed with fibers, essential vitamins, minerals, polyunsaturated fatty acids, and other bioactive compounds.

Seaweed is widely purported to provide health benefits, but does research bear out the claims?

Researchers are increasingly taking an interest in seaweeds for their potential to lower the risk of various chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and hypertension. Moreover, certain seaweeds contain compounds with anticancer, antitumor, and antiviral properties, according to studies.

Seaweed and its extracted compounds are widely marketed for their health-promoting properties, but science has yet to substantiate all of the health claims. And they are still investigating the potential adverse effects, in particular the potentially high and dangerous levels of iodine and heavy metals like arsenic in certain seaweeds.

Let’s take a deeper dive into the health benefits and risks of consuming marine algae.  

Components of seaweed

According to a review published in Frontiers in Marine Science in March, seaweed contains vitamins A, B1, B2, B12, C, D, and E, which offer various health benefits and prompt antioxidant activity. Seaweed may contribute to a lower risk of high blood pressure, cardiovascular disorders, cancer, diabetes, atherosclerosis, and neurodegenerative disease.

Due to its habitat, marine algae is also a great source of minerals, including potassium, sodium, phosphorus, calcium, iodine, magnesium, iron, and zinc, all of which are required for optimal health and function. Plus, seaweed features dietary fibers and proteins, and bioactive ingredients including polysaccharides, polyphenols, phytochemicals, and polyunsaturated fatty acids. According to the review, seaweed may have therapeutic uses in patients with inflammation, cancer, allergies, diabetes, thrombosis, and obesity.

Seaweed and health conditions

As noted in a review published in Phycologia in 2019, seaweeds have been used as a remedy throughout human history, but research into the plant’s value as a nutraceutical is now a major subject of exploration. This includes research into the impact of consuming seaweed on the risk of hypertension and cardiovascular disease. Authors cite several epidemiological studies that found an inverse relationship between regular seaweed consumption and reduced risk of these conditions, including a 15-year study of dietary patterns in almost 80,000 men and women in Japan.

According to the review, researchers hypothesize that the fatty acids and peptides found in seaweed may contribute to its blood-pressure-lowering abilities.

It’s been long established that the consumption of fiber-rich foods like seaweed has a positive impact on appetite, satiety, blood glucose, and cholesterol. But many seaweeds (particularly brown seaweeds) also feature fucoxanthin, which studies have indicated has anti-obesity properties. In light of this, authors of the review posited that, in combination with exercise and dietary changes, seaweed could help treat obesity.

Seaweed may have anti-cancer properties due to the antiproliferative activity of peptides, polysaccharides, and polyphenols, according to the 2021 Frontiers review. The Phycologia review cites studies that have established relationships between high levels of seaweed consumption and reduced risk for bowel, biliary tract, colorectal, and breast cancer.

In addition, the Phycologia review points out that various studies (in animals and humans) have demonstrated the anti-diabetic efficacy of seaweed. One study found that daily consumption of one type of seaweed resulted in more regular blood glucose levels, decreased serum triglyceride concentrations, and increased high-density lipoprotein cholesterol in subjects with type 2 diabetes. Other studies have found that seaweed consumption helped modulate glucose metabolism, which can lead to improved cognitive performance

Beyond this, research indicates that seaweed also has antiviral properties, and may even be able to help those with insomnia. 

Health risks?

Health claims associated with commercially available seaweed products are too often based on insufficient evidence (or no evidence at all) from human intervention studies, according to a review published in Nutrition Reviews. “There are considerable safety concerns related to potential adverse events associated with seaweed consumption, particularly in light of the variable and potentially dangerously high concentrations of iodine and heavy metals (including arsenic species) in certain seaweeds,” the authors wrote. 

Of note, pregnant women should be advised to avoid seaweed due to its iodine content. Authors point out that the iodine found in seaweed, along with other heavy metals (including mercury), may also impair thyroid function. And, although the heavy metal concentrations in edible seaweeds are generally below toxic levels, patients who eat a lot are at a higher risk of bioaccumulating arsenic.

“Edible seaweeds are a rich and sustainable source of macronutrients (particularly dietary fiber) and micronutrients, but if seaweeds are to contribute to future global food security, legislative measures to ensure monitoring and labeling of food products are needed to safeguard against excessive intakes of salt, iodine, and heavy metals,” they wrote, concluding that more human studies are needed to establish how regular consumption of whole seaweeds and their extracted bioactive components affects human health. 

Environmental impacts 

Seaweeds have environmental appeal because they are sustainable, and they don’t need fresh water, extra fertilizer, or land to grow. They use renewable living resources and don’t require the use of pesticides; plus, they absorb carbon dioxide from sea runoffs, which means they’re a carbon-negative food, wrote the authors of the Frontiers review. And of course, they’re abundant in every ocean. 

“Aquaculture is recognized as the most sustainable means of seaweed production and accounts for approximately 27.3 million tonnes (96%) of global seaweed production per annum, yet the growing demand for seaweed-based food ingredients calls for more established guidelines and regulations to ensure sustainability,” they wrote.

Other researchers agree.

Ultimately, wrote the authors of the Nutrition Reviews article, “if seaweeds are to contribute to future global food security, either in their whole form or via extraction of their nutrients, the industry should develop a sustainable heavy metal/iodine monitoring program or, alternatively, identify novel processing technologies to ensure that unsafe components such as arsenic are minimized to safe levels, thus protecting the food chain.”

Is Bioidentical HRT TGA approved.

I attended a medical conference recently when a gynecologist repeated the untruth that Bioidentical hormones are not approved by the TGA. This is the party line given out by the Big Pharmaceutical Companies, to protect the sales of their products. The hormones I use consist of Oestradiol (approved by the TGA in many hormonal products, including the pill), natural Progesterone(Approved by the TGA and used in Prometrium) and Testosterone, which is now approved by the TGA for women with loss of libido.

The other untruth repeated at this conference, was that BHRT is very expensive. In fact it is much less costly than the standard HRT used by most doctors. The average cost per day of the troches I use vary from $1.0 – $1.50 per day. Thirty days for about $30-$45 average, depending on the chemist. A troche last 2 months. It pays to shop around, but be aware that quality and service is not the same with all compounding chemists.The average cost of the standard HRT as prescribed by most specialists and GPs, , is about $20 per month if it only contains Oestrogen, to $140/month if it contain all 3 hormones most women need. Not all women need testosterone, and some doctors may not give progesterone if you have had a hysterectomy, so the cost will be lower. However, progesterone has benefits for most women whether they have had a hysterectomy or not. Search”” Benefits of Progesterone”” on my website.

Just don’t douche – what your vaginal biome can tell you about your health and pregnancy

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Just don’t douche – what your vaginal biome can tell you about your health and pregnancy

November 10, 2021 5.21am AEDT

Authors

  1. Naomi Strout Researcher, Midwife, Nurse, UNSW Microbiome Research Centre, UNSW
  2. Mathew Leonardi Gynaecological Surgeon and Sonologist, McMaster University; PhD Candidate, Nepean Clinical School, University of Sydney, University of Sydney

Disclosure statement

Naomi Strout works for UNSW’s Microbiome Reseach Centre. She has received funding from the MRFF to conduct The MothersBabies Study.

Mathew Leonardi receives funding from the MRFF, Australian Women and Children’s Foundation, AbbVie. He is working with the UNSW’s Microbiome Research Centre.

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University of Sydney and UNSW provide funding as members of The Conversation AU.

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Researchers in the UK recently discovered a rapid test that checks the vaginal microbiome and can detect risks of preterm birth. Usually, tests to check the microbiome are complicated and it takes a long time to get a result.

Up to 50% of preterm births are associated with microbial causes and preterm birth is the most common cause of death in children under 5. So, a rapid test that can return results within minutes could make a world of difference for patients and families.

This groundbreaking research sheds further light on how the vaginal microbiome works and what it can tell someone about the health of their body and their baby.


Read more: Group B strep and having a baby: what pregnant women need to know

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Not just for guts

The microbiome is a buzz word that has popped up a lot lately – and yes, most people associate it with gut health.

In fact, microbiome is the term used when describing all of the DNA content of our microbiota – the trillions of “bugs” that live as a community in us and on us (including our gut, mouth, urine, skin and yes, vagina). These microorganisms include bacteria, viruses and fungi.

Without our microbiome, our bodies would not function correctly. Our microbiome has been shown to impact our immune development, disease defences and our behaviour and mental health. Research shows intergenerational and matrilineal inheritance patterns of birth microbiota. In other words, we inherit the microbiome of our mothers and grandmothers at birth.

While large studies investigating our gut and mouth microbiome and links with health and disease are well established, the science behind the vaginal microbiome is still in its infancy. One of the first papers showing distinct microbial changes throughout the trimesters of pregnancy was only published in 2012. But there is a growing emphasis on how a person’s vaginal microbiome can impact reproductive and public health.

bacteria diagram plus female figure
The balance of ‘good’ and ‘bad’ bacteria is important to maintain vaginal health. Shutterstock

What makes the vaginal microbiome different?

The vaginal microbiome is complex and fascinating. Its dynamics differ significantly between non-pregnant and pregnant states, and over the course of our lifespan – from birth, through to puberty, and beyond menopause.

Ethnicity, socioeconomic status, menstrual cycle, and sexual partners all impact on the microbiota present in your vagina.

Dominated by Lactobacillus species (usually L. crispatus, L. iners, L. jensenii or L. gasseri), the vaginal microbiome has long regarded “healthy” or “normal” in people of European ancestry. But now we understand healthy non-pregnant African-American and Hispanic people have a non-Lactobacillus-dominated microbiome.

States of play

The vaginal microbiome needs to be looked at in two contexts – non-pregnant, and pregnant. When a person is not pregnant, their “normal” vaginal microbiome should be highly diverse and dynamic, fluctuating with their normal hormonal cycle and lifestyle. Once they fall pregnant, these fluctuations should stabilise and overall diversity of the vaginal microbiome should decrease.

Sometimes, the microbiome loses stability and becomes out of balance – this is called dysbiosis. When the vaginal microbiome is out of balance, people may notice inflammation, itch, malodour, discharge or redness.

Some may be familiar with the uncomfortable feeling of a candida (yeast) infection or have encountered the fishy smell commonly caused by bacterial vaginosis. But it’s not just these conditions that come from an imbalanced microbiome.

There is evidence to suggest this can also affect the ability to fall pregnant, pregnancy well-being (such as the potential to develop gestational diabetes or pre-eclampsia) and result in preterm labour and birth.

microscopic cells
A pap smear slide shows cells and signs of bacterial infection. Shutterstock

Read more: Coronavirus while pregnant or giving birth: here’s what you need to know


How can I keep my vaginal microbiome healthy?

There are strategies to improve the health of one’s microbiome – but a magic pill isn’t the answer. Your microbiome is unique and there is no one-size-fits-all approach.

The best way to ensure a healthy microbiome is by eating well, drinking lots of water, exercising regularly and refraining from smoking and alcohol. Minimising stress and maintaining good general hygiene are also essential. But do not douche – this can negatively effect the makeup of your vaginal microbiome! The vagina is considered a “self-cleaning oven”.

There isn’t a lot of high quality evidence on the benefits of probiotics to improve you vaginal microbiome. One paper suggests changes are only present during dosing schedules, and disappear when the person ceases the medication. This indicates the probiotic does not colonise the vaginal microbiome and stick around long term.


Read more: Your vagina cleans itself: why vagina cleaning fads are unnecessary and harmful


Rapid testing on the way

The new research could lead to a convenient, bedside test for preterm birth risk. This would enable clinicians to make faster and more targeted decisions on treatment options, resulting in better outcomes for both mum and bub.

Researchers point out rapid testing might also be useful in other clinical scenarios, but this is yet to be tested. Ultimately, this is new technology, and the focus of a clinical trial – there is still a way to go before we see rapid testing in Australian hospitals or other healthcare settings.

UNSW’s Microbiome Research Centre is recruiting people actively planning a pregnancy, to determine if their preconception microbiome might influence pregnancy and birth outcomes. If we can determine whether your microbiome is dysbiotic before you even fall pregnant, we could transform maternal and child health worldwide.

We can expect more colds and flu as COVID restrictions lift. 5 germs to look out for

We can expect more colds and flu as COVID restrictions lift. 5 germs to look out for

November 8, 2021 6.11am AEDT

Author

  1. Natasha Yates Assistant Professor, General Practice, Bond University

Disclosure statement

Natasha Yates is affiliated with the RACGP

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Australia is opening up, people are mixing and mingling, and schools are back. But there’s a downside. Sharing our lives with each other again also means sharing our germs.

When we look at trends of illnesses in cities coming out of lockdown internationally, one thing is clear. We can expect to see more colds and flu. But what’s actually causing these?

Here are five germs I expect we’ll see more of in the coming months.


Read more: Curious Kids: Why does my snot turn green when I have a cold?

Get news that’s free, independent and based on evidence.

1. Influenza

Usually seasonal influenza kills 290,000 to 650,000 people a year worldwide. But since COVID hit, it has practically vanished.

The most likely reason for such a dramatic drop is the reduction in international travel. Public health interventions designed to curb COVID (such as mask wearing, hand washing, physical distancing) have also likely contributed.

With global travel opening up again, influenza will likely travel too. So we anticipate seeing a lot more of it around.


Read more: Health Check: when is ‘the flu’ really a cold?


2. Streptococcus pneumoniae

Pandemic response measures have also curbed some bacteria, such as Streptococcus pneumoniae.

A study was conducted on data from 26 countries across six continents in the first half of 2020. It found S. pneumoniae infections decreased by 82% after eight weeks of restricted population movement, such as lockdown.

This bacteria causes pneumonia (which is how it got its name). It can also cause a range of other illnesses from ear infections and sinusitis to life-threatening infections of the bloodstream (sepsis), and central nervous system (meningitis).

Young children, older people and people with impaired immune systems are most at risk.

Young child in pain, clutching ear
This bacteria can cause everything from ear infections to meningitis. Shutterstock

Thankfully, we have vaccines (known as pneumococcal vaccines) to help prevent the nastier diseases you can get from this bacteria.

These are already part of the Australian vaccination schedule. So if you have been vaccinated according to routine recommendations, you should already be protected.

If you catch S. pneumoniae, it does respond to antibiotics. However, it’s resistant to at least one antibiotic in three out of every ten cases.

Prevention (with vaccines and hygiene) is definitely the better option. So as a community, we must carefully steward our use of antibiotics to make sure they actually work when we really need them.


Read more: Why resistance is common in antibiotics, but rare in vaccines


3. Neisseria meningitidis

This is another nasty bacteria. You may have already guessed from its name that it can cause meningococcal meningitis, a serious infection of the central nervous system.

The same international study that found a reduction in S. pneumoniae during lockdowns also found rates of Neisseria meningitidis greatly reduced.

This is not surprising as N. meningitidis also lives in the nose and throat and can be transmitted from person to person via droplets as people cough and sneeze.

Meningitis outbreaks have occurred worldwide over the years, and a high proportion of people who become sick with it die. Survivors sometimes have severe, lifelong disability.

Like with S. pneumoniae, there is both prevention (via a vaccine) and treatment (with antibiotics) for N. meningitidis infections. But there is also growing antibiotic resistance.

So getting vaccinated, and avoiding antibiotic overuse, are important ways to reduce the risk of being seriously impacted by this bacteria.


Read more: What is meningococcal disease and what are the options for vaccination?


4. Respiratory syncytial virus

Respiratory syncytial virus (or RSV) is a common virus causing a flu-like lung infection called bronchiolitis. This mostly seriously affects children under the age of two.

Although RSV infections usually cause mild cold symptoms, they are also responsible for a significant number of deaths in children under five worldwide.

Young child in hospital with nebuliser to help breathing
RSV can be particularly serious in toddlers. Shutterstock

During COVID lockdowns around the world, RSV infections were at a historic low for a year. But they started rising again in April 2021 even in the Northern Hemisphere (for example, in the United States and the United Kingdom) where countries were entering summer.

Doctors usually expect to see spikes of RSV in winter months, and before COVID many assumed this was because it survived and replicated better in colder weather.

However, we now realise RSV is less dependent on colder temperatures in winter and more dependent on our hygiene behaviours.

So for the sake of our little ones we should not lose all the good habits we developed to combat COVID, such as staying home when sick, washing our hands, covering our coughs/sneezes and wearing masks in higher risk settings.

5. Rhinovirus

Rhinovirus continued to spread throughout the pandemic and infections even shot up in some countries. But I am including it in this list as its prevalence holds some fascinating potential in our fight against COVID.

Rhinovirus, like RSV, is a major cause of the common cold, particularly in infants. Both rhinovirus and RSV show the same symptoms. So without doing a diagnostic test it is impossible to tell which of these someone has. They require the same acute treatment anyway.

However, recently there has been interest in distinguishing between them for two reasons.

First, if a child has a rhinovirus infection in early childhood they may have a higher risk of recurrent respiratory symptoms and a higher risk of developing recurrent wheezing and childhood asthma.

Second, there is the exciting potential for rhinovirus infections to actually train our immune system to block other viruses, such as the coronavirus and influenza. This is still in the early stages of research but is something to watch.


Read more: Health Check: what’s the right way to blow your nose?


What about COVID testing?

We can reduce the impact of these five germs by keeping up simple hygiene habits, getting immunised where possible, and making sure we only use antibiotics when absolutely necessary.

However, if you do have respiratory symptoms as restrictions ease, and as symptoms do overlap with COVID, you should get a COVID test.

Can eating hot chilli peppers actually hurt you?

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Can eating hot chilli peppers actually hurt you?

July 28, 2021 4.02pm AEST

Authors

  1. Christian Moro Associate Professor of Science & Medicine, Bond University
  2. Charlotte Phelps PhD Student, Bond University

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The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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We all know the burning sensation we get when eating chillies. Some can tolerate the heat, while others may be reaching for the milk carton.

Some people even actively choose to participate in chilli-eating competitions, seeking out the world’s hottest chillies, such as the Carolina Reaper.

The global hot sauce market has grown substantially in the last few years. It sits at around US$2.71 billion (A$3.68 billion), and is expected to grow to $4.38 billion (A$5.95 billion) by 2028.

But can the heat harm our bodies?

Let’s take a look.

Girl choosing whether to add a hot chilli to a meal
The major active compound in chillies, capsaicin, is associated with multiple health benefits. Christian Moro, Author provided

Read more: Explainer: why chilli burns, and milk helps soothe the pain


The heat is a ‘trick’

For all their health benefits, eating hot chillies may cause a bit of discomfort.

This includes swelling, nausea, vomiting, eye pain, diarrhoea, abdominal pain, heartburn from acid reflux, and headaches.

But the feelings we get are simply from our body’s response, not anything the chilli is doing to actually burn us. As such, many of the side effects we notice when eating hot chilli, such as sweating and pain, are a result of the body considering the stimulus to be a real burn.

This is why the heat can be “fun”. Our body senses capsaicin, the major active compound in chillies, and immediately responds to it. But there’s no serious physical damage occurring to the cells. Capsaicin is “tricking” the body into thinking it’s experiencing a real burn.

But what could be an advantage of this? Well, this burning sensation is felt by mammals, but not birds. Therefore, a common theory is the capsaicin response was developed by plants to deter mammals from feeding, while still encouraging birds to eat the fruit and carry the seeds far and wide.

However, although a real burn is not taking place, individual cells in the mouth and digestive system might respond to the stimulus by releasing chemicals which induce a small amount of additional irritation. The response is usually relatively short-lived, and tends to subside once the burning sensation quiets down.

Other than that, there’s not much strong evidence to support any major injury or negative effects from a balanced and moderate consumption of hot chilli.

A weak correlation does exist for a high intake of chillies being somehow associated with cognitive decline. In this study, chilli intake of more than 50g/day (3.5 tablespoons) was reported in more people who exhibited memory loss than others. However, this was self-reported data, and the results have not yet been repeated by further research. https://www.youtube.com/embed/1WeRDUWXeGU?wmode=transparent&start=0

No long-term dangers

Chilli is an integral spice used in many cuisines. And there are many benefits to a regular intake of the spice, with its great source of antioxidants. In addition, those who add chilli to meals tend to add less salt, meaning enjoying a bit of heat could become a healthy habit for some people.


Read more: Getting hot and sweaty: how heat and spice might affect our appetite


Overall, although eating chilli can cause discomfort, in some cases for many hours after eating, there doesn’t seem to be any long-term dangers from eating hot chilli in moderation.

You may have noticed the more heat you eat, the more heat you can tolerate. This is because the pain nerves start to become less sensitive with increased and prolonged stimulation. Additionally, some people can naturally tolerate much higher heat levels which is, in part, regulated by genetics.

Nonetheless, although others may be eating much hotter chillies than you enjoy, the current recommendation is to stay within your comfort zone.

The power of vitamin D

The power of vitamin D: What experts already know (and are still learning) about the ‘sunshine vitamin’

Newswise: Children’s Health|October 30, 2021

It’s no secret that vitamin D is critical to balancing many areas of health. But from pediatric broken bones to cluster headaches, physicians and scientists at The University of Texas Health Science Center at Houston (UTHealth Houston) are still learning just how powerful the so-called “sunshine vitamin” is.

Vitamin D deficiency is already extremely common, affecting approximately 42% of the U.S. population, according to research published in the National Institutes of Health database. Because of this, some researchers across the globe have referred to vitamin D deficiency as an “invisible epidemic.”

Doctors ranging from orthopedic surgeons to family medicine practitioners are seeing an uptick in patients with vitamin D deficiency. More testing, people staying indoors because of skin cancer risk, or more recently, safety precautions during the COVID-19 pandemic, have been factors in the increase.

“The reason why we’re seeing an upward trend is because we’re checking for it,” said family physician Deepa Iyengar, MD, professor of family and community medicine and the Stanley G. Schultz, MD, Endowed Professor in Global Health with McGovern Medical School at UTHealth Houston. “Identifying vitamin D deficiency is such an important part of the family medicine genre because deficiency is seen across all ages.” Iyengar sees patients at UT Physicians, the clinical practice of McGovern Medical School.

Although most people have no symptoms, severe cases of vitamin D deficiency can lead to thin, brittle, or misshapen bones. Fortunately, the deficit is treatable, with doctors often prescribing over-the-counter vitamin D supplementation.

How vitamin D affects the body

Vitamin D is best known for promoting healthy bones and teeth. The human body can only absorb calcium, the primary component of bone, when vitamin D is present.

Accordingly, there is a well-documented relationship between vitamin D and orthopedic health, said pediatric orthopedic surgeon Alfred Mansour III, MD, clinical associate professor of orthopedic surgery with McGovern Medical School. His team at UT Physicians recently conducted a quality improvement project examining the link between low vitamin D levels and broken bones among pediatric patients sent to the emergency room at Children’s Memorial Hermann Hospital.

“Everyone notices a fracture or a broken arm, but now we’re looking deeper and uncovering the ‘why’ behind it. Why did this kid break their arm compared to these thousands of other kids who also fell? Why did this kid get a stress fracture in their foot?” Mansour said. “I’ve had many patients who have struggled to improve from these injuries, and our group has found that vitamin D deficiency played a role in that.”

Of the pediatric patients studied by Mansour’s group who needed surgical treatment for their fracture or broken bone, 85% were found to be vitamin D deficient. The discovery has led his team to implement new protocols, including partnering with the pediatric emergency room at Children’s Memorial Hermann Hospital to test for the condition in admitted patients.

As noted by Iyengar, a person can experience vitamin D deficiency at any age, from birth to later in life. However, some factors put certain individuals at greater risk than others

Infants who are being breastfed are among the high-risk groups, according to UT Physicians pediatrician Kenya Parks, MD, clinical associate professor of pediatrics with McGovern Medical School.

“We definitely want to promote breastfeeding, and breast milk is the best milk for babies, but it is very low in vitamin D,” Parks said. “Breastfeeding moms will want to make sure their infants get supplementation early on.”

The American Academy of Pediatrics recommends breastfed and partially breastfed infants be supplemented with 400 international units (IU) of vitamin D per day, beginning in the first few days of life. Some doctors advise breastfeeding mothers to purchase vitamin D drops, which are available at nearly any pharmacy or grocery store and should be given to breastfed babies on a daily basis. Babies can also get vitamin D through 10 to 15 minutes of sunlight exposure each day.

Parks said other patients who are vitamin D deficient include children and teens who are obese – a phenomenon at least partially attributed to distribution into a greater amount of body tissue – and children and teens who are on certain anti-convulsant and anti-fungal medications, which interfere with their body’s ability to absorb or convert vitamin D.

In children, extreme cases of vitamin D deficiency are manifested as rickets – a disease which results in soft bones and skeletal deformities. Rickets can also cause developmental delays, seizures, muscle spasms, and other abnormalities, Parks said.

“Vitamin D is both a vitamin and a hormone,” Parks said. “Kids have growing bones, so if they don’t get enough vitamin D, their bones aren’t fortified.”

Beyond children with these medical issues, however, vitamin D deficiency is high among Black individuals, whose darker skin has more melanin than lighter-skinned individuals, reducing their ability to synthesize vitamin D from the sun and resulting in lower vitamin D levels.

The deficiency is highest among people who are elderly, institutionalized, or hospitalized. In the U.S., according to a study published in Pharmacotherapy, 60% of nursing home residents were low in vitamin D, while according to research published in The New England Journal of Medicine, 57% of hospitalized patients were found to be vitamin D deficient.

“As you get older, bone resorption increases and bone formation decreases, so if you don’t substitute that loss with enough calcium, it causes a bone mass deficiency,” said Iyengar, who sees geriatric patients at UT Physicians. “Your body thinks you’re short of vitamin D, so it takes that vitamin from the bone and gives it to the blood, which puts people at major risk for osteoporosis.”

Vitamin D production in the skin from sunlight exposure also declines with advancing age, making elderly populations more dependent on the dietary supplements. Additionally, because vitamin D deficiency is also linked to parathyroid metabolism, women become especially prone as they go through menopause and lose estrogen, Iyengar said.

A woman’s ability to build bone peaks in her mid to late 20s, according to Pamela Berens, MD, the Dr. John T. Armstrong Professor in Obstetrics and Gynecology with McGovern Medical School and an OB/GYN with UT Physicians. Therefore, as women enter their 30s, Berens advises her patients to simply work on maintaining their bone health.

“For post-menopausal women, it’s really important to know your bone density and vitamin D level. Having that knowledge gives you the power to fix it,” Berens said. “Younger women just need to think about what they can do to build healthy bones.”

Vitamin D also regulates many other cellular functions, with its anti-inflammatory, antioxidant and neuroprotective properties supporting immune health, muscle function and brain cell activity.

Mark Burish, MD, PhD, assistant professor in the Vivian L. Smith Department of Neurosurgery with McGovern Medical School and a neurologist and headache management specialist with UTHealth Neurosciences, has begun enrolling patients in a clinical trial to determine whether a multivitamin combined with high doses of Vitamin D3 supplements – similar to those prescribed to patients with multiple sclerosis and other diseases – could potentially serve as an effective treatment for excruciating cluster headaches.

Burish theorizes a few possible reasons why increased vitamin D intake might be able to treat cluster headache. One is that vitamin D appears to block a key pain-signaling molecule that is commonly activated during cluster headache. Another theory is that the headaches might be linked to circadian rhythms, a natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours.

“Normally, people receive vitamin D through direct sunlight, and the most common time for a cluster headache attack, no matter where you live, is 2 a.m., when it’s still very dark outside,” said Burish, who is also with The University of Texas MD Anderson Cancer Center Graduate School of Biomedical Sciences. “Vitamin D may be able to help regulate the light-dark pattern that seems to be tied to these headaches.”

How to get enough of it

A person can get vitamin D in three ways: through the skin, from their diet, and from medically prescribed supplements.

Some time in the sun is recommended, but given that too much sun exposure can lead to skin cancer, food may be a better source. A few foods – including fatty fish, beef liver, cheese, mushrooms, and egg yolks – naturally carry the nutrient. It can also be found in fortified foods and beverages, such as milk, breakfast cereals, orange juice, yogurt, and soy drinks.

People also get vitamin D from multivitamins and supplements, which come in both pill and liquid form for infants.

According to the National Institutes of Health, the daily recommended amount of vitamin D is 400 IU for infants up to 12 months old, 600 IU for children and adults up to 70 years old as well as breastfeeding women, and 800 IU for adults who are at least 71 years old.

The standard treatment for vitamin D deficiency involves supplements. Depending on an individual’s condition, their health care provider will recommend how much they need to take, how often they need to take it, and how long they need to take it

The dangers of ‘bikini medicine’

The dangers of ‘bikini medicine’

Alistair Gardiner |October 21, 2021

Healthcare historically has taken a one-size-fits-all approach to diagnosis and treatment. Here’s one reason why: Men have historically had far greater representation in clinical studies than women—and evidence suggests that this under-representation leads to poorer outcomes for female patients.Female doctor talking to masked female patient

A number of health conditions affect women and men differently, from COVID-19, to cardiovascular diseases, mental health, and more.

Sex differences lead to underdiagnosis or diagnostic delay in more than 700 diseases for women, compared with men, according to an article published by the University of Colorado’s Ludeman Family Center for Women’s Health Research.

The outdated and sexist idea that men and women should be cared for similarly has been dubbed “bikini medicine,” a nod to the mistaken belief that women’s health only differs from men’s in the parts of the body that a bikini would cover.

Research has debunked this theory. As noted in a study published in Nature, sex and gender are essential considerations for precision medicine (sex defined as the biological component; gender as a social construction). Study authors pointed out that conditions such as cardiovascular disease, osteoporosis, and autoimmune diseases affect men and women differently. What’s more, some diseases affect both sexes at similar rates, yet women tend to be underdiagnosed.

In light of this, here’s a brief overview of some of the ways that routine healthcare may be failing women, due to outdated practices and beliefs.

Cardiovascular diseases

Sex affects many aspects of cardiovascular diseases, from how symptoms present to how the body interacts with medications. For example, research cited in the aforementioned University of Colorado article indicates that women taking cardiovascular medication are more than twice as likely to experience adverse reactions than men taking the same meds. Despite this, many physicians continue to prescribe the same dose for men and women.

A study published in Circulation in February of this year presents another consideration. For decades, the normal upper limit for adult systolic blood pressure (SBP) has been 120 mm Hg—but researchers concluded that the sex-specific definition of optimal SBP for women may need to be lowered.

The study included a cohort of 27,542 individuals with standard SBP, 54% of whom were women. Analyzing 28 years of participant health data, researchers found that cardiovascular disease risk and incidence increased at the lower thresholds of SBP for women compared with men. They posited that this disparity may be due to sex-specific differences in vascular anatomy and physiology—women tended to have smaller arterial diameters compared with men, after normalizing for body size, for example. They concluded that the physiologic range for SBP should be reassessed on a sex-specific basis, because using the same range could lead to missed cardiovascular disease diagnosis in women.

Mental illness and mental health

Sex also affects the diagnosis of mental illnesses, including attention deficit/hyperactivity disorder (ADHD), according to a study published in the Nordic Journal of Psychiatry in November 2020. 

Researchers examined health data on 50 boys and 50 girls under the age of 18 with a diagnosis of ADHD. The researchers focused on referral reason, diagnostic process, and treatment. They found that, on average, female patients visited the clinic more frequently before receiving a diagnosis, and that the female patients were more likely to have been prescribed non-ADHD medication (typically for emotional symptoms) before and after diagnosis.

Female patients were more likely to be referred to a clinic for suspected emotional problems, researchers noted, while boys tended to be referred with symptoms of a neurodevelopmental disorder. Researchers posited that ADHD symptoms in girls may not be recognized by teachers and/or parents until they are older—and by this point, patients may have increased emotional problems as a result of living with undiagnosed ADHD. Hormonal differences and societal perception of gendered behaviors could also be explanations.

A study published in BMJ Open Sport & Exercise Medicine in March of this year found evidence of other sex-specific differences in mental health symptoms. Researchers examined a cohort of 523 professional athletes, 56% of whom were women, and found that female athletes tend to report higher rates of mental health symptoms, and lower rates of mental well-being. Researchers noted various social factors, including the gender pay gap and public social media abuse, as possible reasons for this.

Stroke symptoms

In some cases, knowing sex-specific differences in symptoms can become a matter of life and death. For example, female patients with stroke tend to present with certain symptoms that male stroke patients don’t experience, according to materials provided by Northwestern Medicine.

During a stroke, men and women typically report numbness or weakness in the face, arm, or leg; confusion; trouble speaking or seeing; difficulty walking; dizziness or loss of balance; or severe headache. The following symptoms are, however, specific to women: hiccups, nausea, chest pain, fatigue, shortness of breath, and a racing heartbeat.

Women tend to have more risk factors for stroke (including prescriptions for birth control pills, current pregnancy, diagnosed atrial fibrillation, and others), and one in five women will have a stroke in their lifetime.

COVID-19

As the pandemic data accrues, research is uncovering sex-specific differences in the impact of SARS-CoV-2. 

In a Journal of Women’s Health study from March of this year, which used data from 1.4 million patients, collected between January 1 and May 1, 2020, researchers found that headache, anosmia, and ageusia were significantly more frequent in females. Ear, nose, and throat symptoms were also more common in women. Chest X-ray and blood tests were performed less frequently in females, and women were hospitalized and admitted to the ICU less frequently, the data showed.