Monthly Archives: February 2022
Why a Woman’s Sex Life Declines After Menopause (Hint: Sometimes It’s Her Partner)
Why a Woman’s Sex Life Declines After Menopause (Hint: Sometimes It’s Her Partner)
A revealing new analysis gives voice to the many reasons a woman’s sex life often falters with age.
July 30, 2019
For many women, sex after menopause is not as satisfying as it used to be. But is menopause entirely to blame?
New research suggests that the hormonal changes that come with menopause are only part of the reason a woman’s sex life declines with age. It’s true that many women experience symptoms after menopause, including vaginal dryness, painful intercourse and loss of desire — all of which can affect the frequency and pleasure of sex.
But the new study shows that the reasons many women stop wanting sex, enjoying sex and having sex are far more complex. While women traditionally have been blamed when sex wanes in a relationship, the research shows that, often, it’s the health of a woman’s partner that determines whether she remains sexually active and satisfied with her sex life. (Most studies have focused entirely on heterosexual women, so less is known about same-sex couples after menopause.)
“We know that menopause seems to have a bad effect on libido, vaginal dryness and sexual pain,” said Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health in Rochester, Minn. “But what is coming up as a consistent finding is that the partner has such a prominent role. It’s not just the availability of the partner — it’s the physical health of the partner as well.”
The latest study, published in the medical journal Menopause, is based on surveys of more than 24,000 women taking part in an ovarian cancer screening study in Britain. The women, aged 50 to 74, answered multiple-choice health questionnaires about their sex lives at the start of the study. But the survey data are unique because about 4,500 of the women also left written comments, giving researchers a trove of new insights about women’s sex lives.
Over all, 78 percent of the women surveyed said they had an intimate partner, but fewer than half the women (49.2 percent) said they had active sex lives. The women’s written answers about why they stopped having sex revealed the pain and sadness behind the percentages.
The main reason was losing a partner to death or divorce, which was cited by 37 percent of the women. (Women who were not having sex cited multiple reasons for the decline, which is why the percentages exceed 100.)
‘‘I have been a widow for 17 years. My husband was my childhood sweetheart, there will never be anyone else.’’ (Age 72)
Some women said life was too complicated to make time for sex — 8 percent said their partner was too tired for sex, and 9 percent of women said they were also too tired for sex.
“I feel my role in life at present is to bring up my 12-year-old son; relationships come second.” (Age 50)
“Caring for older parents at the present. Lack of energy and worrying about them causes a reduction in sexual activity.” (Age 53)
“Husband busy with work. I’m busy with two children. Both collapse into bed at the end of the day.” (Age 50)
A husband with serious health issues was another common theme. About one in four women (23 percent) said the lack of sex was because of their partner’s physical problems, and 11 percent of women blamed their own physical problems.
“He does not maintain erection strong enough for penetration (after prostate surgery and diabetes). My sexual activity is limited by what my husband’s health is.” (Age 59)
“My husband had a stroke which left him paralyzed. Sexual relations are too difficult. I remain with him as a caregiver and companion.” (Age 52)
“My husband has had a heart attack — his medication leaves side effects, which makes sex very difficult, which has saddened us.” (Age 62)
Others cited mental health and addiction issues as the reason for lack of sex.
“He drinks approximately 1 to 1.5 bottles of whiskey a day. Sex is once or twice a year.” (Age 56)
“My husband suffers from anxiety and depression and this has an effect on our relationship and my sleeping.” (Age 53)
“I take an antidepressant which blunts desire for sex.” (Age 59)
About 30 percent of women said their sex lives had halted because they had “no interest.”
“Have lost all interest and feel guilty, and that makes me avoid any mention of it at all.” (Age 53)
“Several symptoms of the menopause have affected my desire for sex, which I find disappointing because I wish I had the same desire as I had in recent years.” (Age 58)
“I find it uncomfortable and sometimes painful. I use vaginal gels but doesn’t help much, so do not have sex these last months.” (Age 54)
“I love my partner very much, this problem upsets me. However if I didn’t have a partner (for sex) I wouldn’t miss it — it’s very hard to desire something you don’t want. I feel sad when I think of how we used to be. He is very understanding.” (Age 54)
And 21 percent of women said their partners had lost interest in sex.
“Only [have sex] twice a year maybe. My partner has lost his libido and never thinks of it, although he loves me and worries about it.” (Age 60)
While most of the written comments were about problems with sex, a few women left more hopeful messages.
“As I have a new partner since one year, I find my sexual life has never been better and it is certainly very frequent. Very much the reason for my happiness, contentment and well-being.” (Age 59)
Sex happens “less often than when younger. We both get tired, but when we do it, it’s good.” (Age 64)
The data and comments were analyzed by Dr. Helena Harder, a research fellow at Brighton and Sussex Medical School, and colleagues. Dr. Harder said the comments show that doctors need to have more frequent conversations with women about sex.
“Women say that they are sorry that things have changed. They wish it was different,” says Dr. Harder. “But in general, it’s not being brought up in discussions. Patients need reassurance that it’s O.K. to discuss sex and ask questions. If you do that, it’s probably a good step toward making changes.”
Dr. Faubion, who is also medical director for the North American Menopause Society, notes that treatments are available to help women with vaginal dryness and painful sex. In addition, two libido drugs have been approved to help increase female desire. One is a pill and the other, an injectable, should be available this fall, although both drugs have drawbacks, including cost, limits on when they can be used and side effects, so they aren’t an option for every woman, she said.
Nan Dill, a 53-year-old Cincinnati woman with three children aged 15, 18 and 21, said it wasn’t until her doctor asked her questions about her sex life that she realized how hot flashes and low desire related to menopause had taken a toll on her sex life. “I thought, ‘Life is busy. This is what happens,’ ” she said.
Ms. Dill began using an estrogen patch for hot flashes and a non-estrogen vaginal dryness treatment. Learning that changes in desire are normal helped both her and her husband understand that they were simply entering a new chapter in their relationship.
“When you have the right information, it helps you understand the change not just in your body but the change in your bedroom,” she said. “You learn sex might be different, but it will still be good, and it will still work for both of you.”
When Doctors Downplay Women’s Health Concerns
When Doctors Downplay Women’s Health Concerns
By Camille Noe Pagán
- May 3, 2018
“Well, you look like you’re doing great,” my primary care physician cheerfully informed me.
I stared at her from the examination table in disbelief. I had just told her that I wasn’t enjoying being with my children and was having trouble doing what needed to be done at work and at home. As a health journalist, I had interviewed dozens of physicians and psychologists. I knew that being unable to live one’s life was the big red flag signaling it was time to get help.
I was asking for help.
But my doctor was under the impression I didn’t need it. “I don’t think you’re at the point where medication is an option, and anyway, it can be addictive. Keep exercising and doing yoga, and maybe consider meditating,” she said with a tight smile. “Try to get some more sleep.”
I had just told her these very steps weren’t helping. And anxiety was keeping me from falling asleep and getting restful sleep. “But …” I began.
She quickly interjected. “If you’re still having trouble a few months from now, come back and see me again. O.K.?”
I nodded numbly. My physician was just like me: A relatively young, educated mother of small children with plenty on her plate. And she had an M.D. after her name. Wouldn’t she know if I were truly in need of treatment?
It took several months for me to summon the courage to see another health professional — this time, a cognitive behavioral therapist who was horrified by my experience with my doctor (who, for the record, is no longer my doctor) and told me there was a lot we could try to help me start feeling better.
Therapy worked. My anxiety decreased immensely in just a few months, freeing up mental space for bigger questions. And I began to wonder just how common it was for women to have their health concerns downplayed or dismissed by a physician.
As it turns out, very. “It’s a huge issue in medicine,” says Dr. Tia Powell, a bioethicist and a professor of clinical epidemiology and population health at Albert Einstein College of Medicine in New York. Health care providers may have implicit biases that affect the way women are heard, understood and treated, she said. “Medical schools and professional guidelines are starting to address this problem, but there’s still much to be done.”
Dr. Powell, who is also the director of the Montefiore Einstein Center for Bioethics, speaks from experience: “A while back, I lost 10 pounds over a couple months, so I went to my doctor and told him I thought it was a sign I was having a recurrence of an old illness. He gave me a few reasons he disagreed and added, “Plus you’ve been on a diet.” That struck her as odd — she had never said this, and doubted her doctor would have made the same assumption about a male patient. A set of tests with a new physician confirmed that Dr. Powell was correct about the recurrence of a previous illness, for which she was immediately treated.
Health disparities are hardly exclusive to women. In the United States, if you’re not wealthy, not white and not heterosexual, you may be receiving less than optimal health care.
But research on disparities between how women and men are treated in medical settings is growing — and it is concerning for any woman seeking care. Research shows that both doctors and nurses prescribe less pain medication to women than men after surgery, even though women report more frequent and severe pain levels. And a University of Pennsylvania study found that women waited 16 minutes longer than men to receive pain medication when they visited an emergency room. Women are also more likely to be told their pain is “psychosomatic,” or influenced by emotional distress. And in a survey of more than 2,400 women with chronic pain, 83 percent said they felt they had experienced gender discrimination from their health care providers.
And then there are the stories that physicians themselves share about their patients. “I can’t tell you how many women I’ve seen who have gone to see numerous doctors, only to be told their issues were stress-related or all in their heads,” says Dr. Fiona Gupta, a neurologist and director of wellness and health in the department of neurosurgery at the Icahn School of Medicine at Mount Sinai in New York City. “Many of these patients were later diagnosed with serious neurological problems, like multiple sclerosis and Parkinson’s disease. They knew something was wrong, but had been discounted and instructed not to trust their own intuition.”
“It can be hard to speak up if you feel you’re not being treated fairly,” Dr. Powell said. “I’m a professor at a medical school and I struggled with it.”
Here are three steps to help ensure your health concerns are taken seriously.
Ask about guidelines
If your doctor recommends something you suspect isn’t right (including “watch and wait”), Dr. Powell advises asking: “What’s the basis for your recommendation? Are there guidelines for this, and what do they say?” “Guidelines tend to be fairly objective and data-driven, so women do better when their doctors follow them,” she notes.
Be direct
If you still feel like you’re being dismissed, say, “I’m concerned, and I feel that maybe you aren’t hearing me. Help me understand why you don’t see this as a problem.” “A good physician can have biases,” says Dr. Powell. “But a good physician should also be able to take a step back and say, ‘I hear you. Let’s talk this through.’”
Check your own bias
“As women, we’ve been taught from an early age to rationalize warning signs of physical or mental health problems,” says Dr. Gupta. (To wit: a Yale cardiology study found that many women hesitated to seek help for a heart attack because they worried about being thought of as hypochondriacs.) Recognize that expressing concern over symptoms doesn’t mean you’re overreacting, self-diagnosing, or trying to do your health care provider’s job for them. Says Dr. Gupta: “If you feel like something isn’t right with your health, honor that — even if a doctor is disagreeing with you. It’s better to find out you’re wrong than to wait too long.”
There’s little evidence to show that female providers offer women more equal care than male providers do. The best doctor, says Dr. Powell, is the one who listens to you and views health care as a conversation — not a set of orders.
How to make your diet more sustainable, healthy or cheap – without giving up nutrients
Shutterstock
How to make your diet more sustainable, healthy or cheap – without giving up nutrients
February 16, 2022 1.06pm AEDT
Author
- Brad Ridoutt Principal Research Scientist, CSIRO Agriculture, CSIRO
Disclosure statement
Brad Ridoutt is a Principal Research Scientist with CSIRO, Australia’s national science agency. He has previously undertaken food system and nutritional research for a variety of private sector organizations and Australian government agencies. The research underpinning this article was partly funded by CSIRO and partly funded by Dairy Australia. Dairy Australia had no role in undertaking the study and the decision to publish research findings was made prior to funding and before the results were known. Dairy Australia had no role in the preparation of this article.
Partners
CSIRO provides funding as a founding partner of The Conversation AU.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.
People choose certain foods or change their diets for a range of reasons: to improve their health, lose weight, save money or due to concerns about sustainability or the way food is produced.Consider the trend towards low-fat products in the 1980s and low-carb diets in the 1990s, and now, the rise in plant-based protein products and ready-to-eat meals.
But before you abandon your traditional food choices, it’s important to consider the nutritional trade-offs. If you’re replacing one food with another, are you still getting the vitamins, minerals and other nutrition you need?
In a recent paper, I sought to raise awareness of nutritional differences between foods by producing a new index specific to Australia. It aims to help Australians make better informed dietary choices and get the nutrients recommended for good health.
Nutrients: are we getting enough?
The Australian Bureau of Statistics publishes tables showing the usual intake of selected nutrients across the population. The tables also show the proportion of Australians whose usual nutrient intake is below what’s known as the “estimated average requirement”.
While Australian adults eat in diverse ways, they generally get enough of some nutrients regardless of their diets.
For example, most people seem to obtain adequate niacin (Vitamin B3) and phosphorus. And the tables suggest 97% of Australians get enough vitamin C.
However, inadequate intake of calcium, magnesium, vitamin B6 and zinc is common.
Around two-thirds of Australian adults consume less calcium than what’s recommended (which ranges from 840 to 1100 mg/day depending upon age). Worryingly, 90% of women aged over 50 don’t get enough calcium.
Inadequate zinc intake is most prevalent among Australian men – more than half aged over 50 consume below recommended levels.
So what about free sugars? These include added sugars and the sugar component of honey and fruit juices, but exclude natural sugars in intact fruit, vegetables and milk.
It’s recommended Australians limit free sugars to less than 10% of dietary energy intake. However, almost 50% of Australian adults exceed this recommended limit.
Read more: Don’t drink milk? Here’s how to get enough calcium and other nutrients
Paying attention to under-consumed nutrients
Every food has a different nutrient composition. And as the Australian Dietary Guidelines show, we should eat a variety of foods to stay healthy.
We should pay particular attention to foods that are important sources of nutrients for which large numbers of Australians are not getting enough. If possible, Australians should seek to include more of these foods in their diet.
At the same time, foods with free sugars should be eaten only in moderation.
The new food index I produced seeks to help Australians achieve this. It provides an overall nutrient composition score tailored to the Australian dietary context.
The index includes eight vitamins (B1, B2, B3, B6, B12, Folate, A and C), eight minerals (calcium, phosphorus, zinc, iron, magnesium, iodine, selenium and molybdenum), along with protein and free sugars.
These 18 elements are weighted in proportion to the extent of inadequate or excessive intake in Australia. A higher score is better than a lower score.
So, the index scores foods highly if they are low in free sugars, and rich in the elements many Australians need more of – calcium, magnesium, vitamin B6, zinc and vitamin A.
Foods containing few nutrients but added sugar score very low. For example, a chocolate chip cookie weighing 35 grams scored 0.004 and a sugar-sweetened cola-flavoured beverage scored below zero.
Swapping foods may not achieve like-for-like
The index can be used to compare foods that might be considered substitutes in pursuit of a diet that’s healthier, more affordable or better for the environment.
In the case of dairy foods, 250ml of full cream milk scored 0.160, and reduced-fat milk almost as high at 0.157.
The index shows the potential nutritional trade-offs when choosing dairy alternatives. A 250ml serving of calcium-fortified oat beverage scored 0.093. Without calcium fortification, the score fell to 0.034.
Looking at meat, 100g of raw lean diced beef scored 0.142. An equivalent serving of plant-based burger made from pea protein, with many added vitamins and minerals, scored almost the same at 0.139. This shows plant-based alternatives are not necessarily less nutrient dense.
The index also shows the different nutritional needs of women and men. For example, the scores for two large eggs were higher for women (0.143) than men (0.094). This reflects, in part, the greater prevalence of inadequate iron intake among younger women.
Read more: How Australia can boost the production of grains, while lowering its carbon footprint
Understanding trade-offs
To date, comprehensive nutritional information about foods eaten in Australia has been found only in databases used by scientists and nutrition professionals.
For the average consumer, packaging on unprocessed foods – such as fruits and vegetables, fresh meats and some cheese – doesn’t usually include nutrition information.
Consumers can consult the nutrition information panel when buying processed foods, but only some nutrients are shown.
I hope my research may prompt manufacturers produce more nutrient-dense foods or those formulated to meet the nutrient needs of a particular subgroup.
In future, I hope the index will also be translated into a user-friendly format or app that everyday Australians can consult, to ensure their changing food preferences result in a healthier choice.
Haven’t yet been vaccinated for COVID? Novavax might change your mind
Haven’t yet been vaccinated for COVID? Novavax might change your mind
February 15, 2022 3.55pm AEDT
Authors
- Jack Feehan Research Officer – Immunology and Translational Research, Victoria University
- Vasso Apostolopoulos Professor of Immunology and Associate Provost, Research Partnerships, Victoria University
Disclosure statement
Vasso Apostolopoulos COVID-19 research has received internal funding from Victoria University place-based Planetary Health research grant and from philanthropic donations.
Jack Feehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment..
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.
After significant delays in production and approval, Novavax – the first protein-based vaccine against COVID approved in Australia – is now available.
Unvaccinated Australians can receive Novavax for their first and second doses, at least three weeks apart, at pharmacies, GP clinics and vaccination hubs.
So what makes Novavax different from the other vaccines? And why are some people waiting for it to get vaccinated?
What is Novavax?
Novavax (or Nuvaxovid) is a protein-based vaccine, meaning it contains a protein fragment of the COVID spike protein.
Get news curated by experts, not algorithms.
These fragments are taken by specialised immune cells which direct an immune response against the SARS-CoV-2 virus which causes COVID.
While these proteins are from the SARS-CoV-2 virus, there is no live virus in the vaccine, and it cannot cause COVID.
The company doesn’t even use SARS-CoV-2 virus to gather the protein, instead using moth cells which have been engineered to produce it.
Each of the two 0.5ml doses contain 5 micrograms of the spike protein and 50 micrograms of an adjuvant called Matrix-M. An adjuvant is a compound which stimulates the immune system. It ensures the immune system picks up the protein fragments.
Matrix-M is a compound derived from the soapbark plant (Quillaja saponaria). It forms part of the plant’s defence against insects and is used to improve the immune response with protein vaccines.
After injection, immune cells rapidly move to the injection site and clear both the adjuvant and viral proteins.
Read more: What is Novavax, Australia’s third COVID vaccine option? And when will we get it?
Who can get Novavax?
In Australia, Novavax is only approved for use in adults aged 18 and over, and only as a primary course of treatment – for doses one and two.
To date, there is no published data available on its efficacy and safety in children, or as a booster for adults.
This may change in coming months as paediatric and booster dose studies continue and additional data on this is provided to Australia’s regulator, the Therapeutic Goods Administraion (TGA).
How effective is it?
Novavax has been shown to be effective in clinical trials, particularly against the original, Alpha and Beta variants. In these studies, Novavax offered 90-92% protection against symptomatic disease, and higher protection against hospitalisation.
A study later showed a lower efficacy (60%) in South Africa against Beta, though it was small and complicated by a large HIV-positive population.
However, there is no specific evidence of Novavax’s efficacy against Omicron. The company reported in a press release its ongoing trial in 12 to 17 year olds has shown “robust immune responses”, though these reports are unverified by scientists.
Is it safe? What are the side effects?
Novavax has a similar safety profile to the other vaccines, with a number of common immediate side effects. These occurred in around 60% of those receiving a first dose and 80% with second dose.
The most common side effects were injection site pain and tenderness, headache, fatigue and muscle pain.
To date, no rare serious conditions are associated with Novavax. This includes blood clots associated with AstraZeneca. While there were three cases of heart inflammation in the trials, one was in the placebo group and the other two are yet to be clearly linked to the vaccine, due to the rarity of the adverse event.
However, further side effects may emerge as the vaccine rolls out across a larger population, as was the case with the other vaccines.
Why are some waiting?
Some people have been waiting for Novavax to get vaccinated against COVID, because of fears about the mechanisms by which other vaccines work.
While Novavax directly places the COVID spike protein in reach of the immune system, the mRNA (Moderna and Pfizer) and vector (AstraZeneca and Johnson & Johnson) vaccines take advantage of our bodies’ own protein-making systems to produce it in the body.
This has been the centre of a mass misinformation campaign falsely claiming they cause permanent changes to our genetics, and therefore have long-term consequences. This is untrue but has still caused concern and vaccine hesitancy in some people.
Read more: No, COVID vaccines don’t stay in your body for years
Others who are unable to receive the mRNA or vector vaccines, such as those with polyethylene glycol (PEG) allergies, may be able to receive Novavax.
Further, some religious believers have concerns about how some COVID vaccines were developed using human embryonic cell lines, however these are cell lines grown in a lab from samples collected decades ago. No embryonic cells are included in the actual vaccines.
Read more: Cells from human foetuses are important for developing vaccines – but they’re not an ingredient
Novavax, in contrast, was developed using a moth cell line.
Whatever the reasons for choosing Novavax, its a welcome addition to Australia’s suite of vaccines and will likely boost our protection against COVID.
The science of sugar: why we’re hardwired to love it and what eating too much does to your brain
Academic rigour, journalistic flair
Where does our love of sugar come from? Magdalena Kucova/Shutterstock
The science of sugar: why we’re hardwired to love it and what eating too much does to your brain – podcast
January 20, 2022 10.35pm AEDT
Authors
- Daniel Merino Assistant Science Editor & Co-Host of The Conversation Weekly Podcast, The Conversation
- Gemma Ware Editor and Co-Host, The Conversation Weekly Podcast, The Conversation
Interviewed
- Anne Levesque Assistant professor, Faculty of Law, L’Université d’Ottawa/University of Ottawa
- Kristine Nolin Associate Professor of Chemistry, University of Richmond
- Lina Begdache Assistant Professor of Nutrition, Binghamton University, State University of New York
- Stephen Wooding Assistant Professor of Anthropology and Heritage Studies, University of California, Merced
Disclosure statement
Kristine Nolin, Stephen Wooding and Lina Begdcahe 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.
Anne Levesque is one of the pro bono lawyers representing the First Nations Child and Family Caring Society in its ongoing litigation against Canada before the Canadian Human Rights Tribunal. She also provided assistance to Sarah Clarke and David Taylor, the Caring Society’s lawyers in the negotiations leading to the agreement.
Partners
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence
What are the evolutionary origins of sugar cravings? What makes something taste sweet? And what does too much sugar do to the brain? In this week’s episode of The Conversation Weekly, we talk to three experts and go on a deep dive into the science of sugar. And after the Canadian government agreed in principle to pay CAN$40bn (US$32bn) over discrimination against First Nations children by the country’s child welfare system, we talk to a legal expert about the long fight for justice.
Why is sugar so irresistible to us humans? It turns out, evolution is a big reason why. “The key to our love of sugar relates to it being a good source of nutrition,” explains Stephen Wooding, assistant professor of anthropology and heritage studies at the University of California, Merced. Sugar helps provide our body with energy, and our ancient ancestors evolved so that they could taste it as they went out foraging for food.
Wooding says humans are not very well adapted to the world today, where sugar is readily available in abundance. “We have this really deep-seated attraction to sugar that throughout evolutionary history was a really important advantage,” says Wooding. But our cravings for sugar are now ancient relics that “belong in a museum”, he adds.
Natural sugars such as glucose and fructose may be where our sweet tooth originated from, but they’re not the only way to sweeten what we eat. Kristine Nolin, associate professor of chemistry at the University of Richmond in the US, explains the chemistry behind what makes something sweet.
Other natural non-sugar sweeteners include stevia or monk fruit. Nolin says they taste sweet “because they will attach to the receptors inside your taste buds”, but your body doesn’t break these molecules down into energy in the same way as natural sugars. The same happens with artificial sugars too, like saccharin, which Nolin says will typically end up going “through our digestive system and end up being excreted from our body”.
Eating too much sugar is linked to obesity, diabetes and other chronic health issues – and it can also have a long-term effect on the brain. “Anything that may be impacting the function of the brain could be affected with long-term sugar intake,” says Lina Begdache, an assistant professor of nutrition at Binghamton University, State University of New York. When children eat too much sugar, it can also be linked to cognitive decline as they become adults, she says, as well as how they go on to regulate their emotions.
To learn more about sugar’s effects on human health and culture, click here to explore a recent series on The Conversation.
For our next story, we head to Canada to hear about a long legal battle over the country’s discrimination against First Nations children in the child welfare system. In late December 2021, the government agreed in principle to pay CAN$40bn in compensation to those affected and to fund structural reform of the child welfare system.
Anne Levesque, assistant professor at the faculty of law at the University of Ottawa, who was involved in the human rights case that led to the deal, explains how Canada systematically underfunded child welfare services for First Nations children and their families. “Nothing is binding yet, and we’ve been disappointed before in the past,” Levesque says, urging Canadians to keep up the pressure on the government “so we can get real outcomes on the ground for First Nations kids”. Listen from 29m20s on the podcast.
And finally, Veronika Meduna, science and health editor at The Conversation in New Zealand, recommends some expert analysis of the recent Tonga volcano eruption. Listen from 45m45s.
This episode of The Conversation Weekly was produced by Mend Mariwany and Gemma Ware, with sound design by Eloise Stevens. Our theme music is by Neeta Sarl. You can find us on Twitter @TC_Audio, on Instagram at theconversationdotcom or via email. You can also sign up to The Conversation’s free daily email here. A transcript of this episode is available here.
Newsclips in this episode are from CBS News: The National and Al Jazeera English.
You can listen to The Conversation Weekly via any of the apps listed above, download it directly via our RSS feed, or find out how else to listen here.
Copyright © 2010–2022, The Conversation Media Group Ltd
Estrogen May Curb Women’s Muscle Pain
Estrogen May Curb Women’s Muscle Pain
Women, who draw on energy reserves of fat more efficiently than men, frequently outperform men on ultraendurance events like the 85-kilometer marathon. Now, some researchers believe that women may have another edge. Recent studies suggest that estrogen might make them less prone to muscle soreness after exercise.
For fitness enthusiasts, the dull pain and stiffness that sets in perhaps 6 to 12 hours after exercise can be a badge of honor, a symbol of a workout that pushed the limits. But for most people it is a consequence they would rather avoid. The soreness generally peaks 24 hours to 36 hours later, and causes a loss of strength and mobility, said Dr. Priscilla Clarkson, an exercise physiologist at the University of Massachusetts at Amherst.
”Some soreness is good because it means that the muscle is growing in response to unaccustomed exercise,” Dr. Clarkson said. ”But if you are so sore that you cannot walk, then you have exercised too intensely.”
The soreness is presumed to result from the body’s reactions to exercise-induced microtears in the muscle tissue, she said. The consensus among exercise researchers is that damage most often occurs when the muscle is extended, as in the downward phase of biceps curls.
Sex may play an important role in the susceptibility to soreness. ”The animal data are very clear,” Dr. Clarkson said. In studies, male rats showed much more muscle damage than female rats after exercises that emphasized muscle extensions, which specialists call eccentric contractions.
”Estrogen seems to explain the difference,” said Dr. Mark Tarnopolsky, a neuromuscular disease specialist at McMaster University Medical Center in Hamilton, Ontario, and the editor of ”Gender Differences in Metabolism,” published this year by CRC Press. When researchers gave male rats estrogen, they showed less damage, he said.
Research is still in the early stages, and it is not known why estrogen might protect muscles. Dr. Clarkson hypothesizes that estrogen ”may be able to insert itself into cells, like muscle membranes, and stabilize them, which would protect them from tearing.”
Human studies are not as consistent as those with animals. In a study reported in the June issue of The Canadian Journal of Applied Physiology, Dr. Clarkson found that compared with women who produce little or no estrogen, those on oral contraceptives, which contain estrogen, experienced less soreness after exercise, suggesting that estrogen does have a protective effect.
And at an academic meeting of physiologists and biochemists in April, Dr. Tarnopolsky reported on a study in which men showed greater inflammation, an indicator of stress, two days after exercising, although men and women showed similar muscle tearing immediately after exercise. ”The damage was the same for men and women, but the body’s response seemed higher for men,” Dr. Tarnopolsky said.
Editors’ Picks
On the other hand, more recent data collected by Dr. Clarkson showed no differences between men and women in the experience of soreness after repeated muscle extensions.
The sex difference in soreness, if it holds up, suggests that women may be able to endure longer exercise sessions than men. ”Women may accumulate less damage over the course of a long event, which would enable them to perform better,” Dr. Tarnopolsky said.
Soreness does have a positive side. It means that muscles have been stimulated to grow stronger as well as more resilient. ”A single bout of eccentric trauma prepares muscles for subsequent bouts,” said Dr. Brent Ruby, an exercise physiologist at the University of Montana. This ”repeated bout effect” can protect muscles from further damage from similar exercise for up to six months, Dr. Clarkson’s research showed.
The best way to avoid soreness is to go easy. ”Some soreness is inevitable when you exercise, but if you go slowly and progress gradually you won’t get one bout that lays you up for a week,” Dr. Ruby said
A healthier heart can protect your brain too. 5 lifestyle changes to prevent dementia
A healthier heart can protect your brain too. 5 lifestyle changes to prevent dementia
January 24, 2022 2.14pm AEDT
Authors
- Dr Alexandra Wade Research associate, University of South Australia
- Dr Ashleigh Elizabeth Smith Senior Lecturer – Exercise Physiology, University of South Australia
- Maddison Mellow PhD candidate, University of South Australia
Disclosure statement
Ashleigh Elizabeth Smith receives funding from the National Health and Medical Research Council (NH&MRC) and the Hospital Research Foundation.
Maddison Mellow receives funding from the Dementia Australia Research Foundation (PhD scholarship).
Dr Alexandra Wade does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Partners
University of South Australia provides funding as a member of The Conversation AU.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.
When we think of dementia, we often fear a loss of control. But the reassuring news is up to 40% of dementias can be prevented or delayed if we change our health habits.
Nearly half a million Australians are living with dementia. Without a cure, this number is expected to reach 1.1 million by 2058.
Dementia shares key risk factors with cardiovascular (of the heart and blood vessels) disease, including high blood pressure, high blood sugar, being overweight and smoking. Inflammation and oxidative stress (where protective antioxidants are losing their fight with damaging free radicals) follow. This damages blood vessels and reduces the flow of blood and oxygen to the brain.
Without enough oxygen, brain cells can’t function effectively, and eventually die. Reduced blood flow also leaves the brain vulnerable to the plaques and tangles seen in forms of dementia.
But by changing our habits, we can both improve heart health and reduce the risk of dementia. Here are five lifestyle changes we can make now …
1. Eat 2–3 serves of oily fish each week
Oily fish, like salmon, sardines and mackerel are rich in omega-3 polyunsaturated fatty acids. Omega-3’s have anti-inflammatory effects and have been shown to significantly reduce blood pressure.
Omega-3s are also needed to support the structure and function of our brain cells and are “essential nutrients”. This means we need to get them from our diet. This is especially true as we age, because reductions in omega-3 intake have been linked to faster rates of cognitive decline.
2. Eat plant foods with every meal
Plant foods – like leafy greens, extra virgin olive oil, blueberries, nuts and pulses – contain a range of vitamins and minerals, including polyphenols, flavonoids, carotenoids, vitamin C and vitamin E. These micronutrients have both antioxidant and anti-inflammatory effects that protect and improve our blood vessel functioning.
Diets high in plant foods, like the Mediterranean diet, have been shown to improve blood pressure, glucose regulation and body composition, and have also been linked to lower rates of cognitive decline, better markers of brain health and lower risk of dementia.
3. Eat less processed food
On the other hand, saturated fats, refined carbohydrates and red and processed meats are believed to trigger inflammatory pathways and highly processed foods have been linked to hypertension, type 2 diabetes and obesity.
Eating more of these foods means we’re also likely to miss out on the benefits of other foods. Whole grains (like whole oats, rye, buckwheat and barley) provide fibre, vitamin B, E, magnesium and phytonutrients which have anti-inflammatory and antioxidant properties. Refined grains (like white bread, rice and pasta) are highly processed, meaning many of these beneficial nutrients are removed.
Read more: Why people with dementia don’t all behave the same
4. Get physical and make it fun
Physical activity can reduce inflammation and blood pressure, while improving blood vessel functioning. This helps the body deliver more oxygen to the brain, improving memory and other cognitive functions affected by dementia.
Guidelines suggest adults should engage in physical activity on most days, break up long bouts of inactivity (like watching TV) and incorporate some resistance exercises.
The key to forming long-term exercise habits is choosing physical activities you enjoy and making small, gradual increases in activity. Any movement that raises the heart rate can be classified as physical activity, including gardening, walking and even household chores.
Read more: Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death
5. Quit smoking
Smokers are 60% more likely to develop dementia than non-smokers. This is because smoking increases inflammation and oxidative stress that harm the structure and function of our blood vessels.
Quitting smoking can begin to reverse these effects. In fact, former smokers have a significantly lower risk of cognitive decline and dementia compared to current smokers, similar to that of people who have never smoked.
Read more: COVID-19 has offered us an unexpected opportunity to help more people quit smoking
Is it too late?
It’s never too early, or too late, to begin making these changes.
Obesity and high blood pressure in midlife are key predictors of dementia risk, while diabetes, physical inactivity and smoking are stronger predictors later in life. Regular physical activity earlier in life can reduce blood pressure and decrease your risk of diabetes. Like giving up smoking, changes at any stage of life can reduce inflammation and change your dementia risk.
Little by little
It can be overwhelming to change your whole diet, start a new exercise program and quit smoking all at once. But even small changes can lead to significant improvements in health. Start by making manageable swaps, like:
- use extra virgin olive oil in place of butter, margarine and other cooking oils
- swap one serve of processed food, like chips, white bread, or commercial biscuits, for a handful of nuts
- swap one serve of meat each week for one serve of oily fish
- swap five minutes of sedentary time for five minutes of walking and slowly increase each day.
Gut bacteria could help protect against COVID and even lead to a new drug – new research
Gut bacteria could help protect against COVID and even lead to a new drug – new research
February 2, 2022 1.56am AEDT Updated February 2, 2022 3.31am AEDT
Author
- Ana Valdes Professor of Molecular and Genetic Epidemiology, University of Nottingham
Disclosure statement
Ana Valdes works for/consults to/owns shares in Zoe Ltd. She receives funding from UKRI, the National Institutes of Health Research and the Medical Research Council..
University of Nottingham provides funding as a founding partner of The Conversation UK.
We believe in the free flow of information
Republish our articles for free, online or in print, under Creative Commons licence.
The number of people who have died with or from COVID has varied greatly around the world. Peru, the world’s worst affected country, has had 6,067 COVID deaths for every million inhabitants and 88,345 recorded cases per million people. Roughly one in every 15 people who has caught COVID in Peru has died.
At the other end of the spectrum there’s New Zealand. It’s had only 10 deaths and 3,136 cases for every million people, meaning only one in every 313 COVID cases in New Zealand ended with the person dying.
In between there are countries that have had a relatively high number of infections but which have still managed to keep their death numbers low – countries like Japan. It’s had 17,612 infections per million people yet only 146 deaths per million. This is despite almost one in three people in Japan being over the age of 65 and so at greater risk of severe COVID (the average age of people dying from COVID is over 80). What has kept the death rate there down?
A recent Japenese study has proposed an answer. It reports that the risk of people dying of COVID in Japan is related to the microbes present in their guts. This isn’t the first study to indicate there’s a link between gut microbes and how severe a form of COVID people get. A link between gut bacteria and COVID has already reported in research from Hong Kong and China.
Get news that’s free, independent and based on evidence.
But is it plausible that this is making a specific difference in Japan? Are people’s gut microbes in Japan really so different to those in other countries? Actually, yes, they are. Although our diets and our genes are very important in determining which gut bacteria we carry, our geographic location is one of the other major factors that influences which microbes we’re home to.
And it’s possible that gut bacteria may have a big effect on COVID outcomes. Severe COVID has been shown to be more common among people who have more of certain types of bacteria that are involved in breaking down and fermenting sugars. These microbes and their functions are also seen in people with high levels of inflammation and low levels of immune cells.
This isn’t surprising. Gut microbes are very important in regulating our immune response. Specifically, they’re crucial in making sure that the T cells that regulate the immune system (T regulatory cells) are properly activated.
The importance of bile
So how is this Japanese study unique? For one thing, its authors say it is the abundance of a specific type of bacteria called Collinsella that coincides with protection from severe COVID. This is unusual because in people from the US and the UK, Collinsella is actually linked to eating a diet low in vegetables and to higher levels of inflammation.
But the Japanese investigators also found something else. People better protected from severe COVID seemed to have high levels of a substance called ursodeoxycholate in their bodies as well. It’s what’s known as a secondary bile acid.
Primary bile acids are produced by our livers and are used by the body to break down fats. They are also transformed by bacteria in the gut to produce secondary bile acids, such as ursodeoxycholate. In some Japanese people, it appears that their abundance of Collinsella bacteria is charging this process, producing more ursodeoxycholate than is typical.
What appears to make having more ursodeoxycholate helpful is that it blocks the coronavirus from binding to cells, which is what the virus needs to do to infect them, reproduce and cause disease.
Not only that, but ursodeoxycholate has also been shown in lab experiments to reduce inflammation in rats with a spinal injury and to help them recover faster. This could also help reduce the severity of COVID, as in bad cases the disease can be made worse by the immune system overreacting to the virus and damaging the body’s own tissues. By lowering the inflammatory response to COVID, ursodeoxycholate could have a secondary protective effect.
Gut bacteria play an important contributory role in producing this secondary bile acid, but levels of ursodeoxycholate aren’t wholly dependant on the gut microbes present. People’s levels will also depend on the levels of bile acids produced by the liver and possibly also on their diets.
The good news is that ursodeoxycholate is safe and available to be taken as a drug – it’s used to treat some liver diseases. What this Japanese study implies is that we could potentially use ursodeoxycholate as a drug to reduce the severity of COVID. Obviously, clinical studies are required to demonstrate if taking it would actually improve the outcomes of people infected with COVID. But this is an exciting new possibility.
Risky business? Pharmaceutical industry sponsorship of health consumer groups
I am often asked why so many doctors are against the natural (Bioidentical ) hormones I have been prescribing for the last 30 years. One of the reasons for this web-site is to inform my patients about health, hormones and to correct the misinformation that is told to my patients. One of the reasons for this state of affairs, is contained in the article below. I am well aware that various menopausal groups, and other women’s health associations, receive generous sponsorship from Pharmaceutical companies. “You scratch my back, I will scratch yours. ”
Editorial
Risky business? Pharmaceutical industry sponsorship of health consumer groups
- Lisa A Bero, Lisa Parker
- Aust Prescr 2021;44:74-6
- 1 June 2021
- DOI: 10.18773/austprescr.2021.017
- Health consumer organisations can include groups specific to a particular condition, such as the Heart Foundation, and health system advocacy groups, such as the Consumers Health Forum of Australia. They play an important role in health care in Australia. Consumer organisations raise awareness about diseases and treatments, fund or conduct research on particular topics, and engage in advocacy for regulatory and legislative reforms that benefit consumers. These groups also educate and provide support to people living with a health condition and gain media attention for consumer issues.
Pharmaceutical industry sponsorship of health consumer groups is common. Since 2013, Medicines Australia has publicly reported the amount of money that member pharmaceutical companies provide to consumer organisations. From 2013 to 2016, companies provided a total of $34,507,810 to 230 Australian health consumer organisations. However, nearly half of these organisations made no mention of industry sponsorship on their websites and fewer than one in five had policies governing sponsorship.1
In a US survey of 245 health consumer groups, two-thirds reported pharmaceutical industry sponsorship with about 10% taking over $1 million each.2 Ties may not be only financial – another US study found that 36% of 104 consumer groups had industry executives on their governing boards.3
Health consumer groups may derive important benefits from relationships with pharmaceutical companies.4 Financial support enables groups to cover administration costs and pursue activities such as education, research funding and advocacy. In-kind support from companies may help groups to grow their organisation.
Health consumer groups are confident that they are able to withstand influence from their pharmaceutical company sponsors.5 However, this same level of confidence is seen in other health sectors that receive pharmaceutical industry funding and evidence shows that this confidence is often misplaced. For example, even small gifts from pharmaceutical companies influence health professionals’ behaviour, despite them strongly believing that they are not influenced by pharmaceutical company money.6
Ties between pharmaceutical companies and health consumer groups can be perceived as a conflict of interest. Companies with a fiduciary responsibility to shareholders to increase product sales tend to fund consumer groups representing patients with the conditions treated by their products. Health consumer groups have a primary mandate to represent the interests of members living with a specific condition. Industry ties could influence the ability of consumer groups to fully represent members’ interests.7
Consumer groups have an important role in advocating for policies that can benefit patients. Condition-specific consumer groups often promote policies that enable access to treatment, for example by lobbying for a drug to be subsidised. Pharmaceutical companies may be eager to sponsor groups whose focus and advocacy is aimed at the disease and the drugs the companies make, because if those drugs become more accessible, sales will increase.
An Australian study identified that the industry prioritised payments to health consumer groups that were focused on diseases for which there were new drugs available. Indeed, most of the companies sponsoring the most heavily funded consumer groups had drugs under review for listing on the Pharmaceutical Benefits Scheme.8 Companies are particularly keen to sponsor group activities likely to lead to more sales, with the bulk of industry money going towards public involvement (communication, advocacy, campaigning, disease awareness) and policy engagement activities. Much less goes towards patient support or organisational maintenance.8-10
Many health consumer groups consider they have closely aligned interests with pharmaceutical companies, making the sponsorship relationship useful for both parties. In particular, both sectors may be interested in public access to affordable new drugs. However, there are important ways in which the interests of the two sectors may diverge, including the promotion of expensive drugs or drugs with questionable efficacy or poor adverse-effect profiles. Although their interests may appear aligned, consumer groups might be placed in a position to overemphasise the benefits and downplay the harms of their sponsors’ products, ultimately putting consumers at risk. For example, a US study found that pharmaceutical industry-sponsored consumer groups that provided commentary on a proposed guideline to restrict the use of opioids for chronic, non-cancer pain were more likely to oppose the guideline than groups without such sponsorship.11 Industry-funded consumer representatives to the European Medicines Agency were more likely, than those without industry funding, to support a legislative proposal permitting some direct-to-consumer advertising of prescription medicines.12
By funding consumer groups whose views are aligned, the pharmaceutical industry may magnify consumer opinions pushing for access to drugs. This may effectively silence those who argue for non-pharmaceutical measures or express concerns about overdiagnosis and overtreatment. Pharmaceutical funders may also push consumer groups to lobby for drug subsidies. Such public lobbying can influence media coverage of new treatments, policies that affect the regulatory approval or financial coverage of medicines, and public opinion. Given the lack of transparency around pharmaceutical industry support for consumer groups, it is often difficult for members of the public to know whether consumer voices have financial links to the manufacturers of the products they support.
Consumer organisations have a mission to educate patients and the public about diseases and treatments. One advantage of pharmaceutical industry sponsorship of consumer groups could be financial support for patient ‘educational’ materials or events. However, these groups should be aware that, globally, pharmaceutical industry sponsorship has been linked to biases in clinical research, education and practice.13,14 An Australian study found that sponsoring pharmaceutical companies sometimes request direct access to consumers at educational events and seek to influence group communications through newsletters and conference materials.4 Internal pharmaceutical company documents have defined education as a ‘marketing strategy’.15 Marketing messages tend to emphasise a medicine’s benefits and provide limited information on harms16 while promoting high-cost, brand-name drugs over well-established, safer generic alternatives.17
Sponsorship of consumer groups could also allow direct marketing to patients through a back door. Direct-to-consumer advertising is illegal in Australia, but industry sponsorship could give companies direct access to patients through their attendance at industry-sponsored events or participation in industry-sponsored support groups. This access could be used to gather information for marketing or for new types of promotion, such as through social media.18
By building relationships with consumer groups, pharmaceutical companies can shift the focus from patients and health to their own corporate interests. In order to maintain the flow of industry money, consumer groups may align their priorities with those of their sponsors. The company priority of selling more medicines may not be the best for public health. Consumers need to be represented by truly independent groups that have consumer interests as their main concern.
Health consumer organisations looking for guidance on how to manage relationships with industry sponsors have limited options. The Consumers Health Forum of Australia has produced a document in conjunction with Medicines Australia, the main organisation for the pharmaceutical industry.19 Consumer organisations might also look to the industry’s own Code of Conduct, which includes information on how the industry expects its member companies to behave. There is room for independent guidance to support groups that are looking for more assistance with developing and enacting sponsorship policies. We recently convened a seminar on this topic in conjunction with Health Consumers NSW and the Consumers Health Forum of Australia. The meeting report is available online.20
We encourage health professionals to investigate funding sources for health consumer groups that they mention to patients or engage with as advisors and to educate themselves about the risks such funding can create. Health professionals can then engage in open discussions with patients about what it might mean for a given consumer group to be funded by a particular company.
We strongly support the global move towards greater transparency around industry funding in the health sector,21 including for health consumer organisations.22-24 If health consumer organisations made clear disclosures about the extent, amount and uses of pharmaceutical industry sponsorship, this would allow patients and referring health professionals to be much better informed about the impacts of industry influence.
Conflicts of interest: none declared
Top 10 drugs 2020–21
- Aust Prescr 2021;44:205
- 1 December 2021
- DOI: 10.18773/austprescr.2021.062
Tables 1–3 show the top 10 drugs for the year July 2020 – June 2021. The figures are based on PBS and RPBS prescriptions from the date of supply. The figures include prescriptions under the co-payment (non-subsidised).
Table 1 – Top 10 PBS/RPBS drugs by DDD/1000 pop/day
| Drug | DDD/1000 pop/day* |
| 1. atorvastatin (Lipitor) | 76.22 |
| 2. rosuvastatin(Crestor) | 66.54 |
| 3. perindopril | 54.35 |
| 4. amlodipine | 53.35 |
| 5. candesartan | 34.56 |
| 6. telmisartan | 34.55 |
| 7. irbesartan | 29.36 |
| 8. sertraline | 27.42 |
| 9. metformin | 26.59 |
| 10. ramipril | 26.52 |
Table 2 – Top 10 PBS/RPBS drugs by prescription counts
| Drug | Prescriptions |
| 1. rosuvastatin | 14,1 85 , 361 |
| 2. atorvastatin | 11,673,109 |
| 3. pantoprazole | 9,299,295 |
| 4. esomeprazole | 8,396, 6 1 1 |
| 5. perindopril | 6,890,787 |
| 6. escitalopram | 5,470,158 |
| 7. metformin | 5,406,768 |
| 8. sertraline | 5,106,720 |
| 9. cefalexin | 4, 6 17,588 |
| 10. amlodipine | 4,475, 471 |
Dr Colin Holloway 
