Monthly Archives: July 2022
The many reasons men need to focus on their health
Published June 21, 2022 | Originally published on Newswise: Gender Issues
The recent MENtion It poll, a project of the Cleveland Clinic, revealed some startling statistics about men’s attitudes toward their own health:
- 72% of men surveyed say they would rather do household chores — including cleaning toilets — than visit their doctor
- 65% say they try to avoid going to the doctor at all possible costs
- 37% have withheld information from their physicians
Why are so many men so reluctant to visit and be honest with their doctors? A major factor is fear: even when they suspect they may have a disease, many men are afraid to be diagnosed because the disease might be serious. Another hindrance is the so-called Superman Complex: many men pride themselves on taking care of everything – their spouses, families, finances, and home upkeep – and they feel that going to the doctor means giving up their “Superman of the House” persona.
There is also a societal component to men’s attitudes towards their health. Generally speaking, women tend to be more open when discussing sensitive topics such as their fears about the symptoms they’re experiencing.
As a doctor, I want to assure everybody that we’re not in the business of giving bad news; we’re in the business of helping people, of prolonging and improving their lives. There are severe consequences to men’s reluctance to engage in their own health; such behavior can unnecessarily delay diagnosis and life-saving treatment. The sooner we know a patient has a disease, the more quickly we can intervene and possibly change its course.
Improving outcomes in prostate cancer
Prostate cancer is one of the leading causes of cancer death among men of all races. Ten years ago, prostate cancer screening consisted solely of a digital rectal exam and prostate-specific antigen (PSA) testing, and if either method revealed anything abnormal, we’d go straight to biopsy. Today, urologists can obtain a clearer, more detailed view of the prostate via advanced imaging technologies such as multiparametric magnetic resonance imaging (mpMRI) and fusion-guided ultrasound. When combined with more sophisticated blood tests including 4K scoring and the prostate health index (PHI), these technologies can yield a deeper understanding of PSA levels and other disease markers, thereby reducing the need for biopsy.
Better risk assessment helps tremendously in terms of avoiding over-treatment and facilitating precision medicine, which not only results in better cancer control, but also minimizes disruptions to patients’ lives. Rather than radiating the entire prostate, as we used to do 10-15 years ago, we can now employ more sophisticated imaging technologies to minimize collateral damage. We can employ in select patients advanced techniques such as focal ablation, high-intensity focused ultrasound (HIFU), and cryosurgery to more precisely target the diseased area and minimize collateral damage to surrounding tissue and remaining prostate.
When surgery is deemed appropriate we have far less invasive techniques which are easier to recover from. Surgeons no longer need to make a seven-to-eight-inch incision and use headlamps and long instruments; nor do they need to go through the abdomen to reach the prostate;. Today’s software-guided, single-port surgical techniques require only a one-inch incision through the patient’s navel, sparing the structures that control urinary continence and erectile function, while lowering the risks of infection and other complications. With surgical trauma thus minimized, many patients can go home the same day. In short, it’s not your father’s operation anymore. When prostate cancer is more advanced and has metastasized (spread) to other tissues, advanced technologies such as prostate-specific membrane antigen (PSMA) testing can help locate metastases, even in cases of recurrent prostate cancer. Additionally, it may soon be possible to attach a radioisotope to a PSMA test to deliver treatment directly to the targeted cells while sparing surrounding tissue and limiting potentially debilitating side effects.
Genetics: The next frontier in precision medicine
To a great extent, recent medical advances are designed to personalize care based on the patient’s genetic makeup. New technologies such as next-generation sequencing (NGS) are helping to advance personalized medicine by identifying who is at risk of certain cancers and other diseases as well as the best way to treat them. Such advances are being driven by enhanced understanding of hereditary mutations, which are changes in the genetic sequence that are passed from parent to child, as well as of somatic mutations, which are alterations in DNA that occur after conception. With NGS, along with blood tests that illuminate the genetic signatures of cancer cells, we can screen patients for both types of mutations, a capability that can help us assess patients’ individual risk more accurately and intervene more quickly with treatments that specifically target the identified mutations.
Harnessing the power of multiple disciplines
Improving men’s health is truly a multidisciplinary pursuit. In addition to urology, the fields of oncology, hematology, radiology, robotics, and nuclear medicine are just a few of the medical specialties that are driving advances in men’s health, aided by the related disciplines of nursing and social work. Their contributions are expanding the knowledge base surrounding new diagnostic technologies and therapeutic approaches, and informing the appropriate use of these innovations.
Hopefully, with that knowledge and the support of their spouses and loved ones, men will be motivated to see their doctors sooner than later, when medical intervention has the greatest chance of producing positive outcomes. And if the doctor’s office still feels like a scary place, men can take advantage of pop-up health screenings at local parks, civic centers, ballparks, bars, and social clubs. By bringing the benefits of health consciousness to wherever men happen to be, such initiatives show men that taking taking charge of their health is easier than they may think.
Depression is probably not caused by a chemical imbalance in the brain – new study
Published: July 20, 2022 3.12pm AEST
- Joanna Moncrieff Senior Clinical Lecturer, Critical and Social Psychiatry, UCL
- Mark Horowitz Clinical Research Fellow in Psychiatry, UCL
Joanna Moncrieff is a co-investigator on a National Institute of Health Research funded study exploring methods of antidepressant discontinuation. She is co-chair person of the Critical Psychiatry Network, an informal and unfunded group of psychiatrists and an unpaid board member of the voluntary group, the Council for Evidence-based Psychiatry.
Mark Horowitz is co-founder of a company aiming to help people safely stop unnecessary antidepressants in Canada. He is an (unpaid) associate of the International Institute of Psychiatric Drug Withdrawal (IIPDW) and a member of the Critical Psychiatry Network.
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For three decades, people have been deluged with information suggesting that depression is caused by a “chemical imbalance” in the brain – namely an imbalance of a brain chemical called serotonin. However, our latest research review shows that the evidence does not support it.
Although first proposed in the 1960s, the serotonin theory of depression started to be widely promoted by the pharmaceutical industry in the 1990s in association with its efforts to market a new range of antidepressants, known as selective serotonin-reuptake inhibitors or SSRIs. The idea was also endorsed by official institutions such as the American Psychiatric Association, which still tells the public that “differences in certain chemicals in the brain may contribute to symptoms of depression”.
Countless doctors have repeated the message all over the world, in their private surgeries and in the media. People accepted what they were told. And many started taking antidepressants because they believed they had something wrong with their brain that required an antidepressant to put right. In the period of this marketing push, antidepressant use climbed dramatically, and they are now prescribed to one in six of the adult population in England, for example.
For a long time, certain academics, including some leading psychiatrists, have suggested that there is no satisfactory evidence to support the idea that depression is a result of abnormally low or inactive serotonin. Others continue to endorse the theory. Until now, however, there has been no comprehensive review of the research on serotonin and depression that could enable firm conclusions either way.
At first sight, the fact that SSRI-type antidepressants act on the serotonin system appears to support the serotonin theory of depression. SSRIs temporarily increase the availability of serotonin in the brain, but this does not necessarily imply that depression is caused by the opposite of this effect.
There are other explanations for antidepressants’ effects. In fact, drug trials show that antidepressants are barely distinguishable from a placebo (dummy pill) when it comes to treating depression. Also, antidepressants appear to have a generalised emotion-numbing effect which may influence people’s moods, although we do not know how this effect is produced or much about it.
First comprehensive review
There has been extensive research on the serotonin system since the 1990s, but it has not been collected systematically before. We conducted an “umbrella” review that involved systematically identifying and collating existing overviews of the evidence from each of the main areas of research into serotonin and depression. Although there have been systematic reviews of individual areas in the past, none have combined the evidence from all the different areas taking this approach.
One area of research we included was research comparing levels of serotonin and its breakdown products in the blood or brain fluid. Overall, this research did not show a difference between people with depression and those without depression.
Another area of research has focused on serotonin receptors, which are proteins on the ends of the nerves that serotonin links up with and which can transmit or inhibit serotonin’s effects. Research on the most commonly investigated serotonin receptor suggested either no difference between people with depression and people without depression, or that serotonin activity was actually increased in people with depression – the opposite of the serotonin theory’s prediction.
Research on the serotonin “transporter”, that is the protein which helps to terminate the effect of serotonin (this is the protein that SSRIs act on), also suggested that, if anything, there was increased serotonin activity in people with depression. However, these findings may be explained by the fact that many participants in these studies had used or were currently using antidepressants.
We also looked at research that explored whether depression can be induced in volunteers by artificially lowering levels of serotonin. Two systematic reviews from 2006 and 2007 and a sample of the ten most recent studies (at the time the current research was conducted) found that lowering serotonin did not produce depression in hundreds of healthy volunteers. One of the reviews showed very weak evidence of an effect in a small subgroup of people with a family history of depression, but this only involved 75 participants.
Very large studies involving tens of thousands of patients looked at gene variation, including the gene that has the instructions for making the serotonin transporter. They found no difference in the frequency of varieties of this gene between people with depression and healthy controls.
Although a famous early study found a relationship between the serotonin transporter gene and stressful life events, larger, more comprehensive studies suggest no such relationship exists. Stressful life events in themselves, however, exerted a strong effect on people’s subsequent risk of developing depression.
Some of the studies in our overview that included people who were taking or had previously taken antidepressants showed evidence that antidepressants may actually lower the concentration or activity of serotonin.
Not supported by the evidence
The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants.
Most antidepressants now in use are presumed to act via their effects on serotonin. Some also affect the brain chemical noradrenaline. But experts agree that the evidence for the involvement of noradrenaline in depression is weaker than that for serotonin.
There is no other accepted pharmacological mechanism for how antidepressants might affect depression. If antidepressants exert their effects as placebos, or by numbing emotions, then it is not clear that they do more good than harm.
Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact, research has shown the opposite, and also that people who believe their own depression is due to a chemical imbalance are more pessimistic about their chances of recovery.
It is important that people know that the idea that depression results from a “chemical imbalance” is hypothetical. And we do not understand what temporarily elevating serotonin or other biochemical changes produced by antidepressants do to the brain. We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe.
If you’re taking antidepressants, it’s very important you don’t stop doing so without speaking to your doctor first. But people need all this information to make informed decisions about whether or not to take these drugs.
Your brain needs proper diet and exercise, too
Published June 21, 2022 | Originally published on University of Kentucky HealthCare News
Healthy brain aging is a concern for all of us. June is recognized as Brain and Alzheimer’s Awareness Month. It’s normal to struggle with small things such as recalling names — and we all experience some slowing of the thought processes with advanced age — but everyone hopes to avoid serious cognitive impairment.
Some cognitive difficulties, such as Alzheimer’s disease, have underlying pathological causes that we are still working to understand. However, we know that brains can also lose function simply through poor physical, mental and social health. Many of the causes of cognitive decline are preventable.
Just as we create exercise regimens for the body, we should create a routine for brain health.
As a general rule, what is good for heart health is good for brain health. Getting regular exercise, eating well and maintaining a healthy weight all promote a healthy brain.
People of all ages, particularly seniors, benefit from leaving the house, engaging in learning activities and having an active social life. It is important to commit to a schedule that encourages all of these healthy brain aging activities.
Summer, in many ways, is an ideal time to set up a routine for healthy brain aging. Warm weather offers the opportunity to get physical exercise through gardening and walking. Many community organizations offer summer classes in dance, photography, art, music and other hobbies.
Summer also is the season of farmers markets and fresh produce. Fresh fruits and vegetables contain compounds called plant polyphenols. These compounds, which help plants fight off disease, have been observed in animal models to extend lifespan by promoting general cellular health. Blackberries, raspberries, blueberries and red wine are all good sources of polyphenols.
Anyone interested in healthy brain aging also can practice “neurobics.” These “aerobics for the brain” are activities that can be thrown into the daily schedule on a whim. Examples include taking a different route home, shopping at a different grocery store, or purposely driving or walking through an unfamiliar neighborhood. These simple activities activate the problem-solving areas of the brain as the person navigates unfamiliar territory.
Social engagement is key for seniors, who might find their social circle shrinking as friends and relatives move, develop serious illness or die.
Senior centers offer great resources for social activities. Something as simple as gathering with others for a regular card game can help keep the cognitive functions of the brain sharp. For some seniors, moving into a senior-living community is ideal, because it provides increased opportunities for structured activities and socialization with peers.
Through socialization, hobbies, lifelong learning, healthy eating, physical activity and challenging their brain on a daily basis, most people have the capacity to achieve healthy brain aging.
I have seen some patients reverse mild cognitive impairment simply by adopting a healthier lifestyle — so it’s never too late to encourage healthy brain aging.
Can you be overweight and healthy?
Published: June 2, 2022 6.14am AEST
- Nick Fuller Charles Perkins Centre Research Program Leader, University of Sydney
Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.
University of Sydney provides funding as a member of The Conversation AU.
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One of the most contentious questions asked in the health community today is whether you can be overweight and healthy.
This question – sometimes framed using the term “fat but fit” – has preoccupied medical researchers for decades, fuelling numerous studies both supporting and debunking the concept.
The debate revolves around whether a physically active overweight or obese person can still be considered metabolically healthy – that is, they have good blood pressure, cholesterol and insulin levels.
As a health professional and obesity expert, my response to this question often surprises: I believe a person can indeed be overweight and healthy. Here’s why.
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1. Weight and health are not perfectly correlated
As I discussed in my article on the Body Mass Index (BMI), a person’s weight doesn’t always tell the full story of their health.
While being overweight increases an individual’s risk of a range of health issues, including heart disease, stroke, diabetes and some cancers, many studies have shown a person’s disease risk is linked not to weight, but to body fat and where it’s distributed in the body.
While BMI calculators provide a starting point for assessing body fat, the BMI is not an accurate measure of health because it doesn’t explain where fat is distributed in the body.
People with a high amount of visceral fat – a type of especially unhealthy fat stored around the stomach, close to the organs – have a higher risk of disease than people who hold body fat around their hips.
It’s also important to remember muscle is much denser than fat – another thing the BMI can’t measure.
Therefore, if a BMI calculator classifies you as overweight or obese, but you’re physically fit, have a healthy diet and lifestyle, and fat stored around your hips, you could be healthier than someone with a BMI in the “normal” range if they don’t exercise or eat a balanced diet.
2. Weight and fitness are not perfectly related either
We’ve been conditioned to believe being overweight is directly associated with being unfit. But it’s inactivity, not our weight, that directly impacts our fitness levels.
Indeed, numerous studies have used exercise testing to show that some overweight and obese people have high cardiovascular fitness and strength levels. The difference? These people engaged in regular physical activity.
Regular exercise will improve your fitness, no matter what you weigh. Sadly, more than half of the Australian population don’t even do the 30 minutes of exercise needed five days a week to stay healthy and alive, let alone help them manage their weight.
3. Lifestyle is more important than a number on the scales
It may sound obvious, but healthy behaviours – not weight – make us healthy.
While understanding and managing the relationship between our weight and health is important, we need to remember other factors influence good health too. Top among these are getting enough exercise, eating a healthy and balanced diet, reducing stress, and improving our sleep quality.
How to be healthy at any weight
You can do several simple things right now to support your overall health, no matter what you weigh.
Mix up your exercise routine
It’s indisputable that exercise has enormous health benefits. Alongside improving your heart health, regular activity improves muscle strength and mobility, reduces stress levels and promotes better sleep and energy levels.
To encourage more exercise, take up something you enjoy, no matter what it is. But make sure to include variety, as doing the same routine every day is a surefire way to get bored and avoid activity, and can also make it hard to hit your goals.
It’s also important to look for ways to incorporate incidental activity in your daily routine. Our sedentary lifestyles are literally killing us, with experts suggesting a week of physical inactivity has the equivalent personal health cost of smoking 20 cigarettes.
Introducing more activity can be as simple as taking the stairs instead of the lift, parking the car a little bit further away from our destination, or switching off the robot vacuum cleaner and taking on the housework ourselves.
Improve your sleep
Getting the recommended seven to nine hours of shuteye we need each night will significantly benefit your health. The good news is it’s easy to dramatically improve your sleep quality by taking simple steps to support good sleep hygiene. Start with the “no blue light after twilight” rule, switching off your devices early to boost your body’s secretion of sleep-inducing hormones such as melatonin.
Retrain your brain to manage your stress
Stress will adversely impact your health, often encouraging unhealthy dietary habits and contributing to chronic conditions such as high blood pressure.
Contrary to popular belief, alcohol isn’t a good way to deal with stress! Instead, take up more beneficial activities to relieve stress, such as exercise and meditation.
The bottom line
Your weight does matter when it comes to your overall levels of health. It’s just not the only thing that matters, and it’s not always necessary to achieve the definition of a “healthy weight” category.
We should all be engaging in healthier lifestyle habits – whatever our weight.
I have posted a few blogs recently on the effect of the vaccines on menopausal women. Here is further evidence that the vaccines cause period changes – this means they are having some effect on women’s normal hormonal functioning. Although they (the experts) are making reassuring comments about this, it is nevertheless a concern, as not much is known as to how exactly it is changing your hormone balance.
Largest Study to Date Shows How Covid Vaccines Affect Periods
For some, a side effect of getting vaccinated was a change in menstrual cycles — but experts say there is no cause for alarm.
- This article is part of our Daily Covid Briefing
By Knvul Sheikh
- July 15, 2022
Nearly half of the participants of a recent study who were menstruating regularly at the time of the survey reported heavier bleeding during their periods after receiving the Covid-19 vaccine. Others who did not typically menstruate — including transgender men, people on long-acting contraceptives, and post-menopausal women — also experienced unusual bleeding.
The new study — the largest to date — expands on research that has highlighted the temporary effects of Covid-19 vaccines on menstrual cycles, but until now focused primarily on cisgender women who menstruate.
Although the vaccines have largely prevented deaths and severe disease with few reported side effects, many medical experts initially brushed aside concerns when women and gender-diverse people started reporting erratic menstrual cycles after receiving the shots.l
To get a better sense of these post-vaccination experiences, researchers at the University of Illinois at Urbana-Champaign and Washington University School of Medicine in St. Louis distributed an online survey in April 2021 to thousands of people across the globe. After three months, the researchers collected and analyzed more than 39,000 responses from individuals between the ages of 18 and 80 about their menstrual cycles. All the survey respondents had been fully vaccinated — with the Pfizer-BioNTech, Moderna, Johnson & Johnson vaccines or another that had been approved outside the United States. And to the best of their knowledge, the participants had not contracted Covid-19 before getting vaccinated.
The research, published Friday in the journal Science Advances, shows that 42 percent of people with regular menstrual cycles experienced heavier bleeding after vaccination, while 44 percent reported no change and 14 percent reported lighter periods. Additionally, 39 percent of respondents on gender-affirming hormone treatments, 71 percent of people on long-acting contraceptives and 66 percent of postmenopausal women experienced breakthrough bleeding after one or both of their shots.
“I think it’s important that people know this can happen, so they’re not scared, they’re not shocked and they’re not caught without supplies,” said Katharine Lee, a biological anthropologist at the Washington University School of Medicine in St. Louis, and the study’s first author.
Dr. Lee cautioned, however, that the study did not compare the results with a control group of people who did not get vaccinated. And it is possible that people who observed changes in their cycles after vaccination may have been more likely to participate in the survey. Still, the findings line up with smaller studies that have reported menstrual changes after vaccination with more robust controls.
Importantly, the new study also found that some demographics may be more likely to experience menstrual changes, and the study may help them be better prepared, Dr. Lee said. A heavier menstrual flow was more likely for those who were older, for instance. Survey respondents who used hormonal contraception, had been pregnant in the past or had been diagnosed with a reproductive condition like endometriosis, fibroids or polycystic ovarian syndrome were also more likely to have heavier bleeding during their periods. People who identified as Hispanic or Latino tended to report heavier bleeding too. And people who experienced other side effects of the vaccines, like a fever or fatigue, also had a higher chance of experiencing erratic periods. story
Postmenopausal women who were slightly younger, around an average age of 60, were more likely to experience breakthrough bleeding after the vaccine than those who were older. But the type of vaccine postmenopausal women received, whether they had other side effects like a fever or whether they had a past pregnancy did not seem to have an effect on their bleeding.
Why do these changes occur?
Some level of variation in menstruation — the number of days you bleed, the heaviness of your flow and your cycle length — is normal.
“Our menstrual cycles are not perfect clocks,” said Dr. Alison Edelman, a professor of obstetrics and gynecology at Oregon Health & Science University who has also studied the impact of Covid-19 vaccines on menstruation.
Hormones secreted by the hypothalamus, the pituitary gland and the ovaries regulate the monthly cycle, and they can be affected by both internal and external factors. Stress and illness, weight loss or weight gain, calorie restriction and intense exercise can all change typical patterns of menstruation.
The endometrium, which lines the uterus and is shed during menstruation, has also been linked to the immune system. Because of the role it plays in the remodeling of uterine tissue and offering protection against pathogens, it is possible that when vaccines activate the immune system, which is what they should be doing, they also somehow trigger downstream effects in the endometrium, causing a disturbance in your menstrual cycle, Dr. Edelman said. And some individuals may be more sensitive to immune or hormone changes in their body.
In her research, Dr. Edelman found that some women’s periods came a day or two later than usual after they got vaccinated against coronavirus. But the changes were temporary — menstruation tended to return to normal after one or two cycles.
What to do if you notice menstrual irregularities after the Covid vaccine
If you experience any new or unusual patterns of bleeding, take note of it. The menstrual cycle can be thought of as another vital sign, just like your body temperature or blood pressure, that provides clues about your health, said Dr. Jennifer Kawwass, a reproductive endocrinologist at Emory University, who was not involved in the study.
“A significant change in menstrual cycle interval or bleeding profile warrants further investigation to be sure there is not an underlying endocrinologic, hematologic or anatomic cause,” Dr. Kawwass said. Breakthrough bleeding in people who no longer normally menstruate, for example, may also be a warning sign of cervical, ovarian, uterine or vaginal cancer.
That being said, subtle variation in your menstrual cycle, if you have regular periods, should not be a cause for concern and does not require that you change anything you would normally do, Dr. Kawwass said.
Should you get vaccinated at a certain time in your cycle?
Experts agree that the chaos Covid-19 can cause throughout your body, including potential lingering effects, is far worse than any side effects caused by vaccination against the disease.
People who have previously gotten a fever after a shot may plan their next dose on a day when they will not have to go in to work, Dr. Edelman said. But you should not let temporary menstrual changes prevent you from getting fully vaccinated or boosted. Since cases are on the rise again, delaying vaccination for two weeks or longer may significantly increase your risk of getting Covid-19, she said.
Still, it’s important to track your body’s response to vaccination, and public health officials should acknowledge concerns about menstrual cycle variations in addition to warning people of the risk of getting Covid-19, said Keisha Ray, a bioethics expert at McGovern Medical School at UTHealth Houston.
The increased transparency around menstrual changes or other side effects of vaccination could also have another benefit: reducing people’s vaccine hesitancy.
“We’re trying to be truthful. We’re trying to validate people’s lived experiences,” said Dr. Lee. In turn, she hopes that the new research will help improve conversations around people’s health and lead to more inclusive clinical trials in the future.