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Can supplements or diet reduce symptoms of arthritis? Here’s what the evidence says

Published: August 29, 2022 3.13pm AEST

Author

1. Clare Collins Laureate Professor in Nutrition and Dietetics, University of Newcastle

Disclosure statement

Clare Collins is a Laureate Professor in Nutrition and Dietetics at the University of Newcastle, NSW and a Hunter Medical Research Institute (HMRI) affiliated researcher. She is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from NHMRC, ARC, MRFF, HMRI, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.

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Republish our articles for free, online or in print, under Creative Commons licence.

Arthritis is a disease that affects body joints. There are more than 100 types of arthritis, with more than 350 million people affected around the globe, including about four million Australians.

Arthritis causes pain and disability and commonly reduces quality of life. In Australia in 2015, about 54,000 people aged 45–64 couldn’t work due to severe arthritis. Their median income was only a quarter of the income of full-time workers who did not have arthritis.

So it is not surprising some people want to try different diets, supplements or therapies to see if they alleviate symptoms or help them gain a sense of control over their condition.

However, a major review found specific supplements or food components were unlikely to lead to significant improvements in arthritis outcomes such as stiffness, pain and function.

The main nutrition recommendation was to adopt healthy eating patterns.

Remind me, what causes arthritis? And what are the symptoms?

Risk factors for developing arthritis include ones you can’t control – such as genetics, sex, and age – and some you may be able to, such as smoking, repetitive injuries, body weight, occupation and some infections.

Types of arthritis include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, juvenile arthritis, gout, systemic lupus erythematosus (lupus) and scleroderma.

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Read more: Arthritis isn’t just a condition affecting older people, it likely starts much earlier

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Common symptoms include:

• pain
• stiffness or reduced joint movement
• swelling, redness and warmth in the joints.

Less specific symptoms include tiredness, weight loss or feeling unwell.

So what does the evidence say about supplements?

The European Alliance of Associations for Rheumatology, the expert European group on arthritis, recently published a detailed critique on diet and supplement use in arthritis. It synthesised findings from 24 systematic reviews of existing research as well as an additional 150 extra studies, covering more than 80 different dietary components and supplements.

The alliance identified there were limited studies on each individual product with the majority of studies being of low quality. This means that for most supplements they couldn’t make recommendations about whether or not to use them.

However, for osteoarthritis and rheumatoid arthritis, although most studies were of low or moderate quality, a few supplements had positive effects.

Vitamin D, chondroitin and glucosamine

For osteoarthritis, there was moderate-quality evidence supporting a small positive effect on pain and function for taking vitamin D, chondroitin and glucosamine (both compounds found in cartilage) supplements.

Here, moderate quality means although the studies had some limitations and their results should be interpreted with caution, they can be used to guide recommendations.

This suggests people could choose to try these common supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement in their symptoms.

Fish oil

For rheumatoid arthritis, there was moderate quality evidence for a small positive effect on pain for omega-3 (fish) oils.

Again, people could try these supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement.

Other supplements

For all other arthritis categories, and other specific dietary components or supplements, the evidence was rated as low to very low (see tables 1–5 in this link).

This means any improvements in arthritis outcomes could be due to chance or bias, with positive results more likely to be published, or potential bias occurring when a trial was sponsored by a supplement manufacturer.

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Read more: I’m taking glucosamine for my arthritis. So what’s behind the new advice to stop?

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What does it all mean?

Current research indicates it’s unlikely specific foods, supplements or dietary components affect arthritis outcomes to a large degree.

However, given the higher risk for heart disease associated with arthritis, the recommendation is to have a healthy diet and lifestyle in order to improve your overall health and wellbeing.

So how do you improve your health and wellbeing? Here are five key things to consider:

1. Eat a healthy, varied diet

Eating food – rather than taking supplements – means you get the other nutrients that foods contain, including healthy sources of fat, protein, dietary fibre and a range of vitamin and minerals essential to maintain a healthy body.

This is why the recommendation for people with arthritis is to eat a healthy diet, because vegetables, fruit, legumes and wholegrains contain a range of phytonutrients needed to help dampen down oxidative stress triggered by inflammatory processes associated with arthritis.

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Read more: What is a balanced diet anyway?

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A healthy diet includes foods rich in omega-3 fats such as fatty fish (salmon, tuna, sardines), chia seeds, flaxseed oil, walnuts, canola oil, and vitamin D (eggs, fish, and milk or margarine fortified with vitamin D). And don’t forget sun exposure, which allows the body to produce vitamin D.

2. Avoid alcohol

Alcohol intake should be discussed with your doctor as it can interact with other treatments.

Small amounts of alcohol are unlikely to have negative impacts on arthritis, unless you have other health issues like liver disease or you take certain medications such as methotrexate or leflunomide.

For rheumatoid arthritis, moderate alcohol consumption could increase the risk of arthritis flare ups.

Alcohol can also increase the risk of gout flare ups.

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Read more: Got gout? Here’s what to eat and avoid

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3. Aim for a healthy weight

Aiming for a healthy weight can help arthritis by reducing the load on affected joints such as hips and knees, and by boosting your intake of healthy foods rich in phytonutrients.

Ask your doctor for support to achieve well managed, intentional weight loss if you’re carrying excess weight. You may need referral to an accredited practising dietitian for personalised medical nutrition therapy or to a physiotherapist or exercise physiologist for specific help to improve mobility and physical activity.

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Read more: Health Check: what’s the best diet for weight loss?

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4. Be cautious with supplements

If you decide to try specific complimentary therapies or dietary supplements, discuss potential side-effects or interactions with your regular medicines with your doctor and pharmacist.

Try the products for a few months (or as long as one container lasts) so you can monitor any side-effects versus your sense of wellbeing, reduction in use of pain medications and the cost. If you’re not getting any benefit then spend that money on more healthy foods instead.

Find out how healthy your diet is by taking our free Healthy Eating Quiz.

How to Harness Your Anxiety

Research shows that we can tame anxiety to use it as a resource.

By Alicia H. Clark

Oct. 16, 2018

Anxiety has long been one of the most feared enemies in our emotional canon. We fear its arrival, feel helpless and trapped under its spell, and grant it power to overtake us in new, exciting and challenging situations. But what if we’ve been going about it all wrong?

Research shows that anxiety can actually be a pathway to our best selves. A range of new neuroscience, along with ideas from ancient philosophy, Charles Darwin, early social scientists and positive psychology, have all pointed in this direction.

To be sure, severe anxiety can be debilitating. But for many people who experience it at more moderate levels it can be helpful, if we are open enough to embrace and reframe it.

For example, if anxiety is holding you back from applying for a new job, tell yourself that the feeling of your heart racing, which you thought was the discomfort of anxiety, is actually a crackle of excitement. This can help motivate you to apply for the job rather than shrinking from the opportunity.

Anxiety has often been linked to the “primitive” part of our brain, an “irrational” remnant left over from our time in the savanna dodging wild animals. This framing can make anxiety doubly problematic: it is seen as both destructive and useless. Most coping strategies based in cognitive behavior therapy likewise assume this view of anxiety and strive to eradicate, or at least quiet, it. And we have learned to fear it.

For a variety of reasons, we are engaged in a feedback loop with anxiety. Fearing it, and in response, trying to avoid it or push it down, is part of what can make it such a problem for us. It feels like an obstacle because we have been treating it as such. But the less we fear anxiety and can embrace it, the more useful and helpful it can be.

A large-scale study from the University of Wisconsin in 2012 demonstrated that how we think about anxiety and stress can change how those feelings impact us. Regardless of actual stress levels, the less harmful you believe the feeling is, the less harmful it will be. “Our minds aren’t passive observers simply perceiving reality,” the Stanford research scientist Alia Crum explained in a speech at, of all places, the World Economic Forum. “Our minds actually change reality. In other words the reality we will experience tomorrow is in part a product of the mind-sets we hold today.”

Here are three ways to tap into anxiety as a resource.

1. Think of anxiety as a signal

You don’t have to like the experience of anxiety to use it effectively. It’s designed to be uncomfortable so you pay attention and do what you need to make it stop. Much like a baby’s cry, anxiety lets you know there is an issue that needs addressing. Just as you try to figure out why the baby is in distress and resolve it, you must work to determine what your anxiety is trying to tell you. Once you determine that and start executing solutions, you’ll notice the anxiety begins to dissipate.

2. Label the feeling to steer your experience

Naming anxiety — and then renaming it — allows you to process its message rather than just react to its discomfort. This reduces distress and activates better emotional regulation, problem solving and planning.

Nervous you may have upset someone? Reframe worry into care about a person who matters.

Terrified about going out on that first date? Consider that your heart is beating fast at the possibility of it going well.

How you label your experience is 100 percent in your control. You can then channel anxiety into a resource you can use to your advantage.

A study published in July from the University of Illinois on brain personality traits and brain volume confirmed that a positive attitude can boost our brain’s ability to manage discomfort. When you start to see how anxiety can work for you, you open up more possibilities for how you can channel it.

3. Aim for the sweet spot

While an overload of anxiety can be detrimental, it is also problematic to have none (sociopaths, for example, tend not to have any). A moderate amount of anxiety promotes optimal functioning, even if the unexpected energy might throw you off. If you understand what anxiety is trying to do, you don’t have to view — and treat — it as an enemy. Anxiety about meeting a deadline, for example, can fuel the focus and energy we need to meet it, especially when tired and prone to distraction. Anxiety keeps us on our toes and focused. In our noisy, busy lives, it is often simply a call to pay attention to the thing that needs our attention.

Understanding anxiety’s inherent motivation, and being clear about your feelings, can help us thrive, according to a German study published last year. Deciding you can handle your anxiety, even if it’s unwelcome, is one of the most effective things you can do to limit its escalation. Just as fearing anxiety increases it, embracing anxiety dissipates it to a point where it’s useful.

What this new research and approach offers is something we could all use a bit more of when it comes to anxiety: hope. The hope rises from the realization that we are in control. Instead of being overtaken by our anxiety, we can partner with it. Not only can we control how we think about anxiety, we can actually change how we experience it. Taking charge of your mind-set, your emotional labeling and your behavior is how you partner with anxiety and reclaim control.

Dr. Alicia Clark is a psychologist and author of “Hack Your Anxiety: How to Make Anxiety Work for You in Life, Love, and All That You Do.”

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I’ve had COVID and am constantly getting colds. Did COVID harm my immune system? Am I now at risk of other infectious diseases?

Published: September 19, 2022 6.15am AEST

Author

1. Lara Herrero Research Leader in Virology and Infectious Disease, Griffith University

Disclosure statement

Lara Herrero receives funding from NHMRC

Griffith University provides funding as a member of The Conversation AU.

View current jobs from Griffith University

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Republish our articles for free, online or in print, under Creative Commons licence.

So you’ve had COVID and have now recovered. You don’t have ongoing symptoms and luckily, you don’t seem to have developed long COVID.

But what impacts has COVID had on your overall immune system?

It’s early days yet. But growing evidence suggests there are changes to your immune system that may put you at risk of other infectious diseases.

Here’s what we know so far.

Get your news from people who know what they’re talking about.

A round of viral infections

Over this past winter, many of us have had what seemed like a continual round of viral illness. This may have included COVID, influenza or infection with respiratory syncytial virus. We may have recovered from one infection, only to get another.

Then there is the re-emergence of infectious diseases globally such as monkeypox or polio.

Could these all be connected? Does COVID somehow weaken the immune system to make us more prone to other infectious diseases?

There are many reasons for infectious diseases to emerge in new locations, after many decades, or in new populations. So we cannot jump to the conclusion COVID infections have given rise to these and other viral infections.

But evidence is building of the negative impact of COVID on a healthy individual’s immune system, several weeks after symptoms have subsided.

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Read more: The latest polio cases have put the world on alert. Here’s what this means for Australia and people travelling overseas

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What happens when you catch a virus?

There are three possible outcomes after a viral infection:

1) your immune system clears the infection and you recover (for instance, with rhinovirus which causes the common cold)

2) your immune system fights the virus into “latency” and you recover with a virus dormant in our bodies (for instance, varicella zoster virus, which causes chickenpox)

3) your immune system fights, and despite best efforts the virus remains “chronic”, replicating at very low levels (this can occur for hepatitis C virus).

Ideally we all want option 1, to clear the virus. In fact, most of us clear SARS-CoV-2, the virus that causes COVID. That’s through a complex process, using many different parts of our immune system.

But international evidence suggests changes to our immune cells after SARS-CoV-2 infection may have other impacts. It may affect our ability to fight other viruses, as well as other pathogens, such as bacteria or fungi.

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Read more: No, the extra hygiene precautions we’re taking for COVID-19 won’t weaken our immune systems

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How much do we know?

An Australian study has found SARS-CoV-2 alters the balance of immune cells up to 24 weeks after clearing the infection.

There were changes to the relative numbers and types of immune cells between people who had recovered from COVID compared with healthy people who had not been infected.

This included changes to cells of the innate immune system (which provides a non-specific immune response) and the adaptive immune system (a specific immune response, targeting a recognised foreign invader).

Another study focused specifically on dendritic cells – the immune cells that are often considered the body’s “first line of defence”.

Researchers found fewer of these cells circulating after people recovered from COVID. The ones that remained were less able to activate white blood cells known as T-cells, a critical step in activating anti-viral immunity.

Other studies have found different impacts on T-cells, and other types of white blood cells known as B-cells (cells involved in producing antibodies).

After SARS-CoV-2 infection, one study found evidence many of these cells had been activated and “exhausted”. This suggests the cells are dysfunctional, and might not be able to adequately fight a subsequent infection. In other words, sustained activation of these immune cells after a SARS-CoV-2 infection may have an impact on other inflammatory diseases.

One study found people who had recovered from COVID have changes in different types of B-cells. This included changes in the cells’ metabolism, which may impact how these cells function. Given B-cells are critical for producing antibodies, we’re not quite sure of the precise implications.

Could this influence how our bodies produce antibodies against SARS-CoV-2 should we encounter it again? Or could this impact our ability to produce antibodies against pathogens more broadly – against other viruses, bacteria or fungi? The study did not say.

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Read more: Explainer: what is the immune system?

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What impact will these changes have?

One of the main concerns is whether such changes may impact how the immune system responds to other infections, or whether these changes might worsen or cause other chronic conditions.

So more work needs to be done to understand the long-term impact of SARS-CoV-2 infection on a person’s immune system.

For instance, we still don’t know how long these changes to the immune system last, and if the immune system recovers. We also don’t know if SARS-CoV-2 triggers other chronic illnesses, such as chronic fatigue syndrome (myalgic encephalomyelitis). Research into this is ongoing.

What we do know is that having a healthy immune system and being vaccinated (when a vaccine has been developed) is critically important to have the best chance of fighting any infection.

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Are home-brand foods healthy? If you read the label, you may be pleasantly surprised

Published: September 12, 2022 6.10am AEST

Authors

1. Lauren Ball Associate Professor and Principal Research Fellow, Menzies Health Institute, Griffith University
2. Katelyn Barnes Postdoctoral Research Fellow, Griffith University

Disclosure statement

Lauren Ball receives funding from the National Health and Medical Research Council, RACGP Foundation, VicHealth and Queensland Health. She is a Director of Dietitians Australia.

Katelyn Barnes is an executive member of the Australasian Association of Academic Primary Care.

The cost of groceries in Australia has sky-rocketed this year. So people may be tempted to switch to home-brand foods to save on their weekly food bill.

Home-brand foods are certainly cheaper. But are they healthy?

Here’s what we know about the nutrients they contain compared with the more expensive named brands.

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Read more: How to save $50 off your food bill and still eat tasty, nutritious meals

Get your news from people who know what they’re talking about.

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What are home-brand foods?

Home-brand foods have various names. You might hear them called supermarket own-brand foods, private label, in-house brands, store brands, or retailer brands.

These are foods made specifically for a supermarket (you cannot buy them at a competing store). They are advertised as low-priced alternatives to more expensive items.

Home-brand foods are widely available in Australia and other countries, making up to 30% of what you can buy at a supermarket.

Some people once viewed these as inferior products. But their nutrient content, and wide availability in supermarkets, may play a role in boosting population health. Some evidence shows home-brand foods increase availability and accessibility to more affordable food options, and contribute to improving food safety standards.

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Read more: Frozen, canned or fermented: when you can’t shop often for fresh vegetables, what are the best alternatives?

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Why are they cheaper?

Cheaper prices associated with home-brand products are possible due to lower costs associated with research and development, marketing and packaging. This means we cannot assume lower prices mean cheaper or inferior ingredients.

In fact, supermarkets can influence the ingredients and processing of home-brand foods by benchmarking against named brands.

Before a home-brand product is made, stores will also specify to manufacturers what it should cost to consumers. Manufacturers often choose to use the same ingredients and processes as name-brand products to reduce costs through economies of scale.

This means not having to clean or reprogram equipment between making the different products. It also means most home-brand products are very similar to branded products, aside from the packaging.

However, for mixed foods, such as breakfast cereals and pre-made sauces, the manufacturer may change the ingredients, such as using cheaper or fewer ingredients, to help reduce costs.

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Read more: How Australians talk about tucker is a story that’ll make you want to eat the bum out of an elephant

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How much can I save?

Home-brand products can be up to 40% cheaper than named brands. So yes, home-brand products can make a real difference to the total cost of groceries.

Most labels on supermarket shelves show the cost per 100g (or equivalent) for an item, which can help shoppers choose the most cost-effective option, especially useful when items are on sale.

But are they healthy?

For simple, unprocessed products such as milk, eggs and pasta there is virtually no difference in nutritional quality between home-brand and named brand foods. There is very little the manufacturers can do to modify ingredients to reduce costs.

But sometimes cheaper ingredients are used in higher concentrations in home-brand products. For example, home-brand pre-made pasta sauces may have less of the vegetable ingredients, and greater amounts of sugar, sodium (salt), and additives (such as stabilisers, colours and flavours). This may change the quality and taste.

Very few studies have explored how home-brand products may differ in nutritional profile.

Overall, serving size, sodium and other nutrients appear similar across home-brand and named brand food. But there are some differences with certain food types.

Serving sizes

For instance, serving sizes are generally smaller in home-brand pizza, canned legumes, grains, biscuits and ready meals. In fact, edible oil is the only type of food where serving size is greater for home-brand foods.

Salt

Sodium levels of home-brand breakfast cereals, cheese and bread are higher than branded products. But sodium levels of cooking sauces, frozen potato products (such as oven-baked fries) and biscuits are lower in home-brand foods.

Other nutrients

For energy and fat intake, again it seems there are inconsistent differences between home-brand foods compared to branded foods.

How about sugar? Unfortunately, the studies didn’t look at this.

In fact, overall, Australian home-brand products are not consistently nutritionally different to branded products.

Health star ratings

On a related note, unhealthy home-brand products – such as juices, meat pies and muesli bars – are more likely to include a health star rating, compared to nutritious foods. This may incorrectly imply they are a healthy choice.

This means no matter which brand you choose, remember to check the food label to make sure you are getting the quality of food you like for the price you are comfortable with.

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Yes, you can reheat food more than once. Here’s why

Published: September 2, 2022 6.02am AEST

Authors

1. Enzo Palombo Professor of Microbiology, Swinburne University of Technology
2. Sarah McLean Lecturer in environmental health, Swinburne University of Technology

Disclosure statement

Enzo Palombo receives funding from the Fight Food Waste CRC.

Sarah McLean 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

Preparing meals in bulk and reheating is a great way to save time in the kitchen and can also help to reduce food waste. You might have heard the myth that you can only reheat food once before it becomes unsafe to eat.

The origins of food myths are often obscure but some become embedded in our culture and scientists feel compelled to study them, like the “five second rule” or “double-dipping”.

The good news is that by following some simple steps when preparing and storing foods, it is possible to safely reheat foods more than once.

Why can food make us sick?

There are many ways bacteria and viruses can end up in foods. They may occur naturally in environments where food is harvested or contaminate foods during processing or by food handlers.

Viruses won’t grow in foods and will be destroyed by cooking (or proper reheating). On the other hand, bacteria can grow in food. Not all bacteria make us sick. Some are even beneficial, such as probiotics in yoghurt or starter cultures used to make fermented foods.

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Read more: You _can_ thaw and refreeze meat: five food safety myths busted

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However, some bacteria are not desirable in foods. These include bacteria which reproduce and cause physical changes making food unpalatable (or spoiled), and pathogens, which cause illness.

Some pathogens grow in our gut and cause symptoms of gastroenteritis, while others produce toxins (poisons) which cause us to become sick. Some bacteria even produce special structures, called endospores, which survive for a long time – even years – until they encounter favourable conditions which allow them to grow and produce toxins.

While cooking and reheating will generally kill pathogenic bacteria in foods, they may not destroy toxins or endospores. When it comes to reheating foods, toxins pose the greatest risk of illness.

The risk increases in foods which have been poorly handled or cooled too slowly after initial cooking or reheating, since these conditions may allow toxin-producing bacteria to grow and proliferate.

Bacteria that cause foodborne illness typically grow at temperatures between 5°C and 60°C (the “temperature danger zone”), with fastest growth occurring at around 37°C.

Foods that are best able to support the growth of these bacteria are deemed “potentially hazardous” and include foods or dishes containing meat, dairy, seafood, cooked rice or pasta, eggs or other protein-rich ingredients.

A common culprit of food poisoning linked to reheated foods is Staphylococcus aureus which many people carry in their nose or throat. It produces a heat-stable toxin which causes vomiting and diarrhoea when ingested.

Food handlers can transfer these bacteria from their hands to foods after cooking or reheating. If the contaminated food is kept within the temperature danger zone for an extended period, Staphylococcus aureus will grow and produce toxins. Subsequent reheating will destroy the bacteria but not the toxins.

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Read more: Health Check: when should you throw away leftovers?

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How to keep food safe to eat, even when reheating

To limit the growth of bacteria, potentially hazardous foods should be kept outside of the temperature danger zone as much as possible. This means keeping cold foods cold (less than 5°C) and hot foods hot (above 60°C). It also means after cooking, potentially hazardous foods should be cooled to less than 5°C as quickly as possible. This also applies to reheated foods you want to save for later.

When cooling foods, Food Standards Australia New Zealand recommends the temperature should fall from 60°C to 21°C in less than two hours and be reduced to 5°C or colder in the next four hours.

In practice, this means transferring hot foods to shallow containers to cool to room temperature, and then transferring the covered containers to the fridge to continue cooling. It’s not a good idea to put hot foods straight into the fridge. This can cause the fridge temperature to increase above 5°C which may affect the safety of other foods inside.

If food has been hygienically prepared, cooled quickly after cooking (or reheating) and stored cold, reheating more than once should not increase the risk of illness. However, prolonged storage and repeated reheating will affect the taste, texture, and sometimes the nutritional quality of foods.

When it comes to safely reheating (and re-reheating) foods, there are a few things to consider:

1. always practice good hygiene when preparing foods
2. after cooking, cool foods on the bench either in small portions or in shallow containers (increased surface area reduces cooling time) and put in the fridge within two hours. Food should be cold (less than 5°C) within the next four hours
3. try to reheat only the portion you intend to immediately consume and make sure it is piping hot throughout (or invest in a thermometer to ensure the internal temperature reaches 75°C)
4. if you don’t consume reheated food immediately, avoid handling it and return it to the fridge within two hours
5. err on the side of caution if reheating food for vulnerable people including children, elderly, pregnant or immunocompromised people. If in doubt, throw it out.

With the ever-increasing cost of food, buying in bulk, preparing meals in large quantities and storing unused portions is convenient and practical. Following a few simple common sense rules will keep stored food safe and minimise food waste.

This article in the New York Times is very interesting, as many of my patients are concerned about their loss of hair. Speak to me next time you see me and I may be able to help you with script for the treatment mentioned below.

An Old Medicine Grows New Hair for Pennies a Day, Doctors Say

Dermatologists who specialize in hair loss say that the key ingredient in a topical treatment worked even better when taken orally at a low dose. It would have to made up by a reputable compounding chemist – someone who knows what they are doing.

By Gina Kolata

Aug. 18, 2022

Leer en español

The ads are everywhere — and so are the inflated claims: Special shampoos and treatments, sometimes costing thousands of dollars, will make hair grow. But many dermatologists who specialize in hair loss say that most of these products don’t work.

“There is an endless array of useless hair growth remedies,” often at “significant cost,” said Dr. Brett King, a dermatologist at Yale School of Medicine. Yet, he added, “because people are desperate, such hair growth remedies continue to abound.”

But there is a cheap treatment, he and other dermatologists say, costing pennies a day, that restores hair in many patients. It is minoxidil, an old and well-known hair-loss treatment drug used in a very different way. Rather than being applied directly to the scalp, it is being prescribed in very low-dose pills.

Although a growing group of dermatologists is offering low-dose minoxidil pills, the treatment remains relatively unknown to most patients and many doctors. It has not been approved by the Food and Drug Administration for this purpose and so is prescribed off-label — a common practice in dermatology.

“I call us the off-label bandits — a title I am proud to bear,” said Dr. Adam Friedman, professor and chair of dermatology at George Washington University. He explained that dermatologists have been trained to understand how medicines work, which allows them to try drugs off-label. In dermatology, it is often clear if a treatment is helping. Does a rash fade, or not?

Dr. Robert Swerlick, professor and chair of the dermatology department at Emory University School of Medicine, agreed.

“I tell people most things we do are off-label because there is nothing on-label,” he said. He provided a long list of conditions, including skin pigment disorders, skin inflammatory disorders and relentless itching, for which the standard treatments are off-label.

Minoxidil, the active ingredient in Rogaine, a lotion or foam that is rubbed on the scalp, was first approved for men in 1988, then women in 1992, and it is now generic. The medicine’s use as a hair-growth treatment was discovered by accident decades ago. High-dose minoxidil pills were being used to treat high blood pressure, but patients often noticed that the pills prompted hair growth all over their bodies. So its manufacturer developed a minoxidil lotion — eventually named Rogaine — and got it approved to grow hair on balding heads.

But dermatologists say the lotion or foam is not particularly effective for some patients, perhaps because they stop taking it. It has to get on the scalp itself — and hair gets in the way. Many, especially women, stop using it because they dislike leaving the sticky substance in their hair.

Johnson and Johnson, the current owner of Rogaine, did not respond to requests for comment.

Others find it simply does not work for them. Minoxidil has to be converted to an active form by sulfotransferase enzymes that may or may not be present in sufficient quantities in hair roots. When the drug is taken orally, it is automatically converted to an active form.

But that was not the reason the low-dose pills were discovered. Instead, the discovery occurred also by accident 20 years ago.

Dr. Rodney Sinclair, a professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness. The hair on top of her head had thinned, and she hated the way it looked. Unlike what happened with most of his patients, Rogaine worked for her, but she developed an allergic rash on her scalp from the drug. Yet if she stopped taking it, her hair would thin again.

“So I was stuck,” Dr. Sinclair said. “The patient was very motivated, and the one thing we knew was that if a patient has an allergy to a topically applied medicine, one way to desensitize is to give very low doses orally.”

To do that, Dr. Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose made her hair grow but did not affect her blood pressure, the original purpose of the higher-dose drug.

He subsequently lowered the dose more and more until he got down to effective doses of one-fortieth of a pill and began routinely prescribing the drug. That first patient still takes it.

At a meeting in Miami in 2015, Dr. Sinclair reported that low doses of minoxidil prompted hair growth in 100 successive women.

He published those results in 2017, noting that rigorous studies were needed, in which some patients would be randomly assigned to take minoxidil and others a sugar pill. But that has not happened. He says he has now treated more than 10,000 patients.

Recently, a rising number of hair-loss dermatologists have been giving the low-dose pills to patients with male and female pattern hair loss, a normal occurrence with age.

“It is just starting to see a surge in popularity,” said Dr. Crystal Aguh, a dermatologist at Johns Hopkins School of Medicine. “More and more at conferences, we are sharing our success stories.”

Doctors who do not specialize in hair loss, she added, “would not be familiar with oral minoxidil,” except as a rarely used treatment for high blood pressure that comes with a black box warning that it can cause heart problems. But, she and others say, the warning is for much higher doses.

If hair loss is too severe, minoxidil will not help, Dr. Aguh warned. “It will not work, for example, if a man is mostly bald, with a shiny scalp. There is nothing to restore.” She added that the ideal patient is not completely bald but has lost enough hair that even a casual observer would notice.

Without a rigorous trial leading to F.D.A. approval, though, the use of minoxidil pills for hair loss remains off-label. And, dermatologists say, it is likely to remain so.

“Oral minoxidil costs pennies a day,” Dr. King said. “There is no incentive to spend tens of millions of dollars to test it in a clinical trial. That study truly is never, ever going to be done.”

Some patients taking low-dose minoxidil, though, notice stray hairs growing on their faces and chins. So some dermatologists, including Dr. Sinclair, have added another drug — very low doses of spironolactone, a blood pressure drug that also blocks certain sex hormones called androgens — to try to prevent unwanted hair growth.

Patients who do not want to go the off-label route are left with what some dermatologists say are useless over-the-counter remedies or one of two F.D.A.-approved products for hair growth.

They include Rogaine and finasteride, a generic medicine used at higher doses in men to treat a benign enlarged prostate. As a hair-loss drug, it is approved for men only. It has also been linked to sexual dysfunction.

Then, there is the word of mouth about minoxidil in pill form.

“I’ve seen miracles happen,” Dr. Aguh said.

One involved Brandy Gray, 44, who lives in Monkton, Md.

“I had been losing my hair over time,” she said. “Then I starting having circular patches” with no hair. “They got worse and worse.”

She had seen another dermatologist who gave her shampoos and supplements, to no avail. Finally, she said her dermatologist told her, “There is nothing left I can try for you, nothing more I can do.”

She went to Dr. Aguh who gave her low-dose minoxidil. Ten months later, her hair was thick and abundant.

“I can part my hair in different ways,” she said. “I don’t wear wigs any more.”

It is as though that hair loss never happened.

Gina Kolata writes about science and medicine. She has twice been a Pulitzer Prize finalist and is the author of six books, including “Mercies in Disguise: A Story of Hope, a Family’s Genetic Destiny, and The Science That Saved Them.” @ginakolata • Facebook

Have you heard soy is linked to cancer risk or can ‘feminise’ men? Here’s what the science really says

Published: September 7, 2022 3.08pm AEST

Author

1. Karen Murphy Associate Professor of Nutrition & Dietetics and Accredited Practicing Dietitian, University of South Australia

Disclosure statement

Karen Murphy receives funding and/or support from the National Health Medical Research Council. In the last 10 years she has had funding from Dairy Australia and the Pork CRC.

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Republish our articles for free, online or in print, under Creative Commons licence.

Soy is common in many Asian cuisines, and is growing more popular in Western countries as many people aim for predominantly plant-based diets. It offers many potential health benefits and is generally cheaper than meat.

However, you might have heard soy is linked to cancer risk, or that it can have a “feminising” effect on men.

But what does the research actually say on this?

In fact, most research finds eating a moderate amount of soy is unlikely to cause problems and may even provide benefits. All said, you can safely include moderate amounts of soy foods in your daily diet.

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Read more: Why Australian dietary recommendations on fat need to change

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Does soy ‘feminise’ men? Not likely

Soy is rich in high quality protein, and contains B vitamins, fibre, minerals and the isoflavones daidzein, genistein and glycitein.

Isoflavones have a similar structure to natural estrogen and are sometimes called “phytoestrogens” (phyto means plant). Soy isoflavones can bind to estrogen receptors in the body. They can act in a way similar to natural estrogen but with a much, much weaker effect.

Some studies have flagged concerns but these tend to be related to people consuming extremely high amounts of soy – such as one unusual case report about a man with gynecomastia (enlarged breast tissue in men) who, it turned out, was drinking almost three litres of soy milk a day.

As one literature review noted, many of the other studies highlighting concerns in this area are are based on animals trials or rare one-off cases (case reports).

The same literature review noted that while more long term data in Western countries is needed, moderate amounts of soy in “traditional soy preparations offer modest health benefits with very limited risk for potential adverse health effects.”

What about soy and cancer risk?

One study of 73,223 Chinese women over more than seven years found:

Women who consumed a high amount of soy foods consistently during adolescence and adulthood had a substantially reduced risk of breast cancer. No significant association with soy food consumption was found for postmenopausal breast cancer.

This could be due to different types and amounts of soy eaten (as well as genetics).

Some animal trials and studies in cells show very high doses of isoflavones or isolated soy protein may stimulate breast cancer growth, but this is not evident in human trials.

A study in Japanese males reported high intake of miso soup (1-5 cups per day), might increase the risk of gastric cancer.

But the authors also said:

We thought that some other ingredients in miso soup might also play a role […] For example, high concentrations of salt in miso soup could also increase the risk of gastric cancer.

What about heart health?

Soy contains isoflavones, healthy fats like polyunsaturated fats, fibre, vitamins and minerals, and is also low in saturated fat.

Swapping meat in the diet with soy products is going to reduce the amount of saturated fat you eat while also boosting intake of important nutrients.

A study with nearly half a million Chinese adults free of cardiovascular disease, showed those who consumed soy four or more days a week had significantly lower risk of death from a heart attack compared with those who never ate soy.

Replacing red meat with plant proteins including soy products has been associated with a lower risk of developing heart disease.

A moderate intake is fine

If you want to include soy in your diet, choose whole soy foods like calcium-enriched soy beverages, tempeh, soy bread, tofu and soybeans over highly processed options high in salt and saturated fat.

Research on soy is ongoing and we still need more long-term data on intakes in Australia and health benefits.

Overall, however, moderate amounts of soy foods can be consumed as part of a healthy diet and may even help with some symptoms of menopause.

According to the Victorian government’s Better Health Channel:

one or two daily serves of soy products can be beneficial to our health.

Harvard University’s School of Public Health says soy:

can safely be consumed several times a week, and probably more often, and is likely to provide health benefits – especially when eaten as an alternative to red and processed meat.

So don’t stress too much about the soy milk in your coffee and tea or the tofu burger for lunch.

Karolina Grabowska/Pexels, CC BY

‘Oh well, wine o’clock’: what midlife women told us about drinking – and why it’s so hard to stop

Published: August 25, 2022 9.02am AEST

Authors

1. Belinda Lunnay Post-doctoral researcher in Public Health , Torrens University Australia
2. Kristen Foley PhD Candidate, Torrens University Australia
3. Paul Ward Professor of Public Health, Torrens University Australia

Disclosure statement

Belinda Lunnay receives funding from the Australian Research Council.

Kristen Foley receives funding from the National Health and Medical Research Council of Australia for her doctoral scholarship which explores the social and commercial determinants of alcohol for Australian women in midlife.

Paul Ward 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

Many of us enjoy a drink at the end of a stressful day. But for some, this is less of a discretionary treat and more of a nightly must-have.

While alcohol reduction campaigns ask us to check our relationship with alcohol, emphasising the role it can play in causing violence and disease, our research has found many Australian women view alcohol in a different way. Many don’t see alcohol as only a bad thing and have complex reasons for their relationships with alcohol.

We conducted 50 interviews with midlife women (45–64 years of age) from different social classes living in South Australia. All women had a relationship with alcohol but the nature of the relationship was really different according to their social class.

Our study, published today in the journal Health Promotion International, suggests the problem for public health lies in the circumstances that shape women’s lives and lead to a relationship with alcohol.

Public health messaging around alcohol harm reduction needs to be more nuanced, and tailored to women’s level of disadvantage and what support they can access. A message that hits home for middle class women won’t necessarily resonate for working class women.

Here are some key themes that emerged from our research.

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Read more: Did you look forward to last night’s bottle of wine a bit too much? Ladies, you’re not alone

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For many midlife women, alcohol makes life better – or at least, liveable

For all women we spoke to, drinking alcohol was perceived to reduce loneliness and isolation. They didn’t just drink alcohol, they had a “relationship” with alcohol.

Women often have many competing responsibilities (working, caring, domestic duties). Many described feeling invisible and unacknowledged.

One middle class woman noted alcohol could be “numbing”. Another said:

[I drink] just on my own; doesn’t bother me. I don’t need to be sociable and I don’t necessarily drink when I’m out […] alcohol has always played a fairly large role.

For working class women however, alcohol can provide a reliable stand-in support in the absence of anything else. As one woman said:

Loneliness is definitely a factor for me, and I think it is for a lot of women. And I think once you start having a drink, it becomes a habitual […] I’d like to see more done in terms of the loneliness because I think it is a real thing.

Another woman noted:

I didn’t have anything – so in my life I have actually always had, like, a glass of wine.

Women with the most privilege drank to celebrate their achievements and enjoy life within social networks of similar women. Many middle class women described drinking alcohol as a long-standing part of their lives – drinking for relaxation, empowerment or because they felt they deserved a reward. As one put it:

It seems to be that ladies our age, all the ones I hang out with, are exactly the same as me. They say, “Oh well, wine o’clock.” […] I don’t need it, I don’t have to have a drink. I just choose to.

Many described drinking as socially acceptable, normal, or even “expected” of them. One middle class woman described “girl’s nights out” where drinking is “what I’m supposed to do”.

But, women with less privilege described drinking alcohol, often alone, to make a difficult and isolated life more liveable. As one put it:

It provides relief, even if for a couple of hours, to take that away, thinking, “Where the hell am I going to come up with A$1000 from?” OK, let me have a drink. Calm down. Think of this. To me, to remove that from women, you’re actually removing a part of their autonomy.

Many working class women we interviewed thought of alcohol as a reliable friend that allowed them to cope with really difficult and sometimes intolerable lives. One remarked:

How is that not a positive? […] I’m not going to cut something out that enhances my life so much.

‘Breaking up with alcohol’ can be hard to do

All women have complex reasons for drinking, which can make it hard to “break up” with alcohol.

Middle class women wanted to change their drinking and sometimes regretted drinking, taking steps to moderate their alcohol. But many working class women felt they could not manage their consumption when they already felt so restricted by life’s difficulties and saw alcohol as the only way to cope.

Some working class women felt punished if their drinking was questioned, because alcohol served as a way to regain control.

Clues for public health messaging

A blunt public health message telling women “do not drink, it is bad for you” does not address the structural reasons women drink in the first place – seeking connection for middle class women and dealing with isolation and hardship for working class women.

The positive and negative roles alcohol plays in women’s lives would need to be replaced, if alcohol were reduced. Our research shows society needs to pay more attention to the broader systemic issues underpinning women’s drinking, particularly the general absence of support for women during midlife. This is especially so for working class women without the resources to access support and appropriate care.

Getting the support needed to reduce drinking can use up a lot of resources (including what we have, who and what we know). And many working class women would lose what they see as an important (and often only) coping mechanism.

The challenge for public health is to make reducing alcohol or becoming “sober curious” a reasonable, affordable and feasible option for all women.

Dementia: the quality of your night’s sleep can affect symptoms the next day – new research

Published: May 17, 2022 12.14am AEST

Authors

1. Sara Balouch Lecturer in Psychology, University of Brighton
2. Derk-Jan Dijk Professor of Sleep and Physiology and Director of Surrey Sleep Research Centre, University of Surrey

Disclosure statement

Sara Balouch received funding from The Centre for Dementia Studies, Brighton & Sussex Medical School to carry out this research.

Derk-Jan Dijk receives funding from the UK Dementia Research Institute, Alzheimer’s Research UK and Defense Advanced Research Projects Agency. He is affiliated with the UK Dementia Research Institute Care Research & Technology Centre at Imperial College London and the University of Surrey

We believe in the free flow of information

Republish our articles for free, online or in print, under Creative Commons licence.

We’ve probably all experienced how a poor night’s sleep can make us feel tired, irritable and have difficulty concentrating the next day. But while the odd night of poor sleep has no impact on our health, research shows that prolonged sleep disturbances predict cognitive decline – and are also a risk factor for dementia. Disrupted sleep is also known to be a symptom of Alzheimer’s disease, a type of dementia.

But while we know that poor sleep is connected to dementia and Alzheimer’s disease on a long-term scale, until now it was unknown to what extent night-to-night variation of sleep affects dementia symptoms in the short term (such as the following day). This is something we tried to answer in our recently published study.

We found that nightly variations in sleep (such as sleeping too long or waking up in the night) had a greater effect on some aspects of brain function (such as memory and mood) the next day in people with Alzheimer’s disease compared to those with mild cognitive impairment or no cognitive impairment.

Trouble sleeping

To conduct our study, we looked at 15 participants with Alzheimer’s, eight with mild cognitive impairment and 22 with no signs of cognitive impairment to compare the relationship between sleep and daytime function.

For two weeks, participants reported their sleep quality and how long they slept using a sleep diary. We also used an activity monitor to record objective sleep measures such as how long participants slept during the night or how long it took them to fall asleep.

To see whether the previous night’s sleep had an effect on their cognitive ability, we also phoned participants every morning to test things like their thinking ability and memory. For example, participants were asked to count backwards in sevens (calculation ability), or to recall a list of words (memory).

In addition to this, participants completed daily measures of their mood (such as how alert they were feeling) and whether they’d experienced any memory problems (such as forgetting an appointment) during a daily telephone session. To ensure that none of the participants with cognitive impairment or Alzheimer’s forgot to complete these tasks, we invited caregivers to help remind them. Caregivers also documented participants’ daily patterns of behaviour.

We found that greater sleep continuity (waking up fewer times during the night) was generally better for daytime performance. Participants with Alzheimer’s had improved alertness the next evening and made fewer memory errors during the day. Both participants with Alzheimer’s and mild cognitive impairment also had fewer observable behavioural problems (such as crying, aggression or asking repeated questions) the next day following higher sleep continuity.

Surprisingly, we also found that for all participants, regardless of whether they had cognitive impairment or not, greater sleep continuity was actually related to worse calculation ability the next day.

These findings persisted even when we adjusted for other factors that might impact results – such as sex, age and years of education. We also excluded participants with conditions, such as anxiety, depression and sleep disorders, which affect sleep and cognitive ability, and thus could have influenced the results.

A good night’s sleep

Though our study was small, our findings seem to be in line with what other research has shown: that there’s an optimal level of sleep when it comes to some cognitive functions. This optimal level is likely to be different for each person.

Although our study didn’t look at why sleep continuity was important for next day function, one potential mechanism suggested by other research states that sleep helps clear the buildup of amyloid (a type of protein) deposits from the brain. If enough amyloid deposits aren’t removed from the brain by deep, continuous sleep, they can clump together as plaques in brain areas linked with memory and cognitive function. Amyloid plaques are also one of the hallmarks of Alzheimer’s disease.

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Read more: Sleep: here’s how much you really need for optimal cognition and wellbeing – new research

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But it’s still unclear why increased sleep continuity led to poorer performance in the calculation task. It may be that because the task took place in the morning, participants were experiencing sleep inertia (grogginess and cognitive impairment felt immediately after waking). Further research, where assessments are scheduled at different times of day, would need to be conducted to rule out the effects of sleep inertia.

The findings of our study also need to be interpreted with caution, given we only looked at a small number of participants – though the repeated testing if each individual meant that collectively there were about 500 opportunities for collecting data overall. It will be important for larger studies to be conducted to see whether our results can be replicated.

In future, we’d also like to measure brain waves and other physiological signals, such as body temperature and eye movement. This will help us to better identify how long people spend in different sleep stages – such as slow wave and rapid eye movement sleep, which are shown to be important for learning and memory. This will help us better understand exactly what type of sleep is most important for daytime function.

Though it will be important for researchers to continue investigating this, our research makes a first step in showing just how important even a single night’s sleep is when it comes to dementia symptoms. This may very well mean it could be possible to optimise how much time a person living with dementia spends in bed and sleeping to improve their symptoms.