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Good news: midlife health is about more than a waist measurement. Here’s why

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> You’re not in your 20s or 30s anymore and you know regular health checks are important. So you go to your GP. During the appointment they measure your waist. They might also check your weight. Looking concerned, they recommend some lifestyle changes. GPs and health professionals commonly <a href="https://theconversation.com/the-body-mass-index-cant-tell-us-if-were-healthy-heres-what-we-should-use-instead-211190">measure waist circumference</a> as a vital sign for health. This is a better indicator than body mass index (BMI) of the amount of intra-abdominal fat. This is the really risky fat around and within the organs that can drive heart disease and metabolic disorders such as type 2 diabetes. Men are at greatly increased risk of health issues if their waist circumference is <a href="https://www.bmj.com/content/311/7017/1401">greater than 102 centimetres</a>. Women are considered to be at greater risk with a waist circumference of <a href="https://www.bmj.com/content/311/7017/1401">88 centimetres or more</a>. More than <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/waist-circumference-and-bmi/latest-release">two-thirds of Australian adults</a> have waist measurements that put them at an increased risk of disease. An even better indicator is waist circumference divided by height or <a href="https://www.baker.edu.au/news/in-the-media/waist-height-ratio#:%7E:text=According%20to%20research%2C%20a%20healthy,the%20highest%20risk%20of%20disease.">waist-to-height ratio</a>. But we know people (especially women) have a propensity to <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/abstract">gain weight around their middle during midlife</a>, which can be very hard to control. Are they doomed to ill health? It turns out that, although such measurements are important, they are not the whole story when it comes to your risk of disease and death. <h2>How much is too much?</h2> Having a waist circumference to height ratio larger than 0.5 is associated with greater risk of chronic disease as well as premature death and this applies in adults of any age. A healthy waist-to-height ratio is between 0.4 to 0.49. A ratio of 0.6 or more <a href="https://www.baker.edu.au/news/in-the-media/waist-height-ratio#:%7E:text=According%20to%20research%2C%20a%20healthy,the%20highest%20risk%20of%20disease">places a person at the highest risk of disease</a>. Some experts recommend <a href="https://www.nature.com/articles/s41574-019-0310-7">waist circumference be routinely measured in patients during health appointments</a>. This can kick off a discussion about their risk of chronic diseases and how they might address this. Excessive body fat and the associated health problems manifest more strongly during midlife. A range of social, personal and physiological factors come together to make it more difficult to control waist circumference as we age. Metabolism tends to slow down mainly due to decreasing muscle mass because people do <a href="https://onlinelibrary.wiley.com/doi/10.1002/jcb.25077">less vigorous physical activity, in particular resistance exercise</a>. For women, hormone levels begin changing in mid-life and this also <a href="https://www.tandfonline.com/doi/full/10.3109/13697137.2012.707385">stimulates increased fat levels particularly around the abdomen</a>. At the same time, this life phase (often involving job responsibilities, parenting and caring for ageing parents) is when elevated stress can lead to <a href="https://journals.lww.com/psychosomaticmedicine/abstract/2000/09000/stress_and_body_shape__stress_induced_cortisol.5.aspx">increased cortisol which causes fat gain in the abdominal region</a>. Midlife can also bring poorer sleep patterns. These contribute to fat gain with <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0010062">disruption to the hormones that control appetite</a>. Finally, your family history and genetics can <a href="https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1002695">make you predisposed to gaining more abdominal fat</a>. <h2>Why the waist?</h2> This intra-abdominal or visceral fat is much more metabolically active (it has a greater impact on body organs and systems) than the fat under the skin (subcutaneous fat). Visceral fat surrounds and infiltrates major organs such as the liver, pancreas and intestines, releasing a variety of chemicals (hormones, inflammatory signals, and fatty acids). These affect inflammation, lipid metabolism, cholesterol levels and insulin resistance, <a href="https://academic.oup.com/eurheartjsupp/article/8/suppl_B/B4/461962">contributing to the development of chronic illnesses</a>. The issue is particularly evident <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/abstract">during menopause</a>. In addition to the direct effects of hormone changes, <a href="https://www.sciencedirect.com/science/article/pii/S0960076013001118?via%3Dihub">declining levels of oestrogen change brain function, mood and motivation</a>. These psychological alterations can result in reduced physical activity and increased eating – often of comfort foods high in sugar and fat. But these outcomes are not inevitable. Diet, exercise and managing mental health can limit visceral fat gains in mid-life. And importantly, the waist circumference (and ratio to height) is just one measure of human health. There are so many other aspects of body composition, exercise and diet. These can have much larger influence on a person’s health. <h2>Muscle matters</h2> The quantity and quality of skeletal muscle (attached to bones to produce movement) a person has makes a <a href="https://www.nature.com/articles/nrendo.2012.49">big difference</a> to their heart, lung, metabolic, immune, neurological and mental health as well as their physical function. On current evidence, it is equally or more important for health and longevity to <a href="https://www.bmj.com/content/345/bmj.e7279">have</a> higher muscle mass and better cardiorespiratory (aerobic) fitness than waist circumference within the healthy range. So, if a person does have an excessive waist circumference, but they are also sedentary and have less muscle mass and aerobic fitness, then the recommendation would be to focus on an appropriate exercise program. The fitness deficits should be addressed as priority rather than worry about fat loss. Conversely, a person with low visceral fat levels is not necessarily fit and healthy and may have quite poor aerobic fitness, muscle mass, and strength. <a href="https://bjsm.bmj.com/content/45/6/504">The research evidence</a> is that these vital signs of health – how strong a person is, the quality of their diet and how well their heart, circulation and lungs are working – are more predictive of risk of disease and death than how thin or fat a person is. For example, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510687/">2017 Dutch study</a> followed overweight and obese people for 15 years and found people who were very physically active had no increased heart disease risk than “normal weight” participants. <h2>Getting moving is important advice</h2> Physical activity has many benefits. Exercise can counter a lot of the negative behavioural and physiological changes that are occurring during midlife including for people going through menopause. And regular exercise reduces the tendency to use food and drink to help manage what can be a <a href="https://journals.lww.com/acsm-msse/fulltext/2008/05000/physical_activity,_sedentary_index,_and_mental.7.aspx">quite difficult time in life</a>. Measuring your waist circumference and monitoring your weight remains important. If the measures exceed the values listed above, then it is certainly a good idea to make some changes. Exercise is effective for fat loss and in particular <a href="https://bjsm.bmj.com/content/57/16/1035">decreasing visceral fat</a> with greater effectiveness when <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0864-5">combined with dietary restriction of energy intake</a>. Importantly, any fat loss program – whether through drugs, diet or surgery – is also a muscle loss program unless resistance exercise is part of the program. Talking about your overall health with a doctor is a great place to start. <a href="https://www.essa.org.au/Public/Public/Searches/find-aep-withdistance.aspx">Accredited exercise physiologists</a> and <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitians</a> are the most appropriate allied health professionals to assess your physical structure, fitness and diet and work with you to get a plan in place to improve your health, fitness and reduce your current and future health risks.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226019/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, Professor of Exercise Medicine, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/good-news-midlife-health-is-about-more-than-a-waist-measurement-heres-why-226019">original article</a>. </div>

Body

Could not getting enough sleep increase your risk of type 2 diabetes?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/giuliana-murfet-1517219">Giuliana Murfet</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/shanshan-lin-1005236">ShanShan Lin</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Not getting enough sleep is a common affliction in the modern age. If you don’t always get as many hours of shut-eye as you’d like, perhaps you were concerned by news of a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815684">recent study</a> that found people who sleep less than six hours a night are at higher risk of type 2 diabetes. So what can we make of these findings? It turns out the relationship between sleep and diabetes is complex. <h2>The study</h2> Researchers analysed data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, a large biomedical database which serves as a global resource for health and medical research. They looked at information from 247,867 adults, following their health outcomes for more than a decade. The researchers wanted to understand the associations between sleep duration and type 2 diabetes, and whether a healthy diet reduced the effects of short sleep on diabetes risk. As part of their involvement in the UK Biobank, participants had been asked roughly how much sleep they get in 24 hours. Seven to eight hours was the average and considered normal sleep. Short sleep duration was broken up into three categories: mild (six hours), moderate (five hours) and extreme (three to four hours). The researchers analysed sleep data alongside information about people’s diets. Some 3.2% of participants were diagnosed with type 2 diabetes during the follow-up period. Although healthy eating habits were associated with a lower overall risk of diabetes, when people ate healthily but slept less than six hours a day, their risk of type 2 diabetes increased compared to people in the normal sleep category. The researchers found sleep duration of five hours was linked with a 16% higher risk of developing type 2 diabetes, while the risk for people who slept three to four hours was 41% higher, compared to people who slept seven to eight hours. One limitation is the study defined a healthy diet based on the number of servings of fruit, vegetables, red meat and fish a person consumed over a day or a week. In doing so, it didn’t consider how dietary patterns such as time-restricted eating or the Mediterranean diet may modify the risk of diabetes among those who slept less. Also, information on participants’ sleep quantity and diet was only captured at recruitment and may have changed over the course of the study. The authors acknowledge these limitations. <h2>Why might short sleep increase diabetes risk?</h2> In people with <a href="https://www.diabetesaustralia.com.au/about-diabetes/type-2-diabetes/">type 2 diabetes</a>, the body becomes resistant to the effects of a hormone called insulin, and slowly loses the capacity to produce enough of it in the pancreas. Insulin is important because it regulates glucose (sugar) in our blood that comes from the food we eat by helping move it to cells throughout the body. We don’t know the precise reasons why people who sleep less may be at higher risk of type 2 diabetes. But <a href="https://doi.org/10.7759/cureus.23501">previous research</a> has shown sleep-deprived people often have increased <a href="https://doi.org/10.1186/1476-511X-9-125">inflammatory markers</a> and <a href="https://doi.org/10.1007/s00125-015-3500-4">free fatty acids</a> in their blood, which <a href="https://doi.org/10.1007/s11892-018-1055-8">impair insulin sensitivity</a>, leading to <a href="https://doi.org/10.7759/cureus.23501">insulin resistance</a>. This means the body struggles to use insulin properly to regulate blood glucose levels, and therefore increases the risk of type 2 diabetes. Further, people who don’t sleep enough, as well as people who sleep in irregular patterns (such as shift workers), experience disruptions to their body’s natural rhythm, known as the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995632/">circadian rhythm</a>. This can interfere with the release of hormones like <a href="https://doi.org/10.1210/edrv.18.5.0317">cortisol, glucagon and growth hormones</a>. These hormones are released through the day to meet the body’s changing energy needs, and normally keep blood glucose levels nicely balanced. If they’re compromised, this may reduce the body’s ability to handle glucose as the day progresses. These factors, and <a href="https://www.science.org/doi/10.1126/sciadv.aar8590">others</a>, may contribute to the increased risk of type 2 diabetes seen among people sleeping less than six hours. While this study primarily focused on people who sleep eight hours or less, it’s possible longer sleepers may also face an increased risk of type 2 diabetes. Research has previously shown a U-shaped correlation between sleep duration and type 2 diabetes risk. A <a href="https://doi.org/10.2337/dc14-2073">review</a> of multiple studies found getting between seven to eight hours of sleep daily was associated with the lowest risk. When people got less than seven hours sleep, or more than eight hours, the risk began to increase. The reason sleeping longer is associated with increased risk of type 2 diabetes may be linked to <a href="https://doi.org/10.2337/dc15-0186">weight gain</a>, which is also correlated with longer sleep. Likewise, people who don’t sleep enough are more likely to be <a href="https://doi.org/10.1016/j.sleh.2017.07.013">overweight or obese</a>. <h2>Good sleep, healthy diet</h2> Getting enough sleep is an important part of a healthy lifestyle and may reduce the risk of type 2 diabetes. Based on this study and other evidence, it seems that when it comes to diabetes risk, seven to eight hours of sleep may be the sweet spot. However, other factors could influence the relationship between sleep duration and diabetes risk, such as individual differences in sleep quality and lifestyle. While this study’s findings question whether a healthy diet can mitigate the effects of a lack of sleep on diabetes risk, a wide range of evidence points to the benefits of <a href="https://www.who.int/initiatives/behealthy/healthy-diet">healthy eating</a> for overall health. The <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815684">authors of the study</a> acknowledge it’s not always possible to get enough sleep, and suggest doing <a href="https://pubmed.ncbi.nlm.nih.gov/33137489/">high-intensity interval exercise</a> during the day may offset some of the potential effects of short sleep on diabetes risk. In fact, exercise <a href="https://doi.org/10.1016/j.jshs.2023.03.001">at any intensity</a> can improve blood glucose levels.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225179/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giuliana-murfet-1517219">Giuliana Murfet</a>, Casual Academic, Faculty of Health, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/shanshan-lin-1005236">ShanShan Lin</a>, Senior Lecturer, School of Public Health, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/could-not-getting-enough-sleep-increase-your-risk-of-type-2-diabetes-225179">original article</a>. </div>

Body

What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

Body

Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can’t be cleaned away? Eye infections may seem like a relatively minor – if unsightly and inconvenient – complaint, but they can also be far more serious. Take the deadly outbreak of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022785/">antibiotic resistant</a> bacteria <a href="https://www.cff.org/managing-cf/burkholderia-cepacia-complex-b-cepacia">Burkholderia cepacia</a> in 2023-24, for example. Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. <a href="https://www.independent.co.uk/news/health/contaminated-eye-gel-outbreak-death-b2523446.html">One person died</a> and at least 25 others suffered serious infections. The outbreak has now subsided and products are <a href="https://www.gov.uk/drug-device-alerts/specific-brands-of-carbomer-eye-gel-recall-of-aacarb-eye-gel-aacomer-eye-gel-and-puroptics-eye-gel-potential-risk-of-infection-dsi-slash-2023-slash-11#update-2-april-2024">back on the shelves</a> but it isn’t the first time that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335909/">medicinal products</a> have led to outbreaks of B cepacia. The bacterium is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing <a href="https://erj.ersjournals.com/content/17/2/295">death in days</a>. But it’s not just B cepacia that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death. Bacteria account for up to <a href="https://pubmed.ncbi.nlm.nih.gov/16148850/">70% of eye infections</a> and globally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032492/">over 6 million people</a> have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at <a href="https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections">increased risk</a>. <figure><iframe src="https://www.youtube.com/embed/pWsx8i1kaxs?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about <a href="https://www.ncbi.nlm.nih.gov/books/NBK11556/">6 million cones and 120 million rods</a> which detect colour and light. Eye cells have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775779/">no ability to regenerate</a> so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a <a href="https://www.ncbi.nlm.nih.gov/books/NBK531490/">bony protective frame</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK482428/">limiting exposure</a> having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated. Despite our bodies’ best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes. <h2>Conjunctivitis</h2> The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the <a href="https://my.clevelandclinic.org/health/body/24329-conjunctiva">conjunctiva</a>. <figure><iframe src="https://www.youtube.com/embed/RZ4danuJwd0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> The conjunctiva is <a href="https://innovations.bmj.com/content/9/4/253">highly vascularised</a>, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328962/">blood vessels to dilate</a> in the conjunctiva. This results in <a href="https://www.cdc.gov/conjunctivitis/about/symptoms.html">“pink eye”</a>, a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself. <h2>Blepharitis</h2> Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It’s most commonly caused by <a href="https://www.tandfonline.com/doi/pdf/10.3109/09273948.2013.870214">Staphylococcus bacteria</a>, or the <a href="https://cks.nice.org.uk/topics/blepharitis/background-information/causes/">dysfunction of the glands</a> of the eyelids. It can be treated by <a href="https://www.nhs.uk/conditions/blepharitis/">cleaning the eyes</a> regularly. <h2>Stye</h2> A stye (also called <a href="https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/hordeolum">hordeolum</a>) is a painful infection of the upper or lower eyelid. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370090/">Internal styes</a> are caused by infection of an oil-producing gland inside the eyelid, whereas <a href="https://pubmed.ncbi.nlm.nih.gov/28723014/">external styes</a> develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1874715">the S aureus form of the Staphylococcus species</a>. <figure><iframe src="https://www.youtube.com/embed/INKrGOdy824?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes – this could spread the infection. <h2>Keratitis</h2> Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye’s main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness. The most common type is bacterial keratitis; however, it can also be caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998329/">amoeba</a>, which can migrate to other parts of the body – including the brain – and cause infection and <a href="https://theconversation.com/nasal-rinsing-why-flushing-the-nasal-passages-with-tap-water-to-tackle-hay-fever-could-be-fatal-225811">even death</a>. Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation. <h2>Uveitis</h2> <a href="https://www.nhs.uk/conditions/uveitis/">Uveitis</a> is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501150/">herpes simplex</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29023181/">herpes zoster</a> or <a href="https://link.springer.com/chapter/10.1007/978-3-319-09126-6_40">trauma</a>. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772296/">partial blindness</a>. <h2>Exogenous endophthalmitis</h2> This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286045/">many other sources</a>. <h2>Dacryocystitis</h2> Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be <a href="https://pubmed.ncbi.nlm.nih.gov/8443113/">acute</a>, <a href="https://www.nature.com/articles/6700662">chronic</a> or <a href="https://www.jebmh.com/articles/a-study-of-congenital-dacryocystitis.pdf.pdf">acquired at birth</a>. Most cases are caused by <a href="https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01792-4">Streptococcus pneumoniae and Staphylococcus aureus</a> bacteria. The condition mainly affects newborns and those over 40. Seventy-five per cent of cases are women and it’s most commonly found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039673/">white adults</a>. It can lead to the stagnation of tears, creating a breeding ground for microbes. <h2>Careful with contacts</h2> Proper eye hygiene reduces the risk of all these conditions – and this is even more important for contact lens wearers. <figure><iframe src="https://www.youtube.com/embed/uENHAntJOIA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Appropriate hygienic cleaning of lenses is paramount. <a href="https://pubmed.ncbi.nlm.nih.gov/30789440/">Non-sterile water</a>, <a href="https://www.aao.org/eye-health/glasses-contacts/contact-lens-care">spit</a> and other fluids can transfer <a href="https://www.science.org/content/article/bacteria-living-your-contact-lens-solution">potentially dangerous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482476/">microbes</a> into the eye – a warm, moist environment that makes an ideal breeding ground for bacteria – leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356/">localised infection</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/">blindness</a> or progress to a more serious <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835757/">systemic infection or death</a>. Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227252/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eye-infections-might-seem-like-a-minor-complaint-but-in-some-cases-they-can-cause-blindness-and-even-death-227252">original article</a>. </div>

Body

Former SAS Australia contestant recalls terrifying Ozempic overdose

Former SAS Australia contestant Roxy Jacenko has opened up on the terrifying experience she had after overdosing on Ozempic. Jacenko was desperate to lose 15kg of extra weight, which she gained as a result of taking Tamoxifen - a hormone therapy drug she took for her breast cancer for seven years. “The Tamoxifen made me put on 15kg,” she said during a special 7NEWS Spotlight TV investigation into the drug. “And whilst to other people, they didn’t look at me and go, 'Oh well, she’s put on a lot of weight,' I didn’t feel comfortable. “And I tried everything. I tried the fad diets. I tried starting at a gym, doing workouts. I tried not eating much and I couldn’t shake the weight. I just wanted to fix it, and this seemed like the way. Ozempic seemed like the easy answer.” Weight loss is one of the side effects of the medication, which is usually used to help adults with Type 2 diabetes control their blood sugar. It is this side effect that has millions wanting to use it for weight loss. Despite Novo Nordisk - the pharmaceutical company supplying Ozempic - advising the Australian Therapeutic Goods Administration that supplies throughout 2023 and 2024 will be limited and it should only be prescribed by doctors to diabetics, people have found other ways to obtain it. Jacenko revealed that despite her local GP telling her she didn't meet the criteria for the injection, she bought it on the black market in Nowra, NSW and ordered an Uber to collect it for her. “It was about $2,500 for the drive there and back, and then it was another $700 for the two pens,” she said. “I was actually like a junkie. I look at it now and I was like a junkie.” She recalled how she took more than the recommended amount in a desperate attempt to lose weight. “I took four times the amount in one hit,” she revealed. “I felt OK at that point in time. The aftermath of it was I think I’m going to die. She added, “in the morning, I was driving to work. I was sweating. I was so hot and then I just kept vomiting nonstop. What not to do? One milligram of Ozempic.” “That night, I ended up in hospital. They had never seen this before. This was the first they had seen of an Ozempic overdose. Like the shaking, my whole body was shaking, I couldn’t control my legs. It’s like I had no control of my body. “My arms and legs were like this. And then in addition to that, they just start pumping you full of fluid. You can rest assure I came out skinny, but it didn’t last for long. Literally, I truly thought this is it. I’ve been sick in my time. Cancer was a walk in the park compared to how bad I felt for those three days. As a result, Jacenko no longer takes the the medication and has since stopped drinking and started following a healthy diet. "And if anyone asks me, “Would you do it again, Ozempic?” No freaking way. I literally thought, “This is it. I’m going to die.” Image: Getty

Body

Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

New search commences for Samantha Murphy’s body

A new search for the body of Samantha Murphy is set to take place on Thursday in the dense bushland in Victoria. The Ballarat mother, 51, went missing without a trace in February when she left home for her morning run and never returned. Since various sources came forward with fresh intelligence, authorities will lead a search through bushland in the Enfield State Park area, about 25km from Ballarat where she was last seen. "The search will focus on an area highlighted by intelligence derived from a number of sources," Victoria Police said in a statement on Thursday. "Since Samantha's disappearance over two months ago, a range of searches and other enquiries have been undertaken in the Ballarat area as part of this investigation.” "This includes extensive large-scale searches such as we have planned this week, but also smaller targeted searches focused in very specific areas.” "I want to assure those in the Ballarat community that police remain focused on doing everything we can to return Samantha to her family." Police have urged members of the public not to join in the search, but assured concerned locals they will share updates on the search as they see fit. In March, 22-year-old Patrick Orren Stephenson was charged with Murphy’s murder, as police allege he killed Murphy while she was on a run through the Canadian State Forest, but have not publicly identified any further details of their case. Image credits: Nine

Legal

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

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”. As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”. We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out. Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise. <h2>How does it work?</h2> Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better. GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more. GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs. Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up. Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>. Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up. <h2>Who is eligible for semaglutide?</h2> Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes. However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use. The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia. When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications. <h2>What else do you need to do during Ozempic treatment?</h2> Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials. Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week. STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling. A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term. Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.

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Could my glasses be making my eyesight worse?

<a href="https://theconversation.com/profiles/james-armitage-399647">James Armitage</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/nick-hockley-1517162">Nick Hockley</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on? Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them <a href="https://www.bbc.com/future/article/20140513-do-glasses-weaken-your-eyesight#:%7E:text=A%20study%20from,they%20are%20right%3F">less likely to wear their glasses</a>. But what they are noticing is how much better the world appears through the glasses. They become <a href="https://www.tandfonline.com/doi/full/10.1080/2576117X.2022.2033588">less tolerant</a> of a blurry world when they remove them. Here are some other things you might notice about eyesight and wearing glasses. <h2>Lazy eyes?</h2> Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”. Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us <a href="https://www.aao.org/museum-eye-openers/how-does-eye-focus">focus on objects</a> in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message). From the age of about 40, the lens in our eye <a href="https://theconversation.com/why-we-lose-our-hearing-and-vision-as-we-age-67930">progressively hardens</a> and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “<a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/presbyopia">presbyopia</a>” and at the moment there are no treatments for this lens hardening. Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power. Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again. <h2>The wrong glasses?</h2> Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause <a href="https://headaches.org/readers-mail-glasses-causing-headache/">eyestrain and headaches</a>. Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children <a href="https://iovs.arvojournals.org/article.aspx?articleid=2126392">as their visual system is still in development</a>. But it is more common for kids to develop long-term vision problems as a result of <a href="https://www.cera.org.au/wp-content/uploads/2021/08/Healthy-Young-Eyes-Guide-ACC.pdf">not wearing glasses when they need them</a>. By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in <a href="https://www.cera.org.au/wp-content/uploads/2021/08/Healthy-Young-Eyes-Guide-ACC.pdf">blurry or uncomfortable vision</a> during daily wear. <a href="https://goodvisionforlife.com.au/">Registered optometrists in Australia</a> are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably. <h2>What about dirty glasses?</h2> Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. <a href="https://www.optometry.org.au/wp-content/uploads/GVFL/Brochure_PDFs/Care-for-Glasses-2018-A4-single-page-final.pdf">Cleaning glasses regularly</a> with a microfibre lens cloth will help. While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207238">harbour bacteria</a> with the remote but theoretical <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628431/#:%7E:text=59%2C60%5D.-,S.,39%2C40%2C41%5D.">potential to cause eye infection</a>. To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207238">reduce bacterial contamination by 96%</a> – but care should be taken as alcohol can damage some frames, depending on what they are made of. <h2>When should I get my eyes checked?</h2> <a href="https://goodvisionforlife.com.au/faqs/">Regular eye exams</a>, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD16%2F20156&dbid=AP&chksum=676U2aH1QM4XJ6ICVAVaKg%3D%3D">expire within two years</a> and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so. Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as <a href="https://goodvisionforlife.com.au/vision-problems/glaucoma/">glaucoma</a>, will be recommended more frequent checks. An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706420/">online prescription estimator</a> is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision. Conditions such as <a href="https://www.cdc.gov/diabetes/managing/diabetes-vision-loss.html#:%7E:text=Diabetic%20retinopathy%20is%20caused%20when,vision%20or%20stopping%20blood%20flow.">diabetes</a> or <a href="https://www.ncbi.nlm.nih.gov/books/NBK525980/">high blood pressure</a>, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225169/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/james-armitage-399647">James Armitage</a>, Associate Professor in Vision Science, Optometry Course Director, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/nick-hockley-1517162">Nick Hockley</a>, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/could-my-glasses-be-making-my-eyesight-worse-225169">original article</a>.

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Whooping cough is surging in Australia. Why, and how can we protect ourselves?

<a href="https://theconversation.com/profiles/laurence-don-wai-luu-1415508">Laurence Don Wai Luu</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Australia is facing a whooping cough outbreak. Some <a href="https://nindss.health.gov.au/pbi-dashboard/">2,799 cases</a> were recorded in the first three months of 2024. Cases are highest in Queensland and New South Wales, with more than 1,000 recorded in each state. The last time Queensland recorded more than 1,000 cases in three months was <a href="https://nindss.health.gov.au/pbi-dashboard/">the first quarter of 2013</a>. This was at the tail end of a significant outbreak that spanned 2008 until 2012 – Australia’s largest reported outbreak since the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi2205-pdf-cnt.htm/$FILE/cdi2205c.pdf">widespread introduction</a> of whooping cough vaccines <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-annlrpt-oz_dis19_91.htm/$FILE/ozdis1917_91.pdf">in the 1950s</a>. More than 140,000 cases were recorded during this period, with the number peaking at 38,748 in 2011. There was a smaller outbreak between <a href="https://nindss.health.gov.au/pbi-dashboard/">2014 and 2017</a>, with more than 60,000 cases in these years. So what is whooping cough, why are cases rising now, and how can you protect yourself? <h2>It’s most dangerous for babies</h2> Whooping cough is a serious and <a href="https://www.healthdirect.gov.au/whooping-cough">highly contagious</a> respiratory disease. Also called pertussis, it’s caused by the bacteria Bordetella pertussis. The initial symptoms of whooping cough resemble other cold and flu-like symptoms. These include runny nose, sneezing, mild cough and fever. However, as the disease progresses into the second week, the coughing fits become worse and more frequent. After or between bouts of coughing, patients may gasp for air and produce the characteristic “whoop” noise. The disease is also sometimes called the “100-day cough” as it can last for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150027/">6–12 weeks</a>. It’s especially serious and can be life-threatening in newborns who are yet to receive their vaccinations. In older children who are fully vaccinated, as well as adolescents and adults, the disease is normally less severe. However, even in adults, the coughing can lead to <a href="https://www.nejm.org/doi/full/10.1056/NEJMicm1701940">fractured ribs</a>. Antibiotics are used to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ebch.1845">treat whooping cough</a> but are most effective when given during the initial stages of the illness. The best protection in the first instance is <a href="https://www.healthdirect.gov.au/whooping-cough">vaccination</a>, which prevents most cases of serious illness, and reduces the spread of whooping cough in the community. It’s recommended children are given six doses of a whooping cough vaccine (which is combined with vaccines for other diseases) between the ages of roughly two months and 13 years. Vaccination is free under the <a href="https://www.health.gov.au/topics/immunisation/vaccines/whooping-cough-pertussis-immunisation-service">National Immunisation Program</a> for children and pregnant women. Vaccinating women against whooping cough during pregnancy protects newborns in their first months of life. Immunity from these vaccines wanes over time, so it’s also recommended adults receive a booster, particularly those who may come into frequent contact with babies. <h2>Why are cases rising now?</h2> Whooping cough outbreaks generally occur <a href="https://www.healthdirect.gov.au/whooping-cough">every 3–4 years</a>. Due to COVID measures such as border closures, social isolation and masks, the number of cases declined dramatically during 2020–23. If trends had followed the usual outbreak cycle, this might have been around the time we’d have seen another outbreak. Missed <a href="https://ncirs.org.au/ncirs-study-confirms-decline-childhood-vaccination-coverage-throughout-covid-19-pandemic">routine whooping cough vaccinations</a> at the height of the pandemic may mean Australia is more vulnerable now. Reduced immunity in the population could be one of the reasons we’re seeing a rise in whooping cough cases in Australia and other countries including the <a href="https://www.gov.uk/government/publications/pertussis-epidemiology-in-england-2024/confirmed-cases-of-pertussis-in-england-by-month">United Kingdom</a> and the <a href="https://www.nyc.gov/assets/doh/downloads/pdf/han/advisory/2024/han-advisory-5.pdf">United States</a>. In Australia, cases have been particularly high during this outbreak in children aged 10–14. <h2>A potential superbug</h2> Over the past two decades, whooping cough has been getting better at evading vaccines and antibiotics. Most vaccines used in Australia and other developed countries stimulate your immune system to recognise and target <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough">three to five components</a> of the bacteria. Over time, the bacteria that causes whooping cough has been slowly acquiring mutations in these genes. These mutations make the bacteria look slightly different to the one used in the vaccine, helping it better hide from the immune system. Most of these changes were small. But in 2008, a new strain appeared in Australia that no longer produced <a href="https://wwwnc.cdc.gov/eid/article/20/4/13-1478_article">pertactin</a>, one of the components targeted by the vaccine. This means your immune system, like a detective, has one less clue to recognise the bacteria. This new strain rapidly increased from <a href="https://wwwnc.cdc.gov/eid/article/25/6/18-0240_article">5% of strains found in 2008</a>, to become the dominant strain in less than ten years, making up <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537726/">90% of strains</a> by 2017. This pertactin-negative strain was shown to survive better in <a href="https://pubmed.ncbi.nlm.nih.gov/26432908/">vaccinated mice</a> and may have contributed to the high number of cases in the 2008–12 outbreak. Worryingly, since 2013, <a href="https://www.cdc.gov/drugresistance/biggest-threats.html">antibiotic-resistant strains</a> of whooping cough have become <a href="https://www.tandfonline.com/doi/full/10.1080/22221751.2019.1587315">widespread in China</a>. While there are other antibiotics available, these are not recommended for infants <a href="https://www.health.nsw.gov.au/Infectious/whoopingcough/Pages/workers-managing-cases.aspx">younger than two months</a> (the age group at most risk of serious disease). These resistant strains are increasingly <a href="https://wwwnc.cdc.gov/eid/article/26/10/20-1035_article">spreading through Asia</a> but are not yet in Australia. <h2>What next?</h2> It’s too early to know how big this outbreak will be or what strains are responsible for it. Greater tracking of whooping cough strains, like we do with COVID, is needed to inform future vaccine design and treatments. Importantly, although the bacteria is evolving, current vaccines are still very effective at preventing serious disease and reducing transmission. They remain our best tool to limit this outbreak. To protect oneself, vulnerable newborns, and the wider community, everyone should ensure they are up-to-date with their <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough">whooping cough vaccinations</a>. You can check this with your GP if you’re not sure. And anyone with cold or flu-like symptoms should <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs/pertussis">stay away</a> from infants.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226918/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/laurence-don-wai-luu-1415508">Laurence Don Wai Luu</a>, Lecturer and Chancellor's Research Fellow, School of Life Sciences, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/whooping-cough-is-surging-in-australia-why-and-how-can-we-protect-ourselves-226918">original article</a>.

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Ozempic isn’t approved for weight loss in Australia. So how are people accessing it?

<a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-bartlett-849104">Andrew Bartlett</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> To say that Ozempic is a <a href="https://www.theguardian.com/business/2024/jan/31/obesity-drug-ozempic-novo-nordisk-record-wegovy">blockbuster drug</a> is an understatement. Manufacturer Novo Nordisk is scrambling to expand production sites to keep up with global demand. While Ozempic is only approved for the treatment of diabetes in Australia, it is also marketed overseas for weight loss under the brand name Wegovy. Social media is full of posts and endorsements by celebrities who are using it for weight loss. Faced with limited access in Australia, some people who need the medication for diabetes can’t access it. Others are turning to the internet to source it from compounding pharmacies – a practice Australia’s regulator, the Therapeutic Goods Administration (TGA), plans to clamp down on. <h2>How doctors are prescribing Ozempic</h2> Use of Ozempic for weight loss in Australia is considered “<a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">off label</a>”. This is when a doctor prescribes a medicine for a purpose outside of what is approved. Ozempic is only approved to be used for the treatment of diabetes in Australia, but its off-label prescribing for weight loss is driving <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#when-will-the-ozempic-shortage-end">shortages</a> which the TGA thinks will last until 2025. To manage these shortages, Australian doctors and pharmacies are being asked <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#information-for-prescribers">not to start new patients</a> on Ozempic and to prioritise it for patients with type 2 diabetes who are already stabilised on this medicine. However, the TGA <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">says</a> it: "does not have the power to regulate the clinical decisions of health professionals and is unable to prevent doctors from using their clinical judgement to prescribe Ozempic for other health conditions." <h2>Why can’t we just make more?</h2> The active ingredient in Ozempic, semaglutide, is a delicate <a href="https://www.britannica.com/story/what-is-the-difference-between-a-peptide-and-a-protein">peptide</a> molecule made up of two small chains of amino acids. It’s just one in a family of drugs that are classified as GLP-1 inhibitors. Because it’s a peptide, its manufacture is complex and requires specialised facilities beyond those used to make normal chemical-based drugs. It is also delivered via an injection, meaning that it has to be manufactured under strict conditions to ensure it is both sterile and temperature controlled. This means increasing production is not as simple as just deciding to manufacture more. Its manufacturer <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">needs time</a> to build new facilities to increase production. <h2>Compounding pharmacies are making their own</h2> <a href="https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding#:%7E:text=Compounding%20is%20generally%20a%20practice,needs%20of%20an%20individual%20patient">Compounding</a> is the practice of combining, mixing, or altering ingredients of a drug to create a formulation tailored to the needs of an individual patient. Australian law allows <a href="https://www.pharmacyboard.gov.au/codes-guidelines.aspx">pharmacists to compound</a> only when it is for the treatment of a particular patient to meet their individual clinical need and there is no suitable commercially manufactured product available. An example is making a liquid form of a drug from a tablet for people unable to swallow. Compounded products are not held to the same safety, quality and efficacy standards required for mass produced medicines. This recognises the one-off nature of such compounded medicines and the professional training of the pharmacists who prepare them. Recently, pharmacies have been relying on these compounding rules to produce their own Ozempic-like products at scale and ship them to consumers around Australia. However, there are risks when using these products. The US Food and Drug Administration (FDA) has recently <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss#:%7E:text=Are%20there%20concerns%20with%20compounded,available%20to%20treat%20a%20patient.">warned consumers</a> of the dangers of using compounded formulations that contain particular salt formulations of semaglutide. It has received more reports of side effects in patients using these products. <h2>How the regulator plans to tighten the loophole</h2> The TGA is taking a number of steps to tighten the compounding loophole and there are ongoing investigations in this area. In December 2023, the agency issued a <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">public safety warning</a> on the dangers of these compounded medicines. More recently, it has proposed <a href="https://www.abc.net.au/news/2024-02-29/compounding-pharmacies-mounjaro-ozempic/103283926">removing GLP-1 drugs</a>, which includes Ozempic, from Australia’s compounding exemptions. This would effectively ban pharmacies from making off-brand Ozempic. This proposal is <a href="https://www.tga.gov.au/news/media-releases/consultation-remove-glucagon-peptide-1-glp-1-receptor-agonist-analogues-pharmacist-extemporaneous-compounding-exemption">currently under consultation</a> and a final decision is expected by June this year. If you want to access the drug for weight loss before the shortage is over, be aware that compounded products are not identical to approved Ozempic and have not been evaluated for safety, quality and efficacy. Supply of copycat versions is also likely to be limited, given the ongoing TGA crackdown. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224859/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-bartlett-849104">Andrew Bartlett</a>, Associate Lecturer Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ozempic-isnt-approved-for-weight-loss-in-australia-so-how-are-people-accessing-it-224859">original article</a>.

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

<a href="https://theconversation.com/profiles/juliana-s-oliveira-709434">Juliana S. Oliveira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/anne-tiedemann-409380">Anne Tiedemann</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/cathie-sherrington-561141">Cathie Sherrington</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/leanne-hassett-1497197">Leanne Hassett</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Daylight saving ends this weekend. The days are shorter and getting colder. It’s less appealing to cycle to work, walk after dinner, or wake up early to hit the gym. But we all know daily physical activity is essential for our health and wellbeing. Physical activity releases feel-good neurotransmitters in our brains, which help to alleviate <a href="https://bjsm.bmj.com/content/57/18/1203">stress, anxiety, and depression</a>. It also helps <a href="https://www.cdc.gov/chronicdisease/resources/infographic/physical-activity.htm#:%7E:text=Regular%20physical%20activity%20helps%20improve,depression%20and%20anxiety%2C%20and%20dementia.">prevent diseases</a> such as diabetes, heart disease and some cancers. Regular physical activity can prolong life and improve overall quality of life. However, many of us find it difficult to achieve the <a href="https://bjsm.bmj.com/content/54/24/1451">recommended 150 minutes of moderate intensity physical activity</a> each week. In fact, three out of ten Australians and half of Australians aged 65 and over are <a href="https://www.aihw.gov.au/reports/physical-activity/physical-activity">inactive</a>. So, what can you do to stay motivated and keep moving regularly through the darker months? Here are some tips. <h2>1. Nail those goals</h2> Goals can provide us with a sense of purpose, meaning and direction. But just aiming to “get fit” is less likely to cut it than goals that are SMART: specific, measurable, achievable, realistic and time-bound. Specific goals are based on an observable behaviour or activity, such as step count, yoga, or competing in an event. Measurable goals can be tracked, so you can easily tell whether you have ticked them off. Achievable goals are realistic and based on your current fitness and abilities. But they can and should still be challenging. If you’ve only ever run 5 kilometres, it won’t be realistic to aim for a half marathon in the next month. But you could aim for 10 kilometres. Relevant goals hold personal meaning for you. Articulating why it’s important will help motivate you to do it. Time-bound goals include a target date for achieving them. You can always revisit your deadline if you’re ahead of schedule or if it’s too unrealistic. An example of a SMART goal could be: “I will walk 10,000 steps every weekday within a month.” Then you can break it down into short-term goals to make it more achievable. If you currently walk 6,000 steps each day, you can increase steps by 1,000 every week to reach 10,000 by the end of the month. <h2>2. Keep track</h2> More than <a href="https://www.deloitte.com/au/en/Industries/tmt/blogs/digital-consumer-trends-who-is-purchasing-what-now.html">90% of Australians own a smartphone</a> and more than <a href="https://www.deloitte.com/au/en/Industries/telecom-media-entertainment/blogs/digital-consumer-trends-touch-less-healthier-wiser.html">two in ten own a fitness tracker or a smartwatch</a>. These devices can help you track your goals and activity, keep you accountable and increase your motivation. A 2021 systematic review suggests fitness trackers and smartphone apps <a href="https://bjsm.bmj.com/content/55/8/422">can assist people</a> to increase their step count by up to 2,000 steps per day. <a href="https://bjsm.bmj.com/content/54/20/1188">Our research</a> demonstrated fitness trackers can also be helpful in increasing physical activity among older people. If you don’t have a fitness tracker, you can buy low-cost pedometers or track your activity times using paper and pen. <h2>3. Plan for success but prepare for barriers</h2> Take some time to think about the potential barriers that could prevent you from being active and plan solutions to overcome them. For example, if the cost of physical activity is too high for you, try to find options that are free, such as walking or running. You can also consider free online programs or streaming videos. If you find it difficult to fit exercise into your busy schedule, try exercising early in the morning before you start your day and laying out your workout clothes the night before. You could consider joining a gym with flexible timetables. A good strategy is to try to fit physical activity into your daily routine, such as walking or cycling to work. If you are living with a chronic health condition or disability, consider seeking guidance from a health professional such as an <a href="https://www.essa.org.au/Public/SearchAEP.aspx?WebsiteKey=44cfee74-3fc3-444e-bb5f-77729c390872">exercise physiologist</a> or <a href="https://choose.physio/find-a-physio">physiotherapist</a>. Start slow and gradually increase your activity and find something you enjoy so you are more likely to keep doing it. <h2>4. Team up with a workout friend</h2> Physical activity can be more fun when you do it with someone else. Studies show <a href="https://www.sciencedirect.com/science/article/abs/pii/S0167494322002953?via%253Dihub&sa=D&source=docs&ust=1712015093947627&usg=AOvVaw1XGQBMDMFspL5YrQtKo3h">working out with friends can be more motivating and enjoyable</a>. It can also help with accountability, as some people are more likely to show up when they have a workout partner. So, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60407-9/fulltext">find a friend</a> who supports your goal of being more active or maintaining your current activity levels. <h2>5. Plan yourself a little treat</h2> Make an appointment with yourself in your diary to exercise. Approach it as just as important as meeting a friend or colleague. One idea is to delay something you’d rather do and make it a reward for sticking to your activity appointment. If you really want to go out for coffee, do a hobby, or watch something, go for a walk first. Research shows <a href="https://www.nature.com/articles/s41746-019-0164-3">incentives can dramatically increase physical activity levels</a>. <h2>6. Find a coach</h2> If you want more support, <a href="https://bjsm.bmj.com/content/51/19/1425">health coaching</a> might be an option. Trained professionals work one-on-one with people, sometimes via telehealth, to find out what’s reducing their motivation to make healthier choices, such as exercise. Then they employ behaviour change techniques to help them meet their health goals. Our recent research suggests health coaching can improve physical activity in <a href="https://bjsm.bmj.com/content/58/7/382">older people</a> and those with <a href="https://www.sciencedirect.com/science/article/pii/S183695532400002X">chronic pain</a>. In <a href="https://www.gethealthynsw.com.au/#:%7E:text=About%20the%20Get%20Healthy%20Service&text=Delivered%20by%20NSW%20Health%2C%20the,and%20achieve%20your%20health%20goals">New South Wales</a>, <a href="https://lifeprogram.org.au/">Victoria</a> and <a href="https://www.myhealthforlife.com.au/">Queensland</a>, these sessions are government-subsidised or free.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226619/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/juliana-s-oliveira-709434">Juliana S. Oliveira</a>, Postdoctoral Research Fellow, Physical Activity, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/anne-tiedemann-409380">Anne Tiedemann</a>, Professor of Physical Activity and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/cathie-sherrington-561141">Cathie Sherrington</a>, Professor, Institute for Musculoskeletal Health, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/leanne-hassett-1497197">Leanne Hassett</a>, Associate Professor in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/days-are-getting-shorter-and-colder-6-tips-for-sticking-to-your-fitness-goals-226619">original article</a>.

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Silent cancers: here’s what you need to know when there are no obvious symptoms

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

Body

12 best yoga poses to strengthen bones

A rehabilitation doctor and yogi of 50 years says your yoga practise is doing way more than centring your mind and opening your joints. If you’re like many yoga lovers, you appreciate how this one physical activity can be so beneficial, while simultaneously so gentle. Few other practises stretch your body, calm your mind or help regulate vitals, such as your heart rate and blood pressure, in quite the way a regular yoga session can do. Researcher and rehabilitation doctor, Dr Loren Fishman has also been a practitioner of yoga for 50 years and is the creator of ‘the Fishman method’ of yoga for osteoporosis. In a conversation with Reader’s Digest, Dr Fishman points out that for all its advantages, yoga can also provide a powerful boost to your long-term bone density. In particular, Dr Fishman published 12 yoga poses in Orthopedic Nursing that are particularly great for strengthening your bones. Of these 12 poses Dr Fishman says: “They all work by putting pressure on the bones of sufficient magnitude and duration.” He says this can “stimulate the osteoblasts to make more bone”, thanks to their placement of “maximum torque, compression or pressure” on particular body parts, as outlined below. So, while a good yoga session is a helpful tool to help you get through the week, its effects are longer-lasting than you realised. Keep reading for the 12 best yoga poses to strengthen your bones. (“With all poses, remember not to round the spine as you go into and out of the poses, and within the poses themselves,” Dr Fishman advises.) Whether you’re a yoga beginner or expert, it’s important you have the right mat. <a href="https://gaiam.innovations.com.au/p/gaiam-yoga/mats?affiliate=GAIAM60" target="_blank" rel="noopener">Check out these mats from Gaiam.</a> 1. Tree pose (Vriksasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/1-yoga-tree-pose-GettyImages-1094418370-JVedit-1280.jpg" alt="" width="1280" height="720" /> Tree pose has a special way of calling you to stillness. Dr Fishman says tree pose also adds pressure that can strengthen the upper femur and hip. He adds that a study at the University of Southern California (USC) showed a 60 per cent increase in pressure, even with the foot placed three-quarters down the calf. Dr Fishman says tree pose is “also extremely valuable for improving balance and avoiding falls,” although he reminds us that the raised foot should always go above or below the knee – never directly on the knee joint. 2. Triangle pose (Trikonasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/2-yoga-triangle-pose-GettyImages-1317111194-Jvedit-1280.jpg" alt="" width="1280" height="720" /> Triangle pose “puts torque on the lumbar spine, the neck of the femur, the hips and ribs,” Dr Fishman says, adding that this is another pose that will help improve balance. Look and feel the part in these <a href="https://gaiam.innovations.com.au/p/gaiam-apparel/apparel?affiliate=GAIAM60" target="_blank" rel="noopener">comfortable yoga clothes from Gaiam</a>. 3. Reverse Triangle Pose (Parivrtta Trikonasan) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/3-yoga-reverse-triangle-pose-GettyImages-1154825406-JVedit-1280.jpg" alt="" width="1280" height="720" /> Dr Fishman says great pressures develop on the proximal femurs (very top of the femur bone that connects with the hip joint) in this pose, as well as the hip and lower back. Reverse triangle also puts helpful pressure in the ribs and wrists and is “a very powerful balance-improver.” 4. Warrior 2 (Virabhadrasana II) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/4-yoga-warrior-pose-GettyImages-1291770866-Jvedit-1280.jpg" alt="" width="1280" height="720" /> “Fabulous mechanical disadvantage means great pressure on the entire forward (bent leg) femur,” Dr Fishman says of full warrior pose. He explains that “the straight leg’s rotation works on the head of femur and hip,” helping to strengthen the upper leg and hip. This is yet another pose that he says helps with balance. 5. Side angle pose (Parsvakonasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/5-yoga-side-angle-pose-GettyImages-1355155879-JVedit-1280.jpg" alt="" width="1280" height="720" /> Another boon for balance, Dr Fishman says side angle pose torques the lower back and the top of the femur – all good things – and stimulates the bone-making cells of the hip, too. Keep your workout going with this <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/restore-massage/27-73270-gaiam-performance-no-knots-massage-ball?affiliate=GAIAM60" target="_blank" rel="noopener">no-knots massage ball from Gaiam</a> – perfect for releasing tension and relieving stiffness. 6. Locust pose (Salabhasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/6-yoga-locus-pose-GettyImages-840155180-Jvedit-1280.jpg" alt="" /> Locust pose “raises pressures, which stimulate bone-making in the posterior elements of the spine,” Dr Fishman says, while it also helps balance some the forward focus on the ribs of the earlier poses. Locust pose also strengthens extensor muscles of the back to improve posture and reverse curvature of the spine in the upper back, which can lead to fractures. 7. Bridge pose (Setu Bandhasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/7-yoga-bridge-pose-GettyImages-470128454-Jvedit-1280.jpg" alt="" width="1280" height="720" /> Dr Fishman says bridge pose can help strengthen the ribs and lower regions of the spine. 8. Reclining hand to big toe (Supta Padangusthasana I) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/8-yoga-hamstring-stretch-GettyImages-1281872287-JVedit-1280.jpg" alt="" width="1280" height="720" /> Also known to be a good hamstring stretch, this pose facilitates “extreme pressure brought to bear on relevant sections” of the femur, hip, pelvis (specifically the sitz bones) and spine. Seated versions of this and the following pose offer less intensity, but Dr Fishman cautions for both: “The seated versions have the potential to be dangerous. Keep the spine straight and against the back of the chair. Do not round the back.” 9. Supine hand to big toe 2 (Supta Padangusthasana II) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/9-yoga-stretch-GettyImages-637025028-Jvedit-1280.jpg" alt="" width="1280" height="720" /> In the side extension variation of this pose, there is “extreme pressure brought to bear” on the upper femur, hip, pubis, ribs, and spine, he says. 10. Straight-legged twist (Marichyasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/10-yoga-twist-GettyImages-1248883385-JVedit-1280.jpg" alt="" width="1280" height="720" /> This “puts great pressure” on the sitz bones and pelvis, as well as “great but safe pressure” on the spine. 11. Bent-leg twist (Matsyendrasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/11-yoga-twist-bent-leg-GettyImages-1133155224-JVedit-1280.jpg" alt="" width="1280" height="720" /> The bent-leg twist “puts great pressure” on the upper femur and pelvis, plus “great but safe pressure” on the vertebra. Dr Fishman suggests you should hug the leg to ensure a straight spine. Staying hydrated during your yoga session is vital to maintain muscle health. <a href="https://gaiam.innovations.com.au/p/takeya/water-bottles-actives-range?affiliate=GAIAM60" target="_blank" rel="noopener">Check out these insulated stainless-steel water bottles</a> designed for every kind of workout. 12. Corpse pose (Savasana) <img src="https://oversixtydev.blob.core.windows.net/media/2024/04/12-yoga-GettyImages-1301651925-Jvedit-1280.jpg" alt="" width="1280" height="720" /> Truthfully, Dr Fishman says, Savasana is “of little value for the bones per se, but truly important at the end of the session for mental and general physiological health.” That’s good enough for us. Written by Jennifer Huizen and Kristine Gasbarre. This article first appeared in <a href="https://www.readersdigest.com.au/healthsmart/12-best-yoga-poses-to-strengthen-bones" target="_blank" rel="noopener">Reader’s Digest</a>. Image: Getty Images

Body

How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

It’s 3am and you’re suddenly wide awake. Try these seven science-backed strategies to fall back to sleep fast. Give meditation a try As a mindfulness coach, I’m very aware of the day-to-day anxieties and worries that can interfere with a good night’s sleep. One of the most effective natural sleep aids is a quick meditation session to ease yourself out of those stresses. If you’ve never meditated before, you’ll likely find the meditation interrupted by thoughts flashing through your mind. It’s important for you to know that this isn’t a failure on your part, and that you aren’t doing anything wrong. Thinking is just what the brain does, as naturally as lungs take in air. The point is to be non-judgmental yet aware of your thoughts, bodily experiences and breath, moment by moment. Sleep better, feel better! <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/rollers-resistance/27-72435-gaiam-strengthen-stretch-kit?affiliate=GAIAM6O" target="_blank" rel="noopener">This Blackout Sleep Mask from Gaiam</a> will help you feel well rested and renewed. Stop wanting to fall asleep It’s counterintuitive, isn’t it? Sometimes trying too hard to do something is the very thing that prevents us from achieving it – and that’s never more true than when it comes to falling asleep. Desperately wanting to sleep will only stoke anxieties that will further stress your brain, essentially feeding it the message that it’s not safe to sleep. Throw in those worries about your to-do list at work the following day, and the whole thing can snowball into a panic attack. Try letting go of that feeling that you absolutely must sleep now, and observe your own anxieties for what they are without judgment. When you stop looking at sleep as a goal, you’ll find it easier to fall asleep. Before you climb into bed, set aside 10-15 minutes to help relax your body and mind, with <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/restore-massage/27-73353-gaiam-wellness-acupressure-neck-back-pillow?affiliate=GAIAM60" target="_blank" rel="noopener">this wellness acupressure neck and back pillow from Gaiam</a>. Start a journal If you find yourself struggling to fall asleep, pick up a pen and paper (not your phone!), and start writing: simply scribble down an account of what’s going on inside your head. Although there’s no “right” way to journal, you might start by listing the events of your day, and from there, how those events and encounters made you feel. Building this structured picture of your thoughts may help you see that the problem that’s keeping you up at night, and is likely less overwhelming than you thought. Why my insistence on a pen and paper? First off, studies show the simple motor action that’s involved in the act of handwriting has a calming effect. Secondly, the light emitted by laptops and phones isn’t conducive to falling asleep. Find yourself a "3am friend" Some of us are lucky to have a ‘3am friend’, that close confidant you can call up in the wee hours knowing that they won’t hold it against you in the morning. Although it’s great to have someone to talk to when you want to fall asleep, it’s important that the conversation doesn’t just rehash the anxieties that are preventing you from catching shut-eye in the first place. Rather than using the call to seek solutions for those issues, talk about things that calm your nerves, or even have them assist you in deep breathing. It may sound silly, but doing a series of deep, relaxing breaths can help you let go of the troubles that are keeping you wide awake. Take a warm shower Taking a warm shower not only relaxes your muscles and soothes minor aches and pains, but it also raises your core body temperature. As soon as you step out of the shower, your body starts working at lowering that temperature, which is something that normally happens when you’re falling asleep naturally. (That’s why we always feel the need for a blanket when we sleep, no matter how warm it is!) By kick-starting that temperature-lowering process, you’re tricking your body into falling asleep fast. Stretch yourself to sleep Anxiety keeping you up? Research suggests mild stretching can help take the edge off and relax muscles that have become stiff and sore after a long day. We’re not talking intricate yoga poses or acrobatics here, either: Simple stretches like an overhead arm stretch and bending over to touch your toes should do the trick. Ramp up the relaxation potential with a soundtrack of ambient noise at a volume that’s just barely audible. There are plenty of white noise apps that are free to download, but soft music can work as well (so long as there are no lyrics). Just remember, if you’re using an electronic device to play these sleep-promoting sounds, make sure it’s placed screen-down so you’re not distracted by the light it emits. Stretching is healing, and this <a href="https://gaiam.innovations.com.au/p/gaiam-wellness/rollers-resistance/27-72435-gaiam-strengthen-stretch-kit?affiliate=GAIAM60" target="_blank" rel="noopener">Strengthen and Stretch Kit from Gaiam</a> is a great way to start. An on-line workout is also included to get you started. Read (or listen!) to something new When you’re struggling with insomnia, it might be tempting to pull an old favourite off the bookshelf. In reality, it’s better to read or listen to an audio book that covers a topic on which you know absolutely nothing. New information, while taking attention away from the stressors that are keeping you up at night, gives your brain enough of a workout to make it tire more quickly than when it’s engaged with familiar subjects and concepts. Again, if it’s an audio book or podcast you’re listening to, make sure the light-emitting side of the device is face down to keep the room as dark as possible. Darkness and warmth play an essential part in the production and maintenance of melatonin, the hormone that plays the central role falling asleep. Image credits: Getty Images This article by Deepak Kashyap originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/sleep/how-to-fall-asleep-without-sleeping-pills-7-natural-sleep-aids-that-actually-work" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs. As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns. But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug. <h2>Potential benefits</h2> 1) It’s likely to help you lose weight The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity. The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight). In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg. Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication. 2) It may reduce your chronic disease risk factors When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases. In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels. In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels. 3) It might improve your quality of life, emotional wellbeing or sense of achievement The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health. Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image. <h2>What about the risks?</h2> 1) You may experience gastrointestinal symptoms In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%). In the UK study, nausea and diarrhoea were also commonly reported. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living. Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study. 2) You might feel fatigued Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants. 3) You might be among the minority who don’t tolerate the drug Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia. In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing. More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period. A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period. Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions. 4) It might be difficult to access Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024. To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication. 5) You might not always get clear information from vested interests Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>. Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications. <h2>Bottom line</h2> Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.

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Rebel Wilson's shocking weight loss confession

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

Body

Eating some chocolate really might be good for you – here’s what the research says

<a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Although it always makes me scoff slightly to see Easter eggs making their first appearance in supermarkets at the end of December, there are few people who aren’t delighted to receive a bit of chocolate every year. It makes sense that too much chocolate would be bad for you because of the high fat and sugar content in most products. But what should we make of common claims that eating some chocolate is actually good for you? Happily, there is a fair amount of evidence that shows, in the right circumstances, chocolate may be both beneficial for your heart and good for your mental state. In fact, chocolate – or more specifically cacao, the raw, unrefined bean – is a medicinal wonder. It contains many different active compounds which can evoke pharmacological effects within the body, like medicines or drugs. Compounds that lead to neurological effects in the brain have to be able to cross the <a href="https://link.springer.com/chapter/10.1007/978-3-642-13443-2_7">blood-brain barrier</a>, the protective shield which prevents harmful substances – like toxins and bacteria – entering the delicate nervous tissue. One of these is the compound <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">theobromine</a>, which is also found in tea and contributes towards its bitter taste. Tea and chocolate also contain caffeine, which theobromine is related to as part of the purine family of chemicals. These chemicals, among others, contribute to chocolate’s addictive nature. They have the ability to cross the blood-brain barrier, where they can influence the nervous system. They are therefore known as <a href="https://pubmed.ncbi.nlm.nih.gov/15549276/">psychoactive</a> chemicals. <figure><iframe src="https://www.youtube.com/embed/HloqayQdR6M?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> What effects can chocolate have on mood? Well, <a href="https://academic.oup.com/nutritionreviews/article/71/10/665/1931144?login=false">a systematic review</a> looked at a group of studies which examined the feelings and emotions associated with consuming chocolate. Most demonstrated improvements in mood, anxiety, energy and states of arousal. Some noted the feeling of guilt, which is perhaps something we’ve all felt after one too many Dairy Milks. <h2>Health benefits of cocoa</h2> There are other organs, aside from the brain, that might benefit from the medicinal effects of cocoa. For centuries, chocolate has been used as a medicine to treat a <a href="https://pubmed.ncbi.nlm.nih.gov/10917925/">long list of diseases</a> including anaemia, tuberculosis, gout and even low libido. These might be spurious claims but there is evidence to suggest that eating cacao has a positive effect on the cardiovascular system. First, it can prevent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068178/">endothelial dysfunction</a>. This is the process through which arteries harden and get laden down with fatty plaques, which can in turn lead to heart attacks and strokes. Eating dark chocolate may also reduce <a href="https://www.sciencedirect.com/science/article/pii/S1537189115001135?via%3Dihub">blood pressure</a>, which is another risk factor for developing arterial disease, and prevent formation of clots which block up blood vessels. <figure><iframe src="https://www.youtube.com/embed/8VUcPCbSSCY?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Some studies have suggested that dark chocolate might be useful in adjusting ratios of <a href="https://pubmed.ncbi.nlm.nih.gov/20968113/">high-density lipoprotein cholesterol</a>, which can help protect the heart. Others have examined insulin resistance, the phenomenon associated with Type 2 diabetes and weight gain. They suggest that the <a href="https://www.sciencedirect.com/science/article/pii/S0963996900000697#:%7E:text=Cocoa%20is%20rich%20in%20polyphenols%20particularly%20in%20catechins,and%20cocoa%20powder%20have%20been%20published%20only%20recently.">polyphenols</a> – chemical compounds present in plants – found in foodstuffs like chocolate may also lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29993262/">improved control of blood sugars</a>. <h2>Chocolate toxicity</h2> As much as chocolate might be considered a medicine for some, it can be a poison for others. It’s well documented that the ingestion of caffeine and theobromine is highly toxic for domestic animals. Dogs are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801869/">particularly affected</a> because of their often voracious appetites and generally unfussy natures. The culprit is often dark chocolate, which can provoke symptoms of agitation, rigid muscles and even seizures. In certain cases, if ingested in high enough quantities, it can lead to comas and abnormal, even fatal heart rhythms. Some of the compounds found in chocolate have also been found to have potentially negative effects in humans. Chocolate is a source of oxalate which, along with calcium, is one of the main components of <a href="https://pubmed.ncbi.nlm.nih.gov/20301742/">kidney stones</a>. Some clinical groups have advised against consuming oxalate rich foods, such as spinach and rhubarb – and chocolate, for those who suffer from recurrent kidney stones. So, what should all this mean for our chocolate consumption habits? Science points in the direction of chocolate that has as high a cocoa solid content as possible, and the minimum of extras. The potentially harmful effects of chocolate are more related to fat and sugar, and may counteract any possible benefits. A daily dose of 20g-30g of plain or dark chocolate with cocoa solids above 70% – rather than milk chocolate, which contains fewer solids and white chocolate, which contains none – could lead to a greater health benefit, as well as a greater high. But whatever chocolate you go for, please don’t share it with the dog.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dan-baumgardt-1451396">Dan Baumgardt</a>, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eating-some-chocolate-really-might-be-good-for-you-heres-what-the-research-says-226759">original article</a>.

Body

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

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

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Good news: midlife health is about more than a waist measurement. Here’s why

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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

Rebel Wilson's shocking weight loss confession

Eating some chocolate really might be good for you – here’s what the research says

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

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Contests

Entertainment

Travel

Health

Lifestyle

Finance

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Keep up to date

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Good news: midlife health is about more than a waist measurement. Here’s why

Could not getting enough sleep increase your risk of type 2 diabetes?

What happens when I stop taking a drug like Ozempic or Mounjaro?

Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

Former SAS Australia contestant recalls terrifying Ozempic overdose

Surgery won’t fix my chronic back pain, so what will?

New search commences for Samantha Murphy’s body

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

Could my glasses be making my eyesight worse?

Whooping cough is surging in Australia. Why, and how can we protect ourselves?

Ozempic isn’t approved for weight loss in Australia. So how are people accessing it?

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

Silent cancers: here’s what you need to know when there are no obvious symptoms

There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

12 best yoga poses to strengthen bones

How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

Rebel Wilson's shocking weight loss confession

Eating some chocolate really might be good for you – here’s what the research says

Vitamin D supplements can keep bones strong – but they may also have other benefits to your health

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