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Australia’s fertility rate has reached a record low. What might that mean for the economy?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/jonathan-boymal-392960">Jonathan Boymal</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/ashton-de-silva-3066">Ashton De Silva</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/sarah-sinclair-385470">Sarah Sinclair</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Australia’s fertility rate has fallen to a new <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release">record low</a> of 1.5 babies per woman. That’s well below the “<a href="https://pubmed.ncbi.nlm.nih.gov/7834459/#:%7E:text=PIP%3A%20Replacement%20level%20fertility%20is,of%202.1%20children%20per%20woman.">replacement rate</a>” of 2.1 needed to sustain a country’s population. On face value, it might not seem like a big deal. But we can’t afford to ignore this issue. The health of an economy is deeply intertwined with the size and structure of its population. Australians simply aren’t having as many babies as they used to, raising some serious questions about how we can maintain our country’s workforce, sustain economic growth and fund important services. So what’s going on with fertility rates here and around the world, and what might it mean for the future of our economy? What can we do about it? <h2>Are lower birth rates always a problem?</h2> Falling fertility rates can actually have some <a href="https://www.rand.org/content/dam/rand/pubs/monograph_reports/2007/MR1274.pdf">short-term benefits</a>. Having fewer dependent young people in an economy can increase workforce participation, as well as boost savings and wealth. Smaller populations can also benefit from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0927537112000620.">increased investment</a> per person in education and health. But the picture gets more complex in the long term, and less rosy. An ageing population can strain pensions, health care and social services. This can hinder economic growth, unless it’s <a href="https://pubmed.ncbi.nlm.nih.gov/21302431/">offset by increased productivity</a>. Other scholars have <a href="https://www.gsb.stanford.edu/faculty-research/publications/end-economic-growth-unintended-consequences-declining-population">warned</a> that a falling population could stifle innovation, with fewer young people meaning fewer breakthrough ideas. <h2>A global phenomenon</h2> The trend towards women having fewer children is not unique to Australia. The global fertility rate has dropped over the past couple of decades, from 2.7 babies per woman in 2000 to <a href="https://www.macrotrends.net/global-metrics/countries/WLD/world/fertility-rate">2.4 in 2023</a>. However, the distribution is not evenly spread. In 2021, 29% of the world’s babies were born in sub-Saharan Africa. This is projected to <a href="https://www.healthdata.org/news-events/newsroom/news-releases/lancet-dramatic-declines-global-fertility-rates-set-transform">rise to 54% by 2100</a>. There’s also a <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/psp.2720">regional-urban divide</a>. Childbearing is often delayed in urban areas and late fertility is more common in cities. In Australia, we see <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release#data-downloads">higher fertility rates</a> in inner and outer regional areas than in metro areas. This could be because of more affordable housing and a better work-life balance. But it raises questions about whether people are moving out of cities to start families, or if something intrinsic about living in the regions promotes higher birth rates. <iframe id="U1wEx" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/U1wEx/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <h2>Fewer workers, more pressure on services</h2> Changes to the makeup of a population can be just as important as changes to its size. With fewer babies being born and increased life expectancy, the proportion of older Australians who have left the workforce will keep rising. One way of tracking this is with a metric called the old-age dependency ratio – the number of people aged 65 and over per 100 working-age individuals. In Australia, this ratio is currently about 27%. But according to the latest <a href="https://treasury.gov.au/publication/2023-intergenerational-report">Intergenerational Report</a>, it’s expected to rise to 38% by 2063. An ageing population means greater demand for medical services and aged care. As the working-age population shrinks, the tax base that funds these services will also decline. Unless this is offset by technological advances or policy innovations, it can mean higher taxes, longer working lives, or the government providing fewer public services in general. <h2>What about housing?</h2> It’s tempting to think a falling birth rate might be good news for Australia’s stubborn housing crisis. The issues are linked – rising real estate prices have made it difficult for many young people to afford homes, with a significant number of people in their 20s <a href="https://pursuit.unimelb.edu.au/articles/more-australian-adult-children-are-living-with-their-parents-longer">still living with their parents</a>. This can mean delaying starting a family and reducing the number of children they have. At the same time, if fertility rates stay low, demand for large family homes may decrease, impacting one of Australia’s most significant economic sectors and sources of household wealth. <h2>Can governments turn the tide?</h2> Governments worldwide, including Australia, have long experimented with policies that encourage families to have more children. Examples include paid parental leave, childcare subsidies and financial incentives, such as Australia’s “<a href="https://theconversation.com/what-the-baby-bonus-boost-looks-like-across-ten-years-81563">baby bonus</a>”. Many of these efforts have had only limited success. One reason is the rising average age at which women have their first child. In many developed countries, including Australia, the average age for first-time mothers has surpassed <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/overview-and-demographics/maternal-age">30</a>. As women delay childbirth, they become less likely to have multiple children, further contributing to declining birth rates. Encouraging women to start a family earlier could be one policy lever, but it must be balanced with women’s growing workforce participation and career goals. Research has previously highlighted the factors influencing fertility decisions, including levels of paternal involvement and workplace flexibility. Countries that offer part-time work or maternity leave without career penalties have seen a <a href="https://faculty.wcas.northwestern.edu/mdo738/research/Doepke_Hannusch_Kindermann_Tertilt_Handbook_23.pdf">stabilisation or slight increases</a> in fertility rates. <h2>The way forward</h2> Historically, one of the ways Australia has countered its low birth rate is through immigration. Bringing in a lot of people – especially skilled people of working age – can help offset the effects of a low fertility rate. However, relying on immigration alone is not a long-term solution. The global fertility slump means that the pool of young, <a href="https://www.imf.org/en/Publications/fandd/issues/2020/03/can-immigration-solve-the-demographic-dilemma-peri">educated workers from other countries</a> is shrinking, too. This makes it harder for Australia to attract the talent it needs to sustain economic growth. Australia’s record-low fertility rate presents both challenges and opportunities. On one hand, the shrinking number of young people will place a strain on public services, innovation and the labour market. On the other hand, advances in technology, particularly in artificial intelligence and robotics, may help ease the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0164070420302020">challenges of an ageing population</a>. That’s the optimistic scenario. AI and other tech-driven productivity gains could reduce the need for large workforces. And robotics could assist in aged care, lessening the impact of this demographic shift.<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/241577/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jonathan-boymal-392960">Jonathan Boymal</a>, Associate Professor of Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/ashton-de-silva-3066">Ashton De Silva</a>, Professor of Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>, and <a href="https://theconversation.com/profiles/sarah-sinclair-385470">Sarah Sinclair</a>, Senior Lecturer in Economics, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT 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/australias-fertility-rate-has-reached-a-record-low-what-might-that-mean-for-the-economy-241577">original article</a>. </div>

Money & Banking

Australia’s gender pay gap has hit a record low – but we still have work to do

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Australia’s gender pay gap – a key measure of economic inequality between men and women – has fallen to a record low of 11.5%. That’s down from 13% this time last year, the steepest annual fall since 2016. Ten years ago, it was almost 19%. The latest figures are great news for our economy and our society – evidence we’re getting better at recognising and fairly valuing women’s capabilities and contributions. More opportunities are now open to women in the workforce, helping them gain and retire with greater financial independence than in previous decades. But national averages don’t tell the whole story. While gender pay gaps have fallen in some industries, they’ve also been rising in others. Today, August 19, is <a href="https://www.wgea.gov.au/pay-and-gender/equal-pay-day-2024">equal pay day</a>. This marks the 50 extra days past the end of the last financial year that Australian women would need to work for their earnings to match those of their male colleagues. This offers us a timely opportunity to reflect on what exactly has driven this year’s improvement – and where we still have work to do. <h2>Women’s earnings picking up pace</h2> We calculate the gender pay gap by comparing the average weekly ordinary-time, full-time <a href="https://www.abs.gov.au/statistics/labour/earnings-and-working-conditions/average-weekly-earnings-australia">earnings</a> for men and women. In dollar terms, women are now earning $231.50, or 11.5%, less than men, on average, in their weekly full-time pay packet. <hr /> <iframe id="HwwJ5" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/HwwJ5/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> The recent narrowing is being driven by women’s average earnings growth picking up pace. This contrasts with <a href="https://www.abc.net.au/news/2018-10-02/fact-check-gender-pay-gap/10302358">earlier periods</a> in which the narrowing of the gap tended to be due to a slowdown in the growth of men’s earnings. <hr /> <iframe id="R7uFE" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/R7uFE/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What’s behind the improvement?</h2> While changes in the gender pay gap reflect a range of economy-wide factors, the Albanese government has been quick to attribute the recent fall to the various <a href="https://www.linkedin.com/feed/update/urn:li:activity:7229747376511447040/">targeted actions</a> it has taken since coming to office. Let’s look at whether and how these actions have played a role. First, the government sought to make wage information more transparent. It <a href="https://theconversation.com/pay-secrecy-clauses-are-now-banned-in-australia-heres-how-that-could-benefit-you-195814">banned pay secrecy clauses</a> and now requires the gender pay gaps of all large companies in Australia to be <a href="https://theconversation.com/qantas-pays-women-37-less-telstra-and-bhp-20-fifty-years-after-equal-pay-laws-we-still-have-a-long-way-to-go-223870">publicly reported</a>. These reforms took effect from 2023, targeting private companies. The gender pay gap in the private sector, though higher to begin with, has fallen more swiftly than that of the public sector, suggesting these actions have had an effect. <hr /> <iframe id="ZKMdm" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ZKMdm/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> Second, the government targeted gender-patterned biases in industrial relations – including the <a href="https://theconversation.com/50-years-after-equal-pay-the-legacy-of-womens-work-remains-118761">legacy effects</a> of past decisions – and instilled gender equity as a new objective of Australia’s Fair Work Act. The Fair Work Commission is now required to take gender equity into account in its wage deliberations, including its <a href="https://www.fwc.gov.au/documents/resources/2024fwcfb3500.pdf">minimum wage decision</a>. The government also introduced multi-employer bargaining in an attempt to strengthen workers’ bargaining capacity in female-concentrated sectors. The effects of these changes will continue to flow across the workforce as the Fair Work Commission undertakes its review of modern awards, prioritising those affecting <a href="https://www.fwc.gov.au/hearings-decisions/major-cases/gender-undervaluation-priority-awards-review">female-concentrated industries</a>. <figure class="align-right zoomable"><figcaption></figcaption></figure> And third, further addressing the historical undervaluation of “women’s work”, the government directly addressed low pay in female-concentrated sectors by supporting a pay rise for <a href="https://www.fairwork.gov.au/newsroom/news/15-per-cent-wage-increase-aged-care-sector">aged care workers</a>. Targeting the low pay and under-valuation of an industry that is about 87% female helped fuel the downward momentum in the overall gender pay gap. The government’s recently announced pay rise for <a href="https://ministers.education.gov.au/anthony-albanese/pay-rise-early-educators-while-keeping-fees-down-families">early childhood education and care workers</a> – a workforce that is around 95% female – will also target gender patterns in low pay once they come into effect. These government actions have been essential for undoing the gender biases embedded in existing systems. And they have complemented other initiatives that have taken effect in the past year, such as the <a href="https://www.respectatwork.gov.au/new-positive-duty-employers-prevent-workplace-sexual-harassment-sex-discrimination-and-victimisation">Respect At Work Act</a>, requiring employers to proactively stamp out sexual harassment. But there is still a way to go to keep closing the gender gaps across all parts of the workforce. <h2>Falling in some industries, rising in others</h2> Breaking down the gender pay gap in earnings by sector paints a more varied picture. In industries like construction, public administration and safety, and retail trade, it has fallen notably over the past two years. <hr /> <iframe id="poLND" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/poLND/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> But it remains high in industries like healthcare and social assistance, at over 20%, and finance and insurance at 18%. <hr /> <iframe id="6cLnT" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/6cLnT/2/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> In some industries, the gap has actually increased over the past two years. In arts and recreation services, as well as electricity, gas, waste and water services, it’s been continually rising. <hr /> <iframe id="M8fve" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/M8fve/1/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>That could reflect a bigger shift</h2> It’s important to interpret these figures carefully. In some instances, a widening of the gender pay gap can reflect a positive shift in an industry’s makeup, if it reflects more women joining a male-dominated sector at entry level, and growing a pipeline of senior women for the future. That’s why the Workplace Gender Equality Agency (WGEA) gives organisations a chance to explain these dynamics in their <a href="https://www.wgea.gov.au/about/our-legislation/publishing-employer-gender-pay-gaps">employer statements</a>, which are published on the WGEA website alongside organisations’ gender pay gaps. Over time, the entry of more women at the junior level can flow through to more gender balance as these women progress to senior and decision-making roles. The real test will be to ensure – by fostering more gender equitable, inclusive and respectful work cultures and systems – that they do.<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/236894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/leonora-risse-405312">Leonora Risse</a>, Associate Professor in Economics, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</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/australias-gender-pay-gap-has-hit-a-record-low-but-we-still-have-work-to-do-236894">original article</a>. </div>

Money & Banking

Walking can prevent low back pain, a new study shows

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <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/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly <a href="https://pubmed.ncbi.nlm.nih.gov/31208917/">70% of people</a> who recover from an episode of low back pain will experience a new episode in the following year. The recurrent nature of low back pain is a major contributor to the <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">enormous burden</a> low back pain places on individuals and the health-care system. In our new study, published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext">The Lancet</a>, we found that a program combining walking and education can effectively reduce the recurrence of low back pain. <h2>The WalkBack trial</h2> We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control). Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences. The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls. The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program. Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred. People in the control group received no preventative treatment or education. This reflects what <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468781222001308?via%3Dihub">typically occurs</a> after people recover from an episode of low back pain and are discharged from care. <h2>What the results showed</h2> We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services. The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%. Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group. Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group. This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings. Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians. <h2>Walking has multiple benefits</h2> We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all <a href="https://www.sciencedirect.com/science/article/pii/S0140673618304896?via%3Dihub">previous studies</a> have focused on treating episodes of pain, not preventing future back pain. A limited number of <a href="https://pubmed.ncbi.nlm.nih.gov/26752509/">small studies</a> have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals. On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care. Walking also delivers many other <a href="https://www.vichealth.vic.gov.au/sites/default/files/VH_Benefits-of-Walking-Summary2020.pdf">health benefits</a>, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases. While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants <a href="https://pubmed.ncbi.nlm.nih.gov/37271689/">reported</a> that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently. <h2>Why is walking helpful for low back pain?</h2> We don’t know exactly why walking is effective for preventing back pain, but <a href="https://www.e-jer.org/journal/view.php?number=2013600295">possible reasons</a> could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which <a href="https://my.clevelandclinic.org/health/body/23040-endorphins">block pain signals</a> between your body and brain – essentially turning down the dial on pain. It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/34783263/">no studies</a> have investigated this. Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.<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/231682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, Postdoctoral research fellow, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, Institute for Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <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>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, Associate Professor, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, Professor of Musculoskeletal Disorders, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie 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/walking-can-prevent-low-back-pain-a-new-study-shows-231682">original article</a>. </div>

Body

I want to eat healthily. So why do I crave sugar, salt and carbs?

<a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods. So why do you crave these foods when you’re trying to improve your diet or lose weight? And what can you do about it? There are many reasons for craving specific foods, but let’s focus on four common ones: <h2>1. Blood sugar crashes</h2> Sugar is a key energy source for all animals, and its taste is one of the most basic sensory experiences. Even without specific sweet taste receptors on the tongue, a strong preference for sugar can develop, indicating a mechanism beyond taste alone. Neurons <a href="https://www.nature.com/articles/s41593-021-00982-7">responding to sugar</a> are activated when sugar is delivered to the gut. This can increase appetite and make you want to consume more. Giving into cravings also drives an appetite for more sugar. In the long term, research suggests a high-sugar diet can affect <a href="https://www.bmj.com/content/369/bmj.m2382">mood</a>, digestion and <a href="https://pubmed.ncbi.nlm.nih.gov/33339337/">inflammation</a> in the <a href="https://www.science.org/doi/10.1126/scitranslmed.aay6218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">gut</a>. While there’s a lot of <a href="https://www.sciencedirect.com/science/article/pii/S0149763402000040?via%3Dihub#aep-section-id23">variation between individuals</a>, regularly eating sugary and high-carb foods can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/30951762/">rapid spikes and crashes</a> in blood sugar levels. When your blood sugar drops, your body can respond by craving quick sources of energy, often in the form of sugar and carbs because these deliver the fastest, most easily accessible form of energy. <h2>2. Drops in dopamine and serotonin</h2> Certain neurotransmitters, such as <a href="https://pubmed.ncbi.nlm.nih.gov/30595479/">dopamine</a>, are involved in the reward and pleasure centres of the brain. Eating sugary and carb-rich foods can trigger the release of dopamine, creating a pleasurable experience and reinforcing the craving. Serotonin, the feel-good hormone, suppresses <a href="https://www.sciencedirect.com/science/article/pii/S1569733910700886">appetite</a>. Natural changes in serotonin can influence daily fluctuations in mood, energy levels and attention. It’s also associated with eating more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829131/">carb-rich snacks in the afternoon</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/21985780/">Low carb diets</a> may reduce serotonin and lower mood. However, a recent systematic review suggests little association between these diets and risk for <a href="https://www.sciencedirect.com/science/article/pii/S0165032722013933?via%3Dihub">anxiety and depression</a>. Compared to men, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189179/">women tend to crave more carb rich foods</a>. Feeling irritable, tired, depressed or experiencing carb cravings are part of premenstrual <a href="https://pubmed.ncbi.nlm.nih.gov/29218451/">symptoms</a> and could be <a href="https://www.ncbi.nlm.nih.gov/books/NBK560698/">linked to</a> reduced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9928757/">serotonin levels</a>. <h2>3. Loss of fluids and drops in blood sugar and salt</h2> Sometimes our bodies crave the things they’re missing, such as hydration or even salt. A low-carb diet, for example, <a href="https://www.ncbi.nlm.nih.gov/books/NBK537084/">depletes</a> insulin levels, decreasing sodium and water retention. <a href="https://www.sciencedirect.com/science/article/pii/S1933287419302673">Very low-carb diets</a>, like ketogenic diets, induce “ketosis”, a metabolic state where the body switches to using fat as its primary energy source, moving away from the usual dependence on carbohydrates. Ketosis is often associated with increased urine production, further contributing to potential fluid loss, electrolyte imbalances and salt cravings. <h2>4. High levels of stress or emotional turmoil</h2> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214609/">Stress</a>, boredom and emotional turmoil can lead to cravings for comfort foods. This is because stress-related hormones can impact our appetite, satiety (feeling full) and food preferences. The stress hormone <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425607/">cortisol</a>, in particular, can drive cravings for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453000000354">sweet comfort foods</a>. A <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453000000354">2001 study</a> of 59 premenopausal women subjected to stress revealed that the stress led to higher calorie consumption. <a href="https://pubmed.ncbi.nlm.nih.gov/37295418/">A more recent study</a> found chronic stress, when paired with high-calorie diet, increases food intake and a preference for sweet foods. This shows the importance of a healthy diet during stress to prevent weight gain. <h2>What can you do about cravings?</h2> Here are four tips to curb cravings: 1) don’t cut out whole food groups. Aim for a well-balanced diet and make sure you include: <ul> <li> sufficient protein in your meals to help you feel full and reduce the urge to snack on sugary and carb-rich foods. Older adults should aim for 20–40g protein per meal with a particular focus on <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.12838">breakfast and lunch</a> and an overall daily protein intake of at least <a href="https://apps.who.int/iris/handle/10665/43411">0.8g</a> per kg of body weight for <a href="https://pubmed.ncbi.nlm.nih.gov/35187864/">muscle health</a> </li> <li> fibre-rich foods, such as vegetables and whole grains. These make you feel full and <a href="https://pubmed.ncbi.nlm.nih.gov/32142510/">stabilise your blood sugar</a> levels. Examples include broccoli, quinoa, brown rice, oats, beans, lentils and bran cereals. Substitute refined carbs high in sugar like processed snack bars, soft drink or baked goods for more complex ones like whole grain bread or wholewheat muffins, or nut and seed bars or energy bites made with chia seeds and oats </li> </ul> 2) manage your stress levels. Practise stress-reduction techniques like meditation, deep breathing, or yoga to manage emotional triggers for cravings. Practising <a href="https://pubmed.ncbi.nlm.nih.gov/30570305/">mindful eating</a>, by eating slowly and tuning into bodily sensations, can also reduce daily calorie intake and curb cravings and stress-driven eating 3) get enough sleep. Aim for <a href="https://pubmed.ncbi.nlm.nih.gov/33054337/">seven to eight</a> hours of quality sleep per night, with a minimum of seven hours. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9031614/">Lack of sleep</a> can disrupt hormones that regulate hunger and cravings 4) control your portions. If you decide to indulge in a treat, control your portion size to avoid overindulging. Overcoming cravings for sugar, salt and carbs when trying to eat healthily or lose weight is undoubtedly a formidable challenge. Remember, it’s a journey, and setbacks may occur. Be patient with yourself – your success is not defined by occasional cravings but by your ability to manage and overcome them.<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/212114/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, Assistant Professor, Faculty of Health Sciences and Medicine, <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/i-want-to-eat-healthily-so-why-do-i-crave-sugar-salt-and-carbs-212114">original article</a>.

Food & Wine

Alzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low

<a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> An article published this week in the prestigious journal <a href="https://www.nature.com/articles/s41591-023-02729-2">Nature Medicine</a> documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person. The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors. Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s. The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop <a href="https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/creutzfeldt-jakob-disease-cjd/">Creuztfeldt-Jakob disease</a> (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million. <h2>What’s CJD got to do with Alzehimer’s?</h2> CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell. Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised <a href="https://en.wikipedia.org/wiki/United_Kingdom_BSE_outbreak">public health concerns</a> over the eating of beef products in the United Kingdom in the 1980s. <h2>Human growth hormone used to come from donated organs</h2> Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue. But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00000563.htm">16,000 donated glands</a>. An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people. hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk. <h2>What are the latest findings about Alzheimer’s disease?</h2> The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission. The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease. They considered other explanations for the findings but concluded donated hGH was the likely cause. Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease. Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-017-0488-7">increasing evidence</a> these proteins spread in the brain in a <a href="https://pubmed.ncbi.nlm.nih.gov/8086126/">similar way to prion diseases</a>. So the mode of transmission the authors propose is certainly plausible. However, given the amyloid protein deposits in the brain <a href="https://www.nia.nih.gov/news/estimates-amyloid-onset-may-predict-alzheimers-progression">at least 20 years</a> before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident. <h2>When was this process used in Australia?</h2> In Australia, donated pituitary material <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">was used</a> from 1967 to 1985 to treat people with short stature and infertility. <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">More than 2,000 people</a> received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch. The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are <a href="https://www.mja.com.au/journal/2010/193/6/iatrogenic-creutzfeldt-jakob-disease-australia-time-amend-infection-control">considered to be</a> incredibly small. Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356853/">around 5%</a> of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution. <h2>The risk is very low – and you can’t ‘catch’ it like a virus</h2> The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide. Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk. The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s disease.<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/222374/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/steve-macfarlane-4722">Steve Macfarlane</a>, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash 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/alzheimers-may-have-once-spread-from-person-to-person-but-the-risk-of-that-happening-today-is-incredibly-low-222374">original article</a>.

Mind

Women and low-income earners miss out in a superannuation system most Australians think is unfair

<a href="https://theconversation.com/profiles/antonia-settle-1019551">Antonia Settle</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Most Australians think the superannuation system is unfair, with only one in three agreeing the retirement savings scheme is fair for most Australians, according to a survey conducted for the University of Melbourne. In fact, only about half of those <a href="https://melbourneinstitute.unimelb.edu.au/publications/research-insights/search/result?paper=4630688">surveyed</a> agreed superannuation works well for them. These results contradict a conventional view based on earlier studies and held by academics and many in the personal finance sector, that Australians give little thought to superannuation. A 2013 survey found Australians have <a href="https://search.informit.org/doi/abs/10.3316/INFORMIT.285049750322819">poor knowledge</a> of how the superannuation system works, while another study in 2022 highlighted <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0011/4382057/HILDA_Statistical_Report_2022.pdf">low financial literacy</a> in general. Australians also showed <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/retirement-planning-saving-attitudes_0_0.pdf">little interest in superannuation</a>, according to a 2020 Department of Prime Minister and Cabinet survey, with few Australians showing interest in reading their superannuation statements, choosing their fund or making voluntary contributions. With Australian households seen as uninformed and uninterested, their opinions tend to be left out of the public debate. We hear much about the gender pension gap, for example, but little about what women actually think about superannuation. Similarly, the distribution of tax advantage in superannuation is hotly debated by economists but survey data tends to refrain from asking households what they think about equity in the superannuation system. The University of Melbourne survey of 1,003 Australians was undertaken by Roy Morgan Research in April. Its results show women and low-income households are widely seen as disadvantaged in the superannuation system. In fact, only one in five Australians see the superannuation system as well suited to the needs of women and of low-income households, while 70% believe super favours wealthy households. <iframe id="5VX3K" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/5VX3K/1/" width="100%" height="400px" frameborder="0"></iframe> This suggests although Australians may show little interest in the management of their super accounts and may report they find the system confusing or even <a href="https://www.professionalplanner.com.au/wp-content/uploads/2016/05/Attitudes-to-Super-Report-May-2016.pdf">boring</a>, they are surprisingly aware of how superannuation is distributed. <h2>Women, singles and low-income earners miss out</h2> The federal government’s 2020 <a href="https://treasury.gov.au/publication/p2020-100554">Retirement Income Review</a> documents these gaps. Renters, women, uncoupled households and those on low-incomes fare poorly in the retirement income system. With little super to supplement the public pension, these groups are vastly over-represented in elderly poverty statistics, which are among the <a href="https://www.oecd-ilibrary.org/sites/d76e4fad-en/index.html?itemId=/content/component/d76e4fad-en">highest in the OECD</a>. Mirroring the gaps in the superannuation system reported by the review, the University of Melbourne survey shows that it is outright homeowners and those who are married who believe the superannuation system works well. Concerns the system works poorly for women and low-income households are strongest among women and low-income households. Only one in three renters believe the superannuation system meets their needs. <iframe id="N9GO6" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/N9GO6/1/" width="100%" height="400px" frameborder="0"></iframe> This suggests individuals’ concerns about fairness in the superannuation system are driven by their own experiences of disadvantage, regardless of financial literacy. This is consistent with my own <a href="https://www.tandfonline.com/doi/full/10.1080/13563467.2023.2195159">research</a> into household attitudes to superannuation, which showed some resentment among women who were well aware their male partners had substantially higher superannuation balances than them. This all matters for policymakers. <h2>Why public perceptions are important</h2> In the short term, these results suggest public support for making super fairer is likely to be stronger than previously thought. Recent government changes to tax concessions on large balances, for example, could have gone much further without losing support from the 70% of households that think the system favours the wealthy. But it matters for the longer term too. Public perceptions of fairness, effectiveness and efficiency are crucial to policy sustainability. This is well established in the academic literature from <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/spol.12683">B Ebbinghaus</a>, 2021 and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1911-3838.12171">H Chung et al.</a>, and accepted by the Retirement Income Review. The review assessed the public’s confidence in the system to both “deliver an adequate retirement income for them(selves) and (to) generate adequate outcomes across society”. As the review makes clear, the system must avoid a loss of public confidence from perceptions of unfairness. Yet perceptions of unfairness are exactly what the University of Melbourne results suggest. This would have been clearer to policymakers if they asked earlier.<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/207633/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/antonia-settle-1019551">Antonia Settle</a>, Academic (McKenzie Postdoctoral Research Fellow), <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</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/women-and-low-income-earners-miss-out-in-a-superannuation-system-most-australians-think-is-unfair-207633">original article</a>.

Retirement Income

6 signs you’re low in iron

Feeling constantly tired, looking pale and having heart palpitations? Well you could be one of the two billion people thought to suffer from some degree of iron deficiency. Low iron is the most common and widespread nutritional disorder in the world, and is the only nutrient deficiency that is significantly prevalent in the western world, according to the World Health Organization. Here's how to know, and what to do if you tick all the low iron boxes 1. You suffer from fatigue (aka feel tired ALL of the time) The body uses iron to make haemoglobin, the substance in red blood cells that transports oxygen around the body. When you don't have enough healthy red blood cells, you start to feel pretty exhausted. 2. You seem to get out of breath easily – even if you’re fit When the body is not efficiently transporting oxygen to the lungs, you can feel breathlessness after minimal exertion. Low iron levels can also cause your endurance to suffer too. 3. You look pale and washed out In addition to looking pale, if the inside of your lips, your gums, and the inside of your bottom eyelids are less red than usual, low iron may be the reason behind this. 4. You get sick often Ever felt like you’re fighting an endless cold? Research has shown iron deficiency can affect the immune system, making you more likely to pick up infections and viruses. 5. You experience heart palpitations Your heart may feel like it's pounding, fluttering or beating irregularly, often for just a few seconds or minutes. 6. You get unusual cravings for non-food substances such as dirt, ice, paint, or clay Yes, this does sound very strange, but it's a real symptom that can occur when your body is low in iron – it's called pica. Image credits: Getty Images

Body

What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a> If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months). There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles. We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>. But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again. <h2>People are often given the wrong advice</h2> People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis. But these findings are very common in people without low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain. Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain. In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress. It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves. <h2>So how should low back pain be treated?</h2> A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety. Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice. <a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language. They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities. An example of this type of care is cognitive functional therapy. <h2>What is cognitive functional therapy?</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out. The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it. It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>. Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required. <h2>What’s the evidence for this type of therapy?</h2> Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments. We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”. We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care. The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>. People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group. The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work. <h2>What does this mean for you?</h2> This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success. <a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up. The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <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/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <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>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin 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/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.

Body

Why do I crave sugar and carbs when I’m sick?

<a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Your nose is running, your head hurts and you feel like you’re coming down with a cold. You’re settling in on the couch for a sick day. Then you reach for the snacks. When you’re sick, your appetite often decreases. So why, at other times, do you crave sugary treats and carbohydrate-loaded comfort foods? A food <a href="https://pubmed.ncbi.nlm.nih.gov/28375878/">craving</a> goes beyond a mere desire to eat, it encompasses a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399671/#CR1">complex mix</a> of emotional, behavioural, cognitive and physiological processes. Whether it’s the need for a quick energy source or a temporary relief from discomfort, our bodies and minds work in tandem to drive our food preferences. Here we’ll explore the science behind why our bodies crave sugar and carbs – especially when we’re sick. <h2>Fuelling the immune system</h2> When sickness strikes, our immune system springs into action, requiring additional energy to combat invaders. This heightened activity often leads to an increase in our <a href="https://pubmed.ncbi.nlm.nih.gov/36505552/">metabolic rate</a>, energy demands and nutritional requirements. Sugary treats and carbs are quick sources of energy, satisfying this increased demand. But while a high sugar diet during times of illness may help meet increased metabolic demands, it could also exacerbate the immune and inflammatory response, potentially impeding recovery. In the longer term, high-sugar diets promote chronic <a href="https://pubmed.ncbi.nlm.nih.gov/33339337/">inflammation</a>, <a href="https://www.science.org/doi/10.1126/scitranslmed.aay6218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">alter gut microbiota</a> composition, and are associated with chronic disease. For a <a href="https://www.mdpi.com/2072-6643/12/4/1181">well-functioning immune system</a>, aim for a <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">balanced intake</a> of <a href="https://pubmed.ncbi.nlm.nih.gov/31267783/">fruits, vegetables</a>, fibre, protein, and low-glycaemic carbohydrates. <h2>The stress response</h2> Being sick is stressful for the body. Acute mild or intense stress, like we’d see if we’re sick, boosts the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">flight or fight</a>” hormones adrenaline and cortisol. This mobilises stored energy to meet increased demands, but it can also curb appetite. <a href="https://pubmed.ncbi.nlm.nih.gov/31125634/">Prolonged stress</a> can disrupt energy balance, and cause nutritional deficiencies and alterations in gut and brain functions. This can reduce a person’s threshold for craving sugar and salt, increasing their preferences towards energy-dense foods. The stress hormone cortisol can also increase your <a href="https://pubmed.ncbi.nlm.nih.gov/24123563/">preference</a> for high-calorie, comfort foods, which can <a href="https://pubmed.ncbi.nlm.nih.gov/36615866/">temporarily alleviate stress</a>. <h2>The brain’s reward system</h2> Comfort foods trigger your brain’s reward system, releasing feel-good neurotransmitters like <a href="https://pubmed.ncbi.nlm.nih.gov/30595479/">dopamine</a> and serotonin. But “<a href="https://pubmed.ncbi.nlm.nih.gov/30951762/">sugar rushes</a>” are often short-lived and can lead to decreased alertness and heightened fatigue within an hour of consumption. The link between carbohydrates (which the body converts to sugar) and serotonin can be traced back to 1971 when <a href="https://www.science.org/doi/10.1126/science.174.4013.1023?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">researchers</a> found elevated tryptophan levels (serotonin’s precursor) in rats’ plasma and brains after a carbohydrate-rich diet. Subsequent studies in humans established connections between carbohydrates and mood, especially in relation to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">obesity, depression and seasonal affective disorder</a>. Therapies enhancing serotonin have since been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/2903717/">reduce carbohydrate intake</a>. Remarkably, around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8911970/pdf/molecules-27-01680.pdf">90% of serotonin</a> production occurs in the gut. The vast microbial population in our gut exerts a potent influence on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106557/">immunity, metabolism</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293578/pdf/40168_2021_Article_1093.pdf">appetite</a>. Recent mouse studies have even identified specific microbes linked to <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(22)01750-X">sugar binges after antibiotic treatment</a>. <h2>Some people eat less when they’re sick</h2> Not everyone craves sugar and carbs when they are sick. Some people eat less for a few reasons: <ul> <li> they have less of an appetite. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610818/pdf/JDR2017-4527980.pdf">ghrelin</a> (the “hunger” hormone) levels might initially rise, prolonged illness can suppress appetite due to nausea, fatigue and discomfort. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921333/">Critically ill</a> patients have reduced food intake and are at risk of malnutrition </li> <li> <a href="https://pubmed.ncbi.nlm.nih.gov/30777142/">metabolic adaptation</a>. The body might slow specific metabolic processes to conserve energy, reducing overall calorie requirements </li> <li> altered taste perception. <a href="https://pubmed.ncbi.nlm.nih.gov/32195512/#:%7E:text=The%20ability%20of%20an%20individual%20to%20perceive%20tastes,intake%2C%20playing%20an%20important%20role%20in%20promoting%20satiation%2Fsatiety.">Taste</a> is an important component that affects both appetite and energy intake. Alterations in taste and smell is a common symptom when we are sick and was common with <a href="https://doi.org/10.1101/2020.04.05.20048421">COVID</a> </li> <li> consuming fluids like water, tea or broths might be more appealing and manageable than solid foods. These fluids provide hydration but contribute minimally to calorie intake.<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/210565/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> </li> </ul> <a href="https://theconversation.com/profiles/hayley-oneill-1458016">Hayley O'Neill</a>, Assistant Professor, Faculty of Health Sciences and Medicine, <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/why-do-i-crave-sugar-and-carbs-when-im-sick-210565">original article</a>.

Body

Rob Lowe's West Wing confession

Rob Lowe has spoken candidly about leaving one of his most acclaimed TV shows. The 59-year-old actor has opened up about leaving The West Wing, which first aired in 1999 with Lowe playing the character of Sam Seaborn, the Bartlet administration's deputy communications director, on the very first episode of the show. The show ran for seven seasons and went off the air in 2006, although Lowe left the show during season four. Despite the show's popularity, Lowe said that leaving the show when he did was the best decision to make for him and his future career. Speaking candidly on the Stitcher Studios' podcast Podcrushed, Lowe was asked about why he left the show, and he summed up his departure with an analogy. He said, "I walked away from the most popular girl at school, but I also knew that it was a super unhealthy relationship, and it was the best thing I ever did." The unofficial story when Lowe left the show, as reported by <a href="https://www.cnn.com/2002/SHOWBIZ/TV/07/24/west.wing.lowe/index.html" target="_blank" rel="nofollow noopener" data-i13n="cpos:3;pos:1" data-ylk="slk:Daily Variety;cpos:3;pos:1;elm:context_link;itc:0" data-rapid_p="33" data-v9y="1">Daily Variety</a>, was that he was doing so because he couldn't get the salary that he wanted. As Lowe explained to Podcrushed hosts Penn Badgley, Nava Kavelin and Sophie Ansari, his decision had boiled down to one thing. "I felt very undervalued," said Lowe, the author of 2012's Stories I Only Tell My Friends. "Whenever I talk to actors who complain about, you know, their relationships on their shows, it happens. It happens in any workplace. You could be in an environment where people sandbag you, want to see you fail, don't appreciate you, whatever it is and whenever I share my stories, people are like, 'I will never share my own stories again.'" "They would make your hair stand up and there's some of them I wrote. I shared some of them in my book, but I purposely didn't share half of the other ones because it would make the people involved look so bad that I didn't want to do it to them." "So, I did not have a good experience. Tried to make it work and tried to make it work and tried to make it work and then what happened was my kids were getting to a certain age where I could see them having first girlfriends or friends and being in a relationship that was abusive and taking it," said Lowe, the father of sons John Owen, a 27-year-old actor, and venture capitalist Matthew, 29. "She's the popular girl, everybody likes her, she's beautiful, it must be great. All the things that people would say about making The West Wing to me. It's so popular, it's so amazing, it must be amazing, but I know what it's like and if I couldn't walk away from it, then how could I empower my kids to walk away from it?" When Lowe did leave the show, he issued a statement on why his character would be written out. "As much as it hurts to admit it, it has been increasingly clear, for quite a while, that there was no longer a place for Sam Seaborn on The West Wing," he said, <a href="https://www.cnn.com/2002/SHOWBIZ/TV/07/24/west.wing.lowe/index.html" target="_blank" rel="nofollow noopener" data-i13n="cpos:5;pos:1" data-ylk="slk:per CNN;cpos:5;pos:1;elm:context_link;itc:0" data-rapid_p="36" data-v9y="1">per CNN</a>. "However, Warner Bros. has allowed me an opportunity to leave the show as I arrived ... grateful for it, happy to have been on it and proud of it. We were a part of television history and I will never forget it." Image credits: Getty Images

Harrison Ford is back as an 80-year-old Indiana Jones – and a 40-something Indy. The highs (and lows) of returning to iconic roles

<a href="https://theconversation.com/profiles/ben-mccann-398197">Ben McCann</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Saddle up, don the fedora and crack that whip: Harrison Ford is back as the intrepid archaeologist in Indiana Jones and the Dial of Destiny. The film premiered at Cannes, where Ford was <a href="https://www.hollywoodreporter.com/movies/movie-news/harrison-ford-honorary-palme-dor-cannes-1235495463/">awarded</a> an Honorary Palme d’Or in recognition of his life’s work. Reviews for the fifth film in the franchise <a href="https://www.hollywoodreporter.com/movies/movie-news/indiana-jones-5-review-roundup-1235495961/">have been mixed</a>, and it is the first Indy film not to be directed by Steven Spielberg (this time, it’s James Mangold, best known for his motor-racing drama Ford v Ferrari). But this is “event” cinema that combines nostalgia, old-school special effects and John Williams’ <a href="https://theconversation.com/from-jaws-to-star-wars-to-harry-potter-john-williams-90-today-is-our-greatest-living-composer-176245">iconic score</a>. So, Ford is back, aged 80. What draws actors back after all this time? <figure><iframe src="https://www.youtube.com/embed/eQfMbSe7F2g?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Role returns</h2> Ford first played Indy in 1981 and last played him in 2008. That is a full 15 years since the most recent film in the series, and 42 years since his first outing in Raiders of the Lost Ark. Ford has form in returning to celebrated characters. One of the great pleasures of watching The Force Awakens back in 2015 was seeing Ford play Han Solo again for the <a href="https://www.dailymotion.com/video/x3j2j09">first time in over 30 years</a>. <figure><iframe src="https://www.youtube.com/embed/0xQSIdSRlAk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Actors return to roles for numerous reasons: <ul> <li>financial (Ford was reportedly paid <a href="https://okmagazine.com/exclusives/harrison-ford-paid-indiana-jones-5-plagued-with-problems/">US$25 million</a> for Dial of Destiny)</li> <li>protection of their brand, image and star persona (Michael Keaton <a href="https://www.fortressofsolitude.co.za/the-flash-movies-biggest-hero-how-michael-keaton-saved-the-film/">returning to play Batman</a> after three decades and three other actors who have embodied the role)</li> <li>professional (Tom Cruise admitted over the 36 years between Top Gun films he wanted to make sure the sequel <a href="https://screenrant.com/top-gun-maverick-tom-cruise-return-how-explained/">could live up to the original</a>)</li> <li>personal (once-huge stars are working less and less, and only feel the need to return to a built-in fan base every few years – Bill Murray in the 2021 Ghostbusters sequel springs to mind).</li> </ul> It’s not always a successful endeavour. Arnold Schwarzenegger and Sylvester Stallone – two of the biggest action stars of the 1980s off the back of iconic roles as The Terminator, Rocky Balboa and John Rambo – have repeatedly returned to those roles, and critics have been <a href="https://screenrant.com/terminator-dark-fate-undermined-john-connor-storyline-franchise-bad/">particularly harsh</a>. It did not work for Sigourney Weaver in <a href="https://www.rogerebert.com/reviews/alien-resurrection-1997">Alien: Resurrection</a> in 1997, 18 years after her first time as Ripley; nor for Keanu Reeves in <a href="https://www.theguardian.com/film/2021/dec/21/the-matrix-resurrections-review-keanu-reeves">The Matrix Resurrections</a> in 2021, 23 years after the original. And still, I’m intrigued to see what Michael Mann could do with his long-rumoured sequel to Heat, his definitive 1995 crime film. Ever since Mann published his novel Heat 2 last year – a kind of origin story for Heat’s key protagonists – fans have been hoping a de-aged Al Pacino (now aged 83) <a href="https://deadline.com/2023/04/michael-mann-heat-2-warner-bros-adam-driver-young-neil-mccauley-1235316777/">might return</a> as LA cop Vincent Hanna. <h2>Undoing time</h2> “Digital de-ageing” first entered the Hollywood mainstream in 2019 with The Irishman and Captain Marvel. <a href="https://www.indiewire.com/features/craft/de-aging-actors-history-benjamin-button-dial-of-destiny-harrison-ford-1234863938/">Via this process</a>, older actors (Robert De Niro, Al Pacino and Samuel L. Jackson have all been subject to the technology) move back and forwards in time without younger actors having to play them. <figure><iframe src="https://www.youtube.com/embed/OF-lElIlZM0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Films still tend to cast two actors to play older and younger versions of the same character, a choice that dates back at least to 1974’s The Godfather Part II, in which a young Robert de Niro plays Vito Corleone, portrayed by the much older Marlon Brando in the first film. In 1989, Indiana Jones and the Last Crusade features a delightful opening scene where River Phoenix plays the young version of Indiana Jones, before Ford takes over for the rest of the film. <figure><iframe src="https://www.youtube.com/embed/AwH6-Yh7_SM?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Actors used to just play characters of their own age when reprising earlier roles. Paul Newman finally won a Best Actor Oscar for his role as “Fast Eddie” Felson in The Color of Money (1986), a quarter of a century after first playing him in The Hustler. The sequel plays on Newman’s age, and his role as a mentor to an upcoming Tom Cruise, and bathes viewers in nostalgia and memories of <a href="https://faroutmagazine.co.uk/paul-newman-schooled-tom-cruise-the-color-of-money/">a younger Newman</a>. <figure><iframe src="https://www.youtube.com/embed/k7gmrKAFshE?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> But actors no longer have to exclusively play their age. The first part of Dial of Destiny is an extended flashback, set in 1944, in which Ford has been digitally de-aged to appear in his 40s. This process used an AI system that scanned used and unused reels of footage of Ford from <a href="https://www.cbr.com/harrison-ford-de-aging-indiana-jones-dial-of-destiny/">the first three Indy films</a> to match his present-day performance. Here, it is as if we are getting two Fords for the price of one: the “younger”, fitter Indy and the older, more world-weary version. It makes for a powerfully emotional connection on screen. Yet there are some <a href="https://variety.com/2023/film/awards/indiana-jones-5-harrison-ford-de-aging-not-working-1235618698/">pitfalls to de-ageing</a>. Some viewers complain that the whole process is distracting and that the hyper-real visual look of de-aged scenes resembles a video game. Even so, de-ageing in Hollywood cinema is here to stay. Tom Hanks’s <a href="https://variety.com/2023/film/news/tom-hanks-robin-wright-digitally-deaged-robert-zemeckis-movie-1235507766/">next film</a> is using AI-based generative technology to digitally de-age him. Given its reduced cost, speed and reduced human input, AI-driven innovation might have <a href="https://filmstories.co.uk/news/new-ai-driven-de-ageing-tools-to-be-used-in-tom-hanks-project/">industry-changing ramifications</a>. <h2>The star of Ford</h2> Harrison Ford remains a bona fide “movie star” in an industry profoundly buffeted by COVID, the rise of streaming platforms, the demise of the monoculture, and the changing nature of who constitutes a star. In the midst of all this industry uncertainty, it seems there is no longer a statute of limitations on actors returning to much-loved characters. The next big ethical issue for the film industry as it further embraces AI is whether to <a href="https://collider.com/james-dean-digital-cgi-performance-in-new-movie/">resurrect deceased actors</a> and cast them in new movies. Still, I’m looking forward to seeing more actors de-aged as the technology improves and audiences acclimatise to watching older actors “playing” younger versions of themselves. We are only at the start of Hollywood’s next big adventure.<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/202357/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ben-mccann-398197">Ben McCann</a>, Associate Professor of French Studies, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</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/harrison-ford-is-back-as-an-80-year-old-indiana-jones-and-a-40-something-indy-the-highs-and-lows-of-returning-to-iconic-roles-202357">original article</a>.

Movies

Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds

<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/andrew-mclachlan-255312">Andrew McLachlan</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <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> Opioids are the one of the most prescribed pain-relief for people with low back and neck pain. In Australia, around <a href="https://link.springer.com/article/10.1007/s00586-017-5178-4">40% of people</a> with low back and neck pain who present to their GP and <a href="https://qualitysafety.bmj.com/content/28/10/826">70% of people</a> with low back pain who visit a hospital emergency department are prescribed opioids such as oxycodone. But our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext">new study</a>, published today in the Lancet medical journal, found opioids do not relieve “acute” low back or neck pain (lasting up to 12 weeks) and can result in worse pain. Prescribing opioids for low back and neck pain can also cause <a href="https://www.healthdirect.gov.au/taking-opioid-medicines-safely">harms</a> ranging from common side effects – such as nausea, constipation and dizziness – to <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary">misuse, dependency, poisoning and death</a>. Our findings show opioids should not be recommended for acute low back pain or neck pain. A change in prescribing for low back pain and neck pain is urgently needed in <a href="https://www.tga.gov.au/resources/publication/publications/addressing-prescription-opioid-use-and-misuse-australia">Australia</a> and <a href="https://www.thelancet.com/commissions/opioid-crisis">globally</a> to reduce opioid-related harms. <h2>Comparing opioids to a placebo</h2> In our trial, we randomly allocated 347 people with acute low back pain and neck pain to take either an opioid (oxycodone plus naloxone) or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo</a> (a tablet that looked the same but had no active ingredients). Oxycodone is an opioid pain medicine which can be given orally. <a href="https://www.nps.org.au/radar/articles/oxycodone-with-naloxone-controlled-release-tablets-targin-for-chronic-severe-pain">Naloxone</a>, an opioid-reversal drug, reduces the severity of constipation while not disrupting the pain relieving effects of oxycodone. Participants took the opioid or placebo for a maximum of six weeks. People in the both groups also received <a href="https://www.sciencedirect.com/science/article/pii/S1836955321000941">education and advice</a> from their treating doctor. This could be, for example, advice on returning to their normal activities and avoiding bed rest. We assessed their outcomes over a one-year period. <h2>What did we find?</h2> After six weeks of treatment, taking opioids did not result in better pain relief compared to the placebo. Nor were there benefits to other outcomes such as physical function, quality of life, recovery time or work absenteeism. More people in the group treated with opioids experienced nausea, constipation and dizziness than in the placebo group. Results at one year highlight the potential long-term harm of opioids even with short-term use. Compared to the placebo group, people in the opioid group experienced slightly worse pain, and reported a higher risk of <a href="https://academic.oup.com/painmedicine/article/20/1/113/4728236#129780622">opioid misuse</a> (problems with their thinking, mood or behaviour, or using opioids differently from how the medicines were prescribed). More people in the opioid group reported pain at one year: 66 people compared to 50 in the placebo group. <h2>What will this mean for opioid prescribing?</h2> In recent years, international low back pain guidelines have shifted the focus of treatment from drug to non-drug treatment due to <a href="https://www.thelancet.com/article/S0140-6736(18)30489-6/fulltext">evidence</a> of limited treatment benefits and concern of medication-related harm. For acute low back pain, <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">guidelines</a> recommend patient education and advice, and if required, anti-inflammatory pain medicines such as ibuprofen. Opioids are <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">recommended only</a> when other treatments haven’t worked or aren’t appropriate. Guidelines for <a href="https://pubmed.ncbi.nlm.nih.gov/33064878/">neck</a> pain similarly discourage the use of opioids. Our latest research clearly demonstrates the benefits of opioids do not outweigh possible harms in people with acute low back pain and neck pain. Instead of advising opioid use for these conditions in selected circumstances, opioids should be discouraged without qualification. <h2>Change is possible</h2> Complex problems such as opioid use need smart solutions, and another study we recently conducted provides convincing data opioid prescribing can be successfully reduced. The <a href="https://qualitysafety.bmj.com/content/30/10/825">study</a> involved four hospital emergency departments, 269 clinicians and 4,625 patients with low back pain. The intervention comprised of: <ul> <li>clinician education about <a href="https://aci.health.nsw.gov.au/networks/musculoskeletal/resources/low-back-pain">evidence-based management</a> of low back pain</li> <li>patient education using posters and handouts to highlight the benefits and harms of opioids</li> <li>providing heat packs and anti-inflammatory pain medicines as alternative pain-management treatments</li> <li>fast-tracking referrals to outpatient clinics to avoid long waiting lists</li> <li>audits and feedback to clinicians on information about opioid prescribing rates.</li> </ul> This intervention reduced opioid prescribing from <a href="https://qualitysafety.bmj.com/content/30/10/825">63% to 51% of low back pain presentations</a>. The <a href="https://emj.bmj.com/content/early/2023/04/02/emermed-2022-212874">reduction was sustained for 30 months</a>. Key to this successful approach is that we worked with clinicians to develop suitable pain-management treatments without opioids that were feasible in their setting. More work is needed to evaluate this and other interventions aimed at reducing opioid prescribing in other settings including GP clinics. A nuanced approach is often necessary to avoid causing <a href="https://theconversation.com/opioid-script-changes-mean-well-but-have-left-some-people-in-chronic-pain-156753">unintended consequences</a> in reducing opioid use. If people with low back pain or neck pain are using opioids, especially at higher doses over an extended period of time, it’s important they seek advice from their doctor or pharmacist before stopping these medicines to avoid <a href="https://www.healthdirect.gov.au/opioid-withdrawal-symptoms">unwanted effects when the medicines are abruptly stopped</a>. Our research provides compelling evidence opioids have a limited role in the management of acute low back and neck pain. The challenge is getting this new information to clinicians and the general public, and to implement this evidence into practice.<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/203244/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/andrew-mclachlan-255312">Andrew McLachlan</a>, Head of School and Dean of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, Postdoctoral Research Associate in Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <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> 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/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">original article</a>.

Body

Back on course: overcoming low back pain for senior golfers

As a retiree and avid golfer, I experienced the debilitating pain of a herniated disc in my lower back. I never thought golf could cause such agony, but I was determined to overcome it and return to the game I love. Low back pain is a common condition among senior-aged golfers, with reported prevalence rates of up to 50%. Which means if you're playing in a foursome with fellow seniors it's likely two of you have low back pain. Why? Because we are more prone to back pain due to age-related changes in the spine, such as disc degeneration, and arthritis. Additionally, poor swing mechanics, lack of flexibility, or poor physical conditioning increase the risk. The golf swing involves a complex sequence of movements that can sometimes place significant stress on the lower back, particularly the lumbar spine. The repetitive twisting, bending, and rotational forces can lead to various types of back injuries, including herniated discs, muscle strains, and degenerative disc disease. After being diagnosed with a herniated disc six weeks ago, my doctor recommended physical therapy treatments with a chiropractor and physiotherapist. I also found relief through regular massage and daily use of a TENS machine. Stretching and strengthening exercises can improve flexibility and core stability. I found simple Qi Gong exercises easy. Qi Gong has been described as like high-powered Tai Chi. The standing exercises appealed to me as I'm stubbornly averse to any exercise requiring laying on the floor. Within weeks of therapy and home exercises, the pain had subsided enough for me to consider a gentle swing in the backyard. A few easy swings with the 7-iron and all felt good. No added discomfort. To prepare for a game, I enrolled in an online course called 'Pain Free Golf' by Croker Golf System. The course helped me adjust my swing to avoid re-injury. To further protect my lower back, I purchased two helpful devices. A ball pick-up device which attaches to the handle end of the putter ($10 approx. from the local pro shop) to enable retrieving my ball from the cup without bending forward. A second device I found was the 'easy tee-up' ($130 approx. - search “Easy Tee Up” online) which helps me tee up the ball without bending down to the ground. Now, six weeks after my herniated disc incident, I'm playing almost painless golf again, and my game has even improved. I never would have thought that a herniated disc would ultimately improve my golf game, but the experience taught me the importance of taking better care of my body and using the right resources to get back in the swing. To all fellow golfers, take care of yourselves and don't give up hope if you ever find yourself in the same situation. There are plenty of people and resources available to help you get back to playing the game you love - with no or low back pain. About the writer: Mike Searles is a Melbourne retiree who loves playing golf. Image: Shutterstock

Body

Don’t blame women for low libido. Sexual sparks fly when partners do their share of chores – including calling the plumber

When a comic about “mental load” <a href="https://english.emmaclit.com/2017/05/20/you-shouldve-asked/">went viral in 2017</a>, it sparked conversations about the invisible workload women carry. Even when women are in paid employment, they remember their mother-in-law’s birthday, know what’s in the pantry and organise the plumber. This mental load often goes unnoticed. Women also <a href="https://theconversation.com/yet-again-the-census-shows-women-are-doing-more-housework-now-is-the-time-to-invest-in-interventions-185488">continue to do more housework</a> and childcare than their male partners. This burden has been exacerbated over the recent pandemic (homeschooling anyone?), <a href="https://theconversation.com/planning-stress-and-worry-put-the-mental-load-on-mothers-will-2022-be-the-year-they-share-the-burden-172599">leaving women</a> feeling exhausted, anxious and resentful. As sexuality researchers, we wondered, with all this extra work, do women have any energy left for sex? We decided to explore how mental load affects intimate relationships. We focused on female sexual desire, as “low desire” affects <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609520307566">more than 50% of women</a> and is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0091302217300079">difficult to treat</a>. Our study, published in the <a href="https://www.tandfonline.com/doi/full/10.1080/00224499.2022.2079111">Journal of Sex Research</a>, shows women in equal relationships (in terms of housework and the mental load) are more satisfied with their relationships and, in turn, feel more sexual desire than those in unequal relationships. <h2>How do we define low desire?</h2> Low desire is tricky to explore. More than simply the motivation to have sex, women describe sexual desire as a state-of-being and a need for closeness. Adding to this complexity is the fluctuating nature of female desire that changes in response to life experiences and the <a href="https://www.bbc.com/future/article/20160630-the-enduring-enigma-of-female-desire">quality of relationships</a>. Relationships are especially important to female desire: relationship dissatisfaction is a <a href="https://pubmed.ncbi.nlm.nih.gov/18410300/">top risk factor</a> for low desire in women, even more than the physiological impacts of age and menopause. Clearly, relationship factors are critical to understanding female sexual desire. As a way of addressing the complexity of female desire, a <a href="https://link.springer.com/article/10.1007/s10508-018-1212-9">recent theory</a> proposed two different types of desire: dyadic desire is the sexual desire one feels for another, whereas solo desire is about individual feelings. Not surprisingly, dyadic desire is intertwined with the dynamics of the relationship, while solo desire is more amorphous and involves feeling good about yourself as a sexual being (feeling sexy), without needing validation from another. <h2>Assessing the link</h2> Our research acknowledged the nuances of women’s desire and its strong connection to relationship quality by exploring how fairness in relationships might affect desire. The research involved asking 299 Australian women aged 18 to 39 questions about desire and relationships. These questions included assessments of housework, mental load – such as who organised social activities and made financial arrangements – and who had more leisure time. We compared three groups: <ul> <li>relationships where women perceived the work as equally shared equal (the “equal work” group)</li> <li>when the woman felt she did more work (the “women’s work” group)</li> <li>when women thought that their partner contributed more (the “partner’s work” group).</li> </ul> We then explored how these differences in relationship equity impacted female sexual desire. <h2>What we found</h2> The findings were stark. Women who rated their relationships as equal also reported greater relationship satisfaction and higher dyadic desire (intertwined with the dynamics of the relationship) than other women in the study. Unfortunately (and perhaps, tellingly), the partner’s work group was too small to draw any substantial conclusions. However, for the women’s work group it was clear their dyadic desire was diminished. This group was also less satisfied in their relationships overall. We found something interesting when turning our attention to women’s solo desire. While it seems logical that relationship inequities might affect all aspects of women’s sexuality, our results showed that fairness did not significantly impact solo desire. This suggests women’s low desire isn’t an internal sexual problem to be treated with <a href="https://www.insider.com/guides/health/yoni-eggs#:%7E:text=Yoni%20eggs%20are%20egg%2Dshaped,bacterial%20infections%20and%20intense%20pain.">mindfulness apps and jade eggs</a>, but rather one that needs effort from both partners. Other relationship factors are involved. We found children increased the workload for women, leading to lower relationship equity and consequently, lower sexual desire. Relationship length also played a role. Research shows long-term relationships are <a href="https://link.springer.com/article/10.1007/s10508-018-1175-x">associated with</a> decreasing desire for women, and this is often attributed to the tedium of over-familiarity (think of the bored, sexless <a href="https://www.youtube.com/watch?v=kBq-Nyo0lQg">wives in 90s sitcoms</a>). However our research indicates relationship boredom is not the reason, with the increasing inequity over the course of a relationship often the cause of women’s disinterest in sex. The longer some relationships continue, the more unfair they become, lowering women’s desire. This may be because women take on managing their partner’s relationships, as well as their own (“It’s time we had your best friend over for dinner”). And while domestic housework may start as equally shared, over time, women <a href="https://www.abs.gov.au/media-centre/media-releases/women-spent-more-time-men-unpaid-work-may">tend to do more</a> household tasks. <h2>What about same-sex couples?</h2> Same-sex couples have <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/fare.12293">more equitable relationships</a>. However, we found the same link between equity and desire for women in same-sex relationships, although it was much stronger for heteronormative couples. A sense of fairness within a relationship is fundamental to all women’s satisfaction and sexual desire. <h2>What happens next?</h2> Our findings suggest one response to low desire in women could be to address the amount of work women have to take on in relationships. The link between relationship satisfaction and female sexual desire has been firmly established in <a href="https://link.springer.com/article/10.1007/s10508-018-1175-x">previous research</a> but our findings explain how this dynamic works: women’s sense of fairness within a relationship forecasts their contentment, which has repercussions on their desire for their partner. To translate our results into clinical practice, we could run trials to confirm if lowering women’s mental load results in greater sexual desire. We could have a “housework and mental load ban” for a sample of women reporting low sexual desire and record if there are changes in their reported levels of desire. Or perhaps women’s sexual partners could do the dishes tonight and see what happens. Image credit: Shutterstock This article originally appeared on <a href="https://theconversation.com/dont-blame-women-for-low-libido-sexual-sparks-fly-when-partners-do-their-share-of-chores-including-calling-the-plumber-185401" target="_blank" rel="noopener">The Conversation</a>.

Relationships

Unique transportable home to be sold at low-cost

A tiny foldable house is set to sell for less than a quarter of the average Queensland home loan deposit, already attracting 48 bids in an ongoing auction. The 35sqm portable house, popularly known as a donga, was listed for auction “brand new” by a company in Toowoomba. The 19ft by 20ft modified transportable house has seen 48 bids cast, lifting the price to $13,000, with bids rising in $250 increments. Market prices for fully fitted out dongas generally sell for around $20,000, depending on the quality of the fittings required. The owner of the literal ‘pick-up-and-go’ home has no reserve price set for the little container, meaning whenever the highest bid is made, the auction will close. The unique foldable home has an ensuite with a basic shower, toilet, sink and mirror. It also has eight lockable windows, one door and is decked out with timber flooring. There are hot and cold water inlets, two waste outlets, lighting, an exhaust fan vent, gas struts and winches for easy assembly. The container home has an efficiency star rating of 4, with water consumption at 4.5l full flush and 3.1l half flush. “Units are plumbed for the shower but showerhead/mixer needs to be supplied and installed by buyer.” The only issue with this unique little unit is it does not come wired, so the buyer has to arrange for an electrician to supply and install the wiring. The home also has “adjustable feet for easy levelling” and can be folded up and ready to transport. Image credit: realestate.com.au

Real Estate

The verdict: Full fat versus low fat milk

The idea of full low milk being healthier for us began circulating in the 1950s. It was shown that saturated fat increased blood cholesterol levels, with certain statistical evidence leading to the assumption it resulted in higher rates of heart disease and obesity. This idea is not totally wrong. Full fat milk does indeed have a high saturated fat content, about 65 percent in fact. <a href="http://www.simoneaustin.com/" target="_blank" rel="noopener">Simone Austin</a>, accredited practising dietitian and spokesperson for the <a href="http://daa.asn.au/" target="_blank" rel="noopener">Dietitians Association of Australia</a> addresses the claims that saturated fat should be avoided when it comes to weight management. “We are still recommending saturated fat should be kept to a minimum as there is still a link between saturated and plasma cholesterol levels, however full cream milk is only 4% total fat and is therefore not a high fat product, depending on quantity of course.” Health and nutrition coach and whole foods chef, Lee Holmes, believes that low-fat milk is a great option for those trying to lose weight. Even though the fat is skimmed, the milk itself still contains an abundance of calcium and protein, and these are essential to weight loss. “Low-fat milk is better for overall weight control and maintenance as it only contains 0.15% fat as opposed to full-cream milk which contains 3.8% fat” she explains. The New Zealand Ministry of Health recommends enjoying mostly low and reduced fat milk and milk products, as it can reduce the total daily kilojoule intake to aid with weight management. This is generally believed to lead to weight loss and reduced risk of heart disease. However, Simone explains why it is not quite that straight forward. “Fat can give some feeling of satiety. If you are having less milk overall, and it is more filling to have full cream milk, then this might decrease overall volume of food consumed and therefore not be detrimental”. This approach is supported by recent research conducted by <a href="../%20http:/www.ncbi.nlm.nih.gov/pubmed/26746178">Swedish researchers</a>, looking at the dairy consumption of a group of middle aged men. If found that those who ate full fat dairy products were less likely to become obese over a period of 12 years, compare with men who rarely ate high- fat diary. This is because the weight-loss effect of reducing saturated fat depends on what replaces it in the diet, which is usually sugar and carbohydrates. Unfortunately, most of us are susceptible to consciously or unconsciously replacing a larger reduction in calories with something else. So, if you drink low-fat varieties of milk in order to reduce calorie intake, you must ensure you are not making up these calories elsewhere for this approach to be effective. However, in your quest for a slimmer waist line, it is important not to overlook other important health factors. Milk is a primary source of nutrients, and according to both Simone and the <a href="http://ro.uow.edu.au/cgi/viewcontent.cgi?article=2032&context=sspapers" target="_blank" rel="noopener">ABS</a>, most over-60s simply aren’t getting what they need. “In New Zealand the annual per capita consumption of milk has declined by 30% in the last 20 years, and 20% of the New Zealand population has an inadequate intake of calcium”. Simone stresses that simply aiming to meet serves is the priority. “Milk also provides a valuable source of protein and as we age our efficiency at using protein reduces, so we need to have a little more”. Lee Holmes echoes this, stating that ideally, people over 60 years of age should be having two to three glasses of cow’s milk daily to absorb the necessary amounts of calcium. If you don’t want to consume that much milk, are lactose intolerant or prefer to opt for non-cow’s milk (such as almond) you need to make these nutrients up elsewhere. “You may want to consider a quality, natural supplement to ensure you are giving your body all the nutrients it needs." So whether it be low-fat or full-fat, say cheers to milk and manage your weight loss in accordance with other health factors. Image: Getty Images

Food & Wine

Sam Newman lashes out at “woke” athletes “with low IQs”

Former AFL player Sam Newman has weighed in on a string of recent conflicts in the sporting world over million-dollar sponsorship deals, calling out “woke” athletes “with low IQs”. He claimed the world was “being run by patronising and pompous, arrogant people”, creating a “ridiculous, woke society of nonsense”. His comments come after the news emerged of controversies involving Netball Australia and the Fremantle Dockers. Netball Australia, which is in desperate need of funding, is in dispute with some of its star players around a $15 million sponsorship deal with Hancock Prospecting, which is owned by mining magnate Gina Rinehart. The deal would also see the company’s logo featured on the uniforms of Diamonds players, but opposition came from Indigenous player Donell Wallam and her teammates in relation to the company’s historical stance against Indigenous communities. Rinehart’s father, Lang Hancock, made a series of racist comments about Indigenous people in a 1984 documentary, Couldn’t Be Fairer, including his solution to the “Aboriginal problem”. “I would dope the water up so that they were sterile and would breed themselves out in future and that would solve the problem,” Hancock said in the film. In the AFL world, major Fremantle Dockers supporter Woodside Energy, a natural gas exporter, has left some high-profile fans concerned. Author Tim Winton and former WA premier Carmen Lawrence are among a group of fans urging the football club to end the agreement with the gas company. These controversies have become fodder for Newman, who shared his opinions on both with Sky News. The 76-year-old said he wouldn’t wear a certain sports jersey if he didn’t agree with what was on the front of it, but that “the price of being virtuous is hypocrisy” and that it’s unrealistic to expect sports could continue without money from the mining or energy sector. “If you think fossil fuels are going to disappear in the very near future then you’re mistaken because that’s the end of the civilised world as we know it no matter what you think of climate and no matter what you think of global warming,” he said. “I notice one of the netballers said they weren’t happy with Hancock because of their climate record, I mean seriously the world we live in is being run by patronising and pompous, arrogant people who have no idea really what they’re on about.” He then dubbed the netballers as hypocrites. “We have people with low IQs telling a sporting body which is on its knees financially that they won’t accept money from sponsorship deals from a company which I’m sure that those people who are complaining use one of those products indirectly or directly that Hancock Mining or Hancock industries have fabricated on a daily basis,” he said. When Sky News host Chris Kenny suggested that sports stars should just not play if they don’t agree with who sponsors their game, Newman disagreed, saying that those running teams or codes have a “duty of care” to inform players before they sign up. “[They have] a duty of care [to] say to the rank and file before they sign them up, "We're going to have Alinta Energy or Hancock mining sponsor us, have you got any problems with it?’” Newman said. “And if they have you could actually sort it out before they did the deal.” As for the Fremantle Dockers, Newman took the opportunity to slam the sport in general. “If I could just go a step further (about) the feigned indignation of the AFL who insist on telling us to be the moral arbiters of what we believe in,” he said. “I've said this before. At the AFL grand final we had three references to Indigenous Australians. “One of them is absolutely appropriate and no one could agree with it more. “But they had three separate references... lest we have to be told that we (have to) respect everything that's going on in the country. “They made a Muslim woman (Haneen Zreika of the Giants) the face of the AFLW, and then... she declined (to) wear the gay pride jumper. “If you get into the political realm in a sporting organisation, you end up creating a hornet's nest for the people who want nothing more than to go to the football or the sporting event just to watch it for what it is. “But they keep forcing this moral code onto us, to perhaps appease their own social prejudices and it turns into a ridiculous, woke society of nonsense.” Image: Sky News (Facebook)

News

Ultra-processed foods: it’s not just their low nutritional value that’s a concern

In countries such as the UK, US and Canada, ultra-processed foods now account for <a href="https://pubmed.ncbi.nlm.nih.gov/30744710/">50% or more</a> of calories consumed. This is concerning, given that these foods have been linked to a number of different health conditions, including a greater risk of <a href="https://pubmed.ncbi.nlm.nih.gov/33167080/">obesity</a> and various chronic diseases such as <a href="https://nutritionj.biomedcentral.com/articles/10.1186/s12937-020-00604-1">cardiovascular disease</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/35896436/">dementia</a>. Ultra-processed foods are <a href="https://pubmed.ncbi.nlm.nih.gov/30744710/">concoctions of various industrial ingredients</a> (such as emulsifiers, thickeners and artificial flavours), amalgamated into food products by a series of manufacturing processes. Sugary drinks and many breakfast cereals are ultra-processed foods, as are more recent innovations, such as so-called <a href="https://www.sciencedirect.com/science/article/pii/S2213453019301144,">“plant-based” burgers</a>, which are typically made of protein isolates and other chemicals to make the products palatable. The intense industrial processes used to produced ultra-processed foods destroy the <a href="https://pubmed.ncbi.nlm.nih.gov/35067754/">natural structure</a> of the food ingredients and strip away many beneficial nutrients such as fibre, vitamins, minerals and phytochemicals. Many of us are well aware that ultra-processed foods are harmful for our health. But it’s been unclear if this is simply because these foods are of poor nutritional value. Now, two new studies have shown that poor nutrition may not be enough to explain their health risks. This suggests that other factors may be needed to fully explain their health risks. <h2>The role of inflammation</h2> The <a href="https://www.bmj.com/content/378/bmj-2022-070688">first study</a>, which looked at over 20,000 health Italian adults, found that participants who consumed the highest number of ultra-processed foods had an increased risk of dying prematurely from any cause. The <a href="https://www.bmj.com/content/378/bmj-2021-068921">second study</a>, which looked at over 50,000 US male health professionals, found high consumption of ultra-processed foods was associated with a greater risk of colon cancer. What’s most interesting about these studies is that the health risks from eating a diet high in ultra-processed foods remained even after they had accounted for the poor nutritional quality of their diets. This suggests that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8747015/">other factors</a> contribute to the harms caused by ultra-processed foods. It also implies that getting the right nutrients elsewhere in the diet may not be enough to cancel out the risk of disease from consuming ultra-processed foods. Similarly, attempts by the food industry to improve the nutritional value of ultra-processed foods by adding a few more vitamins may be side-stepping a more fundamental problem with these foods. So what factors may explain why ultra-processed foods are so harmful to our health? The Italian study found that inflammatory markers – such as a higher white blood cell count – were higher in groups that ate the most ultra-processed foods. Our bodies may trigger an inflammatory response for any number of reasons – for example, if we catch a cold or get cut. The body responds by sending signals to our immune cells (such as white blood cells) to attack any invading pathogens (such as bacteria or viruses). Usually, our inflammatory response resolves quite quickly, but some people may develop chronic inflammation throughout their body. This can cause tissue damage, and is involved in many chronic diseases – such as <a href="https://pubmed.ncbi.nlm.nih.gov/25859884/">cancer</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28744020/">cardiovascular disease</a>. Many studies have found that poor diets can increase inflammation in the body, and that this is linked to <a href="https://pubmed.ncbi.nlm.nih.gov/28744020/">higher risk</a> of chronic diseases. Given that signs of inflammation were seen in participants of the Italian study who ate the most ultra-processed foods, this could suggest that inflammation may contribute to why ultra-processed foods increase disease risk. Some food additives common in ultra-processed foods (such as emulsifiers and artificial sweeteners) also increase inflammation in the gut by causing <a href="https://pubmed.ncbi.nlm.nih.gov/29899036/">changes to the gut microbiome</a>. <figure class="align-center ">Some researchers have theorised that ultra-processed foods increase inflammation because they are recognised by the body as foreign – much like an invading bacteria. So the body mounts an inflammatory response, which has been dubbed “<a href="https://pubmed.ncbi.nlm.nih.gov/24939238/">fast food fever</a>”. This increases inflammation throughout the body as a result.</figure> Although the US colon cancer study did not establish if inflammation increased in the men consuming the most ultra-processed foods, inflammation is strongly linked with an <a href="https://pubmed.ncbi.nlm.nih.gov/27821485/">increased risk of colon cancer</a>. Research shows that other mechanisms – such as <a href="https://www.bmj.com/content/378/bmj-2022-070688">impaired kidney function</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/19502515/">toxins in packaging</a> – may also explain why ultra-processed foods cause so many dangerous health problems. Since inflammatory responses are hard-wired in our bodies, the best way to prevent this from happening is by not eating ultra-processed foods at all. Some plant-based diets high in natural, unprocessed foods (such as the <a href="https://pubmed.ncbi.nlm.nih.gov/36039924/">Mediterranean diet</a>) have also been shown to be anti-inflammatory. This may also explain why plant-based diets free from ultra-processed foods can help ward off <a href="https://pubmed.ncbi.nlm.nih.gov/26148921/">chronic diseases</a>. It’s currently not known to what extent an anti-inflammatory diet can help counteract the effects of ultra-processed foods. Simply reducing your intake of ultra-processed foods may be a challenge. Ultra-processed foods are designed to be hyper-palatable – and together with persuasive marketing, this can make resisting them an enormous challenge for <a href="https://pubmed.ncbi.nlm.nih.gov/33153827/">some people</a>. These foods are also not labelled as such on food packaging. The best way to identify them is by looking at their ingredients. Typically, things such as emulsifiers, thickeners, protein isolates and other industrial-sounding products are a sign it’s an ultra-processed food. But making meals from scratch using natural foods is the best way to avoid the harms of ultra-processed foods.<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/189918/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/richard-hoffman-221275">Richard Hoffman</a>, Associate lecturer, Nutritional Biochemistry, <a href="https://theconversation.com/institutions/university-of-hertfordshire-799">University of Hertfordshire</a> This article is republished from <a href="https://theconversation.com">The Conversation</a>. Read the <a href="https://theconversation.com/ultra-processed-foods-its-not-just-their-low-nutritional-value-thats-a-concern-189918">original article</a>.

Food & Wine

Low iron is a health risk made worse by COVID

“Beauty is an iron mine,” once remarked the Australian mining magnate, Gina Reinhart. She was talking about a precious resource, but iron is also profoundly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464783/" target="_blank" rel="noopener">important to living organisms</a>: from bacteria and fungi, to mammals like us. Iron acts as a key to numerous metabolic functions within our bodies. But iron deficiency remains as <a href="https://cdn.who.int/media/docs/default-source/nutritionlibrary/focusing-on-anaemia_970a28fe-a055-4e63-b3ba-11be7b940b16.pdf?sfvrsn=9ab36bdb_6&download=true" target="_blank" rel="noopener">one of the top global health risks</a> recognised by the World Health Organization (WHO). Iron deficiency has become the most prevalent micronutrient disorder worldwide, and COVID may be worsening the problem. <h2>Iron is hard to get</h2> The type of iron we mine is different from the “free-form” iron that can be used biologically. Free-form iron has a propensity to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842161/" target="_blank" rel="noopener">jump between two chemical states</a>, allowing it to bind to various molecules, and participate in all sorts of essential reactions within our bodies. But we see a different story again during food digestion. Inside our upper small intestine where iron is most effectively absorbed, free-form iron tends to bind to oxygen, other minerals and food components. This often results in rock-like, insoluble clumps (which are like the ones we mine!). These are too big to pass through or between our cells. This means that even when we consume enough iron, <a href="https://www.ncbi.nlm.nih.gov/books/NBK448204/#:%7E:text=Heme%20iron%2C%20derived%20from%20hemoglobin,and%20is%20less%20well%20absorbed." target="_blank" rel="noopener">typically only ~15–35% of it is absorbed</a>. It also means iron availability can be <a href="https://ift.onlinelibrary.wiley.com/doi/10.1111/1541-4337.12669" target="_blank" rel="noopener">improved, or inhibited</a> depending on how we eat it or what we eat it with. For example, heme iron from animal flesh has a <a href="https://omlc.org/spectra/hemoglobin/hemestruct/heme-struct.gif" target="_blank" rel="noopener">cage-like structure</a>, which carries the iron in a soluble form that prevents it from clumping during absorption. In many Western countries, heme iron only accounts for <a href="https://academic.oup.com/metallomics/article/3/2/103/6016197?login=true#219037456" target="_blank" rel="noopener">10% of the iron eaten, but two thirds</a> of the total iron absorbed. <h2>More of us are at risk of deficiency</h2> Getting sufficient iron sounds like simple maths: we want to add enough to our dietary intake to make up for the iron being lost from the body, such as through faeces, skin shedding, menstruation (for women) and sweat. But the two sides of the equation can change depending on who and where we are throughout our lifetime. Generally, iron deficiency occurs when our body’s stores of iron are depleted from not having consumed or absorbed enough iron to meet our needs. This can happen when people restrict their diets, such as for religious, social or medical reasons. Some people also have a tough time keeping up when their iron needs increase, such as <a href="https://www.nature.com/articles/s41430-019-0400-6" target="_blank" rel="noopener">pregnant women</a> and <a href="https://academic.oup.com/ajcn/article/106/suppl_6/1681S/4823199" target="_blank" rel="noopener">growing children</a>. But iron deficiency can also happen when the body has enough iron, <a href="https://onlinelibrary.wiley.com/doi/10.1111/bjh.12311" target="_blank" rel="noopener">but can’t effectively transport it into cells</a>. This is common in those with both acute and chronic infections, heart and autoimmune conditions, and cancers. In these cases, the underlying disease needs to be treated first, rather than improving iron intake. The table below summarises some common causes of iron deficiency. Sometimes multiple causes may occur simultaneously – for example, for many elite athletes (<a href="https://link.springer.com/article/10.1007/s00421-019-04157-y" target="_blank" rel="noopener">35% of women and 11% of men</a>), iron deficiency results from reduced absorption due to inflammation, on top of increased loss through sweat and breakdown of blood cells. <h2>COVID hasn’t helped</h2> The ongoing COVID epidemic has also introduced multiple risk factors for iron deficiency. We know severe infection with SARS-CoV-2 (the virus that causes COVID) may change the way some people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305218/" target="_blank" rel="noopener">metabolise iron</a>, leading to lower iron levels up to two months after infection. This <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.26774" target="_blank" rel="noopener">contributes to symptoms</a> commonly reported after infection, such as fatigue and lethargy. Recovery from the pandemic itself has also exacerbated <a href="https://www.oecd.org/coronavirus/policy-responses/food-supply-chains-and-covid-19-impacts-and-policy-lessons-71b57aea/" target="_blank" rel="noopener">food supply issues</a>, as well as the <a href="https://blogs.worldbank.org/developmenttalk/global-income-inequality-and-covid-19-pandemic-three-charts" target="_blank" rel="noopener">rising global income inequality</a>. This means more people face barriers to food security – and the nutrient-dense foods that help boost our iron intake like red meat or leafy greens may be unavailable or unaffordable for them. <h2>Before you pick up a pill</h2> It may be tempting to pick up one of the many widely available iron supplements to attempt to boost your intake. However, we have to keep in mind that conventional iron supplementation is <a href="https://www.tandfonline.com/doi/full/10.1185/03007995.2012.761599" target="_blank" rel="noopener">associated with some negative side effects</a>. These include damage to our gut lining, nausea, diarrhoea and constipation. Iron supplementation has also been linked to changes in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400826/" target="_blank" rel="noopener">gut microbiome</a>, a critical determinant of health. The WHO has recommended <a href="https://cdn.who.int/media/docs/default-source/micronutrients/gff-part-1-en.pdf?sfvrsn=afc1c426_2" target="_blank" rel="noopener">two other approaches</a>: diet diversification and food fortification. <a href="https://cdn.who.int/media/docs/default-source/anaemia/areacop-webinar---24-september-2020/areacop-webinar-nancyaburto-presentation.pdf?sfvrsn=7abd1427_4" target="_blank" rel="noopener">Diet diversification</a> is exactly as it sounds: having a diet with a variety of wholefoods such as fruits and vegetables, grains and legumes, meat, dairy, and nuts and seeds. This approach not only ensures sufficient levels of iron are found in the foods we eat, but also that they come with different forms or “vehicles” to improve absorption. This approach works <a href="https://apps.who.int/iris/bitstream/handle/10665/349086/WHO-EURO-2021-4007-43766-61591-eng.pdf?sequence=1&isAllowed=y" target="_blank" rel="noopener">even with plant-based foods</a>. Food fortification, where iron is added to processed foods, is also a fairly safe yet accessible option due to its lower dose. In Australia, iron is commonly fortified in products such as bread, cereals and ready-to-drink mixes. It can be challenging to get the iron into our body and where it’s needed. But before turning to supplements, we must remind ourselves that food sources should always be first-in-line. In cases of diagnosed deficiencies, your healthcare professional will provide you with further information where supplements are necessary. This article originally appeared on <a href="https://theconversation.com/low-iron-is-a-health-risk-made-worse-by-covid-how-to-get-more-without-reaching-for-supplements-185020" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Body

“What a low act!": Daniel Morcombe's parents outraged at upcoming film

The devastated parents of murdered Queensland boy Daniel Morcombe have blasted an upcoming film about their son’s death. Daniel Morcombe was only 13 years old when he was abducted and murdered on Queensland’s Sunshine Coast in December, 2003. In August 2011, Brett Peter Cowan was arrested and later found guilty of Daniel’s murder. Now parents Denise and Bruce Morcombe have come out attacking the film The Stranger, which tells the story of an undercover detective trying to catch a killer in Australia. The Stranger premiered at Cannes earlier this year and will play at the Melbourne International Film Festival in August. A statement from the Morcombe’s was shared on the Daniel Morcombe Foundation Facebook page calling the film a “low act” and have asked people not to watch it. <blockquote class="twitter-tweet"> The movie “The Stranger” is not supported by the Morcombe family. Individuals who make money on a heinous crime are parasites. They are callously disrespectful to Daniel, the DMF & the Morcombe family. We find the making of the movie morally corrupt and cruel. Shame on you. <a href="https://t.co/9FEFAp5g0G">pic.twitter.com/9FEFAp5g0G</a> — Denise Morcombe OAM (@DeniseMorcombe) <a href="https://twitter.com/DeniseMorcombe/status/1547358728286261248?ref_src=twsrc%5Etfw">July 13, 2022</a></blockquote> “What a low act! I won’t be going to watch this movie. I won’t be recommending anyone go. The movie is not supported or sanctioned in any way by the Morcombe family,” the statement read. “It’s appalling storyline ignores our family‘s pain and chooses to profit from 13-year-old Daniel Morcombe. “Next year will mark 20 years since we lost Daniel. The passage of time does not make it any easier. Personally, I find the making of this movie morally corrupt and a cruel, callous, selfish cash grab by all involved. Shame on you. “I recommend the public stay away from it and either save their money or consider donating it to the Daniel Morcombe Foundation.” Mrs Morcombe took it further and called the movie makers “parasites” for disrespecting her son. <blockquote class="twitter-tweet"> We are not amused! How can anyone give oxygen to a crime that is so, so evil? Connections of the movie have blood on their hands. — Bruce Morcombe (@BruceMorcombe) <a href="https://twitter.com/BruceMorcombe/status/1547361223804481536?ref_src=twsrc%5Etfw">July 13, 2022</a></blockquote> “The movie ‘The Stranger’ is not supported by the Morcombe family. Individuals who make money on a heinous crime are parasites,” she wrote. “They are callously disrespectful to Daniel, the DMF & the Morcombe family. We find the making of the movie morally corrupt and cruel. Shame on you.” Mr Morcombe responded to his wife’s tweet saying: “We are not amused! How can anyone give oxygen to a crime that is so, so evil? Connections of the movie have blood on their hands.” Director Thomas M Wright said he made the film to share a different perspective of the story because he could not “presume” what the family was going through. “One reason I chose not to show the child or family (in The Stranger) was to make a film with a clear moral perspective,” he previously said. “I couldn’t presume to know anything of the experience of that family. But I could see that there was a story about empathy and making meaning in the wake of violence, not violence itself.” According to Hollywood reporter, “the film offers a fictionalised portrait of the massive undercover operation that cracked the infamous cold case of 13-year-old Daniel Morcombe, who went missing in 2003.” Images: Daniel Morcombe Foundation

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