tag:theconversation.com,2011:/uk/topics/cholesterol-926/articlesCholesterol – The Conversation2024-03-18T13:44:34Ztag:theconversation.com,2011:article/2255902024-03-18T13:44:34Z2024-03-18T13:44:34ZOats and oatmeal aren’t bad for you, as some claim – in fact, they probably have more health benefits than you realise<figure><img src="https://images.theconversation.com/files/581925/original/file-20240314-24-ysaqlb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3494%2C1964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Oats are a great source of fibre, which can help you stay full after eating.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oatmeal-porridge-berries-honey-healthy-breakfast-1721472361">Vladislav Noseek/ Shutterstock</a></span></figcaption></figure><p>Oats have long had a reputation for being one of the healthier foods you can choose for breakfast. But some people on social media have been calling this claim into question, suggesting that rather than being a healthy staple, oatmeal (and porridge, which is often made using oats) might in fact have <a href="https://www.dailymail.co.uk/health/article-12509825/cardiologist-SHOULDNT-eat-oatmeal.html">no nutritional value</a> whatsoever.</p>
<p>However, while these claims have garnered plenty of media attention, there’s little evidence to back them up. Rather, the science overwhelmingly shows that oats can be beneficial for your health in many ways. </p>
<p>One line of reasoning used to argue oats aren’t healthy is that eating them can lead to spikes in blood sugar (glucose). This seems to be linked to the <a href="https://www.mdpi.com/1424-8220/22/5/2030">rising use of glucose monitors</a> by people who don’t have diabetes. These monitors may depict normal changes in blood glucose, which happen after we eat, as a “<a href="https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pdi.2475">spike</a>” in blood sugar. </p>
<p>Foods that contain carbohydrates (including starchy foods such as oats and other cereals) are broken down during digestion into sugar (mainly glucose but also fructose and galactose). As the foods are broken down, the levels of sugar in the bloodstream begin to rise. This is a normal but important process – the sugar provides us with immediate energy or is stored by the muscles and liver cells for energy later. </p>
<p>Some foods take longer to digest, which means they spend more time in the stomach before reaching the intestines. As such, they will cause a smaller but more sustained rise in blood sugar. This can be better understood by looking at the glycaemic index, which rates foods based on how quickly they affect blood sugar levels.</p>
<p>The glycaemic index shows that the <a href="https://glycemicindex.com/gi-search/?food_name=oatmeal&product_category=&country=&gi=&gi_filter=&serving_size_(g)=&serving_size_(g)_filter=&carbs_per_serve_(g)=&carbs_per_serve_(g)_filter=&gl=&gl_filter=">sugars in oatmeal and porridge</a> are absorbed at about two-thirds the rate of sugar from white bread. This means oats are considered a <a href="https://www.nhs.uk/common-health-questions/food-and-diet/what-is-the-glycaemic-index-gi/">medium glycaemic index</a> food, similar to pasta but absorbed more slowly than many other breakfast cereals. </p>
<p>Generally, it is a good thing for food to be absorbed more slowly, as it is thought this helps with appetite control. So, while your blood sugar may rise after eating oats, this rise is a normal part of the digestive process.</p>
<p>But while the glycaemic index tells us how quickly sugars are absorbed by the body, it doesn’t really look at the portion size of the food. The <a href="https://www.nhs.uk/common-health-questions/food-and-diet/what-is-the-glycaemic-index-gi/">more carbs you eat</a> in one go, the more it will increase your blood glucose levels <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/glycemic-load#:%7E:text=Glycemic%20load%20refers%20to%20the,the%20bloodstream%20(glycemic%20index).">after a meal</a> – even if they are normal overall.</p>
<h2>Cholesterol-lowering benefits</h2>
<p>Oats are also a great <a href="https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/">source of fibre</a>, which not only helps us stay full after eating but also keeps our bowel movements <a href="https://academic.oup.com/nutritionreviews/article/78/5/343/5602346">regular and healthy</a>.</p>
<p>Oatmeal contains specific types of fibre called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236515/">beta-glucans</a>. These have been linked to lower risk of insulin resistance (associated with type 2 diabetes), weight gain, high blood pressure and high <a href="https://efsa.onlinelibrary.wiley.com/doi/abs/10.2903/j.efsa.2010.1885#:%7E:text=The%20following%20wording%20reflects%20the,oat%20beta%2Dglucan%20per%20day.">cholesterol</a>. Beta-glucans are also linked with a <a href="https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.81#:%7E:text=Daily%20dietary%20intake%20levels%20of,of%20whole%20oats%20and%20barley.">lower risk of heart disease</a>.</p>
<figure class="align-center ">
<img alt="A bowl of uncooked rolled oats." src="https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581928/original/file-20240314-24-4nh1zr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Beta-glucans are a beneficial type of fibre.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oats-spoon-plate-on-table-scattered-417963298">Timmary/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This cholesterol-lowering effect is the result of the way the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892284/#:%7E:text=Viscous%20%CE%B2%2Dglucan%20is%20hypothesized,systemic%20LDL%20cholesterol%20(59).">beta-glucan bind to bile</a>, a fluid that helps with digestion, in our intestines. This process reduces the amount of bile that can be re-absorbed into the body as cholesterol.</p>
<p>But in order to get these benefits from beta-glucans, you need to consume at least 3g of them daily. Given an average <a href="https://www.heartuk.org.uk/ultimate-cholesterol-lowering-plan/uclp-step-3">30g serving of oats contains 1g</a> of beta-glucans, pairing a bowl of porridge with other foods that are rich in beta-glucans (such as oat cakes and pearled barley) can help you get enough of these important fibres in your diet each day.</p>
<h2>Oatmeal and gut health</h2>
<p>Oatmeal is a source of soluble fibre, which means it can be fermented by the bacteria in our digestive tract. This has led to suggestions that oats might be beneficial for our gut microbiome. </p>
<p>Emerging evidence suggests that as well as increasing numbers of bacteria linked to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10459712/#:%7E:text=Oat%20fiber%20increased%20expression%20of,not%20all%20indices%20(Shannon)">healthy bowel</a>, oatmeal may also help with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10459712/#:%7E:text=Oat%20fiber%20increased%20expression%20of,not%20all%20indices%20(Shannon).">short-chain fatty acid production</a>. </p>
<p>These are produced by bacteria and help nourish the cells in the colon. They may even help us to <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/control-of-appetite-and-energy-intake-by-scfa-what-are-the-potential-underlying-mechanisms/A1EFBE12AD6F9838EBE3D7314D1EE1B4">regulate our appetite</a> and control <a href="https://link.springer.com/article/10.1007/s13668-018-0248-8">blood fats and glucose</a>, which may help reduce risk of type 2 diabetes and heart disease.</p>
<h2>Is all oatmeal healthy?</h2>
<p>Although all oatmeal will contain fibre, how it’s milled can affect how quickly it’s digested. Instant oats are digested more quickly compared with rolled oats due to the way they’re milled.</p>
<p>Unlike other cereals, oats need steaming and heating before they can be cut or rolled. This is to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0733521007000689#:%7E:text=Steaming%20is%20routinely%20used%20during,process%20also%20improves%20the%20flavour.">stop enzymes</a> breaking down the fats in the oats, which would cause rapid spoilage. </p>
<p><a href="https://library.dpird.wa.gov.au/cgi/viewcontent.cgi?article=1161&context=bulletins">Oats can be rolled</a> to make larger oat flakes, or cut first before rolling to make quick or instant oats. Larger (rolled) oats are digested more slowly than cut oats. </p>
<p>Making oatmeal with milk can add additional nutrients such as calcium, vitamin B12 and protein. But even if your porridge is made with water, oats are a good source of manganese, phosphorous and zinc, as it is. These are <a href="https://www.fao.org/3/ab470e/ab470e06.htm">essential</a> for hormone production, bone health and wound healing. So, although oats may not be fortified in the same way as other cereals, they contain <a href="https://fdc.nal.usda.gov/fdc-app.html#/food-details/173905/nutrients">valuable nutrients</a> and fibre, and are far from nutrient-free.</p>
<p>Oats clearly have benefits. But what this debate highlights is that no food is perfect – or completely useless – for our health. We need to look beyond the positives and negatives of individual foods, even oatmeal, and look instead at how all the foods in our diet work together when it comes to our health.</p><img src="https://counter.theconversation.com/content/225590/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor is a member of the British Dietetic Association</span></em></p>Oats have many health benefits – including keeping our bowels regular and healthy.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236762024-03-13T14:23:30Z2024-03-13T14:23:30ZAre you sitting too long in your office job? South African study offers some health tips<p>Sedentary behaviour can result in chronic health conditions such as obesity and heart diseases, bad news for the millions of office workers who are forced to sit behind their desks every day.</p>
<p>In its simplest form, the term “sedentary behaviour” describes sitting for too long and not breaking this up with movement. </p>
<p>Sitting for more than one hour without a break can be considered as <a href="https://doi.org/10.1007/s40279-023-01915-z">too much</a> sitting time.</p>
<p>Existing evidence shows that about 25% of adults and over 75% of adolescents worldwide are not meeting the World Health Organization physical activity recommendations.</p>
<p>The WHO’s latest <a href="https://www.who.int/publications/i/item/9789240015128">guidelines on physical activity and sedentary behaviour</a> recommend physical inactivity by around 15% in all age groups by 2030.</p>
<p>The WHO guidelines, released in 2020, are <a href="https://doi.org/10.1136/bjsports-2020-102955">particularly important</a> for office workers who spend a significant portion of their work day sitting. </p>
<p>As a specialist in the epidemiology of physical activity I took part in a new study into sedentary behaviour among a group of office-based workers in South Africa. </p>
<p>We found that conscious movement – even if this means standing instead of sitting – helped office workers stay healthy.</p>
<h2>What we found</h2>
<p>In our <a href="https://doi.org/10.1177/15598276231210479">study</a>, published in the American Journal of Lifestyle Medicine, colleagues and I collected data from 122 office workers based in Johannesburg. </p>
<p>The majority of the participants were female (68%) with an average age of 40 years. All had completed high school.</p>
<p>We measured body mass index, waist circumference, blood pressure and other key medical indicators of health and wellbeing.</p>
<p>Participants were asked to record their own sitting times. </p>
<p>We also used wrist-worn <a href="https://www.sciencedirect.com/topics/engineering/accelerometer-sensor">accelerometers</a> to collect data. This innovative method gave us a more accurate understanding of physical activity and sedentary behaviour compared to self-reported questionnaires.</p>
<p>The self-reported data by participants averaged 1.3 hours a day sitting for mealtimes, 3.9 hours a day related to work, 1.4 hours a day for transport, 1.7 hours a day for screen time, and 3.4 hours a day for other activities. This amounted to about 12 hours of sitting per day. </p>
<p>This was significantly higher than the three hours a day recorded by accelerometers. The discrepancy could partly be explained by participants – consciously or unconsciously – feeling more motivated to move when wearing these smart devices.</p>
<p>The blood pressure, cholesterol and <a href="https://medlineplus.gov/lab-tests/triglycerides-test/#:%7E:text=A%20triglycerides%20test%20is%20used,the%20risk%20of%20heart%20disease.">serum triglyceride levels</a> of our study participants were within normal ranges.</p>
<p>This finding is encouraging because they seemed to be at less risk of cardiovascular diseases. It could possibly be explained by the fact that these office workers were engaged in light physical activity for about two hours a day.</p>
<p>This also supports the WHO’s message emphasising that any movement is better than none. </p>
<p>They engaged in moderate to vigorous physical activity for about 50 minutes a day. This was less than the WHO recommendation of at least 60 minutes of moderate to vigorous physical activity a day. </p>
<p>In terms of overall health for South African office workers, our findings show that conscious efforts to move during the day can help them keep them healthier.</p>
<h2>Keep standing and keep moving</h2>
<p>Light intensity physical activity, sometimes referred to as gentle exercise, can include movement such as getting up, and walking to make a cup of coffee.</p>
<p>Office workers should stand whenever possible, as there is a growing body of evidence showing that standing is better than prolonged sitting, particularly for <a href="https://doi.org/10.1177/2047487317752186">energy expenditure</a> and reducing the risk of <a href="https://doi.org/10.1016/s0140-6736(16)30370-1">cardiovascular disease</a>.
It also activates muscle activity. </p>
<p>In practical terms, light physical activities during the workday could include:</p>
<ul>
<li><p>standing up to take a break</p></li>
<li><p>using a standing workstation</p></li>
<li><p>standing during meetings. </p></li>
</ul>
<p>Moderate to vigorous physical activities could include:</p>
<ul>
<li><p>using the stairs instead of the lifts</p></li>
<li><p>parking further from the office building entrance and walking at a brisk pace to the entrance</p></li>
<li><p>introducing fun activity breaks</p></li>
<li><p>engaging in various types of activities at a private gym close to work.</p></li>
</ul>
<p>Office workers should make conscious efforts to engage in physical activities during recreational times. </p>
<p>These could include: </p>
<ul>
<li><p>participating in weekly park runs</p></li>
<li><p>walking groups</p></li>
<li><p>structured sporting activities such as organised cycling, especially with safety and security in mind.</p></li>
</ul>
<p>In general, the more physically active people are, the better the health outcomes. </p>
<h2>Moving forward</h2>
<p>By 2021 worldwide obesity had nearly <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">tripled</a> since 1975.</p>
<p>Physical inactivity is the leading modifiable risk factor for cardiometabolic diseases and all-cause mortality.</p>
<p>Studies such as ours help policymakers, businesses and companies formulate strategies to keep office workers healthier, promote a positive work-life balance and contribute to a more efficient work environment.</p>
<p>Our research underscores the urgent need to include more opportunities for movement into our everyday lives, especially important for South African office workers. </p>
<p>More studies from the global south are needed to develop context-relevant workplace interventions that can be easily integrated into employee health and wellness policy.</p><img src="https://counter.theconversation.com/content/223676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippe Gradidge receives funding from the National Research Foundation (South Africa) and The South African Medical Research Council.</span></em></p>Office workers are sedentary for hours at a time. Our research looked at what they should do to stay healthy.Philippe Gradidge, Associate Professor, Department of Exercise Science and Sports Medicine, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236672024-03-05T13:29:22Z2024-03-05T13:29:22ZThe Atlantic diet: how it compares to its Mediterranean counterpart – and what benefits it might have<figure><img src="https://images.theconversation.com/files/579168/original/file-20240301-22-1qoqvf.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4822%2C3203&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Atlantic diet also places an emphasis on fresh, minimally-processed foods.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cod-fish-potato-tomato-cherry-on-562428598">Natalia Mylova/ Shutterstock</a></span></figcaption></figure><p>The Mediterranean diet has long been seen as one of the most beneficial diets out there. It’s been associated with many health benefits, including lower risk of <a href="https://cdt.amegroups.org/article/view/14269/14736">cardiovascular disease</a> and other <a href="https://pubmed.ncbi.nlm.nih.gov/34204683/">chronic diseases</a> (including <a href="https://pubmed.ncbi.nlm.nih.gov/31480794/">cancer</a>), better <a href="https://pubmed.ncbi.nlm.nih.gov/35889954/">sleep</a> and even <a href="https://gut.bmj.com/content/69/7/1218">good gut health</a>.</p>
<p>But a recent study suggests that a slightly modified version of this diet – named the “<a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814624">Atlantic diet</a>” – may also be beneficial for your health. </p>
<p>The Atlantic diet draws inspiration from the traditional eating habits of people living in northwestern Spain and Portugal. Like the Mediterranean diet, it’s characterised by eating local, fresh and minimally processed seasonal foods – such as vegetables, fruits, fish, wholegrain, nuts, beans and olive oil. But unlike the Mediterranean diet, the Atlantic diet also includes moderate amounts of meat and pork products, as well as starchy vegetables such as potatoes.</p>
<p>According to this latest study, the Atlantic diet may reduce the risk of <a href="https://www.heartuk.org.uk/genetic-conditions/metabolic-syndrome">metabolic syndrome</a>. This is the combination of high blood pressure, high blood fat levels, obesity and high blood sugar – all of which can lead to heart disease, stroke and type 2 diabetes.</p>
<p>The researchers conducted what’s known as a secondary analysis. This meant they analysed data from a previous study on the Atlantic diet, the <a href="https://pubmed.ncbi.nlm.nih.gov/27539113/">GALIAT Atlantic Diet study</a>, in order to better understand its effects. This was a six-month randomised clinical trial, which included more than 500 participants who were grouped together by family.</p>
<p>As part of the GALIAT trial, families were placed into two groups. One group followed the Atlantic diet. They were also taught about the diet and given cooking classes to help adhere to it. The second group, who acted as the control group, followed their usual diet and lifestyle. </p>
<p>The study lasted for six months. At the beginning of the study and after six months, researchers collected information on participants’ food intake using a three-day food diary, as well as their physical activity levels, any medications they took and other variables such as weight if they smoked.</p>
<p>In the <a href="https://www.mdpi.com/2072-6643/13/4/1211">initial GALIAT diet study</a>, the researchers found that the Atlantic diet group lost weight – whereas those in the control group gained weight. The Atlantic diet group also saw improvements in their levels of one type of cholesterol – though other types of cholesterol still remained the same. There were also no changes in their blood pressure and blood sugar.</p>
<figure class="align-center ">
<img alt="A plate of food with cooked fish and slices of pork or chorizo." src="https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Atlantic diet may also include pork and other types of meat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/prawn-rice-closeup-traditionnal-spanish-food-106809581">ilolab/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In the recent secondary analysis of this study, the researchers found that overall, participants who had followed the Atlantic diet had significantly lower risk of developing metabolic syndrome compared to the control group. They also found that following the Atlantic diet lowered risk of obesity, improved waist circumference and levels of cholesterol (specifically high-density lipoprotein).</p>
<p>But though the Atlantic diet had an overall effect on lowering risk of metabolic syndrome, it wasn’t shown to have much effect on specific aspects of metabolic syndrome. Specifically, the researchers did not see any benefit from the Atlantic diet on blood pressure, blood sugar and blood fat levels.</p>
<p>Overall, the study shows that consuming the Atlantic diet may be helpful for managing weight – which may in turn lower risk of some long-term chronic conditions (such as cardiovascular disease). </p>
<h2>Balanced diet</h2>
<p>This is not the first time the effects of the Atlantic diet have been researched. </p>
<p><a href="https://www.atherosclerosis-journal.com/article/S0021-9150(12)00830-1/abstract">Previous studies</a> have shown that the Atlantic diet is associated with lower levels of inflammation, blood fat levels and blood pressure among adults living in Spain. <a href="https://www.mdpi.com/2072-6643/11/4/742">Another study</a> also found that Spanish people who paired the Atlantic diet with regular physical activity had a lower risk of cardiovascular disease, lower cholesterol and lower rates of obesity.</p>
<p>But while research does show some potential benefits in adhering to the Atlantic diet, these results may not hold true for everyone. </p>
<p>First, most studies on the Atlantic diet – including this latest one – only included participants of Spanish or white European descent. This means we don’t know whether the Atlantic diet will be equally beneficial for ethnic groups who are at <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/0470025131.ch2">greater risk of metabolic syndrome</a> – such as people of south Asian, Black African and Caribbean descent.</p>
<p>It’s well established that regularly consuming fruits, vegetables, wholegrains, nuts and fish provides a wide range of essential vitamins, minerals, fibre and antioxidants that are <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">vital for good health</a>. While the Atlantic diet is said to contain plenty of these foods, there’s no clear information from this latest study on portion sizes or what quantity of certain foods participants consumed in order to reduce their risk of metabolic syndrome.</p>
<p>Another thing worth mentioning is that the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3441-y">GALIAT study gained a lot of media attention at the time</a>. This may have influenced the particpants’ eating and lifestyle habits as a result, making them adhere more strictly to it – making it appear the diet had a greater affect than it actually might in reality.</p>
<p>And, even though participants in both groups had similar characteristics at the start of the study (such as how physically active they were on average, or if they smoked), the researchers were unable to adjust their findings to fully account for all the factors that might influence a person’s risk of developing metabolic syndrome.</p>
<p>The participants in the Atlantic diet group were also provided with the food they needed in order to stick with their diet. But in a real world setting, not everyone can regularly access or afford the kinds of foods the Atlantic diet consists of. This makes it difficult to know whether the findings will still stand outside of a controlled environment. </p>
<p>At the end of the day, the ideal diet to follow for improving metabolic health is one that includes a wide range of foods from each of the main food groups: fruits and vegetables, starchy carbohydrates (opting for wholegrain alternatives where possible), protein, dairy or dairy alternatives and healthy fats that you find accessible, affordable, enjoyable, as well as nourishing.</p><img src="https://counter.theconversation.com/content/223667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taibat (Tai) Ibitoye does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Atlantic diet draws inspiration from the traditional eating habits of people living in Spain and Portugal.Taibat (Tai) Ibitoye, Senior Lecturer in Public Health and Registered Dietitian, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2239092024-03-04T13:26:22Z2024-03-04T13:26:22ZSouth Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment<p>Diabetes is a chronic condition that affects how the body turns food into energy. </p>
<p>In South Africa there has been a notable <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199430/">rise in the prevalence of type 2 diabetes</a> in recent years, due to changing diets. People are consuming more processed foods, sugary drinks and high-calorie meals. </p>
<p>Other factors are the lack of physical activity and high levels of obesity. </p>
<p><a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Type 2 diabetes</a> is the most common form, making up 90% of cases. With this type, the body produces insulin but can’t use it effectively. It typically affects overweight adults with a family history of the condition.</p>
<p>Approximately one in nine South African adults have diabetes, totalling around <a href="https://diabetesatlas.org/data/en/country/185/za.html">4.2 million individuals</a>. </p>
<p>Diabetes is also the leading cause of death <a href="https://www.statssa.gov.za/publications/P03093/P030932017.pdf">among women</a> in the country. </p>
<p>As public health specialists and clinicians focusing on diabetes, we <a href="https://www.tandfonline.com/doi/full/10.1080/16089677.2024.2311497">researched</a> the standard of primary care that people living with type 2 diabetes receive in South Africa. </p>
<p>We found that the management of diabetes falls short of optimal standards, putting individuals at risk of the many side effects associated with diabetes.</p>
<h2>What we found and why it matters</h2>
<p>We examined 479 medical records of individuals diagnosed with type 2 diabetes across 23 primary healthcare facilities in the Tshwane district of Gauteng province. </p>
<p>The majority of patients were women. Patients had been living with diabetes for an average of 5.5 years. The average age was 58 years.</p>
<p>When it comes to managing diabetes, there are targets for blood glucose, blood pressure and cholesterol. We used guidelines set out by the <a href="https://www.semdsa.org.za/for-members/guidelines">Society for Endocrinology, Metabolism and Diabetes South Africa</a> for this study. </p>
<p>Our audit found a significant number of patients with type 2 diabetes were not receiving adequate treatment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Over 12% of South African adults have diabetes - education is critical to achieve good outcomes</a>
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<p>Only 23% of patients met the glucose target. This meant more than 70% of the patients were at risk of serious health complications.</p>
<p>Patients attended clinic visits regularly, yet they experienced prolonged periods of <a href="https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar/">hyperglycaemia</a> (high blood sugar levels).</p>
<p>We also found that healthcare providers often displayed <a href="https://diabetes.medicinematters.com/quality-of-life/type-2-diabetes/tackling-clinical-inertia-the-role-of-patient-engagement/15918202">clinical inertia</a>. In other words, they failed to set targets or to initiate or adjust treatment to achieve these goals. They delayed starting or changing a patient’s treatment plan, even when it was clear the current plan wasn’t working well.</p>
<p>Factors contributing to clinical inertia included a uniform treatment approach not suited to all patients, limited treatment options and an inadequately equipped healthcare system. </p>
<p>Given the absence of comprehensive surveillance systems like <a href="https://link.springer.com/article/10.1007/s00592-020-01576-8">diabetes registries</a>, studies serve as the primary source of information regarding the implementation and quality of diabetes care in South Africa. </p>
<p>Our results aligned with various studies conducted across South Africa, including one about <a href="https://doi.org/10.1016/j.pcd.2014.05.002">a decade ago within the same district</a>.</p>
<p>A more recent study of 116,726 patients in <a href="https://doi.org/10.1016/j.pcd.2022.05.011">Cape Town</a> found three-quarters of participants had poor glycaemic control as blood sugar levels were not being managed well.</p>
<p>These consistent findings highlight the extra effort needed to overcome clinical inertia to improve diabetes care in South Africa.</p>
<h2>High cost of poor treatment</h2>
<p>For poorly managed patients, diabetes can lead to <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">severe health complications</a>, such as nerve damage, kidney issues, heart disease, stroke, vision impairment and mental health disorders.</p>
<p>For society as a whole, suboptimal diabetes care places a strain on the healthcare system and contributes to higher healthcare costs. </p>
<p>Another consequence is <a href="https://link.springer.com/article/10.1007/s11892-019-1124-7">loss of productivity</a> due to absenteeism from work and even disability, which has an <a href="http://www.samj.org.za/index.php/samj/article/view/13330/9830">economic impact on the country</a>.</p>
<h2>Ways forward</h2>
<p>Monitoring the quality of diabetes care and evaluating the effectiveness of therapies and treatment in clinical practice is a challenge in South Africa. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diabetes-is-a-ticking-time-bomb-in-sub-saharan-africa-149766">Diabetes is a ticking time bomb in sub-Saharan Africa</a>
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</em>
</p>
<hr>
<p>New strategies could include: </p>
<ul>
<li><p>adopting individualised patient-centred management with access to a wider choice of glucose-lowering drugs </p></li>
<li><p>addressing clinical inertia and the failure to intensify therapy when indicated </p></li>
<li><p>building a health system that caters for the needs of South Africans with diabetes.</p></li>
</ul>
<p>Inadequate treatment for the country’s many people living with diabetes has devastating consequences, not just for individuals and their families, but for the country’s health system at large.</p><img src="https://counter.theconversation.com/content/223909/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Rheeder received research funding from Eli Lilly Global health partnerships (2019-2023)</span></em></p><p class="fine-print"><em><span>Patrick Ngassa Piotie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Healthcare workers in South Africa aren’t always well equipped to treat diabetes. This has devastating consequences for patients.Patrick Ngassa Piotie, Project Manager, University of Pretoria Diabetes Research Centre, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172872024-02-04T19:09:37Z2024-02-04T19:09:37ZHow much weight do you actually need to lose? It might be a lot less than you think<figure><img src="https://images.theconversation.com/files/572339/original/file-20240131-15-eetcro.jpg?ixlib=rb-1.1.0&rect=81%2C0%2C5381%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-drink-water-during-morning-1079331911">Flotsam/Shutterstock</a></span></figcaption></figure><p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. </p>
<p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p>
<p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p>
<p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. </p>
<p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">Can you be overweight and healthy?</a>
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</em>
</p>
<hr>
<h2>Using BMI to define our target weight is flawed</h2>
<p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. </p>
<p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. </p>
<p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: </p>
<ul>
<li><p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p></li>
<li><p>does not account for significant differences in body composition based on gender, ethnicity and age.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520959736476274690"}"></div></p>
<h2>How does losing weight benefit our health?</h2>
<p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p>
<p><strong>1. Reducing cholesterol</strong></p>
<p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p>
<p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p>
<p><strong>2. Lowering blood pressure</strong></p>
<p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. </p>
<p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p>
<p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. </p>
<figure class="align-center ">
<img alt="Older man takes his blood pressure at home" src="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Losing weight can lower your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
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<p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). </p>
<p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p>
<p><strong>3. Reducing risk for type 2 diabetes</strong></p>
<p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p>
<p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-actually-target-areas-to-lose-fat-like-my-belly-205203">Can I actually target areas to lose fat, like my belly?</a>
</strong>
</em>
</p>
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<p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p>
<p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p>
<p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p>
<p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p>
<figure class="align-center ">
<img alt="Man on bathroom scales" src="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight eases stress on joints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-feet-on-scale-bathroom-1030174888">Shutterstock/Rostislav_Sedlacek</a></span>
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<h2>Focus on long-term habits</h2>
<p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p>
<p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
</strong>
</em>
</p>
<hr>
<p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/217287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Weight loss can seem like an impossible, unachievable task. But you don’t need to lose a lot of weight to start noticing the health benefits.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129192023-10-11T16:36:25Z2023-10-11T16:36:25ZIn praise of almonds and nuts<p>They’re known as <a href="https://www.em-consulte.com/article/79057/les-categories-d-aliments">‘oily fruits’</a>. Because of their numerous health benefits, notwithstanding their high fat content, almonds, hazelnuts and other nuts are among foods recommended for consumption in <a href="https://pubmed.ncbi.nlm.nih.gov/27712954/">Canada</a>, <a href="https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015">the US</a>, <a href="https://www.santepubliquefrance.fr/determinants-de-sante/nutrition-et-activite-physique/documents/rapport-synthese/recommandations-relatives-a-l-alimentation-a-l-activite-physique-et-a-la-sedentarite-pour-les-adultes">France</a> and across <a href="https://ec.europa.eu/jrc/en/health-knowledge-gateway/promotion-prevention/nutrition/food-based-dietary-guidelines">the EU</a> – to the tune of a small handful each day.</p>
<p>From a nutritional standpoint, these hard-shelled fruits are <a href="https://www.elsevier-masson.fr/nutrition-clinique-pratique-9782294754685.html">distinguished</a> by high levels (50-75%) of unsaturated fats (which are seen as ‘good fats’), significant protein content (10-25%), plus minerals (sodium, magnesium, potassium), vitamins B3, B9, B6 and E, fibre, antioxidants and vegetable oils. A stack of data suggests that they could help us age well and protect us from a range of chronic conditions.</p>
<h2>Stripping out ‘bad’ cholesterol</h2>
<p>If there’s one area where shelled fruits <a href="https://mail.google.com/mail/u/0/"> [JN1]</a> have proved their worth, it’s bringing cholesterol down. Reducing the amount of animal fat in your diet and eating fibre are, for certain, effective ways to cut levels of LDL-cholesterol, that’s to say ‘bad cholesterol’. But many studies have also shown the benefits of a daily handful of almonds. The same seems true of all nuts.</p>
<p>In 2010, <a href="https://pubmed.ncbi.nlm.nih.gov/20458092/">a study of the collected data</a> over the course of 25 clinical trials involving men and women with high cholesterol showed that eating 67g of nuts every day for 3-8 weeks could cut LDL-C levels by 7.4%, with more sizeable effects than this on symptoms since the patients were over healthy limits previously.</p>
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<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/29931130/">systematic data review</a>confirmed this, albeit at a more modest rate. Carried out in 2018, it analysed results from 26 clinical trials: the authors in this case detected a 3.7% fall in LDL-C levels for a diet rich in shelled fruits (15-108g per day) over a period of one to 12 months. It’s known that lowering LDL-C levels is linked to <a href="https://pubmed.ncbi.nlm.nih.gov/29677301/">a reduction in total mortality and in deaths from cardiovascular disease</a>, particularly if levels were high to start with. Even if no clinical study has yet shown that eating nuts can reduce the risk of heart failure, there’s no shortage of arguments to support such a hypothesis.</p>
<h2>Lower risk of cardiovascular disease</h2>
<p>First one might point to the results of a <a href="https://pubmed.ncbi.nlm.nih.gov/31361320/">meta-analysis published in 2019</a>. Applying the criteria used by Canada’s Cochrane Centre, the authors chose 19 studies, and evaluated that a 28g daily portion of shelled fruits is associated with a 13% fall in cardiovascular disease, and 29% in deaths from heart disease.</p>
<p>You could also refer to a <a href="https://pubmed.ncbi.nlm.nih.gov/29897866/">huge randomised and controlled study across many different locations</a> on the role of a Mediterranean diet enriched with nuts in reducing the risk of heart disease. Participants in this, aged 55-80 and registering a significant risk of heart disease were assigned one of three diets – low-fat, a Mediterranean diet rich in olive oil, and a Mediterranean diet with added nuts. They were tracked for almost 5 years on average. At the end of the research, it was shown that heart problems were less frequent among the two groups following the Mediterranean diet.</p>
<h2>Fat that doesn’t make you put on weight</h2>
<p>On the energy side, 30g of almonds, peanuts, pistachios or cashews work out as a 180 calorie snack; the same quantity of pecans or Brazil nuts come to 220-230 calories. These figures are roughly equivalent to 30-40g of milk chocolate. Since the calorific content is essentially made up of fats, one might be given to think one must beware of ‘oily fruits’ if weight-watching. But that assumption would be wrong…</p>
<p>In fact, <a href="https://pubmed.ncbi.nlm.nih.gov/29977320/">a recent piece of research closely analysed</a> six cohort studies and 62 randomised diet tests. This concluded that regularly eating nuts for a longer or shorter period of time (between 3 and 336 weeks) is linked to very slight weight loss (an average of 200g) and a shrinking waistline (by an average of 0.5cm).</p>
<p>If the reasons for these counter-intuitive outcomes haven’t been adequately explained yet, various theories can be put forward. For one, the matrix that encases the oils in nuts limits, to an extent, their absorption in the gut. To put it simply – some of the fat content in nuts is eliminated in the body’s cells, rather than being absorbed. Meanwhile, thanks to how they blunt our appetite, almonds and other nuts reduce the amount we eat at meals, so much so that our overall calorie count is no greater, or perhaps less than it would have been without them.</p>
<h2>Do nuts have anti-cancer properties?</h2>
<p>Other benefits are attributed to shelled fruits – notably around cancer prevention, although the evidence for this is weak. The relevant studies rely on observations alone, and suffer from various interpretation biases.</p>
<p>Thus, according to <a href="https://pubmed.ncbi.nlm.nih.gov/32041895">an analysis of 33 studies published before June 2019</a>, increased consumption of nuts is demonstrably linked to a 10% fall in cancer risk; and the effect is more marked for cancers of the digestive system, with a risk reduction of 17%.</p>
<p>Nuts’ <a href="https://pubmed.ncbi.nlm.nih.gov/19703258">high antioxidant content</a> might be one of the drivers for this. But before exploring this hypothesis further, we need to check the observed data with verifiable controlled and randomised clinical trials. For the moment, there’s nothing that allows us to say that eating nuts protects against cancer.</p>
<h2>Fewer neurodegenerative conditions</h2>
<p>Oils and fats are vital for the brain. After fat tissue, it’s the organ in the body <a href="https://hal.archives-ouvertes.fr/hal-00897946/document">richest in lipids</a>: they can be found in the neuron membranes and related cells, but also in the myelin which speeds up the transmission of electrical impulses through the nervous system.</p>
<p>Several research teams have set out to evaluate the <a href="https://content.iospress.com/download/nutrition-and-aging/nua007?id=nutrition-and-aging%2Fnua007">benefits</a> of nuts for the central nervous system. What have they learned?</p>
<p>Their notable discovery was that <a href="https://pubmed.ncbi.nlm.nih.gov/18778529/">after a few weeks</a> of a diet more or less rich in nuts, 19 month-old rats performed better on psychometric tests. A diet of 2% nuts boosted their performance on a rod-clambering test, one of 6% nuts saw them do better on a plank-walking test, and at both these levels their powers of short term memory were heightened. <a href="https://pubmed.ncbi.nlm.nih.gov/22048906/">These results have been confirmed</a> by a study of shorter duration, with a marked improvement detectable in the rodents’ learning and memory.</p>
<p>As for humans, <a href="https://pubmed.ncbi.nlm.nih.gov/22349682/">a study of the PREDIMED diet intervention</a> has shown that a Mediterranean diet rich in nuts improves short-term memory. It has also offered evidence, at a biological level, of a <a href="https://pubmed.ncbi.nlm.nih.gov/22005283/">reduced risk of low BDNF plasma</a> – a protein which helps the growth and vigour of new neurons. Nuts seem to have a beneficial role at warding off age-related cognitive decline. However, we don’t have direct proof that if one regularly eats nuts, it reduces the risk of neurodegenerative diseases.</p>
<p>To sum up: nuts appear at first glance to have all the features allowing them to be considered allies of our health. While they are calorie-rich and high in fats, a 30g serving per day seems to cut “bad cholesterol” and protect us from cardiovascular disease, without affecting our weight. There are plenty of theories that suggest they a positive impact, both on other illnesses and warding off cognitive decline associated with age.</p>
<p>Plenty of good reasons to recommend everyone to include a handful of almonds, hazelnuts or other nuts in the food they eat each day – obviously without added sugar or salt!</p>
<hr>
<p><em>Translation from French into English by <a href="https://twitter.com/JoshNeicho">Joshua Neicho</a></em></p><img src="https://counter.theconversation.com/content/212919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur organisme de recherche.</span></em></p>Despite their high fat content, almonds, nuts and other shelled fruits do not make you put on weight. In fact, research continues to marvel over their seemingly endless health benefits.Boris Hansel, Médecin, Professeur des universités- Praticien hospitalier, Inserm U1148, Faculté de Santé, Université Paris CitéDiana Kadouch, Praticien Hospitalier, Hôpital Bichat, Service de Diabétologie-Nutrition, AP-HP, Chargée de cours au sein du DU de nutrition, Université Paris CitéJérémy Puyraimond-Zemmour, Assistant spécialiste, Service de Diabétologie-Nutrition, Hôpital Bichat, AP-HP, Chargé de cours au sein du DU de nutrition, Université Paris CitéLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117482023-09-15T00:56:34Z2023-09-15T00:56:34ZHow can I lower my cholesterol? Do supplements work? How about psyllium or probiotics?<figure><img src="https://images.theconversation.com/files/545897/original/file-20230901-17-zovk4b.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C1908%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/white-ceramic-bowls-with-supplements-7615572/">Nataliya Vaitkevich/Pexels</a></span></figcaption></figure><p>Your GP says you have high cholesterol. You’ve six months to work on your diet to see if that’ll bring down your levels, then you’ll review your options. </p>
<p>Could taking supplements over this time help?</p>
<p>You can’t rely on supplements alone to control your cholesterol. But there’s some good evidence that taking particular supplements, while also eating a healthy diet, can make a difference.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-high-cholesterol-here-are-five-foods-to-eat-and-avoid-63941">Got high cholesterol? Here are five foods to eat and avoid</a>
</strong>
</em>
</p>
<hr>
<h2>Why are we so worried about cholesterol?</h2>
<p>There are two main types of cholesterol, both affecting your risk of heart disease and stroke. Both types are carried in the bloodstream inside molecules called lipoproteins.</p>
<p><strong>Low-density lipoprotein or LDL cholesterol</strong></p>
<p>This is often called “bad” cholesterol. This lipoprotein carries cholesterol from the liver to cells throughout the body. High levels of LDL cholesterol in the blood can lead to the <a href="https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011433">build-up of plaque</a> in arteries, which leads to an <em>increased</em> risk of heart disease and stroke. </p>
<p><strong>High-density lipoprotein or HDL cholesterol</strong></p>
<p>This is often called “good” cholesterol. This lipoprotein helps remove excess cholesterol from the bloodstream and transports it back to the liver for processing and excretion. Higher levels of HDL cholesterol are <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.119.312617">linked to</a> a <em>reduced</em> risk of heart disease and stroke. </p>
<p>Diet can play a key role in reducing blood cholesterol levels, especially LDL (“bad”) cholesterol. Healthy dietary choices are <a href="https://theconversation.com/got-high-cholesterol-here-are-five-foods-to-eat-and-avoid-63941">well recognised</a>. These include a focus on eating more unsaturated (“healthy”) fat (such as from olive oil or avocado), and eating less saturated (“unhealthy”) fat (such as animal fats) and trans fats (found in some shop-bought biscuits, pies and pizza bases).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cut avocado, glass of olive oil, green herbs and cut lemon on timber background" src="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can find unsaturated fat in foods such as olive oil and avocado.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/food-background-fresh-organic-avocado-lime-253287091">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-healthier-butter-or-margarine-19777">Health Check: what's healthier, butter or margarine?</a>
</strong>
</em>
</p>
<hr>
<h2>Fibre is your friend</h2>
<p>An additional way to significantly reduce your total cholesterol and LDL cholesterol levels through diet is by eating more <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">soluble fibre</a>.</p>
<p>This is a type of fibre that dissolves in water to form a gel-like substance in your gut. The gel can bind to cholesterol molecules preventing them from being absorbed into the bloodstream and allows them to be eliminated from the body through your faeces. </p>
<p>You can find soluble fibre in whole foods such as fruits, vegetables, oats, barley, beans and lentils.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">Fiber is your body's natural guide to weight management – rather than cutting carbs out of your diet, eat them in their original fiber packaging instead</a>
</strong>
</em>
</p>
<hr>
<h2>Fibre supplements, such as psyllium</h2>
<p>There are also many fibre supplements and food-based products on the market that may help lower cholesterol. These include:</p>
<ul>
<li><p><strong>natural soluble fibres</strong>, such as inulin (for example, Benefiber) or psyllium (for example, Metamucil) or beta-glucan (for example, in ground oats)</p></li>
<li><p><strong>synthetic soluble fibres</strong>, such as polydextrose (for example, STA-LITE), wheat dextrin (also found in Benefiber) or methylcellulose (such as Citrucel)</p></li>
<li><p><strong>natural insoluble fibres</strong>, which bulk out your faeces, such as flax seeds.</p></li>
</ul>
<p>Most of these supplements come as fibres you add to food or dissolve in water or drinks. </p>
<p>Psyllium is the fibre supplement with the strongest evidence to support its use in improving cholesterol levels. It’s been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/">studied</a> in at least 24 high-quality randomised controlled trials.</p>
<p>These trials show consuming about 10g of psyllium a day (1 tablespoon), as part of a healthy diet, <a href="https://www.sciencedirect.com/science/article/pii/S0002916523070107#:%7E:text=Conclusions%3A,mild%2Dto%2Dmoderate%20hypercholesterolemia.">can significantly lower</a> total cholesterol levels by 4% and LDL cholesterol levels by 7%.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person stirring in psyllium into glass of water, bowl of psyllium next to glass" src="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can mix psyllium fibre into a drink or add it to your food.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-adds-spoon-psyllium-fiber-mix-2031428417">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-eating-the-right-sorts-of-fibre-20089">Health Check: are you eating the right sorts of fibre?</a>
</strong>
</em>
</p>
<hr>
<h2>Probiotics</h2>
<p>Other cholesterol-lowering supplements, such as probiotics, are not based on fibre. Probiotics are thought to help lower cholesterol levels via a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3352670/">number of mechanisms</a>. These include helping to incorporate cholesterol into cells, and adjusting the microbiome of the gut to favour elimination of cholesterol via the faeces.</p>
<p>Using probiotics to reduce cholesterol is an upcoming area of interest and the <a href="https://www.sciencedirect.com/science/article/abs/pii/S089990071500461X">research</a> is promising. </p>
<p>In a <a href="https://pubmed.ncbi.nlm.nih.gov/29384846/">2018 study</a>, researchers pooled results from 32 studies and analysed them altogether in a type of study known as a meta-analysis. The people who took probiotics reduced their total cholesterol level by 13%.</p>
<p><a href="https://www.tandfonline.com/doi/full/10.3109/07853890.2015.1071872">Other</a> <a href="https://link.springer.com/article/10.1007/s11906-020-01080-y">systematic reviews</a> support these findings.</p>
<p>Most of these studies use probiotics containing <em>Lactobacillus acidophilus</em> and <em>Bifidobacterium lactis</em>, which come in capsules or powders and are consumed daily.</p>
<p>Ultimately, probiotics could be worth a try. However, the effects will likely vary according to the probiotic strains used, whether you take the probiotic each day as indicated, as well as your health status and your diet.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-healthy-people-take-probiotic-supplements-95861">Health Check: should healthy people take probiotic supplements?</a>
</strong>
</em>
</p>
<hr>
<h2>Red yeast rice</h2>
<p><a href="https://www.nccih.nih.gov/health/red-yeast-rice">Red yeast rice</a> is another non-fibre supplement that has gained attention for lowering cholesterol. It is often used in Asia and some European countries as a complementary therapy. It comes in capsule form and is thought to mimic the role of the cholesterol-lowering medications known as statins.</p>
<p>A <a href="https://www.frontiersin.org/articles/10.3389/fphar.2021.819482/full">2022 systematic review</a> analysed data from 15 randomised controlled trials. It found taking red yeast rice supplements (200-4,800mg a day) was more effective for lowering blood fats known as triglycerides but less effective at lowering total cholesterol compared with statins.</p>
<p>However, these trials don’t tell us if red yeast rice works and is safe in the long term. The authors also said only one study in the review was registered in a major <a href="https://www.clinicaltrials.gov">database</a> of clinical trials. So we don’t know if the evidence base was complete or biased to only publish studies with positive results.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Red yeast rice capsules" src="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Red yeast rice is often used in Asia and some European countries to lower cholesterol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-yeast-rice-supplement-capsules-on-1625852824">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Diet and supplements may not be enough</h2>
<p>Always speak to your GP and dietitian about your plan to take supplements to lower your cholesterol.</p>
<p>But remember, dietary changes alone – with or without supplements – might not be enough to lower your cholesterol levels sufficiently. You still need to quit smoking, reduce stress, exercise regularly and get enough sleep. Genetics can also play a role.</p>
<p>Even then, depending on your cholesterol levels and other risk factors, you may still be recommended cholesterol-lowering medications, such as <a href="https://jamanetwork.com/journals/jama/fullarticle/2795522">statins</a>. Your GP will discuss your options at your six-month review.</p><img src="https://counter.theconversation.com/content/211748/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health, Mater Misericordia and the Royal Australian College of General Practitioners. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch works for Southern Cross University.</span></em></p>If you try supplements, you still need to eat a healthy diet, exercise, reduce your stress, quit smoking and get enough sleep. Even then, they may still not be enough.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Dietitian, Researcher & Lecturer, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016342023-04-24T12:23:40Z2023-04-24T12:23:40ZPrescription drugs’ fine print is important – a toxicologist explains how to decode package inserts to take medications safely and increase their effectiveness<figure><img src="https://images.theconversation.com/files/521891/original/file-20230419-14-q2jf4i.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Package inserts contain information on the pharmacology of a drug.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-reading-package-insert-close-up-of-royalty-free-image/945662858">Kathrin Ziegler/DigitalVision via Getty Images</a></span></figcaption></figure><p><a href="https://www.kff.org/health-reform/issue-brief/data-note-prescription-drugs-and-older-adults/">Many adults</a> take prescription drugs, and usage rates are <a href="https://www.statista.com/statistics/238702/us-total-medical-prescriptions-issued/">continually increasing</a>. With <a href="https://www.cdc.gov/medicationsafety/adult_adversedrugevents.html">approximately 1.3 million emergency department visits</a> in the U.S. caused by adverse drug events each year, patient education is becoming increasingly important.</p>
<p>All prescription drugs come with instructions on how to safely and effectively use them. Depending on the medication, there may be <a href="https://www.fda.gov/drugs/fdas-labeling-resources-human-prescription-drugs/patient-labeling-resources">several types of information</a> included: the patient package insert, medication guide and instructions for use. One or more of these documents could be folded up in the box or attached as a printed page provided by your pharmacist.</p>
<hr>
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<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/us/topics/audio-narrated-99682">here</a>.</em></p>
<hr>
<p><a href="https://www.engr.colostate.edu/cbe/people/brad-reisfeld/">I am a scientist</a> who studies how drugs and other chemicals affect human health. While they may look intimidating, package inserts – and particularly the prescribing information – can help patients better understand the science inside the pill bottle and blister pack, among others.</p>
<h2>What can I learn from package inserts?</h2>
<p>An often overlooked part of the package insert is the <a href="https://www.fda.gov/drugs/fdas-labeling-resources-human-prescription-drugs/prescribing-information-resources">prescribing information</a>. Though written primarily for health care professionals, it contains a wealth of information regarding the ways in which the medication interacts with the body.</p>
<p>If the prescribing information was not included with your prescription, you can often find a copy on the National Institutes of Health’s <a href="https://dailymed.nlm.nih.gov/dailymed/index.cfm">DailyMed website</a> or <a href="https://www.drugs.com">other drug information websites</a>.</p>
<p>As an example, let’s consider one of the <a href="https://clincalc.com/DrugStats/Drugs/Atorvastatin">most widely prescribed medications in the U.S.</a>, atorvastatin (Lipitor). Among other effects, it reduces elevated levels of cholesterol overall as well as levels of low-density lipoprotein cholesterol – LDL, or <a href="https://www.webmd.com/heart-disease/ldl-cholesterol-the-bad-cholesterol">“bad” cholesterol</a>.</p>
<p>Reading the insert can answer a few important questions about the drug. If you’d like to follow along, a copy of the prescription information for Lipitor <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020702s073lbl.pdf">can be found here</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of Lipitor prescription label" src="https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522202/original/file-20230420-17-slnlgo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Atorvastatin (Lipitor) is one of the most commonly prescribed drugs in the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/prescription-bottle-label-of-pfizers-lipitor-known-as-news-photo/55908498">Tim Boyle/Getty Images</a></span>
</figcaption>
</figure>
<h2>How does the drug work?</h2>
<p>To answer this question, you can refer to the “Mechanism of Action” and “Pharmacodynamics” subsections of the prescription insert.</p>
<p>The mechanism of action and pharmacodynamics are related concepts. The <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/mechanism-of-action">mechanism of action</a> describes the chemical and molecular interactions that cause a drug’s therapeutic or toxic effects. <a href="https://www.ncbi.nlm.nih.gov/books/NBK507791/">Pharmacodynamics</a> refers to “what the drug does to the body,” which includes the mechanism of action as well as how other factors like drug concentration influences its effects.</p>
<p>Often the mechanism of action of a drug is related to how it <a href="https://theconversation.com/how-do-drugs-know-where-to-go-in-the-body-a-pharmaceutical-scientist-explains-why-some-medications-are-swallowed-while-others-are-injected-182488">interacts with cell receptors and enzymes</a> involved in mediating specific signals and biochemical reactions in the body.</p>
<p>In the case of Lipitor, the prescribing information tells us three important things about how the drug works. First, the liver is the primary site that produces cholesterol in the body and the area the drug is meant to target. Second, the drug works by inhibiting an enzyme involved in cholesterol production called <a href="https://www.ncbi.nlm.nih.gov/gene/3156">HMG-CoA reductase</a>. And third, the drug increases the number of LDL cholesterol receptors on cell surfaces, ultimately increasing the <a href="https://www.britannica.com/science/catabolism">catabolism</a>, or metabolic breakdown, of LDL cholesterol.</p>
<h2>Where does the drug go in my body?</h2>
<p>Before we answer this question, let’s start with some background information in the “Pharmacokinetics” subsection.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK557744/">Pharmacokinetics</a> can be thought of as “what the body does to the drug.” It focuses on four major processes the body undergoes in response to the chemical: absorption, or how the drug gets into the body; distribution, or how the drug is dispersed throughout the body; metabolism, or how the drug is converted into other chemical forms; and excretion, or how the drug is eliminated from the body.</p>
<p>The pharmacokinetics of a drug are <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">determined by factors</a> related to the chemical itself and the person taking the medication. For instance, disease state, age, sex and genetic makeup can all cause the same medication to work differently in different people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people read a package insert together with a weekly pill organizer on the table before them" src="https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522203/original/file-20230420-18-4x8eyn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Understanding what factors influence how a drug works in the body can aid in safer administration.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-couple-medicating-at-home-royalty-free-image/1344980750">andreswd/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Now, let’s look at the “Distribution” subsection.</p>
<p>For Lipitor, the prescription insert does not specifically say where the drug goes in the body, but it does note that the <a href="https://www.ncbi.nlm.nih.gov/books/NBK545280/#article-31259.s1">volume of distribution</a> is 381 liters. The volume of distribution is the ratio of the amount of the drug in the body overall to its concentration in the blood. A value greater than about 30 liters suggests that the drug has <a href="https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-distribution-to-tissues">entered body tissues</a> and is not confined to the bloodstream. For reference, the drug <a href="https://www.ncbi.nlm.nih.gov/books/NBK470313/">warfarin</a>, which prevents blood clots, is tightly bound to proteins in the blood and has a volume of distribution of only 8 liters. On the other hand, <a href="https://www.ncbi.nlm.nih.gov/books/NBK551512/">chloroquine</a>, an antimalarial drug that enters body fat, has a value of 15,000 liters. </p>
<h2>Does the drug cause the effects or its byproducts?</h2>
<p>Though the therapeutic effects of most drugs come from the chemical compound it’s made of, many break down into <a href="https://doi.org/10.1021/jm040066v">active metabolites</a> in the body that also have some relevant biological effects.</p>
<p>Some medications are administered in an <a href="https://doi.org/10.1038/nrd.2018.46">inactive form called a prodrug</a> that the body converts into metabolites with the desired therapeutic effects. Drugmakers generally use prodrugs because they have better pharmacokinetics – such as improved absorption and distribution in the body – than the active form of the drug.</p>
<p>In the case of Lipitor, the “Metabolism” subsection under “Pharmacokinetics” tells us that the drug is broken down into several products and that these metabolites contribute significantly to its therapeutic effect.</p>
<h2>How long will the drug be in my system?</h2>
<p>A key drug property to consider in this case is its <a href="https://www.ncbi.nlm.nih.gov/books/NBK554498/">half-life</a>, which is the length of time required for the concentration of the drug to decrease to half of its initial amount in the body. Information about a drug’s half-life is found in the “Excretion” subsection under “Pharmacokinetics.”</p>
<p>The half-life for Lipitor is approximately 14 hours. If you were to stop taking the medication, 97% of the drug would be gone from your blood after about three days, or five half-lives.</p>
<p>The prescription insert provides another interesting piece of information: because Lipitor’s active metabolites have a longer half-life than the drug itself, the half-life for its cholesterol enzyme inhibiting effects is 20 to 30 hours. This means that the drug’s effects may last even after the drug itself is out of your system.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/aDsW8tx1KsY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Drugs can interact with one another and certain foods in harmful ways.</span></figcaption>
</figure>
<h2>Why do I need to take medications with food or at certain times?</h2>
<p><a href="https://theconversation.com/explainer-why-must-some-medications-be-taken-with-food-34649">Eating food</a> can change the amount and rate at which a drug is absorbed into the body in several ways, including changing the acidity of the digestive system, altering the release of bile and increasing blood flow to the gut.</p>
<p>For Lipitor specifically, the answer to this question can be found in the “Absorption” subsection under “Pharmacokinetics.” Food decreases the rate and extent of Lipitor’s absorption but doesn’t significantly affect LDL cholesterol reduction.</p>
<p>Interestingly, the insert also states that the blood concentration of the drug is significantly lower when taken in the evening than in the morning, but reduction in LDL cholesterol levels is the same regardless of when the drug is taken.</p>
<p>The upshot of all of this is written on the drug label on the outside of the package: Lipitor can be taken with or without food. Morning or evening is not specified, but the recommendation is to take it at the same time every day.</p>
<h2>Why does my doctor ask about other drugs I’m taking?</h2>
<p>Drugs can <a href="https://theconversation.com/watch-out-for-dangerous-combinations-of-over-the-counter-cold-medicine-and-prescription-drugs-two-pharmacoepidemiology-experts-explain-the-risks-195167">interact with one another</a> in ways that affect their safety and efficacy. For instance, two drugs may rely on the same enzyme system in the body to break them down. Taking them at the same time can ultimately lead to higher-than-anticipated levels of either or both drugs in the body.</p>
<p>Information to answer this question can be found in the “Drug Interactions” section. </p>
<p>One of the drug categories of concern for Lipitor are “strong inhibitors of CYP 3A4,” an enzyme that plays a key role in <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">metabolizing many drugs</a>. Because Lipitor itself is broken down by this enzyme, taking it alongside drugs that inhibit CYP 3A4, such as the antibiotic clarithromycin or the fungal infection drug itraconazole, can lead to its increased concentration in the blood and potentially result in adverse effects.</p><img src="https://counter.theconversation.com/content/201634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Reisfeld does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Don’t be intimidated by the package insert that comes with your medication. Learning how to read it can help you better understand how drugs work.Brad Reisfeld, Professor of Chemical and Biological Engineering, Biomedical Engineering, and Public Health, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002282023-03-19T11:51:51Z2023-03-19T11:51:51Z3 ways to unlock the power of food to promote heart health<figure><img src="https://images.theconversation.com/files/515920/original/file-20230316-2393-gn90tf.jpg?ixlib=rb-1.1.0&rect=172%2C111%2C5146%2C3700&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Heart-healthy approaches to eating include the Mediterranean diet, the DASH diet and the Portfolio diet.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Your diet — the foods and drinks you eat, not short-term restrictive programs — can impact your heart disease risk. Evidence-based approaches to eating are used by dietitians and physicians to prevent and treat cardiovascular (heart) disease. </p>
<p>National Nutrition Month, with its 2023 theme of <a href="https://www.dietitians.ca/Advocacy/Nutrition-Month/Nutrition-Month-2023?lang=en-CA">Unlock the Potential of Food</a>, is an ideal opportunity to learn more about these approaches and adopt more heart-friendly behaviours.</p>
<p>The <a href="https://doi.org/10.1016/j.cjca.2016.07.510">Canadian Cardiovascular Society (CCS) Clinical Practice Guidelines</a> recommend three main dietary patterns for lowering heart disease risk: the Mediterranean Diet, Dietary Approaches to Stop Hypertension (DASH) and the Portfolio Diet.</p>
<ol>
<li><p><strong>The Mediterranean Diet</strong> is rich in colourful vegetables and fruits, whole grains, legumes, nuts, olive oil and seafood. Research studies have shown that this diet <a href="https://doi.org/10.1056/nejmoa1800389">reduces risk of having a heart attack or stroke</a>, even <a href="https://doi.org/10.1016/s0140-6736(22)00122-2">if you already have heart disease</a>, and provides several other health benefits. <a href="https://www.dietitians.ca/DietitiansOfCanada/media/Documents/Mediterranean%20Diet%20Toolkit/Mediterranean-Diet-Toolkit-A-Guide-to-Healthy-Eating-(handout).pdf">Dietitians of Canada has created a resource</a> that summarizes the details of this approach to eating. </p></li>
<li><p><strong>The DASH Diet</strong> focuses on eating plenty of vegetables, fruit, low-fat dairy, whole grains and nuts, while limiting red and processed meats, foods with added sugar, and sodium. <a href="https://doi.org/10.3390/nu11020338">Originally developed to treat high blood pressure</a>, this diet can also lower low-density lipoprotein cholesterol (LDL-C — the unhealthy type of cholesterol) and provides several other health benefits. <a href="https://www.heartandstroke.ca/healthy-living/healthy-eating/dash-diet">Heart & Stroke has several resources</a> on this approach to eating. </p></li>
<li><p><strong>The Portfolio Diet</strong> was originally developed in Canada to treat high cholesterol. It emphasises plant proteins (for example, soy and other legumes); nuts; viscous (or “sticky”) fibre sources such as oats, barley and psyllium; plant sterols; and healthy oils like olive oil, canola oil and avocado. <a href="https://doi.org/10.1016/j.pcad.2018.05.004">Many research studies</a> have shown that this diet can lower LDL-C, and provides several other health benefits. Research shows that <a href="https://doi.org/10.1161/jaha.121.021515">even small additions of Portfolio Diet heart-healthy foods</a> can make a difference; the more you consume of these recommended foods, the greater your reductions in LDL-C and heart disease risk. The <a href="https://ccs.ca/app/uploads/2020/11/Portfolio_Diet_Scroll_editable_eng.pdf">Canadian Cardiovascular Society has an infographic</a> on how to follow the Portfolio Diet. </p></li>
</ol>
<p>A common theme among these three approaches to eating is that they are all considered plant-based, and small changes can make a difference in your overall heart disease risk. “Plant based” does not necessarily mean you have to be 100 per cent vegan or vegetarian to get their benefits. Plant-based diets can range from entirely vegan to diets that include small to moderate amounts of animal products.</p>
<p>Knowledge of healthy eating approaches is key, but behaviours unlock the power of food. Below are three strategies to use to apply the potential of food to promote heart health. They show that by combining the power of nutrition and psychology, you can <a href="https://www.newharbinger.com/9781684033331/healthy-habits-suck/">improve your chances of making long-term changes</a>.</p>
<p>You don’t need to do this alone. We recommend requesting a referral from your physician (this helps with getting the appointment covered by your insurance) to work with a registered dietitian and/or psychologist (behaviourist) to co-create your own ways to unlock the potential of food. </p>
<h2>3 ways to unlock the power of food</h2>
<figure class="align-center ">
<img alt="A woman in a white coat holding an apple, with a bowl of fresh produce on her desk, consulting with a woman who has her back to the camera" src="https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516092/original/file-20230317-4846-oh3wlb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Working with a registered dietitian or psychologist (behaviourist) can help you create a personalized plan to unlock the potential of food. A physician’s referral can help with getting the appointment covered by insurance.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>1. Master and conquer the 90 per cent goal</h2>
<p>Pick a goal you’re 90 per cent sure you can succeed at, while creating a plan to meet larger and harder goals in the future. This approach will help you build confidence in your skills and give you valuable information about what does and does not work for you.</p>
<p><a href="https://www.newharbinger.com/9781608824342/the-abcs-of-human-behavior/">Research shows</a> starting with 90 per cent goals makes it more likely we meet future goals. A 90 per cent goal could be swapping out animal protein for plant protein — such as tofu or beans — at lunch on Mondays (<a href="https://www.mondaycampaigns.org/meatless-monday">Meatless Mondays</a>). Another example: use a meal delivery service that provides measured ingredients with plant-based recipes on Monday, Wednesday and Friday, so you can get some new ideas about how to incorporate more plants into your meals.</p>
<h2>2. Why eliminate and restrict, when you can substitute?</h2>
<p>Pick a “do instead” goal or work with a registered dietitian to substitute healthier choices for your current foods and drinks. Avoid setting goals that may <a href="https://doi.org/10.1016/j.eatbeh.2010.03.001">make you focus MORE on the foods you’re trying to avoid</a> (for example, “stop eating sugar”).</p>
<p>Instead, the substitution approach can include things like choosing lower-sodium soup or purchasing pre-cut vegetables with the aim of reducing your starch portion at meals by half. <a href="https://food-guide.canada.ca/en/tips-for-healthy-eating/make-healthy-meals-with-the-eat-well-plate/">Canada’s Food Guide</a>, <a href="https://www.diabetes.ca/resources/tools---resources/basic-meal-planning">Diabetes Canada</a> and <a href="https://www.heartandstroke.ca/-/media/pdf-files/what-we-do/publications/living-well-with-heart-disease/chapter-3.ashx?rev=bae93023086643e8873730f4bd29b946">Heart & Stroke</a> recommend that half your plate be vegetables.</p>
<h2>3. Set value-based goals</h2>
<p>Connect your goal to something that deeply matters to you. While long-term outcomes (such as heart disease) may be the impetus for change, <a href="https://doi.org/10.1093/oxfordhb/9780197550076.013.18">research shows that things that matter to us right now motivate us most</a>. Picking personal and meaningful reasons for change will help with sustained change.</p>
<p>For example, choose to cook one meal that incorporates a vegetable with a close friend or family member, so you can share the experience and spend time together. This example may be rooted in the following values: kindness, relational values, cultural values, empathy, courage.</p>
<h2>Unlock the power of food</h2>
<p><a href="https://obesitycanada.ca/wp-content/uploads/2021/07/10-Psych-Interventions-2-v7-with-links-1.pdf">Research shows</a> a key to changing diet is focusing on changing eating habits and food behaviours, one at a time. The support of a nutrition professional, such as a registered dietitian and/or a psychologist, can help you make informed choices and plans, tailored to your unique needs, situation, preferences, traditions, abilities and capacity.</p><img src="https://counter.theconversation.com/content/200228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shannan M. Grant has received funding from Diabetes Canada, Dietitians of Canada and currently holds funding from Medavie, Tri-Council Funding Programs, Canadian Foundation for Dietetic Research, IWK Health, Mount Saint Vincent University. She is affiliated with Mount Saint Vincent University, IWK Health, Dalhousie University, Dietitians of Canada, Diabetes Canada, People in Pain (PIPN), and Dr. Dayna Lee-Baggley and Associates.</span></em></p><p class="fine-print"><em><span>Andrea J. Glenn receives postdoctoral research funding from the Canadian Institutes of Health Research (CIHR). She has received honoraria from the Soy Nutrition Institute (2020) and the Academy of Nutrition and Dietetics (2022). </span></em></p><p class="fine-print"><em><span>Dayna Lee-Baggley, Ph.D, Registered Psychologist owns shares in Dr. Lee-Baggley and Associates. She has received funding in the past from the Kidney Foundation of Canada (research grant), QEII Foundation (research grant), CIHR (research grant), SSHRC (research grant) and honoraria/speaking fees from Tobacco Free Nova Scotia, Bausch Health, and Novo Nordisk. She receives royalties from New Harbinger. </span></em></p>Research shows the key to changing your diet is focusing on changing eating habits and food behaviours, one at a time.Shannan M. Grant, Associate Professor, Registered Dietitian, Department of Applied Human Nutrition, Mount Saint Vincent UniversityAndrea J. Glenn, Postdoctoral research fellow, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard UniversityDayna Lee-Baggley, Adjunct professor, Department of Family Medicine & Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1945022022-11-14T10:44:38Z2022-11-14T10:44:38ZOver 12% of South African adults have diabetes - education is critical to achieve good outcomes<figure><img src="https://images.theconversation.com/files/494927/original/file-20221112-29604-1ypgsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Type 2 diabetes mostly affects adults of a certain age.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Over <a href="https://www.up.ac.za/tshwane-insulin-project-tip/news/post_2937261-world-diabetes-day-up-insulin-project-acknowledges-crucial-role-of-nurses-in-managing-the-disease">12%</a> of adults in South Africa have diabetes. Since 2019, researchers at the University of Pretoria have been working on the <a href="https://www.up.ac.za/diabetes-research-centre/article/3107624/tshwane-insulin-programme-tip">Tshwane Insulin Project</a>. The project consists of delivering training workshops on comprehensive diabetes and hypertension management in primary care. The researchers also provide technical assistance to healthcare professionals to improve diabetes care. The Conversation Africa spoke to project manager Dr Patrick Ngassa Piotie about what diabetes is and why it’s so difficult to manage.</em></p>
<hr>
<h2>What is diabetes?</h2>
<p>Diabetes mellitus, or <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">diabetes</a>, refers to a group of conditions that affect how the body uses blood glucose (sugar). Diabetes occurs when the pancreas is no longer <a href="https://www.idf.org/aboutdiabetes/what-is-diabetes.html">able to make insulin</a>, or when the body cannot make good use of the insulin it produces. This leads to elevated glucose levels in the blood. Over time, high blood glucose levels cause damage to the body and the failure of various organs.</p>
<p>There are different types of diabetes. Type 2 is the most common. It accounts for 90% of all cases. With type 2, the body is still able to produce insulin but can’t use it correctly. Type 2 diabetes mostly affects adults of a certain age, who are overweight, don’t exercise, and have a family history of diabetes.</p>
<p>Type 1 diabetes can develop at any age, but it occurs most frequently in children and adolescents. With type 1 diabetes, the pancreas produces very little to no insulin. This means people who have type 1 diabetes need insulin daily to maintain blood glucose levels. </p>
<p>Lastly, there’s diabetes that occurs during pregnancy – gestational diabetes. It affects both mother and child, but usually disappears after pregnancy.</p>
<p>Pre-diabetes is a reversible condition. It happens when blood glucose levels are higher than normal, but <a href="https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444">not high enough to be called diabetes</a>. It can lead to diabetes unless measures such as lifestyle modifications are taken to prevent it.</p>
<p>The symptoms of diabetes are linked to the high levels of sugar in the blood. They include feeling tired and weak, feeling more thirsty than usual, urinating often, or losing weight without trying. Other symptoms such as blurry vision, recurring infections or slow-healing sores are signs of an advanced stage of the disease.</p>
<h2>How is it managed?</h2>
<p>This depends on the type of diabetes. For example, people with type 1 diabetes need daily insulin injections. The management of type 2 diabetes consists of adopting a healthy lifestyle including increased physical activity and healthy diet. However, type 2 diabetes is a progressive disease. This means that, as the condition progresses, people with type 2 diabetes will need oral drugs and/or insulin to keep their blood glucose levels under control.</p>
<p>Managing diabetes is not just about keeping the blood glucose levels within normal ranges. Often, people with diabetes and healthcare professionals must control the blood pressure and cholesterol levels as well. In addition, a key aspect of managing diabetes is to prevent complications by protecting target organs such as the kidneys and the heart, or the feet.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/technology-and-home-visits-can-help-south-africans-with-diabetes-cope-with-insulin-186000">Technology and home visits can help South Africans with diabetes cope with insulin</a>
</strong>
</em>
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<p>At the <a href="http://www.diabetes.up.ac.za">University of Pretoria Diabetes Research Centre</a>, we have developed an acronym that summarises our approach to good diabetes care: the <a href="https://www.up.ac.za/media/shared/856/ZP_Resources/living-with-diabetes_starting-insulin.zp225902.pdf">four “Bs” and four “Cs”</a> or 4Bs 4Cs.</p>
<p>The 4Bs are critical elements to control diabetes:</p>
<ul>
<li><p>Blood pressure control</p></li>
<li><p>Blood glucose control</p></li>
<li><p>Blood cholesterol control</p></li>
<li><p>Breathe air, don’t smoke</p></li>
</ul>
<p>The 4Cs are important tests that people with diabetes should receive every year:</p>
<ul>
<li><p>Check eyes, with a diabetic eye screening – a specific test to check for eye problems caused by diabetes</p></li>
<li><p>Check mouth, by going to the dentist</p></li>
<li><p>Check kidneys, with a laboratory test</p></li>
<li><p>Check feet, with a simple easy-to-do foot exam.</p></li>
</ul>
<p>To manage diabetes, healthcare professionals need the full participation of people with diabetes and their families. That is why it’s important that people with diabetes and their families receive <a href="https://www.semdsa.org.za/">diabetes education</a>. People with diabetes must be <a href="https://worlddiabetesday.org/about/theme/">equipped</a> with the skills to navigate self-management decisions and activities. </p>
<h2>What are the main challenges in managing the condition?</h2>
<p>In South Africa, most people with diabetes rely on the public health system for care. This system is overburdened, overstretched and under-resourced. These systemic challenges have an impact on the delivery of diabetes care, despite the availability of diabetes medication – including insulin – free of charge at primary care clinics.</p>
<p>Healthcare professionals often don’t have time for diabetes education because of long queues and congested health facilities. As a result, people with diabetes <a href="https://pubmed.ncbi.nlm.nih.gov/28156143/">don’t receive the education they need</a>. This, in turn, means people don’t have a good understanding of their condition, which affects their ability to adopt appropriate self-management behaviours, and to adhere to their medication.</p>
<p>Research conducted in South Africa has consistently shown that healthcare workers <a href="https://pubmed.ncbi.nlm.nih.gov/32242428/">don’t comply with diabetes management guidelines</a>. They also fail to implement the recommended processes of care such as measurements of body mass index, waist circumference or weight.</p>
<p>Having paper-based medical records instead of electronic medical records is an additional barrier. The medical records are often lost or misplaced. In a context where healthcare professionals rotate often between departments, it becomes difficult to preserve patient history and to ensure continuity of care. A paper-based system makes it difficult to implement structured diabetes care.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/our-research-shows-gaps-in-south-africas-diabetes-management-programme-160275">Our research shows gaps in South Africa's diabetes management programme</a>
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<p>South African <a href="https://pubmed.ncbi.nlm.nih.gov/35532128/">studies</a> have found that screening for diabetes-related complications is lacking. For example, healthcare professionals are <a href="https://www.diabetessa.org.za/challenges-facing-sa-in-the-fight-against-diabetic-retinopathy/">not able to screen patients for eye problems</a> caused by diabetes. Diabetic eye screening requires a specific camera that is not available in most clinics and community health centres. </p>
<h2>How can these be addressed?</h2>
<p><a href="https://guidelines.diabetes.ca/cpg">Diabetes care</a> should be structured, evidence-based and facilitated by a multidisciplinary team trained in diabetes management.</p>
<p>South Africa’s health system should be strengthened. Investments are needed to improve the delivery of diabetes care. There is a pressing need for the continuous training of healthcare professionals in diabetes management.</p>
<p>Because of the heavy workload on primary care nurses and doctors, allied healthcare workers, community health workers and health promoters should be trained to carry out non-clinical duties like diabetes education and support.</p>
<p>The recognition and integration of diabetes educators within the public healthcare system should be a priority. This will ensure that diabetes education becomes systematic and consistent. It should be repeated at regular intervals. Families of people living with diabetes should also be involved and receive diabetes education because their support is crucial.</p>
<p>Technology, digital health solutions and telehealth can improve the delivery of quality diabetes care. Clinical information systems such as electronic medical records and electronic patient registries can have a positive impact on evidence-based diabetes care. Those systems should be introduced as a matter of urgency.</p>
<h2>What are some of the key lessons from the Tshwane Insulin Project so far?</h2>
<p>The use of digital health, enhancing the role played by community health workers and following patients proactively are some of the <a href="https://pubmed.ncbi.nlm.nih.gov/34733467/">innovations that were introduced</a>.</p>
<p>Most healthcare professionals are eager to embrace change and new knowledge. And people with diabetes and their families were appreciative of the education they were receiving. They qualified it as life changing.</p>
<p>Improving diabetes care and outcomes in South Africa will require a strong will and unwavering support from the health authorities, the introduction of clinical information systems, the use of technology and digital solutions, advocacy and accountability.</p><img src="https://counter.theconversation.com/content/194502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Ngassa Piotie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Improving diabetes care in South Africa requires strong will and support from health authorities, introduction of clinical information systems, the use of technology and digital solutions.Patrick Ngassa Piotie, Project Manager, University of Pretoria Diabetes Research Centre, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1593832022-08-29T13:07:42Z2022-08-29T13:07:42ZHow safe is it to drink rainwater?<figure><img src="https://images.theconversation.com/files/481568/original/file-20220829-26-3te7ch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are concerns about how safe rainwater is to drink.</span> </figcaption></figure><p><em>In many parts of the world, including Africa, people rely on <a href="https://iwaponline.com/washdev/article/10/3/502/74755/Rainwater-harvesting-and-primary-uses-among-rural">rainwater as a source of drinking water</a>, as well as for other <a href="https://blogs.worldbank.org/water/roofs-rain-and-life-rainwater-harvesting-safe-water-supply-and-sustainable-co-benefits">household and livelihood uses</a>. One of the reasons is water scarcity – sub-Saharan Africa has the <a href="https://www.intechopen.com/chapters/63707">largest number of water-scarce countries</a> in the world. But there are concerns about how safe rainwater is to drink. It can be <a href="https://orca.cardiff.ac.uk/id/eprint/150054/1/washdev0100502.pdf">contaminated</a> by dust and ash in the surroundings or by heavy metal from roofing material. Another concern is the presence of manufactured chemicals called perfluoroalkyl and polyfluoroalkyl substances (PFAS), or “forever chemicals”. As environmental scientist Ian Cousins and his team explain, they are a threat to the use of rainwater for domestic purposes.</em></p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/how-safe-is-it-to-drink-rainwater-159383&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<h2>What are PFAS and why should we be worried about them?</h2>
<p>PFAS are a group of man-made substances often described as “forever chemicals” because they never <a href="https://pubs.rsc.org/en/content/articlelanding/2020/em/d0em00355g">break down in the environment</a>. </p>
<p>They are found everywhere – in air, soil, and water as well as in wildlife, plants and humans. They can be found on the highest mountains, in the deep oceans and on both poles. A <a href="https://pubs.acs.org/doi/10.1021/acs.est.2c02765">recent study</a> highlighted the widespread presence of PFAS in rainwater, from the Tibetan Plateau to Antarctica, and noted that according to recently published health advisories, rainwater everywhere could be considered unsafe to drink. </p>
<p>According to the US Environmental Protection Agency, there are <a href="https://comptox.epa.gov/dashboard/chemical-lists/PFASMASTER">more than 12,000 of these chemicals </a> in use. They have been produced and used on a large scale in a wide range of <a href="https://pubs.rsc.org/en/content/articlelanding/2020/em/d0em00291g">industrial and commercial applications</a> since the second world war. Well-known uses include fire-fighting foams, non-stick cookware, and paper and board used to wrap and contain food. There are hundreds of uses, too numerous to list.</p>
<p>The human exposure pathways and health effects of <a href="https://pubs.acs.org/doi/10.1021/acs.est.6b04806">most of the chemicals are poorly understood</a> or unknown, except for four about which there is good information. They are: PFOS (perfluorooctanesulfonic acid), PFOA (perfluorooctanoic acid), PFHxS (perfluorohexanesulfonic acid) and PFNA (perfluorononanoic acid). </p>
<p>At elevated levels of exposure, these four have been associated with serious <a href="https://www.atsdr.cdc.gov/pfas/index.html">human health harms</a>, including different forms of cancer, development toxicity, infertility and pregnancy complications, high cholesterol, ulcerative colitis, liver hypertrophy (“enlargement”), and thyroid disease. </p>
<p>The recent extremely low advisories for drinking water were prompted by the observation that exposure to these chemicals can lead to <a href="https://www.mdpi.com/1660-4601/14/7/691/htm">decreased vaccine effectiveness</a> in children.</p>
<p>PFAS have been used for a long time. But intensive research on them began only about 20 years ago. Since then, the knowledge of toxicity has increased enormously. Based on this knowledge, the exposure level that is considered safe for humans has <a href="https://setac.onlinelibrary.wiley.com/doi/full/10.1002/etc.4863">been set lower and lower</a>.</p>
<p>The PFAS levels in health advisories for <a href="https://www.efsa.europa.eu/en/news/pfas-food-efsa-assesses-risks-and-sets-tolerable-intake">food</a> and <a href="https://www.epa.gov/sdwa/drinking-water-health-advisories-pfoa-and-pfos">drinking water</a> have been reduced to a point that is hard to achieve. This is because the advisory values are close to or even higher than the PFAS level in the environment. </p>
<p>In our <a href="https://www.epa.gov/sdwa/drinking-water-health-advisories-pfoa-and-pfos">recent study</a> we showed that levels of certain PFAS in rainwater now exceed the guidelines set by the US Environmental Protection Agency even in the remotest regions of the Earth. </p>
<p>It is important to note that the levels of the four PFAS in rainwater and other environmental media have not increased recently. The use and emission of these <a href="https://pubs.acs.org/doi/10.1021/acs.est.6b04806">so-called “legacy” PFAS</a> was discontinued in many countries in recent years. But their stability means that they will remain in the environment indefinitely.</p>
<p>The <a href="https://environmentalevidencejournal.biomedcentral.com/articles/10.1186/s13750-017-0114-y">levels of the four PFAS</a> in the atmosphere have been stable since they were first measured in the early 2000s, which means their levels have been above the most recent drinking water advisories since then.</p>
<p>The situation will also not improve soon. PFAS do not not break down in the environment. Their only route for removal from environments where we produce food is <a href="https://pubs.acs.org/doi/10.1021/es0512475">slow dilution into the deep oceans</a>. Rainwater levels may take decades to fall below the levels set in health advisories. The exact recovery time is uncertain.</p>
<h2>How are people most exposed?</h2>
<p>For the four well-studied PFAS, <a href="https://www.nature.com/articles/s41370-018-0094-1">humans are exposed</a> primarily through food, drinking water and household dust. Food and drinking water are contaminated primarily by the environment. </p>
<p>For the larger class of PFAS, human exposure pathways vary enormously, and there are many thousands of other PFAS that are not monitored or studied at all, so we know nothing about their exposure levels or toxicities, which is concerning.</p>
<p>There are <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/rem.21553">ways to remove</a> PFAS from water, but it is not clear if the levels can be brought below the latest health advisories. </p>
<p>Regular vacuuming can reduce dust exposure, but there is no way to remove PFAS from food. Therefore, it is not possible to completely avoid exposure to low-level PFAS. Humans will have to live with it. </p>
<h2>Is it safe to drink rainwater?</h2>
<p>We are uncertain. It is unlikely that many of the effects listed above would be observed at very low exposure levels, of pg/L or ng/L (picogram/litre and nanogram/litre are units of concentration). An effect that might be observed at these low levels is the decreased effectiveness of vaccines. </p>
<p>The health advisories are set so low because the authorities want to be close to certain that no effects will occur at those levels. The precautionary assumptions are used to ensure that the public is protected. Therefore, we have to hope that some effects on the large scale will not occur, but we cannot be certain.</p>
<h2>What lessons can be learned?</h2>
<p>There are more than 12,000 PFAS currently in use, with hundreds of individual uses. All PFAS are man-made and, therefore, they have no place in the natural environment. Due to concerns about their eternal presence and potential toxicities, scientists have suggested that PFAS should only be used where they are <a href="https://pubs.rsc.org/en/content/articlelanding/2019/em/c9em00163h">essential</a> and that the essentiality of every PFAS used should be evaluated.</p><img src="https://counter.theconversation.com/content/159383/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rainwater may be contaminated with chemicals and scientists are still uncertain about their effects.Ian Cousins, Professor of Contaminant Chemistry, Stockholm UniversityBo Sha, PhD Candidate, Stockholm UniversityJana H. Johansson, Researcher, Department of Environmental Science, Stockholm UniversityMartin Scheringer, Senior scientist, Swiss Federal Institute of Technology ZurichMatthew Salter, Researcher, Department of Environmental Science, Stockholm UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835912022-06-08T12:33:31Z2022-06-08T12:33:31ZNo, Latinos don’t actually have less heart disease – a new large study refutes the longstanding ‘Latino paradox’<figure><img src="https://images.theconversation.com/files/467233/original/file-20220606-20-3pn9ey.jpg?ixlib=rb-1.1.0&rect=233%2C0%2C4958%2C3362&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For at least three decades, studies have shown that Latinos have better heart health than other people, but new research calls that into question. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/grandmother-teaching-granddaughter-to-cook-in-royalty-free-image/1312462880?adppopup=true">The Good Brigade/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Latinos may have higher rates of heart disease than previously thought, refuting a well-accepted idea known as the “Latino paradox,” according to a <a href="https://doi.org/10.1007/s11606-022-07625-y">new study that I was involved in</a>.</p>
<p>The crux of the Latino paradox is as follows: A broad body of research shows that Latinos have <a href="https://www.diabetesresearch.org/file/national-diabetes-statistics-report-2020.pdf">higher rates of diabetes</a>, <a href="https://doi.org/10.1001/jama.2020.14590">obesity</a> and <a href="https://doi.org/10.1097/HCO.0000000000000636">uncontrolled blood pressure</a> and <a href="https://doi.org/10.1161/JAHA.115.001867">cholesterol levels</a> than non-Hispanic white people. So naturally, it would follow that Latino people should also have higher levels of cardiovascular disease. </p>
<p>But for the past 30 years, <a href="https://doi.org/10.2105/AJPH.2012.301103">a wide body of studies</a> has found the opposite: Despite greater risk factors for heart disease, Latinos have lower mortality from rates of heart disease than non-Latino people. </p>
<p>We found, however, that both Latino men and women have significantly higher rates of heart disease than non-Hispanic whites. In fact, for men we found rates of heart disease that were even slightly higher than among Black people, a group with <a href="https://doi.org/10.1161/cir.0000000000000534">the highest rates of heart disease</a>. We found that 9.2% of Latinos had a diagnosis of heart disease, compared with 8.1% among Black people and 7.6% among non-Hispanic white men. </p>
<p>To do the analysis, we used data from <a href="https://doi.org/10.1056/NEJMsr1809937">the All of Us research program</a>, which seeks to enroll at least 1 million people from diverse backgrounds over the next few years. We examined medical record data from the more than 200,000 people who have already signed up for the program, <a href="https://doi.org/10.1371/journal.pone.0234962">including over 40,000 Latinos</a>. </p>
<p>Going into the study, we assumed that we would find evidence in support of the Latino paradox. Prior data on the paradox was based mostly on mortality records or self-reporting, both of which have inherent limitations. For example, without an autopsy, it is often hard to know for certain what led to a person’s death. People also may not be aware that they had heart disease, especially if they have not seen a doctor in a long time.</p>
<p>Instead, our work looked at medical records and examined diagnoses of heart disease as determined by a physician during health care visits. We think this is a novel approach, as it uses more robust data to examine this issue. </p>
<h2>Why it matters</h2>
<p>The widely accepted <a href="https://doi.org/10.1016/j.ejim.2013.09.003">“Latino paradox</a>” has been studied extensively. And until now, most <a href="https://doi.org/10.1016/j.pcad.2014.09.001">studies have supported it</a>, though none have found a <a href="https://theconversation.com/the-cheerful-lexicon-of-the-spanish-language-may-help-solve-a-health-mystery-called-the-hispanic-paradox-173598">concrete explanation for it</a>. Medical and public health students are often taught about it as an unexplained phenomenon. But our study, using the largest research cohort of Latinos in the United States, seems to refute the paradox.</p>
<p>The implications are critical because they suggest that like all groups, Latinos still need to take care of themselves by eating healthily, exercising regularly, watching their weight, avoiding smoking and getting regular check-ups. Those with diabetes, hypertension or cholesterol, need to make sure those conditions are well-controlled. </p>
<p>These seemingly straightforward messages are the ones that doctors have been telling all of their patients for decades. Yet this study makes it clear that Latinos don’t get a free pass when it comes to heart disease and that they also need to follow health guidelines. And our study highlights the ongoing need for culturally tailored cardiovascular health programs for the Latino community. </p>
<h2>What is still unknown</h2>
<p>Although our study analyzed data from the largest existing cohort of Latinos, we do not think ours is the definitive word on the topic. More research is needed, and we need to continue to think creatively about how to get at these questions. It is also important to keep in mind that Latino populations are not homogeneous. Latinos come from many different parts of Latin America, where diets, customs and lifestyles are all unique.</p>
<p>For that reason, our team is interested in looking at health data focused on Latino subgroups, as well as comparing U.S.-born Latinos with immigrants. We also hope to examine the Latino paradox when it comes to other conditions such as cancer, which research has also shown occurs <a href="https://doi.org/10.3322/caac.21695">less frequently among Latinos than other groups</a>. That is another paradox that we need to reexamine.</p><img src="https://counter.theconversation.com/content/183591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olveen Carrasquillo receives funding from National Institutes of Health (NIH) and Patient Centered Outcomes Research Institute (PCORI).</span></em></p>It has long puzzled researchers why Latinos seem to have lower rates of heart disease than their non-Latino counterparts, even though they have higher risk factors for heart disease.Olveen Carrasquillo, Professor of Medicine and Public Health Sciences, University of MiamiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1794542022-05-19T12:23:24Z2022-05-19T12:23:24ZIs intermittent fasting the diet for you? Here’s what the science says<figure><img src="https://images.theconversation.com/files/453968/original/file-20220323-23-zm8qqm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Intermittent fasting could have an array of health benefits, but as of yet there are no long-term studies into its effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/intermitted-farsting-diet-concept-royalty-free-image/1361961784?adppopup=true">neirfy/iStock via Getty Images Plus</a></span></figcaption></figure><p>What if I told you all you need to do to lose weight is read a calendar and tell time? These are the basics for successfully following an intermittent fasting diet. </p>
<p>Can it be that simple, though? Does it work? And what is the scientific basis for fasting? As a registered dietitian and <a href="https://experts.okstate.edu/mckale.montgomery">expert in human nutrition and metabolism</a>, I am frequently asked such questions.</p>
<p>Simply stated, intermittent fasting is defined by alternating set periods of fasting with periods in which eating is permitted. One method is <a href="https://doi.org/10.1093/ajcn/86.1.7">alternate-day fasting</a>. On “fast days,” followers of this form of fasting are restricted to consuming no more than 500 calories per day; on “feast days,” which occur every other day, they can eat freely, with no restrictions on the types or quantities of foods eaten. </p>
<p>Other methods include the increasingly popular <a href="https://doi.org/10.1038/s41574-022-00638-x">5:2 method</a>. This form of fasting involves five days of feasting and two days of fasting per week. </p>
<p>Another variation relies on time-restricted eating. That means followers should fast for a specified number of hours – typically 16 to 20 per day – while freely consuming foods within a designated four- to eight-hour period.</p>
<p>But what about eating breakfast and <a href="https://doi.org/10.1056/NEJM198910053211403">then small meals throughout</a> the day to keep the body’s metabolism running? After all, that’s the <a href="https://doi.org/10.1093/ajcn/81.1.16">conventional wisdom</a> that many of us grew up with. </p>
<p>To answer these questions, it helps to understand the basics of human metabolism. </p>
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<figcaption><span class="caption">A TV host went on a two-month intermittent fast to lose weight. Did it work?</span></figcaption>
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<h2>Human metabolism 101</h2>
<p>The human body requires a continual supply of energy to sustain life, and the foods we eat provide us with this energy. But because eating is often followed by periods of time without eating, an intricate set of biological pathways is in place to meet the body’s energy demands between meals. </p>
<p>Most of the pathways function at some level all the time, but they fluctuate following a meal in a predictable pattern called the <a href="https://doi.org/10.1007/s13679-018-0308-9">fed-fast cycle</a>. The time frames of the cycle can vary, depending on the food types eaten, the size of the meal and the person’s activity level.</p>
<p>So what happens, metabolically speaking, after we eat? Consuming carbohydrates and fats leads to a rise in blood glucose and also <a href="https://doi.org/10.1001/jama.2013.280593">lipid levels</a>, which include cholesterol and triglycerides. </p>
<p>This triggers the release of insulin from the pancreas. The insulin helps tissues throughout the body take up the glucose and lipids, which supplies the tissues with energy. </p>
<p>Once energy needs are met, leftover glucose is stored in the liver and skeletal muscle in a condensed form called glycogen. When glycogen stores are full, excess glucose converts to fatty acids and is stored in fat tissue. </p>
<p><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/absorptive-state">About three to 18 hours</a> after a meal – again, depending upon a person’s activity level and size the of the meal – the amount of circulating blood glucose and lipids returns to baseline levels. So tissues then must rely on fuel sources already in the body, which are the glycogen and fat. A hormone called glucagon, secreted by the pancreas, helps facilitate the breakdown of glycogen and fat to provide energy for the body between meals. </p>
<p>Glucagon also initiates a process known as <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/gluconeogenesis">gluconeogenesis</a>, which is the synthesis of glucose from nondietary sources. This helps maintain the right level of blood glucose levels.</p>
<p>When the body reaches a true fasting state – about 18 hours to two days without additional food intake – the body’s stores of glycogen are depleted, and tissues like the heart and skeletal muscle start to rely heavily on fats for energy. That means an increase in the breakdown of the stored fats. </p>
<p>“Aha!” you might say. “So intermittent fasting is the key to ultimate fat burning?” Well, it’s not that simple. Let’s go through what happens next.</p>
<h2>The starvation state</h2>
<p>Though many tissues adapt to using fats for energy, the brain and red blood cells need a continual supply of glucose. But when glucose is not available because of fasting, the body starts to break down its own proteins and <a href="https://doi.org/10.1152/ajpendo.1997.273.6.E1209">converts them to glucose instead</a>. However, because proteins are also critical for supporting essential bodily functions, this is not a sustainable process.</p>
<p>When the body enters the starvation state, the body goes into self-preservation mode, and a metabolic shift occurs in an effort to spare body protein. The body continues to synthesize glucose for those cells and tissue that absolutely need it, but the breakdown of stored fats increases as well to provide energy for tissues such as the skeletal muscle, heart, liver and kidneys. </p>
<p>This also <a href="https://www.ncbi.nlm.nih.gov/books/NBK493179/#">promotes ketogenesis</a>, or the formation of ketone bodies – molecules produced in the liver as an energy source when glucose is not available. In the starvation state, ketone bodies are important energy sources, because the body is not capable of solely utilizing fat for energy. This is why it is inaccurate when some proponents of intermittent fasting claim that fasting is a way of burning “just fat” - it’s not biologically possible.</p>
<p>What happens when you break the fast? The cycle starts over. Blood glucose and lipids return to basal levels, and energy levels in the body are seamlessly maintained by transitioning between the metabolic pathways described earlier. The neat thing is, we don’t even have to think about it. The body is well-equipped to adapt between periods of feasting and fasting. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/G5J6BfFMZPM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Intermittent fasting – fact or fiction? What the science actually says.</span></figcaption>
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<h2>Possible downsides</h2>
<p>If an “all-or-nothing” dietary approach to weight loss sounds appealing to you, chances are it just might work. Indeed, intermittent fasting diets have produced <a href="https://doi.org/10.1001/jamainternmed.2017.0936">clinically significant</a> amounts of weight loss. Intermittent fasting may also <a href="https://doi.org/10.1038/s41574-022-00638-x">reduce disease risk</a> by lowering blood pressure and blood lipid levels.</p>
<p>On the flip side, numerous studies have shown that the weight reduction from intermittent fasting diets is <a href="https://doi.org/10.1001/jamainternmed.2017.0936">no greater than</a> the weight loss on a standard calorie-restricted diet.</p>
<p>In fact, the weight loss caused by intermittent fasting is due not to spending time in some sort of magic metabolic window, but rather to reduced overall calorie consumption. On feast days, dieters do not typically <a href="https://doi.org/10.1186/1475-2891-9-35">fully compensate</a> for lack of food on fasted days. This is what results in mild to moderate weight loss. Approximately 75% of the weight is fat mass; the rest is lean mass. That’s about the <a href="https://doi.org/10.1038/s41574-022-00638-x">same ratio as a standard low-calorie diet</a>.</p>
<p>Should you still want to go forward with intermittent fasting, keep a few things to keep in mind. First, there are no studies on the long-term safety and efficacy of following this type of diet. Second, studies show that intermittent fasters don’t get enough of <a href="https://doi.org/10.1016/j.clnu.2020.02.022">certain nutrients</a>. </p>
<p>Exercise is something else to consider. It helps preserve lean muscle mass and may also contribute to increased weight loss and long-term weight maintenance. This is important, because nearly a quarter of the weight lost on any diet is muscle tissue, and the efficacy of intermittent fasting for weight loss has been demonstrated <a href="https://doi.org/10.1038/s41574-022-00638-x">for only short durations</a>.</p>
<p>Also, once you stop following an intermittent-fasting diet, you will very likely gain the weight back. This is a critical consideration, because many people find the diet difficult to follow long-term. Imagine the challenge of planning six months’ worth of feasting and fasting around family dinners, holidays and parties. Then imagine doing it for a lifetime. </p>
<p>Ultimately, the best approach is to follow an eating plan that meets current dietary recommendations and fits into your lifestyle.</p><img src="https://counter.theconversation.com/content/179454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>McKale Montgomery receives funding from the National Institutes of Health.</span></em></p>Proponents of intermittent fasting say the clock can help you win the battle of the bulge. But the science behind it is a little more complicated.McKale Montgomery, Assistant Professor of Nutritional Sciences, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1572352022-01-04T19:13:15Z2022-01-04T19:13:15Z4 plant-based foods to eat every week (and why science suggests they’re good for you)<figure><img src="https://images.theconversation.com/files/436253/original/file-20211208-140109-1hurlbt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4500%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As a laureate professor in nutrition and dietetics people often ask – what do you eat? </p>
<p>Plant-based foods are good sources of healthy nutrients. These include different types of dietary fibre, vitamins, minerals, and a range of “<a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">phytonutrients</a>”, which plants produce to help them grow or protect them from pathogens and pests.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33951994/">review of research published in May 2021</a> looked at 12 studies with more than 500,000 people who were followed for up to 25 years. It found those who ate the most plant foods were less likely to die from any cause over follow-up time periods that varied across the studies from five to 25 years, compared to those who ate the least.</p>
<p>Here are four versatile and tasty plant foods I have on my weekly grocery list, and the research showing why they’re good for you.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/plant-rich-diets-may-help-prevent-depression-new-evidence-103898">Plant-rich diets may help prevent depression – new evidence</a>
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</em>
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<h2>1. Tomatoes</h2>
<p>Tomatoes are a berry fruit (not a vegetable). They’re rich in vitamin C and “<a href="https://en.wikipedia.org/wiki/Lycopene">lycopene</a>”, which is a carotenoid. Carotenoids are pigments produced by plants and give vegetables their bright colours. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/32243013/">review of six trials</a> asked people to consume tomato products equivalent to 1-1.5 large tomatoes or 1-1.5 cups of tomato juice daily for about six weeks.</p>
<p>The researchers found people who did this had reduced blood levels of triglycerides (a type of fat in your blood that <a href="https://pubmed.ncbi.nlm.nih.gov/31530008/">increases heart disease risk</a>), as well as lower total and “bad” cholesterol levels, compared to those who didn’t have any tomatoes.</p>
<p>These people also had increased levels of “good cholesterol”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/love-meat-too-much-to-be-vegetarian-go-flexitarian-73741">Love meat too much to be vegetarian? Go 'flexitarian'</a>
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<p>Another review of 11 studies tested the <a href="https://pubmed.ncbi.nlm.nih.gov/33676812/">effect of tomatoes and lycopene on blood pressure</a>.</p>
<p>Researchers found consuming any tomato products led to a large decrease in systolic blood pressure (the first number that measures the pressure at which the heart pumps blood).</p>
<p>However, there was no effect on the diastolic pressure (the second number which is the pressure in the heart when it relaxes).</p>
<p>In the group who had high blood pressure to begin with, both systolic and diastolic blood pressure decreased after eating tomato products compared to placebos.</p>
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<img alt="Tomatoes" src="https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Tomatoes are high in vitamin C and other important healthy nutrients.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/29317772/">review of studies</a> included a total of 260,000 men and found those with the highest intakes of cooked tomatoes, tomato sauces and tomato-based foods (equivalent to around one cup per week) had a 15-20% lower risk of developing prostate cancer compared to those with the lowest tomato intakes. Keep in mind correlation doesn’t necessarily mean causation, though. </p>
<p><strong>Recipe tips</strong></p>
<p>Keep canned tomatoes in the cupboard and add to pasta sauce, casseroles and soup. Make your own sauce by roasting tomatoes and red capsicum with a splash of olive oil and balsamic vinegar, then puree with a spoon of chilli paste or herbs of your choice. Keep in the fridge.</p>
<p>Try our fast tomato <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--tomato">recipes at No Money No Time</a>, a site full of dietary advice and recipes founded by my team at the University of Newcastle. </p>
<h2>2. Pumpkin</h2>
<p>Pumpkin is rich in beta-carotene, which is also a carotenoid (plant pigment). It gets converted into vitamin A in the body and <a href="https://pubmed.ncbi.nlm.nih.gov/24782580/">is used in the production of antibodies that fight infection</a>. It’s also needed to maintain the integrity of cells in eyes, skin, lungs and the gut. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/30475962/">review of studies that followed people over time</a> looked at associations between what people ate, blood concentrations of <a href="https://en.wikipedia.org/wiki/Beta-Carotene">beta-carotene</a> and health outcomes.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/carrots-and-pumpkin-might-reduce-your-risk-of-cancer-but-beware-taking-them-in-pill-form-75537">Carrots and pumpkin might reduce your risk of cancer, but beware taking them in pill form</a>
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</p>
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<p>People who had the highest intakes of foods rich in beta-carotene (such as pumpkin, carrots, sweet potato and leafy greens) had an 8-19% lower relative risk of having coronary heart disease, stroke, or dying from any cause in studies over 10 years or more compared to those with the lowest intakes.</p>
<p><strong>Recipe tips</strong></p>
<p>Pumpkin soup is a favourite. Try our <a href="https://nomoneynotime.com.au/healthy-easy-recipes/design-your-own-pumpkin-soup">design-your-own</a> soup recipe.</p>
<p>Heat oven to 180°C, chop the pumpkin into wedges, drizzle with olive oil, roast till golden. Speed it up by microwaving cut pumpkin for a couple of minutes before roasting.</p>
<figure class="align-center ">
<img alt="Carrots, pumpkins, sweet potato and other vegetables" src="https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pumpkins, carrots and sweet potato have high levels of beta-carotene, which has health benefits.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>3. Mushrooms</h2>
<p>Mushrooms are rich in nutrients with strong antioxidant properties.</p>
<p>The body’s usual processes create <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/antioxidants">oxidative stress</a>, which generates “free radicals”. These are small particles that damage cells walls and cause the cells to die.</p>
<p>If these aren’t neutralised by antioxidants, they can trigger inflammation, contribute to ageing and development of some cancers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-antioxidants-and-are-they-truly-good-for-us-86062">What are antioxidants? And are they truly good for us?</a>
</strong>
</em>
</p>
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<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33724299/">review of 17 studies on mushrooms and health</a> found people who ate the most mushrooms had a 34% lower risk of developing any type of cancer compared to those with lowest intakes. For breast cancer, the risk was 35% lower. Though, again, correlation doesn’t necessarily mean causation.</p>
<p>Across the studies, a high mushroom intake was equivalent to eating a button mushroom a day (roughly 18 grams).</p>
<p><strong>Recipe tips</strong></p>
<p>Check out our <a href="https://nomoneynotime.com.au/healthy-easy-recipes/basic-mushroom-baby-spinach-side">mushroom and baby spinach stir-fry recipe</a>. It makes a tasty side dish to serve with scrambled or poached eggs on toast. </p>
<h2>4. Oats</h2>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33296453/">review of ten studies</a> tested the effects on blood sugar and insulin levels from eating intact oat kernels, thick rolled oats or quick rolled oats compared to refined grains.</p>
<p>These found eating intact oat kernels and thick rolled oats led to significant reductions in blood glucose and insulin responses, but not after eating quick rolled oats.</p>
<p>This is likely due to the longer time it takes for your body to digest and absorb the less-processed oats. So it’s better to eat whole grain oats, called groats, or rolled oats rather then quick rolled oats.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">Phytonutrients can boost your health. Here are 4 and where to find them (including in your next cup of coffee)</a>
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</em>
</p>
<hr>
<p>Oats are a good sources of <a href="https://pubmed.ncbi.nlm.nih.gov/34828872/">beta-glucan</a>, a soluble fibre shown to help lower blood cholesterol levels.</p>
<p>Across <a href="https://pubmed.ncbi.nlm.nih.gov/27724985/">58 studies where people were fed a special diet</a> containing about 3.5 grams of oat beta-glucan a day, “bad” cholesterol levels were significantly lower compared with control groups.</p>
<p>The impact of oats <a href="https://pubmed.ncbi.nlm.nih.gov/25668347/">on blood pressure has been tested in five intervention trials</a> which showed a small, but important, drop in blood pressure.</p>
<p><strong>Recipe tips</strong></p>
<p>You can eat rolled oats for breakfast year round.</p>
<p>Eat them as <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--oats">muesli in summer or porridge in winter</a>, add to meat patties, mix with breadcrumbs for coatings or add to fruit crumble toppings.</p><img src="https://counter.theconversation.com/content/157235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She has received research grants from NHMRC, ARC, MRFF, Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>As a laureate professor in nutrition and dietetics, people often ask me what I eat. Here are four plant-based foods I have on my weekly grocery list.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1663932021-09-28T11:56:22Z2021-09-28T11:56:22ZCan healthy people who eat right and exercise skip the COVID-19 vaccine? A research scientist and fitness enthusiast explains why the answer is no<figure><img src="https://images.theconversation.com/files/422695/original/file-20210922-25-11lek97.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5439%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Several thousand protestors opposed to the COVID-19 vaccine march through the streets of midtown Manhattan in New York on Sept. 18, 2021. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/several-thousand-protestors-opposed-to-the-covid-19-vaccine-news-photo/1341164693?adppopup=true">Andrew Lichtenstein/Corbis News via Getty Images</a></span></figcaption></figure><p>I’m a fitness enthusiast. I also adhere to a nutrient-dense, “clean” eating program, which means I minimize my sugar intake and eat a lot of whole foods for the purpose of optimizing my health. </p>
<p>You might wonder how effective such a diet and exercise plan would be in the fight against COVID-19, since some <a href="https://www.washingtonpost.com/technology/2021/09/12/wellness-influencers-vaccine-misinformation/">have suggested</a> – without supporting evidence – that vaccination may be unnecessary if a detailed wellness lifestyle is closely followed. </p>
<p>As a <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C43&q=Bloomer+and+memphis&btnG=">research scientist</a> who has studied nutrition for close to 20 years, I have watched the wellness community’s response to the COVID-19 vaccines with great interest. While eating right can <a href="https://doi.org/10.3390/nu12061562">favorably impact the immune system</a>, it is not reasonable to expect that nutrition alone will defend against a potentially life-threatening virus. </p>
<h2>My experience with nutrition science</h2>
<p>My lab group at the <a href="https://www.memphis.edu/healthsciences/">University of Memphis</a> studies the effect of food and isolated nutrients on human health. In January 2009, we conducted an initial study of a stringent vegan diet. We enrolled 43 men and women who were allowed to eat as much plant-based food as desired, but drank only water, for 21 days. </p>
<p>The results demonstrated improvements <a href="https://doi.org/10.1186/1476-511X-9-94">in many variables</a> related to cardio-metabolic health, such as blood cholesterol, blood pressure, insulin and C-reactive protein – a protein that increases in response to inflammation. We have <a href="https://pubmed.ncbi.nlm.nih.gov/?term=bloomer+and+daniel+fast">since completed</a> multiple human and animal nutrition studies using this dietary program. </p>
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<img alt="A woman eating a healthy salad." src="https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Diet improvements may reduce or eliminate the need for some medications, but a clean diet cannot completely protect you from COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-eating-salad-royalty-free-image/912617718?adppopup=true">Tara Moore via Getty Images</a></span>
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<p>My lab’s research has resulted in some 200 peer-reviewed scientific manuscripts and book chapters specific to <a href="https://umwa.memphis.edu/fcv/viewprofile.php?uuid=rbloomer">nutrients and exercise</a>, and the interaction between these two variables. The results of our work, as well as that of other scientists, clearly demonstrate the power of food to favorably impact health.</p>
<p>For many individuals, a positive change in eating habits results in such an improvement in clinically relevant measures like <a href="https://doi.org/10.1186/1476-511X-9-94">blood cholesterol</a> <a href="https://doi.org/10.3390/ijerph17072557">and glucose</a> that doctors can sometimes reduce or eliminate certain medications used to treat high cholesterol and diabetes. In other cases, these measures improve but the patient still requires the use of medications to control their disease. This tells us that in some situations, a great nutrition program is simply not enough to overcome the body’s challenges.</p>
<h2>Nutrition and other wellness approaches do matter</h2>
<p>Although certain <a href="https://doi.org/10.3389/fphar.2020.01189">natural products</a> have been discussed as treatments for COVID-19, little emphasis has been placed on whole food nutrition as a protective measure. I think this is unfortunate, and I believe strengthening our immune system with the goal of battling COVID-19 and other viral infections is of great importance. And the <a href="https://theconversation.com/good-nutrition-can-contribute-to-keeping-covid-19-and-other-diseases-away-145086">evidence tells us</a> that a <a href="https://doi.org/10.3390/nu12061562">nutrient dense diet</a>, <a href="http://dx.doi.org/10.1136/bjsports-2021-104080">regular exercise</a> and <a href="https://doi.org/10.1007/s00424-011-1044-0">adequate sleep</a> can all contribute to optimal immune function. </p>
<p>Regarding nutritional intake, a <a href="https://doi.org/10.1136/bmjnph-2021-000272">recently published study</a> using a sample of health care workers who contracted COVID-19 noted that those who followed a plant-based or pescatarian diet had 73% and 59% lower odds of moderate to severe COVID-19, respectively, compared to those who did not follow those diets. Although interesting, it’s important to remember that these findings represent an association rather than a causal effect. </p>
<p>While people can use nutrition to help shore up their immune system against COVID-19, diet is only one important consideration. Other <a href="https://doi.org/10.3945/an.115.010207">variables matter</a> a great deal too, including <a href="https://pubmed.ncbi.nlm.nih.gov/29306937/">stress management</a>, <a href="https://doi.org/10.3389/fimmu.2020.570122">nutritional supplements</a> and <a href="https://doi.org/10.1016/S0140-6736(20)31142-9">physical distancing and mask-wearing</a>.</p>
<p>But to be clear, all of those elements should be considered tools in the toolbox to help combat COVID-19 – not a replacement for potentially life-saving vaccines. </p>
<figure class="align-center ">
<img alt="A teenage boy at a clinic getting a COVID-19 shot." src="https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Charles Muro, age 13, receives a COVID-19 shot at a mass vaccination center in Hartford, Connecticut. Without the vaccine, even young people in good health are not fully protected from the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/charles-muro-age-13-is-inoculated-by-nurse-karen-pagliaro-news-photo/1232871480?adppopup=true">Joseph Prezioso/AFP via Getty Images</a></span>
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<h2>Vaccines are not perfect, but they save lives</h2>
<p>I find it interesting that nearly all parents understand the importance of having their kids <a href="https://abcnews.go.com/US/vaccine-mandates-place-attend-school-us/story?id=80046650">vaccinated against serious illnesses</a> like mumps, measles and varicella. They do not expect that certain foods, or a nurturing environment, will do the job of a vaccine. </p>
<p>Yet, when it comes to COVID-19, this thought process is abandoned by <a href="https://www.washingtonpost.com/technology/2021/09/12/wellness-influencers-vaccine-misinformation/">some who believe</a> that a healthy lifestyle will substitute for the vaccine, without seriously considering <a href="https://theconversation.com/what-happens-when-the-covid-19-vaccines-enter-the-body-a-road-map-for-kids-and-grown-ups-164624">what the vaccine actually does to provide protection</a> against the virus – something that a healthy lifestyle alone simply cannot do. </p>
<p>When contemplating whether to receive the COVID-19 vaccine, consider the following: All medications have risks, including things as <a href="https://www.huffingtonpost.co.uk/entry/daily-aspirin-causes-more-than-3000-deaths-per-year-scientists-warn_uk_593fb481e4b0b13f2c6daa10">seemingly benign as aspirin</a>. <a href="https://doi.org/10.1177/0024363918816683">Hormonal contraception</a> – something used by millions of women every month – is thought to cause an estimated 300-400 deaths annually in the U.S. The same is true for <a href="https://www.huffpost.com/entry/what-would-wendy-davis-do_b_3672484">cosmetic surgery</a>, <a href="https://doi.org/10.1007/s00266-020-02027-z">Botox injections</a> and other elective procedures. </p>
<p>Many people are willing to accept the low risks in those cases, but not with those involving <a href="https://theconversation.com/what-does-full-fda-approval-of-a-vaccine-do-if-its-already-authorized-for-emergency-use-165654">the COVID-19 vaccines</a> – despite the fact that the risk of <a href="https://www.theguardian.com/world/2021/aug/27/blood-clot-risk-greater-after-covid-infection-than-after-vaccination">serious complications or death from COVID-19</a> far outweighs the low risk of serious <a href="https://theconversation.com/new-covid-19-vaccine-warnings-dont-mean-its-unsafe-they-mean-the-system-to-report-side-effects-is-working-164455">adverse events</a> from the vaccines. </p>
<p>No lifestyle approach, including strict adherence to a holistic, nutrient-dense diet – vegan, plant-forward or otherwise – will confer total protection against COVID-19. The vaccines <a href="https://theconversation.com/medicine-is-an-imperfect-science-but-you-can-still-trust-its-process-166811">aren’t perfect</a> either; <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">breakthrough infections</a> do occur in some cases, though the vaccines <a href="https://www.wsj.com/articles/breakthrough-cases-covid-19-delta-variant-11627596643">continue to provide robust protection</a> against <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w#T1_down">severe illness and death</a>. </p>
<p>I encourage people to do all they can to improve the health and functioning of their immune system, naturally. Then, seriously consider what additional protection would be gained from vaccination against COVID-19. When people make decisions based on the latest science – which is always evolving – rather than on emotions and misinformation, the decision should become much clearer.</p><img src="https://counter.theconversation.com/content/166393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard J. Bloomer has received research support and has served as a consultant to a variety of dietary ingredient and supplement companies over the past 20 years. </span></em></p>A growing body of research shows that nutrition, sleep, exercise and a host of other lifestyle choices can help optimize the immune system. But they are no substitute for life-saving vaccines.Richard Bloomer, Dean of the College of Health Sciences, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671552021-09-23T10:00:51Z2021-09-23T10:00:51ZDiabetes targets would cost more but the impact would be worth it: here’s how<figure><img src="https://images.theconversation.com/files/421845/original/file-20210917-15-1alo6s0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early detection of diabetes is important in setting treatment targets </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nov-14-2019-a-doctor-makes-free-blood-sugar-test-on-world-news-photo/1182443866?adppopup=true">Xinhua/Mohamed Khidir via Getty Images</a></span></figcaption></figure><p>Setting global health targets, which is often done by multinational organisations, such as the United Nations or World Health Organisation (WHO), is commonly used to improve health outcomes. For example, the United Nations <a href="https://www.avert.org/global-hiv-targets">target</a> to improve access to treatment for HIV has resulted in many more people receiving the treatment that they need, which has <a href="https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/july/20200706_global-aids-report">saved</a> lives. </p>
<p>Now, the WHO <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00111-X/fulltext">Diabetes Compact</a> to support people living with diabetes is under development. The content of the Compact will not be finalised until 2022. However, to help inform whether targets should be part of the Compact, we asked what the health benefits from achieving various targets for people with diabetes would be, and whether these could be cost-effective over the next 10 years. </p>
<p>The WHO is considering whether targets should be set, and our <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00340-5/fulltext">analysis</a> feeds into that process as there was little previous evidence to inform what the targets should be. We were involved in some of the WHO processes for the Compact, and our results have been shared with WHO, but the analysis we did was independent. Similar to the UN targets for HIV/AIDS, the targets we considered were the percentages of people with diabetes and its associated cardiovascular disease risk factors (for example high blood pressure and choesterol) who were diagnosed, treated and controlled.</p>
<p>Our study was based on data from 23,678 people with diabetes living in 67 low- or middle-income countries. These countries were chosen as they had data available and they are home to <a href="http://www.healthdata.org/gbd/data">80% of the world’s people</a> with diabetes. </p>
<p>We found that setting targets for 80% of people with diabetes to have the condition (and other risk factors) diagnosed, treated, and controlled would substantially reduce death and improve healthy-years lived. And it would also be highly cost effective. </p>
<h2>Diabetes is often overlooked</h2>
<p>The most common form of diabetes, type 2 diabetes, is often associated with obesity and usually starts in later life. It is seldom noticed unless picked up by a medical professional. Over time it causes complications such as cardiovascular diseases (like heart attacks and strokes), kidney disease and blindness. These complications are far more likely to happen if a person with diabetes also has high blood pressure (hypertension), another condition that often goes unnoticed. </p>
<p>Treating diabetes and raised blood pressure markedly reduces the risk of future complications. Whether or not cholesterol is raised, giving a medication called a statin to lower it also <a href="https://journals.plos.org/plosmedicine/peerReview?id=10.1371/journal.pmed.1003485.r005">reduces</a> risk. These treatments to reduce risk in people with diabetes are also <a href="https://www.who.int/nmh/publications/essential_ncd_interventions_lr_settings.pdf">recommended</a> by the WHO. </p>
<p>However, our research has <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(21)00089-1/fulltext">previously shown</a> that fewer than 6% of people with diabetes get all the treatment they need to reduce risk of future complications.</p>
<h2>Three targets</h2>
<p>We therefore asked two questions. How would achieving certain targets reduce future complications from diabetes? And, in looking at costs relative to the health benefits, could achieving these targets be cost effective?</p>
<p>Reducing complications from diabetes requires interventions to reduce elevated blood sugar, blood pressure and cholesterol. We asked what benefits would be seen, and at what cost, for all three of these interventions combined.</p>
<p>We studied combinations of three targets. The first is that patients with diabetes are actually diagnosed, and their high blood pressure, if present, is also diagnosed. Second, that they are on treatment for blood sugar, blood pressure and cholesterol using a statin medication. And third, that their blood sugar and blood pressure are controlled to below internationally recommended levels. We tested these at targets of 60%, 70%, or 80% for each of diagnosis, treatment, or control. In other words, what would happen if 80% of people with diabetes and high blood pressure were diagnosed, 80% of those patients were treated and 80% of them were controlled.</p>
<p>We compared this to a baseline scenario in which diagnosis, treatment and control continued at current levels. </p>
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Read more:
<a href="https://theconversation.com/how-changing-blood-pressure-targets-in-south-africa-could-save-costs-and-lives-153674">How changing blood pressure targets in South Africa could save costs and lives</a>
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<p>We found that achieving each of these targets dramatically reduced deaths and improved the number of years people could live in good health. The number of years that people can live in good health is captured by a measure called <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/158">Disability Adjusted Life Years or DALYs</a>. One DALY is equivalent to the loss of a year in full health, hence it captures both early death and being unwell due to a disease.</p>
<p>We found that the greatest impact of achieving the targets would be from reducing the risk of cardiovascular diseases. Other risks like blindness and kidney diseases would be less affected by achieving the targets. </p>
<p>In addition, most of the benefits came from improving treatment of high blood pressure and giving a statin for cholesterol, rather than from treating or controlling high blood sugar.</p>
<p>Overall, at the highest target of 80% diagnosis, 80% treatment, and 80% control, we found that healthy-years-lived were improved by around 6%. This means that around 6% more people with diabetes would be expected to live healthier lives. Even achieving the lower targets of 60% resulted in substantial improvements. </p>
<p>We also showed that achieving the 80% targets would greatly reduce deaths, especially those from cardiovascular diseases.</p>
<p>There was substantial variation in benefits by world regions. For example, reduction in deaths due to cardiovascular diseases was greatest in east sub-Saharan Africa. In this region, deaths would fall from around 46 per 1,000 people in the baseline scenario to 27 per 1,000 with a target of 80% for diagnosis, treatment, and control. In central Latin America deaths fell from around 18 per 1,000 people at baseline to 14 per 1,000 with this target.</p>
<h2>Achieving targets is cost effective</h2>
<p>In our <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00340-5/fulltext">study</a>, we considered the costs of diagnosing and treating diabetes and hypertension, and giving a statin, and the costs of treating the complications of diabetes, for the baseline scenario (current diagnosis, treatment, and control levels continued for the next 10 years) and each of the targets. </p>
<p>In the baseline scenario, the costs of managing diabetes in the countries in the study would be $2,222,882 per 1,000 people with diabetes over the next 10 years. </p>
<p>If diagnosis, treatment, and control were scaled up to achieve 80% targets for each, the costs would increase by a small amount, to $2,832,000 per 1,000 people with diabetes. Most of the increased costs would come from achieving the target for increasing treatment of hypertension. But the costs of treating cardiovascular disease complications would fall. </p>
<p>Overall this gave an incremental cost-effectiveness ratio (effectively the costs per extra healthy-life-year lived, or DALY averted) of $1,362. These costs are well below the WHO <a href="https://www.valueinhealthjournal.com/article/S1098-3015(15)00574-4/fulltext#relatedArticles">thresholds</a> for cost effectiveness of three times GDP per capita for each country. So, each extra year of healthy life would cost $1,362, but the WHO has a benchmark of three times GDP per capita as a worthwhile investment in a year of healthy life. For example, GDP per capita in Angola is $2,790, therefore an intervention would be considered cost effective (by WHO) if it cost less than $8,370 per DALY.</p>
<p>We have shown that targets for diabetes would improve healthy lives and reduce deaths, and that they would be cost effective. But these targets should not be for managing the blood sugar element of diabetes alone; they must include treating hypertension and giving statins to patients with diabetes. </p>
<p><em>This study was done by multiple co-investigators, and this article is written on behalf of the co-investigator team.</em></p><img src="https://counter.theconversation.com/content/167155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justine Ina Davies receives funding from the UK National Institute for Health Research, the UK Medical Research Council, and the US National Institute of Health. </span></em></p><p class="fine-print"><em><span>David Flood receives funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). He also serves as an unpaid Staff Physician for Maya Health Alliance and GlucoSalud, which are two non-governmental health organizations in Guatemala; in his role with these organizations, he occasionally carries out diabetes advocacy and solitics funding for clinical diabetes programs.</span></em></p><p class="fine-print"><em><span>Sanjay Basu receives funding from the US Centers for Disease Control and Prevention, the Clinton Global Health Access Initiative, and the US National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Jennifer Manne-Goehler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Targets for diabetes would improve healthy lives, reduce deaths, and be cost effective. But they should not be for managing diabetes alone; they must include treating hypertension.Justine Ina Davies, Professor of Global Health, Institute for Applied Research, University of BirminghamDavid Flood, Research Fellow, University of MichiganJennifer Manne-Goehler, Research Fellow in Medicine, Harvard UniversitySanjay Basu, Director of Research, Center for Primary Care, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1675042021-09-10T11:52:49Z2021-09-10T11:52:49ZCholesterol jab: why gene silencing drugs may work better than current treatments<figure><img src="https://images.theconversation.com/files/420471/original/file-20210910-15-1kperel.jpg?ixlib=rb-1.1.0&rect=19%2C9%2C6470%2C4310&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The jab would be given twice a year.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid19-vaccine-vial-syring-coronavirus-sarscov2-1905018964">Girts Ragelis/ Shutterstock</a></span></figcaption></figure><p>The NHS has very recently approved a <a href="https://www.england.nhs.uk/2021/09/nhs-cholesterol-busting-jab-to-save-thousands-of-lives/">new cholesterol-lowering jab</a> which will be offered to 300,000 people over the next three years. </p>
<p><a href="https://www.bmj.com/content/368/bmj.m139">The drug</a> – inclisiran – will be administered twice a year as an injection. It will mainly be prescribed to patients who suffer with a genetic condition that leads to high cholesterol, those who have already suffered a heart attack or stroke, or those who haven’t responded well to other cholesterol-lowering drugs, such as statins.</p>
<p>There has been plenty of excitement surrounding the approval of the drug, both because of what it may be able to achieve, and because the drug uses a technique known as “gene silencing”. This is an emerging therapeutic technique that works by targeting the underlying causes of a disease, rather than the symptoms it causes. It does this by targeting a particular gene, and preventing it from making the protein that it produces.</p>
<p>Until now, most treatments using gene silencing technology have been used to treat rare genetic diseases. This means the cholesterol jab will be one of the first gene silencing drugs used to treat people on a wider scale. Researchers are also currently investigating whether gene silencing could be used to treat a wide variety of health conditions, including <a href="https://www.alzheimers.org.uk/blog/genetic-research-dementia-daniel-bradbury">Alzheimer’s disease</a> and <a href="https://www.frontiersin.org/articles/10.3389/fphar.2021.644718/full#:%7E:text=RNA%20interference%20(RNAi)%2C%20also,of%20treatments%2C%20particularly%20genetic%20therapies.">cancer</a>.</p>
<h2>Gene silencing</h2>
<p>Gene silencing drugs work by targeting a specific type of RNA (ribonucleic acid) in the body, called “messenger” RNA. RNAs are found in every cell of the body, and play an important role in the flow of genetic information. But messenger RNA (mRNA) is one of the most important types of RNA our body has, as it copies and carries genetic instructions from our DNA and makes specific proteins depending on the instructions.</p>
<p>In the case of the cholesterol jab, gene silencing works by targeting a protein called PCSK9 and degrading it. This protein is involved in regulating cholesterol in our bodies, but occurs in excess in people with high levels of LDL cholesterol (the “bad” cholesterol). Preventing this protein from being produced in the first place will reduce cholesterol levels.</p>
<p>In order to target this specific mRNA, researchers need to create a synthetic version of another type of RNA – called small interfering RNA (siRNA) – in the lab. This is a highly specific stretch of RNA which can be used to target specific mRNAs. In this case, the siRNA is designed to specifically target the mRNA which carries instructions for the PCSK9 protein. It binds to its target mRNA and destroys the instructions, which significantly reduces the amount of these proteins that are produced.</p>
<figure class="align-center ">
<img alt="Female doctor gives elderly patient an injection into his arm." src="https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420472/original/file-20210910-14-gsthvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The jab specifically targets the liver cells.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/seasonal-flu-shot-brazilian-nurse-medical-1633008724">Prostock-studio/ Shutterstock</a></span>
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<p>Gene therapies are usually delivered using a viral vector – a virus-like vehicle that delivers genes to our cells in the same way a virus might infect them. So far, viral vector therapies have been used to treat rare <a href="https://rupress.org/jem/article/217/2/e20190607/132743/Gene-therapy-for-severe-combined">genetic blood disorders</a>, <a href="https://www.sciencedaily.com/releases/2019/09/190909170745.htm">genetic blindness</a> and <a href="https://www.ema.europa.eu/en/news/new-gene-therapy-treat-spinal-muscular-atrophy-corrected">spinal muscular atrophy</a>. </p>
<p>Although viral vectors are very effective with one treatment, it may be impossible to deliver a second dose if needed due to adverse immune reactions. These drugs are also <a href="https://www.npr.org/sections/health-shots/2019/05/24/725404168/at-2-125-million-new-gene-therapy-is-the-most-expensive-drug-ever?t=1631004513813">extremely costly</a>.</p>
<p>Because of this, many of the gene silencing drugs currently being investigated are delivered using a different technique. Known as non-viral vector gene therapies, these deliver the drug using a nanoparticle which protects it from degradation in the blood so it can be delivered specifically to the target – such as the liver, which is the target of the cholesterol jab.</p>
<p>Gene silencing therapies delivered by non-viral vectors seem to hold more promise as they can be administered several times with <a href="https://www.mdpi.com/1422-0067/22/14/7545">limited side effects</a>. Currently, non-viral vector therapies are used to treat a rare genetic condition called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041433/">hereditary transthyretin-mediated amyloidosis</a>, as well as in mRNA vaccines, such as <a href="https://www.nature.com/articles/s41578-021-00281-4">BionTech/Pfizer and Moderna</a>. </p>
<p>Interestingly, though, the cholesterol jab is not buried inside a nanoparticle or delivered with a viral vector. Instead, the siRNA has been heavily modified in the lab to withstand degradation in the blood. It also has a ligand (a sugar molecule that works a bit like a hook) attached to it that allows it to specifically target liver cells.</p>
<h2>Future treatments</h2>
<p>Several more gene silencing drugs are currently being investigated to treat a <a href="https://www.nature.com/articles/s41392-020-0207-x">variety of other disorders</a>, including in the kidney (such as preventing adverse reactions after a transplant), the skin (scarring), cancer (including melanoma, prostate, pancreatic, brain and other tumours) and <a href="https://pubmed.ncbi.nlm.nih.gov/33548256/">eye disorders</a> (such as age-related macular degeneration and glaucoma). Researchers are also investigating whether gene silencing therapies could be useful in treating <a href="https://www.nature.com/articles/d41586-019-03069-3">neurological and brain disorders</a>, such as Huntington’s disease and Alzheimer’s disease. </p>
<p>Each of these gene silencing treatments would use similar techniques as other drugs that currently exist – by targeting a specific gene or protein and shutting it off. But in the case of cancer, because it’s very complex, multiple different proteins may need to be targeted. </p>
<p>These gene silencing technologies will need to be shown to be effective in further clinical trials before they can be rolled out for use on a wider scale. Another important challenge will be ensuring that the costs of these drugs remain low so many people can access them. But overall, these developments are very promising: gene silencing drugs are more specialised as they can target specific proteins in our cells. This may be why they can be more successful in treating diseases than current treatments.</p><img src="https://counter.theconversation.com/content/167504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aristides Tagalakis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gene silencing drugs target the underlying causes of a disease, rather than the symptoms it causes.Aristides Tagalakis, Reader in Gene Delivery and Nanomedicine, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1507972020-12-01T16:44:03Z2020-12-01T16:44:03ZEight cracking facts about eggs<figure><img src="https://images.theconversation.com/files/372017/original/file-20201130-21-zuzh18.jpg?ixlib=rb-1.1.0&rect=44%2C8%2C5852%2C3925&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/top-view-brown-eggs-carton-box-796082269">Krasula/Shutterstock</a></span></figcaption></figure><p>One of life’s true miracles, the humble egg is maybe one of the most versatile foodstuffs on the planet. It’s formed in 24 to 26 hours and hens can lay up to <a href="https://www.fresheggsdaily.blog/2017/05/how-long-does-it-take-chicken-to-lay-egg.html">250 eggs a year</a>. The incredible egg is pure protein and there are numerous (both sweet and savoury) methods to prepare this natural <a href="https://countryroadsmagazine.com/cuisine/recipes/100-ways-to-fix-an-egg/">nutritional powerhouse</a>. </p>
<p>Eggs can be added raw to smoothies, they can be fried, boiled, scrambled or poached and can be eaten for breakfast, lunch, tea and dinner. </p>
<p>They can be bought nearly anywhere, they last for a number of weeks, they are relatively inexpensive and they can do magical things to <a href="https://www.thekitchn.com/how-to-cook-an-egg-in-many-many-ways-cooking-guides-from-the-kitchn-211289">baked goods</a>. </p>
<p>We all know how easily they can be knocked up into a meal, but there’s also a lot more to the egg than meets the eye. Here’s all the things you need to know about the mighty egg.</p>
<h2>1. Eggs are ancient history</h2>
<p>Humans have been <a href="https://food.ndtv.com/food-drinks/10-different-types-of-edible-eggs-1784859">eating eggs</a> since the dawn of human time. <a href="http://www.foodtimeline.org/foodeggs.html">The Ancient Romans</a> ate peafowl eggs and the Chinese were said to be fond of pigeon eggs. When most of us think of an egg it’s usually the kind laid by a hen, however quail, duck, goose and turkey eggs are also among those consumed. Ostrich and Emu eggs are possibly the largest edible eggs weighing in at 1-2kg. Then there’s also fish eggs such as Caviar and Hilsa – a delicacy packed with essential nutrients. </p>
<figure class="align-center ">
<img alt="Toast with avocado, spinach and fried egg, top view." src="https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372021/original/file-20201130-15-1r6rzbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eggs make a meal out of it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toast-avocado-spinach-fried-egg-top-753380983">Anna Shepulova/Shutterstock</a></span>
</figcaption>
</figure>
<h2>2. Eggs = a nutritional powerhouse</h2>
<p>Eggs are considered one of the most <a href="https://www.healthline.com/nutrition/why-are-eggs-good-for-you">nutritious foods on the planet</a>. They are a natural source of inexpensive, high quality protein – more than half the protein being found in the white, which also includes vitamin B2 and lower amounts of fat than the yolk. The protein in eggs helps to lower blood pressure, optimise bone health and increases muscle mass. </p>
<p><a href="https://www.healthline.com/nutrition/selenium-benefits">Eggs</a> are also rich sources of selenium – an antioxidant that is important for thyroid function and our immune system and mental health – along with <a href="https://theconversation.com/why-covid-makes-it-more-important-than-ever-that-pregnant-and-breastfeeding-women-take-vitamin-d-148863">vitamin D</a>, <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/%20%20and%20various%20minerals%20including%20calcium">B6, B12</a>, <a href="https://www.healthline.com/nutrition/best-foods-high-in-zinc">zinc</a> , and <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/iron/">iron</a>. They are good sources of <a href="https://pubmed.ncbi.nlm.nih.gov/26404361/#:%7E:text=Although%20eggs%20are%20known%20for,generally%20considered%20as%20antioxidant%20foods.&text=Some%20lipophilic%20antioxidants%20such%20as,to%20produce%20antioxidant%2Denriched%20eggs.">antioxidants</a> and can also help to reduce the likelihood of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611842/">macular degeneration and eye cataracts</a>.</p>
<h2>3. They used to have a bad rep</h2>
<p>For many years eggs were <a href="https://theconversation.com/five-foods-that-used-to-be-bad-for-you-but-now-arent-50333">considered to be unhealthy</a> due to the high levels of cholesterol found within them. In fact it was recommended to limit the amount eggs eaten. But this fact originated from what are now considered incorrect conclusions drawn from early research stating that dietary cholesterol contributed to <a href="https://www.nhs.uk/news/food-and-diet/eating-egg-day-does-not-raise-risk-heart-attack-or-stroke/#:%7E:text=%22Eggs%20are%20NOT%20bad%20for,also%20quite%20high%20in%20cholesterol">raised blood cholesterol</a>. Many people believe cholesterol to be harmful, but the truth is that it’s essential for our <a href="https://www.ncbi.nlm.nih.gov/books/NBK9898/">bodies to function</a>. So despite what you might have heard, there’s no recommended limit on how many <a href="https://pubmed.ncbi.nlm.nih.gov/16340654/">eggs you can eat</a>.</p>
<h2>4. But they’ve always been symbolic</h2>
<p>In many cultures worldwide, the egg is <a href="https://www.huffpost.com/entry/easter-eggs-history-origin-symbolism-tradition_n_1392054">a symbol</a> of <a href="https://www.dailynews.com/2010/04/02/easter-eggs-are-symbols-of-new-life/#:%7E:text=Eggs%20have%20signified%20new%20life,that%20they%20embody%20Christian%20teaching%20or%20https://www.alimentarium.org/en/knowledge/eggs-symbol-life">new life</a> , fertility and rebirth. They have signified new life far back into the mists of human origin, long before <a href="https://blogs.loc.gov/folklife/category/material-culture/eggs/#:%7E:text=Whether%20this%20is%20true%20or,celebrated%20at%20the%20vernal%20equinox.&text=Orthodox%20Christians%20in%20Mesopotamia%20took,a%20symbol%20of%20Christ's%20blood.">Christianity</a>. Indeed, an ancient Roman proverb said that all life comes from an egg.</p>
<figure class="align-center ">
<img alt="Artists display painted multicolored Easter eggs against the background of a historic building" src="https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372019/original/file-20201130-19-1tbwq29.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Easter Festival in Kyiv, Ukraine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kyiv-ukraine-april-07-2018-easter-1312183439">S.Borisovich/Shutterstock</a></span>
</figcaption>
</figure>
<h2>5. No, eggs are not chicken periods</h2>
<p>You may have heard <a href="https://www.peta.org/features/eat-chickens-period/">the rumour</a> that eating an egg is eating a chicken’s period. But as chickens are not mammals they do not have wombs and so the egg is actually classed as both the egg and the womb. So it’s not the same as the <a href="https://www.selvabeat.com/home/bad-egg">human reproductive system</a>. Eggs laid on a daily basis by chickens and sold commercially have <a href="https://www.canr.msu.edu/news/can_you_hatch_an_egg_bought_from_the_store#:%7E:text=Most%20eggs%20sold%20commercially%20in,and%20have%20not%20been%20fertilized.&text=Given%20the%20right%20nutrients%2C%20hens,and%20laying%20of%20the%20egg">not been fertilised</a>. If they are provided with the correct nutrients hens will lay eggs with or without having been in the presence of a rooster. In fact the only thing chickens need to lay eggs <a href="https://cutt.ly/khlZiaQ">is light</a>. </p>
<h2>6. COVID has increased demand</h2>
<p>Egg sales have skyrocketed during the pandemic, surpassing 13 billion for the first time <a href="https://www.independent.co.uk/life-style/egg-sales-uk-flexitarian-diet-meat-free-vegetarian-plant-a8800901.html">since the 1980s</a>, which in turn has led to a significant rise in the <a href="https://econlife.com/2020/04/coronavirus-egg-demand/">cost of eggs</a>. </p>
<p>The demand for eggs has historically been strong during tougher <a href="https://www.latimes.com/business/story/2020-04-08/egg-prices-rising-coronavirus">economic stretches</a>, possibly due to the fact that they are a relatively cheap source of protein and other nutrients and are also an extremely versatile ingredient. And with more time spent at home, the current pandemic has led to more families cooking from scratch, <a href="https://www.washingtonpost.com/business/2020/03/26/shortages-eggs-stress-baking/">baking and eating at home</a> – so more egg use. </p>
<figure class="align-center ">
<img alt="Hens in the garden." src="https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372020/original/file-20201130-15-1byxne3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More people are choosing to keep hens in their gardens.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-free-chicken-garden-122971255">Imcsike/Shutterstock</a></span>
</figcaption>
</figure>
<h2>7. Battery cages are banned in the EU</h2>
<p>Over 90% of eggs produced in the UK have the <a href="https://www.egginfo.co.uk/egg-facts-and-figures/production">Lion trademark</a>. This means the hens and eggs are guaranteed to be British, with all hens vaccinated against salmonella and kept to higher welfare standards than the law demands. Across the EU, conventional “battery cages” have been banned. And in the UK, they have been replaced by larger, “enriched” <a href="https://www.nfuonline.com/sectors/poultry/poultry-news/enriched-colony-cages-the-facts/">cages</a> which can allow hens to express more of their natural behaviours, such as perching, dustbathing, and nesting.</p>
<h2>8. So many uses</h2>
<p>Eggs are not just for eating. They have many more uses both in and <a href="https://goodyfeed.com/8-uses-eggs-besides-cooking-eating/">around the home</a> and garden – alongside being great in <a href="https://www.medicalnewstoday.com/articles/323602">homemade beauty products</a>. Eggs can make a great homemade glue, leather cleaner and can even work as plant food. The shell is also a surprisingly <a href="https://morningchores.com/egg-shell-uses/">useful resource</a> and a vital and <a href="http://www.meandmybody.com/news_article.php?newsArticleId=9">important part</a> of this nutrient packed wonder food. Just some of the many uses for eggshells include feeding your compost pile, using as an abrasive drain cleaner or as pest control in the garden. And the eggshell membrane can even be used as a makeshift plaster for any cuts or grazes – just make sure you clean it thoroughly first.</p><img src="https://counter.theconversation.com/content/150797/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Flight does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s all the things you need to know about the mighty egg.Hazel Flight, Programme Lead Nutrition and Health, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1279582019-12-19T13:50:43Z2019-12-19T13:50:43ZShould you avoid meat for good health? How to slice off the facts from the fiction<figure><img src="https://images.theconversation.com/files/307749/original/file-20191218-11939-at7ajp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Meat is a very popular food for most Americans. Its nutritional value is a topic of much debate.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-eat-food-man-eating-barbecue-1162627036">puhhha/Shutterstock.com</a></span></figcaption></figure><p>More than half of Americans who make New Year’s resolutions <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2018/12/13/new-years-resolutions-2019-exercise-healthy-eating">resolve to “eat healthier</a>.” If you’re one, you might be confused about the role meat should play in your health. </p>
<p>It’s no wonder you’re confused. One group of scientists says that reducing red and processed meat is a <a href="https://doi.org/10.1016/S0140-6736(18)31788-4">top priority</a> for your health and the planet’s. Another says these foods <a href="https://doi.org//10.7326/M19-1621">pose no problems</a> for health. Some of your friends may say it depends, and that grass-fed beef and “nitrite-free” processed meats are fine. At the same time, plant-based meat alternatives are <a href="https://theconversation.com/americans-especially-millennials-are-embracing-plant-based-meat-products-124753">surging in popularity</a>, but with uncertain health effects.</p>
<p>As a <a href="https://scholar.google.com/citations?user=vO-AtYoAAAAJ&hl=en">cardiologist and professor of nutrition</a>, I’d like to clear up some of the confusion with five myths and five facts about meat.</p>
<p>First, the myths.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307807/original/file-20191218-11946-wxhnuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Red meat, while very popular, has not been shown to have health benefits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/raw-fresh-marbled-meat-steak-seasonings-255809239">Natalia Lisovskaya/Shutterstock.com</a></span>
</figcaption>
</figure>
<p><strong>Myth: Red meat is good for health</strong></p>
<p>Long-term observational studies of <a href="https://doi.org/10.1371/journal.pone.0175149">heart disease</a>, <a href="https://www.aicr.org/continuous-update-project/colorectal-cancer.html">cancers</a> or <a href="https://academic.oup.com/ajcn/article/105/6/1462/4569801">death</a> and <a href="https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.118.035225">controlled trials</a> of risk factors like blood cholesterol, glucose and inflammation suggest that modest intake of unprocessed red meat is relatively neutral for health. But, no major studies suggest that eating it provides benefits. </p>
<p>So, while an occasional serving of steak, lamb or pork may not worsen your health, it also won’t improve it. And, too much <a href="https://doi.org//%2010.1007/s11154-014-9303-y.">heme iron</a>, which gives red meat its color, may explain why red meat increases risk of <a href="https://doi.org/10.1136/bmj.l2368">Type 2 diabetes</a>. Eating red meat often, and eating <a href="https://www.healthline.com/nutrition/why-processed-meat-is-bad#section8">processed meat</a> even occasionally, is also strongly linked to <a href="https://www.aicr.org/continuous-update-project/colorectal-cancer.html">colorectal cancer</a>. </p>
<p><strong>Myth: You should prioritize lean meats</strong> </p>
<p>For decades, dietary guidance has focused on lean meats because of their lower fat, saturated fat and cholesterol contents. But these nutrients <a href="https://doi.org/10.1038/s41569-019-0206-1">don’t have strong associations</a> with heart attacks, cancers or other major health outcomes. </p>
<p>Other factors appear more important. Processed meats, such as bacon, sausage, salami and cold cuts, contain high levels of <a href="https://doi.org/10.1186/1741-7015-11-136">preservatives</a>. Sodium, for example, raises blood pressure and stroke risk, while the body converts nitrites to cancer-causing <a href="https://www.ncbi.nlm.nih.gov/pubmed/6831466">nitrosamines</a>. Lean or not, these products aren’t healthy.</p>
<p><strong>Myth: Focus on a ‘plant-based’ diet</strong> </p>
<p>“Plant-based” has quickly, but somewhat <a href="https://www.nutritionletter.tufts.edu/issues/15_4/current-articles/Plant-Based-and-Unhealthy_2556-1.html">misleadingly</a>, become a shorthand for “healthy.” First, <a href="https://doi.org/10.1161/CIRCULATIONAHA.115.018585">not all animal-based foods are bad</a>. Poultry and eggs appear relatively neutral. Dairy may have metabolic benefits, especially for reducing body fat and Type 2 diabetes. And, seafood is linked to several health benefits. </p>
<p>Conversely, many of the worst foods are plant-based. Consider white rice, white bread, fries, refined breakfast cereals, cookies and so on. These foods are high in refined starch and sugar, representing <a href="https://doi.org/10.1001/jama.2019.13771">42% of all calories in the U.S.</a>, compared to about 5% of U.S. calories from unprocessed red meats, and 3% from processed meats. </p>
<p>Either a “plant-based” or omnivore diet is not healthy by default. It depends on what you choose to eat.</p>
<p><strong>Myth: Grass-fed beef is better for your health</strong></p>
<p>Conventional livestock eat a combination of forage (grass, other greens, legumes) plus hay with added corn, soy, barley or grain. “Grass-fed,” or “pasture-raised,” livestock eat primarily, but not exclusively, forage. “Grass-finished” livestock should, in theory, only eat forage. But no agency regulates industry’s use of these terms. And “free range” describes where an animal lives, not what it eats.</p>
<p>“Grass-fed” may sound better, but no studies have compared health effects of eating grass-fed versus conventional beef. Nutrient analyses show <a href="https://doi.org/10.1016/j.meatsci.2013.08.010">very modest differences</a> between grass-fed and conventionally raised livestock. You might eat grass-fed beef for personal, environmental or philosophical reasons. But don’t expect health benefits. </p>
<p><strong>Myth: Plant-based meat alternatives are healthier</strong> </p>
<p>Products like Impossible Burger and Beyond Meat are clearly better for the environment than conventionally raised beef, but their health effects remain uncertain. Most nutrients in plant-based alternatives are, by design, similar to meat. Using genetically engineered yeast, Impossible even <a href="https://impossiblefoods.com/heme/">adds heme iron</a>. These products also pack a lot of salt. And, like many other <a href="https://doi.org/10.1016/j.cmet.2019.05.008">ultra-processed foods</a>, they may lead to higher calorie intake and weight gain. </p>
<p>So, what are the facts?</p>
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<img alt="" src="https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307809/original/file-20191218-11939-19rsnbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sausages wrapped in bacon are a double whammy of unhealthy meat, as both bacon and sausage are processed meats.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pigs-blankets-sausages-wrapped-bacon-strips-612579671">MShev/Shutterstock.com</a></span>
</figcaption>
</figure>
<p><strong>Fact: Processed meats are bad for health</strong> </p>
<p>Processed meats contain problematic preservatives. Even those labeled “no nitrates or nitrites added” contain nitrite-rich fermented celery powder. A current <a href="https://cspinet.org/sites/default/files/attachment/2019%20Petition%20No%20Nitrates%20Added%20CSPI%20CU_COMPLETE.pdf">petition</a> by the Center for Science in the Public Interest asks the FDA to ban the misleading labeling.</p>
<p>Besides the sodium, nitrites and heme, processed meats can contain other <a href="https://doi.org/10.1016/j.foodres.2019.108608">carcinogens</a>, produced by charring, smoking or high-temperature frying or grilling. These compounds may not only harm the person who eats these products; they can also cross the placenta and <a href="https://doi.org/10.1016/j.tox.2018.10.003">harm a fetus</a>. </p>
<p><strong>Fact: A meatless diet is not, by itself, a healthy diet</strong></p>
<p>Most diet-related diseases are caused by <a href="https://doi.org/10.1001/jama.2013.13805">too few health-promoting foods </a> like fruits, nuts, seeds, beans, vegetables, whole grains, plant oils, seafood and yogurt. Additional health problems come from too much soda and ultra-processed foods high in salt, refined starch or added sugar. Compared to these major factors, avoiding or occasionally eating unprocessed red meat, by itself, has modest health implications.</p>
<p><strong>Fact: Beef production is devastating the environment</strong></p>
<p>In terms of land use, water use, water pollution and greenhouse gases, unprocessed red meat production causes about <a href="https://doi.org/10.1073/pnas.1906908116">five times the environmental impact</a> of fish, dairy or poultry. This impact is about 20 times higher than that of eggs, nuts or legumes, and 45 to 75 times higher than the impact of fruits, vegetables or whole grains. A 2013 <a href="http://www.fao.org/3/a-i3437e.pdf">UN report</a> concluded that livestock production creates about 15% of all global greenhouse gas emissions, with nearly half coming from beef alone. </p>
<p><strong>Fact: Plant-based meats are better for the environment</strong></p>
<p><a href="https://impossiblefoods.com/mission/lca-update-2019/">Production</a> of plant-based meat alternatives, compared to conventional beef, <a href="http://css.umich.edu/sites/default/files/publication/CSS18-10.pdf">uses</a> half the energy, one-tenth of the land and water, and produces 90% less greenhouse gas. But, no studies have yet compared plant-based meat alternatives to more natural, less processed options, such as mushrooms or tofu. </p>
<p><strong>Fact: Many questions remain</strong></p>
<p>Which preservatives or other toxins in processed meat cause the most harm? Can we eliminate them? In unprocessed red meats, what exactly increases risk of Type 2 diabetes? What innovations, like feeding cows <a href="https://phys.org/news/2019-05-cultivate-seaweed-slashes-greenhouse-emission.html">special strains of seaweed</a> or using <a href="https://www.sciencedirect.com/science/article/pii/S0308521X17310338">regenerative grazing</a>, can reduce the large environmental impacts of meat, even <a href="https://doi.org/10.1016/j.jclepro.2016.11.138">grass-fed beef</a>? What are the health implications of grass-fed beef and plant-based meat alternatives? </p>
<p>Like much in science, the truth about meat is nuanced. Current evidence suggests that people shouldn’t eat unprocessed red meat more than once or twice a week. Grass-fed beef may be modestly better for the environment than traditional production, but environmental harms are still large. Data don’t support major health differences between grass fed and conventional beef. </p>
<p>Similarly, plant-based meat alternatives are better for the planet but not necessarily for our health. Fruits, nuts, beans, vegetables, plant oils and whole grains are still the best bet for both human and planetary health.</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/127958/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Mozaffarian reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Brightseed, DayTwo, Elysium Health, and Filtricine; and chapter royalties from UpToDate; all outside the submitted work. </span></em></p>Confused about whether meat is good or bad for you? You’re not alone. Various studies, some of which were funded by the meat industry, have added to the confusion. A noted expert sorts it out.Dariush Mozaffarian, Dean of Nutrition Science and Policy, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1271542019-12-05T16:02:06Z2019-12-05T16:02:06ZLimited eating times could be a new way to fight obesity and diabetes<figure><img src="https://images.theconversation.com/files/304824/original/file-20191202-67028-7oi1vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Time limits on eating may help to keep diabetics' blood glucose in check.
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glucometer-ripe-fruits-shape-clock-time-1557461105">ratmaner/Shutterstock.com</a></span></figcaption></figure><p>People with obesity, high blood sugar, high blood pressure or high cholesterol are often advised to eat less and move more, but <a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30611-4">our new research suggests</a> there is now another simple tool to fight off these diseases: restricting your eating time to a daily 10-hour window.</p>
<p><a href="Http://doi.org/10.1016/j.cmet.2014.11.001">Studies done</a> <a href="Http://doi.org/10.1016/j.cmet.2012.04.019">in mice</a> and <a href="http://doi.org/10.1038/s41467-019-10563-9">fruit</a> <a href="https://doi.org/10.1126/science.1256682">flies</a> <a href="http://doi.org/10.1186/s12967-016-1044-0">suggest</a> that limiting when animals eat to a daily window of 10 hours can prevent, or even reverse, <a href="https://www.cdc.gov/pcd/issues/2017/16_0287.htm">metabolic diseases that affect millions in the U.S.</a> </p>
<p>We are scientists - <a href="https://panda.salk.edu">a cell biologist</a> and a <a href="https://profiles.ucsd.edu/pam.taub#narrative">cardiologist</a> - and are exploring the effects of the timing of nutrition on health. Results from flies and mice led us and others to test the idea of time-restricted eating in healthy people. <a href="https://doi.org/10.1016/j.cmet.2015.09.005">Studies lasting more than a year</a> showed that <a href="https://doi.org/10.1139/apnm-2018-0389">TRE was safe among healthy individuals</a>. Next, we tested time-restricted eating in patients with conditions known collectively as <a href="https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916">metabolic syndrome</a>. We were curious to see if this approach, which had a profound impact on obese and diabetic lab rats, can help millions of patients who suffer from early signs of diabetes, high blood pressure and unhealthy blood cholesterol. </p>
<h2>A leap from prevention to treatment</h2>
<p>It’s not easy to count calories or figure out how much fat, carbohydrates and protein are in every meal. That’s why using <a href="https://doi.org/10.1017/jns.2018.13">TRE provides</a> <a href="https://doi.org/10.1016/j.cmet.2015.09.005">a new strategy for fighting</a> <a href="http://doi.org/10.1002/oby.22449">obesity and</a> <a href="http://doi.org/10.1017/S0007114513001359">metabolic diseases</a> that affect millions of people worldwide. Several studies had suggested that TRE is a lifestyle choice that healthy people can adopt and that can <a href="http://doi.org/10.1016/j.cmet.2018.04.010">reduce their risk</a> for future metabolic diseases. </p>
<p>However, TRE is rarely tested on people already diagnosed with metabolic diseases. Furthermore, the vast majority of patients with metabolic diseases are often on medication, and it was not clear whether it was safe for these patients to go through daily fasting of more than 12 hours – as many experiments require – or whether TRE will offer any benefits in addition to those from their medications. </p>
<p>In a unique collaboration between our basic science and clinical science laboratories, we tested whether restricting eating to a 10-hour window improved the health of people with metabolic syndrome who were also taking medications that lower blood pressure and cholesterol to manage their disease.</p>
<p><a href="http://doi.org/10.1161/CIRCULATIONAHA.109.192644">We recruited patients</a> from UC San Diego clinics who met at least <a href="http://doi.org/10.1016/j.jacc.2015.06.1328">three out of five criteria</a> for <a href="https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome">metabolic syndrome</a>: obesity, high blood sugar, high blood pressure, high level of bad cholesterol and low level of good cholesterol. The patients used a <a href="https://doi.org/10.1016/j.cmet.2015.09.005">research app called myCircadianClock</a>, developed in our lab, to log every calorie they consumed for two weeks. This helped us to find patients who were more likely to spread their eating out over the span of 14 hours or more and might benefit from 10-hour TRE. </p>
<p>We monitored their physical activity and sleep using a watch worn on the wrist. As some patients with bad blood glucose control may experience low blood glucose at night, we also placed a continuous glucose monitor on their arm to measure blood glucose every few minutes for two weeks. </p>
<p>Nineteen patients qualified for the study. Most of them had already tried standard lifestyle interventions of reducing calories and doing more physical activity. As part of this study, the only change they had to follow was to self-select a window of 10 hours that best suited their work-family life to eat and drink all of their calories, say from 9 a.m. to 7 p.m. Drinking water and taking medications outside this window were allowed. For the next 12 weeks they used the <a href="https://mycircadianclock.org/">myCircadianClock</a> app, and for the last two weeks of the study they also had the continuous glucose monitor and activity monitor. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=629&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=629&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=629&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=790&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=790&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304982/original/file-20191203-66994-1n414zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=790&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tens of millions of people in the U.S. have symptoms of metabolic syndrome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/metabolic-syndrome-signs-symptoms-apple-pear-315847109">Designua/Shuttersock.com</a></span>
</figcaption>
</figure>
<h2>Timing is the medicine</h2>
<p>After 12 weeks, the volunteers returned to the clinic for a thorough medical examination and blood tests. We compared their final results with those from their initial visit. <a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30611-4">The results, which we published in Cell Metabolism</a>, were pleasantly surprising. We found most of them lost a modest amount of body weight, particularly fat from their abdominal region. Those who had high blood glucose levels when fasting also reduced these blood sugar levels. Similarly, most patients further reduced their blood pressure and LDL cholesterol. All of these benefits happened without any change in physical activity. </p>
<p>Reducing the time window of eating also had several inadvertent benefits. On average, patients reduced their daily caloric intake by a modest 8%. However, statistical analyses did not find strong association between calorie reduction and health improvement. <a href="http://doi.org/10.1016/j.cmet.2018.04.010">Similar benefits of TRE on blood pressure and blood glucose</a> control were also found among healthy adults who did not change caloric intake. </p>
<p>Nearly two-thirds of patients also reported restful sleep at night and less hunger at bedtime – similar to what was reported in other TRE studies on <a href="https://doi.org/10.1016/j.cmet.2015.09.005">relatively healthier cohorts</a>. While restricting <a href="http://doi.org/10.1016/j.cmet.2018.04.010">all eating to just a six-hour window</a> was hard for participants and caused several adverse effects, patients reported they could easily adapt to eating within a 10-hour span. Although it was not necessary after completion of the study, nearly 70% of our patients continued with the TRE for at least a year. As their health improved, many of them reported having reduced their medication or stopped some medication. </p>
<p>Despite the success of this study, time-restricted eating is not currently a standard recommendation from doctors to their patients who have metabolic syndrome. This study was a small feasibility study; more rigorous randomized control trials and multiple location trials are necessary next steps. Toward that goal, we have started a <a href="https://clinicaltrials.gov/ct2/show/NCT04057339?term=Pam+taub&draw=2&rank=2">larger study</a> on metabolic syndrome patients. </p>
<p>Although we did not see any of our patients go through dangerously low levels of glucose during overnight fasting, it is important that time-restricted eating be practiced under medical supervision. As TRE can improve metabolic regulation, it is also necessary that a physician pays close attention to the health of the patient and adjusts medications accordingly. </p>
<p>We are cautiously hopeful that time-restricted eating can be a simple, yet powerful approach to treating people with metabolic diseases. </p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/127154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Satchin Panda receives funding from the National Institute of Health, Department of Defense, Federal Emergency Management Agency, Helmsley Charitable trust, Robertwood Johnson Foundation, and Glenn Foundation for Medical Research. He is the author of the book "The Circadian Code" for which he receives author royalty. Satchin Panda is a founding member of the Center for Circadian Biology at UC San Diego. </span></em></p><p class="fine-print"><em><span>Pam Taub receives funding from NIDDK, American Heart Association, Department of Defense. </span></em></p>What if you could treat obesity, diabetes and high blood pressure just by limiting when you eat and drink all your calories? New research says it might work.Satchin Panda, Professor of Regulatory Biology at the Salk Institute for Biological Studies, Adjunct Professor of Cell and Developmental Biology at UCSD, University of California, San DiegoPam Taub, Associate Professor of Medicine, University of California, San DiegoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1265782019-11-14T17:01:54Z2019-11-14T17:01:54ZDwindling tropical rainforests mean lost medicines yet to be discovered in their plants<figure><img src="https://images.theconversation.com/files/301603/original/file-20191113-77342-193w2br.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Brazilian soldier puts out fires.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/APTOPIX-Brazil-Amazon-Fires/dc1ccd8045d340ddae1279337a5adef7/69/0">AP Photo/Leo Correa</a></span></figcaption></figure><p>Growing up in Tanzania, I knew that fruit trees were useful. Climbing a mango tree to pick a fruit was a common thing to do when I was hungry, even though at times there were unintended consequences. My failure to resist consuming unripened fruit, for example, caused my stomach to hurt. With such incidents becoming frequent, it was helpful to learn from my mother that consuming the leaves of a particular plant helped alleviate my stomach pain. </p>
<p>This lesson helped me appreciate the medicinal value of plants. However, I also witnessed my family and neighboring farmers clearing the land by slashing and burning unwanted trees and shrubs, seemingly unaware of their medicinal value, to create space for food crops. </p>
<p>But this lack of appreciation for the medicinal value of plants extends beyond my childhood community. As <a href="https://www.npr.org/2019/08/23/753639869/macron-urges-g7-members-to-put-amazon-fires-at-top-of-agenda">fires continue to burn in the Amazon</a> and land is cleared for agriculture, most of the concerns have focused on the drop in global oxygen production if swaths of the forests disappear. But I’m also worried about the loss of potential medicines that are plentiful in forests and have not yet been discovered. Plants and humans also share many genes, so it may be possible to test various medicines in plants, providing a new strategy for drug testing.</p>
<p><a href="https://scholar.google.com/citations?user=YZshYWgAAAAJ&hl=en">As a plant physiologist</a>, I am <a href="https://www.iaea.org/topics/plant-biodiversity-and-genetic-resources">interested in plant biodiversity</a> because of the potential to develop more resilient and nutritious crops. I am also interested in plant biodiversity because of its <a href="https://link.springer.com/chapter/10.1007%2F10_2014_273">contribution to human health</a>. About 80% of the world population <a href="https://link.springer.com/chapter/10.1007%2F10_2014_273">relies on compounds derived from plants for medicines</a> <a href="https://doi.org/10.1016/j.jep.2005.09.020">to treat various ailments</a>, such as <a href="https://doi.org/10.1016/j.tips.2008.07.004">malaria</a> and <a href="https://doi.org/10.1002/cncr.26285">cancer</a>, and to <a href="https://www.annualreviews.org/doi/pdf/10.1146/annurev.pp.43.060192.002255">suppress pain</a>.</p>
<h2>Future medicines may come from plants</h2>
<p>One of the greatest challenges in fighting diseases is the emergence of drug resistance that renders treatment ineffective. <a href="https://doi.org/10.1186/1475-2875-10-144">Physicians have observed drug resistance</a> in the fight against malaria, <a href="https://doi.org/10.15171/apb.2017.041">cancer</a>, <a href="https://www.cdc.gov/tb/topic/drtb/default.htm">tuberculosis</a> and <a href="https://doi.org/10.3389/fmicb.2016.02173">fungal infections</a>. It is likely that drug resistance will emerge with other diseases, forcing researchers to find <a href="https://doi.org/10.1186/s12936-019-2724-z">new medicines</a>. </p>
<p>Plants are a rich source of new and diverse compounds that may prove to have medicinal properties or serve as building blocks for <a href="https://doi.org/10.1016/j.jep.2006.12.005">new drugs</a>. And, as tropical rainforests are the largest reservoir of diverse species of plants, preserving biodiversity in tropical forests is important to ensure the supply of <a href="https://pubs.acs.org/doi/abs/10.1021/bk-1993-0534.ch002">medicines of the future</a>.</p>
<h2>Plants and new cholesterol-lowering medicines</h2>
<p>The goal of my own research is to understand how <a href="https://doi.org/10.3389/fpls.2019.00354">plants control the production of biochemical compounds called sterols</a>. Humans produce one sterol, called cholesterol, which has functions including formation of testosterone and progesterone - hormones essential for normal body function. By contrast, plants produce a diverse array of sterols, including sitosterol, stigmasterol, campesterol, and cholesterol. These sterols are used for plant growth and defense against stress but also serve as <a href="https://doi.org/10.1073/pnas.1807482115">precursors to medicinal compounds</a> such as those found in the Indian Ayurvedic medicinal plant, ashwagandha. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301581/original/file-20191113-77331-2kahxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Withania somnifer</em>, known commonly as ashwagandha, manufactures molecules that could be useful for cholesterol medicine..</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/a/ad/WithaniaFruit.jpg">Wowbobwow12/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Humans produce cholesterol through a string of genes, and <a href="https://doi.org/10.1038/343425a0">some of these genes produce proteins</a> that are the target of <a href="https://doi.org/10.1038/343425a0">medicines for treating high cholesterol</a>. <a href="https://doi.org/10.1111/j.1399-3054.1983.tb06570.x">Plants also use this collection of genes</a> to make their sterols. In fact, the sterol production systems in plants and humans are so similar that medicines used to treat high cholesterol in people also block sterol production in plant cells.</p>
<p>I am fascinated by the similarities between how humans and plants manufacture sterols, because identifying new medicines that block sterol production in plants might lead to medicines to treat high cholesterol in humans. </p>
<h2>New medicines for chronic and pandemic diseases</h2>
<p>An example of a gene with medical implications that is present in both plants and humans is NPC1, which controls the transport of cholesterol. However, the protein made by the NPC1 gene is also the <a href="https://doi.org/10.1038/nature10348">doorway through which the Ebola virus</a> infects cells. Since <a href="https://doi.org/10.1007/s00425-015-2322-4">plants contain NPC1 genes</a>, they represent potential systems for developing and testing new medicines to block Ebola. </p>
<p>This will involve identifying new chemical compounds that interfere with <a href="http://doi.org/https://doi.org/10.1104/pp.16.01805">plant NPC1</a>. This can be done by extracting chemical compounds from plants and testing whether they can effectively prevent the Ebola virus from infecting cells.</p>
<p>There are many conditions that might benefit from plant research, including <a href="https://www.who.int/gho/ncd/risk_factors/cholesterol_text/en/">high cholesterol</a>, <a href="https://www.who.int/news-room/fact-sheets/detail/cancer">cancer</a> and even infectious diseases <a href="https://doi.org/10.1371/journal.pntd.0006580">such as Ebola</a>, all of which have significant global impact. To treat high cholesterol, <a href="https://doi.org/10.1161/CIRCULATIONAHA.117.027966">medicines called statins</a> are used. <a href="http://doi.org/10.1038/ncb3427">Statins may also help to fight cancer</a>. However, not all patients <a href="https://doi.org/10.1007/s40256-017-0259-7">tolerate statins, which means that alternative therapies</a> must be developed. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301595/original/file-20191113-77338-yymwxj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Villagers take a break during a meeting of Tembé tribes at the Tekohaw indigenous reserve, Para state, Brazil. From the trees they take traditional medicines, as well as products they sell, such as acai, an Amazonian berry that’s a vitamin- and calorie-packed breakfast staple in Brazil.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Brazil-Amazon-Indigenous/02431ef7d634483c8e1e4f7bc4dcadb8/1/0">AP Photo/Rodrigo Abd</a></span>
</figcaption>
</figure>
<h2>Tropical rainforests are medicine reservoirs</h2>
<p>The need for new medicines to <a href="http://doi.org/10.1158/0008-5472.CAN-14-0130">combat heart disease and cancer</a> is dire. A rich and diverse source of chemicals can be <a href="https://doi.org/10.1006/bbrc.1997.6520">found in natural plant products</a>. With knowledge of genes and enzymes that make medicinal compounds in native plant species, scientists can apply genetic engineering approaches <a href="https://www.wpi.edu/news/engineering-plant-cells-speed-production-widely-used-cancer-drug">to increase their production</a> in a sustainable manner.</p>
<p>Tropical rainforests house <a href="http://doi.org/10.1073/pnas.1706264114">vast biodiversity of plants</a>, but this diversity faces significant <a href="http://doi.org/10.1073/pnas.1809753115">threat from human activity</a>. </p>
<p>To help students in my genetics and biotechnology class appreciate the value of plants in medical research, I refer to findings from <a href="https://doi.org/10.1111/ppl.12413">my research on plant sterols</a>. My goal is to help them recognize that many cellular processes are similar between plants and humans. My hope is that, by learning that plants and animals share similar genes and metabolic pathways with health implications, my students will value plants as a source of medicines and become advocates for preservation of plant biodiversity.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/126578/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Walter Suza receives funding from Gates Foundation and USAID. </span></em></p>Destruction of rainforests through wildfires or deforestation may harm human health. As these forests disappear, we may be losing precious medicinal plants that hold treatments for various diseases.Walter Suza, Adjunct Assistant Professor of Agronomy, Iowa State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1140382019-08-06T12:37:02Z2019-08-06T12:37:02ZI sent my DNA to Norway for personalised nutrition advice, what I discovered made me rethink my diet completely<figure><img src="https://images.theconversation.com/files/286921/original/file-20190805-36377-4hevar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p><a href="https://theconversation.com/personalised-nutrition-unravels-why-you-are-what-you-eat-12668">Personalised nutrition</a>, where your DNA tells you what to eat and what not to eat, is gaining momentum. And for those with money to spare, a number of companies now offer fully personalised nutritional advice aimed at improving your overall health.</p>
<p>Having <a href="http://web.dmz.brad.ac.uk/social-sciences/staff-profiles/psychology/stewart-knox-j-barbara.php">researched this area</a> for a number of years, I thought it was time to put my money where my mouth is and find out for myself what it feels like to receive personalised nutrition advice based on my genetics. So I sent off a saliva sample to a company in Norway that came highly recommended by a dietitian friend. </p>
<p>The results came back and I was shocked to discover I have a <a href="https://theconversation.com/blame-it-on-mum-and-dad-how-genes-influence-what-we-eat-45244">genetic predisposition</a> to high cholesterol and cardiovascular disease, both of which can be prevented by making simple dietary changes – which I have since made. Seeing the evidence related to me, only me, and not a generic healthy eating note, literally brought the message home. At first glance I saw only my eventual mortality. But looking again in a more positive light, I saw that I now held the key to postponing that mortality and took action. </p>
<p>To cut a long story short, I am now pretty much teetotal and “B” vitamin pill popping, as according to my genetics, I cannot absorb what I need from diet alone. And because meat is the main source of <a href="https://theconversation.com/can-having-high-cholesterol-reduce-your-chances-of-dementia-92367">LDL cholesterol</a> – the one that’s sometimes called “bad cholestrol” as it’s known to raise your risk for heart disease and stroke – I am now <a href="https://theconversation.com/why-arent-more-people-vegetarian-58367">vegetarian</a> and my cholesterol is normal. </p>
<p>Of course this regime would not be “<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">healthy</a>” for everyone as not everyone is alcohol intolerant. Nor will everyone have a genetic tendency toward <a href="https://theconversation.com/cardiovascular-disease-declines-in-rich-countries-but-poor-countries-suffer-more-25277">cardiovascular disease</a>. It wasn’t all bad news though, apparently I am caffeine and dairy tolerant so can enjoy cheese (reduced fat of course) and thankfully, coffee.</p>
<h2>Digesting data</h2>
<p>But doing the test got me thinking, doesn’t everyone have a right to know their <a href="https://theconversation.com/nutrigenomics-how-nutrition-and-genetics-impact-health-11875">dietary related health risk</a>? And aren’t younger people best placed to make changes that can bring about a sustainable benefit to health and well-being? And what about the majority of people in society who do not have the money to throw away on something that may only deliver benefit if dietary changes are achieved? </p>
<p>Whether I made dietary changes or not, I had a right to know this information about my health. And it’s a pity I did not have this information in my twenties rather than in my sixties, by which time there may already be irreparable damage to my body. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286925/original/file-20190805-36367-bnoddz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The technology is there, so why aren’t we utilising it?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>At the moment, such information is only available to those who can afford to pay for it. And the problem with this approach is that if public health services fail to roll out <a href="https://theconversation.com/you-are-what-you-eat-why-the-future-of-nutrition-is-personal-119477">personalised nutrition</a> to everyone as part of routine health care, it could soon lead to widened health inequalities – which would create a <a href="https://www.researchgate.net/publication/225294582_Associations_between_obesity_BMI_and_waist_circumference_and_socio-demographic_factors_physical_activity_dietary_habits_life_events_resilience_mood_perceived_stress_and_hopelessness_in_healthy_older_E">negative health impact</a> in and of itself.</p>
<h2>Make the future personal</h2>
<p><a href="https://www.bbc.co.uk/news/health-25588544">At the start of 2019 the NHS pledged</a> to collect genetic information on all patients attending clinics. But this is probably a case of too little too late, as people attending clinics are already likely to have conditions that are developing. Given that personalised nutrition technologies are already available, it seems unethical to let people go through life not knowing how they can prevent themselves from becoming ill. And <a href="https://www.eufic.org/en/collaboration/article/eu-funded-food4me-project-paves-way-for-personalised-nutrition-to-better-pu">as research shows</a>, personalised nutrition goals can be motivating to patients. </p>
<p>The European funded <a href="https://www.eufic.org/en/healthy-living/article/personalised-nutrition-food4me-project">Food4me research project</a> that I collaborated in, found that a personalised approach was motivating not only because the information upon which advice is based is tailored, but also because it puts the individual in control. </p>
<p>It’s clear then that we need to start using genetic based technology to prevent diseases now. Personalised nutrition has the potential to reduce the burden of disease on health services and in doing so reduce public spending on health care. Of course, not all patients will make all the changes needed, but once people have this information, what they do with it is up to them – and it’s their choice to make.</p><img src="https://counter.theconversation.com/content/114038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Barbara J Stewart-Knox received funding from the European Commission
as a collaborator in Food4me </span></em></p>Personalised nutrition has the power to save lives.Barbara J Stewart-Knox, Professor of Psychology, University of BradfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1142972019-06-03T20:07:44Z2019-06-03T20:07:44ZHad pre-eclampsia in pregnancy? These 5 things will lower your risk of heart disease<figure><img src="https://images.theconversation.com/files/277568/original/file-20190603-69095-1rg063y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who have had pre-eclampsia have twice the risk of heart disease throughout their lifetime than their peers.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><a href="https://www.healthdirect.gov.au/pre-eclampsia-pregnancy-induced-hypertension">Pre-eclampsia</a> is a serious condition triggered by pregnancy that starts with an increase in blood pressure and the detection of protein in the woman’s urine. </p>
<p>While most cases are mild, if left untreated, women <a href="https://www.healthdirect.gov.au/pre-eclampsia-pregnancy-induced-hypertension">with pre-eclampsia can develop</a> dangerously high blood pressure which damages vital organs – including the brain, liver and kidneys – and can cause seizures and strokes. </p>
<p>The unborn baby’s growth can also be affected, leading to <a href="https://www.pregnancybirthbaby.org.au/premature-baby">premature birth</a> or <a href="https://www.pregnancybirthbaby.org.au/what-is-a-stillbirth">stillbirth</a>. </p>
<p>One in 30 pregnant women in Australia are <a href="https://consultations.health.gov.au/health-services-division/antenatal-care-guidelines-review/">diagnosed with pre-eclampsia</a>. Each year, <a href="https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2016/report-editions">two Australian women die</a> from pre-eclampsia or other high blood pressure conditions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pre-eclampsia-and-how-does-it-affect-mums-and-babies-97781">Explainer: what is pre-eclampsia, and how does it affect mums and babies?</a>
</strong>
</em>
</p>
<hr>
<p>Signs and symptoms of pre-eclampsia usually resolve by about two months after the birth. However, <a href="https://link.springer.com/article/10.1007/s10654-013-9762-6">women then have four times</a> the risk of developing high blood pressure and <a href="https://link.springer.com/article/10.1007/s10654-013-9762-6">twice the risk</a> of having heart disease over their lifetime. The greatest risk is in the first <a href="https://www.ncbi.nlm.nih.gov/pubmed/28228456?dopt=Abstract">ten years following pre-eclampsia</a>. </p>
<p>Yet a survey of 127 Australian women with a history of pre-eclampsia found only two-thirds were aware of their increased heart disease risk, with most discovering this by their own efforts. </p>
<p>The good news is <a href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/ajo.12900">lifestyle changes</a> can help lower heart disease risk. If you’ve had pre-eclampsia, here are five ways you can improve your heart health: </p>
<h2>1. Have regular heart health check-ups</h2>
<p>Regular <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/heart-health-check">heart health check ups</a> means having your blood pressure and blood cholesterol checked by your doctor every five years, as a minimum. </p>
<p>Your GP can help monitor and manage factors that put you at higher risk of heart disease.</p>
<h2>2. Develop heart healthy eating habits</h2>
<p>Using the Heart Foundation’s <a href="https://www.heartfoundation.org.au/for-professionals/food-and-nutrition/heart-healthy-eating-principles">Heart Healthy Eating Principles</a> as a guide, aim to include:</p>
<ul>
<li><p>five serves of vegetables and two serves of fruit per day. This can seem like a lot, but try having some at each meal: adding fruit to breakfast cereal or as a snack; including salad vegetables at lunch; and a vegetable-based stir fry or salad at dinner </p></li>
<li><p>wholegrain and high-fibre breads and cereals. This could include a wholegrain sandwich at lunch time and brown rice or wholemeal pasta at dinner </p></li>
<li><p>a variety of lean protein sources including fish and seafood, lean meat and poultry, legumes, nuts and seeds </p></li>
<li><p>avoid highly processed meats such as salami, ham, sausages and bacon </p></li>
<li><p>reduced-fat dairy, including unflavoured milk, yoghurt and cheese. This helps reduce your total kilojoule intake </p></li>
<li><p>heart-healthy fat sources, including nuts, seeds, avocados, olives and oils higher in monounsaturated and polyunsatured fats such as olive and canola oil for cooking </p></li>
<li><p>herbs and spices to flavour foods, instead of salt </p></li>
<li><p>choosing water as your preferred drink. </p></li>
</ul>
<p><a href="https://www.heartfoundation.org.au/healthy-eating">Following these recommendations</a> will boost your intake of fibre, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/phytonutrient">phytonutrients</a> and unsaturated fats (omega-3 and omega-6). In the longer term this will help reduce high blood pressure and high blood cholesterol, which are major risk factors for heart disease.</p>
<p>Check your eating habits by taking the <a href="http://healthyeatingquiz.com.au/">Healthy Eating Quiz</a> and get some brief advice on how to boost your score. Or visit an <a href="https://daa.asn.au/find-an-apd/">accredited practising dietitian</a> for tailored advice. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277569/original/file-20190603-69067-453bnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fruits and vegetables, legumes, wholegrains and fish are among the foods good for our heart health.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<h2>3. Be physically active</h2>
<p>Regular <a href="https://www.sciencedirect.com/science/article/pii/S0749379704000340?via%3Dihub">physical activity helps reduce heart disease risk in women</a> who have had pre-eclampsia. It does this by <a href="https://www.sciencedirect.com/science/article/pii/S0002937814003858">improving your blood pressure, blood cholesterol and blood glucose</a> (sugar) levels and helping achieve a healthy weight after childbirth. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S0002937814003858">study of 24 women</a> with a recent history of pre-eclampsia found that a 12-week exercise intervention helped improve indicators of heart function.</p>
<p>Doing <em>any</em> physical activity is better than doing none. But if you are <a href="https://www.pregnancybirthbaby.org.au/safe-return-to-exercise-after-pregnancy">returning to exercise after recently giving birth</a>, talk to your GP or an exercise physiologist or physiotherapist about how best to start. </p>
<p><a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines">Australia’s exercise guidelines</a> recommend women be active for 30 to 60 minutes on most, if not all days of the week. Include moderate intensity activities (that don’t make you too breathless) or vigorous intensity activities (that make you huff and puff) or a combination of both. </p>
<p>It’s also recommended that women do <a href="https://www.babycenter.com/2_postpartum-exercises-strengthening-your-core-and-pelvic-floo_10415802.bc">muscle strengthening activities</a> – such as pilates, yoga, or activities that include lifting weights or resistance training – twice a week.</p>
<p>Finally, when sitting, it’s important to <a href="https://www.heartfoundation.org.au/active-living/sit-less">get up and move every 30 minutes</a>. </p>
<h2>4. Aim for a healthy body weight</h2>
<p>It takes time for women to return to their pre-pregnancy weight. </p>
<p>About <a href="https://www.nature.com/articles/0801631#ref-CR1">half of pregnancy weight gain is commonly lost in the first six weeks</a> postpartum, due to birth of the baby and the placenta, and the loss of blood and fluids needed to support the pregnancy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277572/original/file-20190603-69075-ifsdpz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pre-eclampsia affects about one in 30 pregnant women.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While some of the remaining weight gain is intended to support the energy cost of breastfeeding, it can be much harder to shift. <a href="https://www.ncbi.nlm.nih.gov/pubmed/22974518">A study in 152 women</a> found 68% of women had retained around 4.5kg of their pregnancy weight gain at 12 months post-partum. </p>
<p><a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">Fad diets are not recommended</a>, especially while breastfeeding. By focusing on healthy eating and regular physical activity, it’s reasonable for women to expect to lose 0.5-1 kg per week. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-bouncing-back-balance-is-the-healthiest-way-to-manage-weight-post-pregnancy-98306">Forget bouncing back, balance is the healthiest way to manage weight post-pregnancy</a>
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<p>Your non-pregnant waist circumference is another indicator of heart health and reflects the amount of fat stored around your internal organs. <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/waist-measurement">The target waist circumference for women</a> for optimal heart health is is less than 80cm. Measuring your waist circumference is an easy check you can do at home. </p>
<p>If appropriate, a long-term goal can be to aim for a <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator">body mass index</a> (BMI) in the <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight">“healthy weight” range</a> (18.5 to 24.9 kg/m2) to help reduce heart disease risk. </p>
<p>Just keep in mind that BMI is a population-level indicator of health risks; it’s not an accurate measure of body fat for everyone.</p>
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Read more:
<a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">Health Check: what's the best diet for weight loss?</a>
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<h2>5. Quit smoking</h2>
<p>Women who smoke <a href="https://www.bmj.com/content/360/bmj.j5855">one cigarette per day have double the risk</a> of developing heart disease. </p>
<p>Quitting smoking can <a href="https://www.sciencedirect.com/science/article/pii/S0140673674922144">halve your risk of a heart attack</a>. </p>
<p>Your GP can provide advice about quitting, or you can call <a href="http://www.quitnow.gov.au/">Quitline</a> on 13 QUIT (137 848) or use the Heart Foundation’s <a href="https://www.heartfoundation.org.au/after-my-heart-attack/heart-attack-recovery/action-plans/quit-smoking-action-plan">Quit Smoking Action Plan</a>.</p>
<p>With education, knowledge and support, women with a history of pre-eclampsia can take control of their heart health.</p><img src="https://counter.theconversation.com/content/114297/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and 2017 evidence review on dietary patterns for the Heart Foundation.</span></em></p><p class="fine-print"><em><span>Dr Lisa Vincze is a Lecturer in Nutrition & Dietetics at Griffith University (Gold Coast, Australia). She receives funding from The Children's Hospital Foundation and has also received funding from the Hunter Medical Research Institute (HMRI) and University of Newcastle, Australia.</span></em></p><p class="fine-print"><em><span>Melinda Hutchesson is affiliated with the Priority Research Centre for Physical Activity and Nutrition, and is currently a University of Newcastle Gladys M Brawn Career Development Fellow (Teaching Assistance). She has received funding from the National Health and Medical Research Council, National Heart Foundation, Diabetes Australia, Foundation for High Blood Pressure Research, Hunter Medical Research Institute, Exercise and Sports Science Australia, and the University of Newcastle.</span></em></p><p class="fine-print"><em><span>Rachael Taylor is affiliated with the Priority Research Centre for Physical Activity and Nutrition at the University of Newcastle.</span></em></p>Symptoms of pre-eclampsia, including high blood pressure, usually resolve by about two months after the birth. But some health problems can develop later.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLisa Vincze, Lecturer, Community and Public Health Nutrition, Griffith UniversityMelinda Hutchesson, Senior Lecturer in Nutrition and Dietetics, University of NewcastleRachael Taylor, Early career researcher, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1125742019-05-15T20:54:29Z2019-05-15T20:54:29ZCould the solution to osteoporosis be in the bile?<figure><img src="https://images.theconversation.com/files/270881/original/file-20190425-121228-jndadn.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5535%2C3759&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Osteoporosis affects one in three women, but men are also concerned.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Osteoporosis is a degenerative disease where the bone density and quality are reduced. This disease is associated with substantial pain and disability leading to devastating long-term physical and psychological consequences. In Europe, the total osteoporosis economic burden was estimated at 30.7 billion euros in 2010, and is expected to reach <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794536/#B74">76.7 billion in 2050</a>, based on changes in demography.</p>
<p>Osteoporosis is highly prevalent and actually affects one in three women over the age of 50. Over the next 50 years, the number of hip fracture is expected to more than double meaning that the prevalence of osteoporosis will continue to rise and become a significant burden on health-care systems and life quality, especially in women. </p>
<p>So far, efficient treatments for osteoporosis without any side effects and with optimal bioavailability are currently missing, making highly relevant the search of alternatives. The proposed research includes a pre-clinical phase to evaluate the use of bile acid analogues in a mouse model of menopause-induced osteoporosis. If this study is successful it could eventually lead to the development of pharmacological agents for this disease.</p>
<h2>The bone is a dynamic tissue</h2>
<p>The bone undergoes continuous remodeling to grow, heal and maintain metabolic demand (the bone is dynamically storing and releasing minerals in the form of calcium phosphate). This remodeling is carried out by two different cell types; the osteoblast, that are in charge of bone formation, and the osteoclast, which mediate bone resorption or break down. Osteoporosis is the result of an imbalance between bone formation and resorption. This imbalance reduces bone mass and quality, eventually leading to bone fracture, the main clinical manifestation of this disease. </p>
<p>Sterols (fat-like compounds that occur naturally in plants, animals, or fungi and exert multiple physiological roles in the cells), are major actors of bone remodeling processes. Among these sterols, œstrogen inhibits osteoclast formation (“differentiation”), therefore preventing bone resorption. It means that oestrogen deficiency, like the one observed during the menopause, can promote an accelerated bone turnover rate increasing the risk to develop osteoporosis.</p>
<h2>How bile acids affect bone tissues</h2>
<p>Bile acids are small metabolic molecules that are produced in the liver from another famous “sterol”, cholesterol. They are the main constituents of bile. After someone eats, bile acids are secreted into the intestinal lumen to participate in the absorption of dietary lipids by emulsifying them. During enterohepatic recirculation (their way back from the intestine to the liver), bile acids spill over in the systemic circulation and can reach every tissue in our body including the bone. </p>
<p>In addition to their lipid emulsifying function, bile acids are now considered versatile signaling molecules that can activate dedicated receptors and induce cellular responses. A growing body of evidence shows that bile acids regulate skeletal homeostasis (i.e., its relatively stable state of equilibrium of the skeleton) through direct effects on osteoblasts and osteoclasts. In particular, when added to osteoblast cell cultures some bile acid species are able to activate them and to promote bone mineralization.</p>
<p>If these results are confirmed in animals, these molecules could be good candidates for future drugs to treat osteoporosis. As an AXA-granted post-doctoral researcher at the School of Life Sciences of EPFL (Ecole Polytechnique Fédérale de Lausanne), my goal is to contribute, together with my research team, to the elucidation of the role of one of the main bile acid-signaling mediators in bone remodeling, the cell-surface receptor TGR5. </p>
<h2>TGR5, a central actor in osteoporosis</h2>
<p>Once bile acids link to TGR5, multiple metabolic responses take place. For example, TGR5 activation increases energy expenditure <a href="https://www.ncbi.nlm.nih.gov/pubmed/16400329">in brown adipose tissue and muscle</a>, decreases <a href="https://www.ncbi.nlm.nih.gov/pubmed/25365223">inflammation </a>, improves <a href="https://www.ncbi.nlm.nih.gov/pubmed/19723493">glucose metabolism</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22152303">inhibits atherosclerosis</a>. </p>
<p>Interestingly, our preliminary data indicated that TGR5 is also needed in order to maintain healthy bones. Indeed, when this receptor is genetically deleted in mice, their bone mass decreases, mimicking osteoporosis already at young age. Conversely, would it be possible to increase TGR5 activity in order to prevent osteoporosis?
In order to answer this question, our strategy includes the combination of in vitro (which means outside an alive organism, i.e., on cell cultures), in vivo (which means in living animals, i.e., mice) and in silico (which means in computer models) approaches. </p>
<p>In vitro, we will explore the role of TGR5 in osteoblast and osteoclast cell models. In vivo, we will test the efficacy of synthetic bile acid mimetics intended to activate TGR5 for the treatment of menopause-induced osteoporosis using mice whose ovaries have been removed to mimic the menopause conditions. In silico, we will apply bioinformatic tools to identify novel biomarkers that could be used for the prevention or early detection of this disease. Current biomarkers are of limited interest because their impairment indicates that the person has already developed the disease. They can be used to evaluate treatment response and disease progression, but they are useless for prevention. Our hope is that by comparing the genetic and metabolic profile of a mice population exhibiting a predisposition to develop osteoporosis with a normal population, we will identify an impairment of some enzymes or metabolites related to bile acid metabolism or function.</p>
<p>With this innovative investigation approach, we will contribute to a better understanding of the development of this pathology and to the increasing efforts for its prevention and treatment. These novel insights will provide a robust translational bridge to potential human applications in the context of osteoporosis.</p>
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<p><em>Created in 2007 to help accelerate and share scientific knowledge on key societal issues, the AXA Research Fund has been supporting nearly 600 projects around the world conducted by researchers from 54 countries. To learn more about this author’s research, visit her <a href="https://www.axa-research.org/en/projet/laura-velazquez">dedicated page</a> on the AXA Research Fund website.</em></p><img src="https://counter.theconversation.com/content/112574/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Alejandra Velazquez Villegas a reçu des financements de AXA Research Fund, AXA postdoctoral fellowship on projects related to women’s health issues and women’s access to healthcare.</span></em></p>There is no treatment for osteoporosis, which affects millions of people and costs billions of euros every year. What if the solution was in the bile? Explanations.Laura Alejandra Velazquez Villegas, Research associate, EPFL – École Polytechnique Fédérale de Lausanne – Swiss Federal Institute of Technology in LausanneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1162832019-04-30T22:24:42Z2019-04-30T22:24:42ZHow we used CRISPR to narrow in on a possible antidote to box jellyfish venom<figure><img src="https://images.theconversation.com/files/271864/original/file-20190430-136800-u6bay2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Venom from box jellyfish causes extreme pain and tissue damage. Massive exposure can cause death. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/box-jellyfish-lesion-on-child-leg-488958124?src=nm9W0vMB1jI5XWj42eHEmQ-1-9">from www.shutterstock.com</a></span></figcaption></figure><p>Warm Australian waters are home to the box jellyfish (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773479/"><em>Chironex fleckeri</em></a>), which is considered to be one of the most venomous animals on the planet. </p>
<p>Box jellyfish stings lead to excruciating pain lasting days, tissue death and scarring at the site of the sting, and with significant exposure, death within minutes. While most jellyfish stings do not lead to death, pain and scarring is quite common.</p>
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Read more:
<a href="https://theconversation.com/why-we-dont-know-if-irukandji-jellyfish-are-moving-south-109653">Why we don't know if Irukandji jellyfish are moving south</a>
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<p>Despite its potent ability to cause pain and death, to date we’ve had very little understanding of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773479/">how this deadly venom works</a>. This makes it very difficult to understand how it can cause so much pain – and how to develop medicines to block venom actions.</p>
<p>Published today, our <a href="https://www.nature.com/articles/s41467-019-09681-1">new research</a> has uncovered a potential antidote for box jellyfish venom. By working with humans cells and the gene-editing tool CRISPR, we identified a common, cheap drug that is already on the market and which could be a candidate for treating box jellyfish stings. </p>
<h2>Flipping all the switches</h2>
<p>This work began in 2012, when we set out to determine what it was about box jellyfish venom molecules that made them so effective in causing pain and damage. </p>
<p>The venom didn’t seem to work through the known pathways that cause cell death. So we used <a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">CRISPR</a> genome editing technologies in human cells grown in the laboratory. This let us systematically turn off each gene in the human genome, and test to see which of these is needed for the jellyfish venom to kill the cells. </p>
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Read more:
<a href="https://theconversation.com/what-is-crispr-gene-editing-and-how-does-it-work-84591">What is CRISPR gene editing, and how does it work?</a>
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<p>It’s kind of like flipping all the switches in a house, trying to figure out which one turns off the kitchen lights, but at the whole genome level. We actually didn’t even know if it would be possible to find single genes that when turned off could block the venom action.</p>
<p>But luckily, we were successful. While normal human cells exposed to venom die in the laboratory within five minutes, we identified gene-edited cells that could last for two weeks continually exposed to venom.</p>
<h2>Putting the evidence together</h2>
<p>Then using new DNA sequencing technologies (that allow us to identify CRISPR guide RNAs targeting specific genes), we identified which human genes had been switched off in our genome editing experiments.</p>
<p>By putting the evidence together, we worked out which genes the box jellyfish venom needs to target in order to kill human cells in the lab.</p>
<p>One we identified is a calcium transporter molecule called ATP2B1, and is present on the surface of cells. </p>
<p>We tested a drug that we know targets this gene. If we added the drug before the venom, we could block cell death, but if we added the drug after the venom, it didn’t have any effect. </p>
<p>So this helped us understand more about how the venom works – and maybe even how it causes pain. We are still looking at this particular pathway in more detail, but at the moment it doesn’t seem promising for a therapy.</p>
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Read more:
<a href="https://theconversation.com/going-to-the-beach-this-easter-here-are-four-ways-were-not-being-properly-protected-from-jellyfish-112955">Going to the beach this Easter? Here are four ways we're not being properly protected from jellyfish</a>
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<h2>Stopping cell death</h2>
<p>Next we looked at the pathways involved in <em>how</em> box jellyfish venom kills cells. </p>
<p>We found four of the top ten genes required for venom action were all part of a pathway that makes cholesterol in cells. </p>
<p>Since cholesterol has been heavily studied over the last 30 years, there are already drugs available that target lots of different steps in cholesterol regulation. We focused on drugs that could bind to cholesterol and remove it quickly, basically acting like a cholesterol sponge.</p>
<p>We found these drugs could completely block the box jelly fish venom’s ability to kill human cells in the lab if added before venom exposure. We also found there is a 15-minute window after venom exposure where if we add this cholesterol sponge, it still blocks venom action. </p>
<p>This was exciting, as the capacity to have effect after the venom means the drug could work as a treatment in the case of being stung by a box jellyfish. </p>
<p>So far our additional studies show that these same drugs can block pain, tissue death and scarring associated with a mouse model of box jellyfish stings. </p>
<h2>Moving towards a human treatment</h2>
<p>The really cool thing about this work is that the potential box jellyfish antidote we found is in a family of drugs called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273856/">cyclodextrins</a>. These are known to be safe for us in humans, and are cheap and stable. </p>
<p>So now we are trying to work with the state or national government, or first responders, to see if we can move this venom antidote forward for human use.</p>
<p>As well as developing a topical application at the site of a sting, we also aim to develop this idea as a potential treatment for cardiac injection in the emergency room in the case of very severe box jellyfish sting cases.</p><img src="https://counter.theconversation.com/content/116283/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Neely receives funding from the NHMRC and Cancer Council NSW. </span></em></p>Box jellyfish stings are excruciating and occasionally deadly. We have identified a common, cheap drug that is already on the market and which could be a treatment candidate with further development.Greg Neely, Associate Professor , University of SydneyLicensed as Creative Commons – attribution, no derivatives.