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New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

<a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was <a href="https://theconversation.com/the-rise-of-ozempic-how-surprise-discoveries-and-lizard-venom-led-to-a-new-class-of-weight-loss-drugs-219721">originally developed</a> to help people with type 2 diabetes manage their blood sugar levels. However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032183">weight loss</a>, and hundreds of thousands of people around the world are using it <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">for this purpose</a>. Evidence has also shown the drug can help manage <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2306963">heart failure</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403347">chronic kidney disease</a> in people with obesity and type 2 diabetes. Now, a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">New England Journal of Medicine</a> has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked? <h2>Osteoarthritis and obesity</h2> Osteoarthritis is a common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. Most people with osteoarthritis <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">have pain</a> and find it difficult to perform common daily activities such as walking. The knee is <a href="https://pubmed.ncbi.nlm.nih.gov/37675071/">the joint most commonly affected</a> by osteoarthritis. Being overweight or obese is a <a href="https://pubmed.ncbi.nlm.nih.gov/25447976/">major risk factor</a> for osteoarthritis in the knee. The link between the two conditions <a href="https://pubmed.ncbi.nlm.nih.gov/26821091/">is complex</a>. It involves a combination of increased load on the knee, <a href="https://www.nature.com/articles/s41413-023-00301-9">metabolic factors</a> such as high cholesterol and high blood sugar, and inflammation. For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/30712918/">development of osteoarthritis</a>. Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. <a href="https://pubmed.ncbi.nlm.nih.gov/31908149/">International</a> and <a href="https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf">Australian guidelines</a> suggest losing as little as 5% of body weight can help. But losing weight with just diet and exercise can be difficult for many people. <a href="https://pubmed.ncbi.nlm.nih.gov/26180980/">One study</a> from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten. Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness. <h2>Semaglutide for osteoarthritis?</h2> The rationale for the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">recent study</a> was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight. They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight. As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group. The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group. This is much greater than the pain reduction in another <a href="https://pubmed.ncbi.nlm.nih.gov/36511925/">recent study</a> among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale. The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/35442752/">anti-inflammatories</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">opioids</a> and <a href="https://www.bmj.com/content/372/bmj.m4825">antidepressants</a>. Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test. <h2>How could semaglutide reduce knee pain?</h2> It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain. But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have <a href="https://www.sciencedirect.com/science/article/pii/S1043661822002651">anti-inflammatory</a> properties, and could even protect against <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6731440/">cartilage wear and tear</a>. While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not. The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/34527976/">are prescribed opioids</a>. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity. It’s also important to consider semaglutide can have a range of <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">side effects</a>, including gastrointestinal symptoms and fatigue. There are some concerns that semaglutide could reduce <a href="https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss">muscle mass</a> and <a href="https://www.healthline.com/health-news/ozempic-muscle-mass-loss">bone density</a>, though we’re still learning more about this. Further, it can be difficult to access. <h2>I have knee osteoarthritis, what should I do?</h2> Osteoarthritis is a disease caused by multiple factors, and it’s important to take <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard/information-consumers-osteoarthritis-knee-clinical-care-standard">a multifaceted approach</a> to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">self-management</a>. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243159/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, Associate Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstocl This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-study-suggests-weight-loss-drugs-like-ozempic-could-help-with-knee-pain-heres-why-there-may-be-a-link-243159">original article</a>.

Body

Don’t like drinking plain water? 10 healthy ideas for staying hydrated this summer

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Have you heard the saying “water is life?” Well, it’s true. Water is an <a href="https://www.hsph.harvard.edu/nutritionsource/water/">essential nutrient</a>. Our body cannot produce sufficient water to live, so we need to consume water through food and fluids to survive. Maintaining hydration is one of the most fundamental components of good health. But lots of people don’t like drinking plain water much. The good news is there are many other healthy ways to help you stay hydrated. <h2>Why hydration is important</h2> Water is vital for many aspects of body functioning. About half our blood is “blood plasma”, which is over 90% water. Blood plasma is essential for carrying energy, nutrients and oxygen to the cells in the body that need it most. Water helps to remove waste products via the kidneys. It also helps keep joints lubricated, the digestive system functioning, the body’s temperature controlled and skin plump and strong. If you don’t consume enough water, you may experience symptoms of dehydration such as headaches, dizziness, tiredness, low concentration, constipation and a dry mouth. Being severely dehydrated increases the risk of <a href="https://www.kidney.org/atoz/content/kidneystones">kidney stones</a> and <a href="https://www.healthdirect.gov.au/urinary-tract-infection-uti">urinary tract infections</a>. If you feel thirsty, it means your body is already <a href="https://my.clevelandclinic.org/health/treatments/9013-dehydration#:%7E:text=If%20you're%20thirsty%2C%20you,life%2Dthreatening%20illnesses%20like%20heatstroke.">mildly dehydrated</a>, so make sure you pay attention to what your body is telling you. <h2>How much fluid do you need?</h2> The amount of fluid we need changes as we age. Relative to our body weight, our needs decrease. So, a newborn baby has higher fluid needs (per kilogram body weight) than their parent, and older adults have lower fluid needs than younger adults. Fluid requirements are related to metabolic needs and vary from person-to-person. The normal turnover of water in adults is approximately 4% of total body weight per day. So, for example, if you weigh 70 kilograms, you’ll lose about 2.5 to 3 litres of water a day (not including sweating). This means you will need to consume that amount of water from food and drinks to maintain your hydration. Eight cups (or two litres) a day is often <a href="https://www.npr.org/2022/09/21/1124371309/busting-common-hydration-water-myths?utm_source=npr_newsletter&utm_medium=email&utm_content=20221016&utm_term=7386723&utm_campaign=health&utm_id=31926817&orgid=&utm_att1=">mentioned</a> as the amount of water we should aim for and a nice way to track your intake. But it doesn’t account for individual variation based on age, gender, body size and activity levels. Alcohol is a diuretic, which means it dehydrates the body by promoting water loss through urine. This fluid loss is a key factor that contributes to the severity of a hangover. Always have a glass of water in between alcoholic drinks to help stay hydrated. Caffeinated drinks (like tea and coffee) only have a mild diuretic effect. For most healthy adults, it’s okay to consume up to 400 mg of caffeine a day – that’s about four cups of coffee or eight cups of tea. If you drink more than this, it may impact your hydration levels. To check your specific requirements, check out the Australian <a href="https://www.nrv.gov.au/nutrients/water">guidelines</a> for fluid intake. <h2>People who should take extra care</h2> Some people are at greater risk of the harmful health effects from dehydration and need to pay special attention to their fluid intake. The highest priority groups are babies, young kids, pregnant women, and older adults. These groups are at greater risk for many reasons, including relatively higher water needs per kilo of body weight, reduced ability to detect and respond to symptoms of dehydration, and barriers to consuming fluids regularly. Family and friends can play an important role in <a href="https://www.agedcareguide.com.au/information/hydration-for-elderly-people-and-the-dangers-of-dehydration">supporting loved ones</a> to maintain hydration, especially during warm weather. <h2>Ten ideas for keeping fluids up this summer</h2> <ol> <li> Download a water reminder app on your phone This will help keep you on track during the day and give you digital “high fives” when you hit your water goals. </li> <li> Add sugar-free flavouring Try a sugar-free fruit infusion in your water to make it more appealing. Prepare a jug in the refrigerator and infuse it overnight so it’s chilled for you the next day. Fill it up and take it everywhere with you! </li> <li> Add some fresh fruit Add some slices of lime, lemon, berries, pineapple or orange to your water bottle for some natural flavouring. If the bottle is kept in a fridge, the fruit will stay fresh for about three days. </li> <li> Make a jug of iced tea (not the bottled stuff) There are many great sugar-free recipes online. Tea contributes to fluid intake too. For green and black teas, brew in boiling water then cool overnight on the bench before refrigerating. Fruit teas can be made using cold water immediately. </li> <li> Add a dash of cordial to your water A small amount of cordial in your water is a healthier alternative to drinking a sugar-sweetened soft drink or fruit juice. Diet cordials have less added sugar again. </li> <li> Make a fruit ‘slushie’ Combine fresh fruit, ice and water at home in the morning and sip to increase your fluid intake for the day. </li> <li> Buy a soda maker for your home Some people find plain water tastes better with bubbles. Sparkling mineral water is great too, as long as there is no added sugar or sweeteners. </li> <li> Before you eat anything, have a glass of water Make it a rule with yourself to have a glass of water before every snack or meal. </li> <li> Eat water-rich fruits and vegetables Many fruits and vegetables have a high water content. Some of the best include berries, oranges, grapes, carrots, lettuce, cabbage, spinach and melons. Keep a container full of cut-up fruit to snack on in your fridge. </li> <li> Use a water bottle Take it with you during the day and keep it by your bed overnight. </li> </ol> <h2>A tip on water bottles</h2> Water bottles are everywhere and sometimes seem to offer <a href="https://www.refinery29.com/en-au/emotional-support-water-bottle-girlies-tiktok-trend">emotional support</a> as well as hydration. Having a water bottle you enjoy using can go a long way in helping you keep up your fluids during the day. Pay attention to the material of the water bottle and use one that helps you form good habits. Some people prefer metal water bottles as they can keep water cooler for longer (others feel like they are camping). Some prefer glass bottles because the water isn’t affected by any flavours from the container (others fear breaking the glass). Consider the practical aspects, too: Will it fit in your bag? Will it be light enough to carry with you? Can you “chug” on it when you’re exceptionally thirsty? Does the lid require screwing? How durable is it in preventing leaks? Do some <a href="https://www.marthastewart.com/7842071/best-water-bottles-hydration">homework</a> on your water bottle, an essential accessory! <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Dietitian and Researcher, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/dont-like-drinking-plain-water-10-healthy-ideas-for-staying-hydrated-this-summer-191859">original article</a>.

Body

Filling the silences in family stories − how to think like a historian to uncover your family’s narrative

<a href="https://theconversation.com/profiles/andrea-kaston-tange-1417052">Andrea Kaston Tange</a>, <a href="https://theconversation.com/institutions/macalester-college-2632">Macalester College</a> Great-grandmothers. We all have them. But most of us will never know them except through glimpses of fading bits of paper: sepia photographs, recipe cards, letters in handwriting traced by a fountain pen dispensing cocoa-colored ink. What does it take to build coherent stories out of such tantalizing fragments of lives? I face this question routinely in my career as a <a href="https://www.macalester.edu/english/facultystaff/andreakastontange/">professor of 19th-century literature and culture</a>. Recently, I’ve turned that experience to writing a book about my own family. When I inherited my great-grandmother’s diary, a repurposed teacher’s planner in which she chronicled the family’s 1926 move from Michigan to Miami, I found a wedding portrait tucked inside. The angled profile showcases her youthful skin and a dress too elaborate for a Midwestern schoolteacher’s daily wear. It is easy to imagine that she took pleasure in inscribing her new name on the picture’s reverse: Faith Avery. I stared at her beautiful image for years, as if details of her satin gown could explain why a woman widowed in 1918 would, for the rest of her life, refuse to admit to having had that first husband and yet carefully preserve this portrait. And then, because archives have been at the center of my scholarly work, I turned to research. I located marriage records and draft cards, pored over maps, found family members in censuses and obituaries. Within those documents lay answers both surprising and poignant. What did I look for? How might anyone with a half-told family story begin to uncover more truths? And what does it take to make sense of them? <h2>The digging</h2> Questions that begin with “why” can rarely be answered easily. Researchers thus often prefer to start with “who” and “when” and “how,” locating a person in one spot and then tracing them through time. This adventure down a rabbit hole follows a method. Make a list of unknowns. These may be facts or enticing tidbits of incomplete family lore. My mother, trying to be helpful, told me things like, “Faith always said there was a horse thief in the family, but she was too mortified to reveal his name” and “I think Aunt Harriette (Faith’s sister) was married once briefly.” Do precise, not general, searches. Typing “horse thief Avery” into Google yields nothing useful, but many other sources contain rich information about old-fashioned exploits. The New York Public Library’s <a href="https://www.nypl.org/blog/2019/03/25/genealogy-guide-books">guide for family research</a> introduces some options. The <a href="https://www.loc.gov/pictures/">Library of Congress print and photograph collection</a> can also help you envision your ancestors’ world. Physical libraries contain historic photographs, maps, local records and digitized newspapers not available online. Historical societies and state universities typically allow free, in-person use of their collections. Know that sometimes you will fail and need to change course. I spent several days looking for the horse thief to no avail, much to my mother’s disappointment. But when I turned to Aunt Harriette’s marriage, I found a character no less fascinating, one I now think of as “Four Wives Frank.” Read old documents knowing they were produced by a patchwork of individuals who took information on trust. The handwritten birth, death, marriage and <a href="https://www.archives.gov/research/census/about">census records</a> of past centuries relied on self-reported data that required no verification. They can be plagued by carelessness in the name of efficiency. One hurried census-taker recorded Faith’s mother Cara as “Cora,” another renamed her brother Horace “Harris.” Frank offered up a variety of birth years, countries of origin and maiden names for his mother as he worked his way west. He must have been charming. Who but a charming man could have convinced woman after woman to marry him, each thinking she was, at most, his second wife? Marriage register officers and census-takers, not to mention his trail of brides, were none the wiser. Which leads me to this: Cross-check information. I knew I had the right Frank because he had the same three sons in multiple records. Inconsistencies across those records, in conjunction with the trajectory of his life, made this conclusion inevitable: The man purposefully reinvented himself. <h2>The assembly</h2> My academic work has taught me that most <a href="https://doi.org/10.2979/victorianstudies.63.2.02">archival answers lead to more questions</a>. As a result, I expect multiple phases of collecting. I gathered everything I could find about Faith’s early life, in hopes something might explain her reticence about her first marriage. As her story emerged, I periodically hit holes in the narrative that sent me back for more digging. Understanding people is easier if you are familiar with their world. For background, I read histories of Miami in the 1920s and researched details in Faith’s diary that might reveal her personality or motivations. Exploring her reading lists showed me a woman who enjoyed popular entertainment, such as 1926’s blockbuster “<a href="https://www.imdb.com/title/tt0016598/">Aloma of the South Seas</a>.” Primers of <a href="https://libraryguides.missouri.edu/pricesandwages/1920-1929">1920s wages and prices</a> explained the family’s economic worries. As I got to know Faith, I revisited documents with new questions. To figure out whether Harriette’s husband Frank had anything to do with Faith, I made timelines for both sisters. To ponder the emotional underpinnings of those events, I reread Faith’s diary, paying particular attention to entries about Harriette and about Faith’s second husband. Because every pile of documents contains multiple stories, the key to a coherent narrative is locating a through line that addresses the biggest conundrums while identifying the tangents. I let go of the horse thief. <h2>The results</h2> The detective-style plots of what I call “<a href="https://www.writersdigest.com/be-inspired/lilly-dancyger-memoir-as-detective-novel">investigative memoir</a>” may inspire you to do your own family research. Genealogy sites such as <a href="https://www.ancestry.com/">Ancestry.com</a> and <a href="https://www.familysearch.org/en/united-states/">FamilySearch.org</a> can help. But it’s worth remembering that secondary reading will add richness to any family story. And local librarians are extraordinary at helping patrons navigate the search process. Improbable as it might seem, Four Wives Frank helped me understand the extent of Faith’s secrets and that she harbored them in hopes that her children’s lives would be easier. Such self-sacrifices are common for mothers. And yet, their particulars are as individual as the faintly silvered portrait of the soft young woman who married Harold Avery in 1911, and whose story requires an entire book to tell properly.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234341/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/andrea-kaston-tange-1417052">Andrea Kaston Tange</a>, Professor of English, <a href="https://theconversation.com/institutions/macalester-college-2632">Macalester College</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/filling-the-silences-in-family-stories-how-to-think-like-a-historian-to-uncover-your-familys-narrative-234341">original article</a>.

Family & Pets

What does a good death look like when you’re really old and ready to go?

<a href="https://theconversation.com/profiles/naomi-richards-182120">Naomi Richards</a>, <a href="https://theconversation.com/institutions/university-of-glasgow-1269">University of Glasgow</a> <a href="https://www.huffingtonpost.co.uk/entry/hawaii-legalizes-assisted-suicide_us_5ac6c6f5e4b0337ad1e621fb">Hawaii</a> recently joined the growing number of states and countries where doctor-assisted dying is legal. In these jurisdictions, help to die is rarely extended to those who don’t have a terminal illness. Yet, increasingly, very old people, without a terminal illness, who feel that they have lived too long, are arguing that they also have a right to such assistance. Media coverage of <a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/05/09/this-104-year-old-plans-to-die-tomorrow-and-hopes-to-change-views-on-assisted-suicide/?utm_term=.b00a9036f9bc">David Goodall</a>, the 104-year-old Australian scientist who travelled to Switzerland for assisted dying, demonstrates the level of public interest in ethical dilemmas at the <a href="https://www.bmj.com/content/361/bmj.k1891.full">extremities of life</a>. Goodall wanted to die because he no longer enjoyed life. Shortly before his death, he told reporters that he spends most of his day just sitting. “What’s the use of that?” he asked. <a href="https://www.sciencedirect.com/science/article/pii/S0277953615002889?via%3Dihub">Research</a> shows that life can be a constant struggle for the very old, with social connections hard to sustain and health increasingly fragile. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25982088">Studies</a> looking specifically at the motivation for assisted dying among the very old show that many feel a deep sense of loneliness, tiredness, an inability to express their individuality by taking part in activities that are important to them, and a hatred of dependency. Of the jurisdictions where assisted dying is legal, some make suffering the determinant (Canada, for example). Others require a prognosis of six months (California, for example). Mainly, though, the focus is on people who have a terminal illness because it is seen as less of an ethical problem to hasten the death of someone who is already dying than someone who is simply tired of life. <h2>Why give precedence to physical suffering?</h2> Assisted dying for people with psychological or existential reasons for wanting to end their life is unlikely to be supported by doctors because it is not objectively verifiable and also potentially remediable. In the Netherlands, despite the legal power to offer assistance where there is no life-limiting illness, doctors are <a href="https://www.ncbi.nlm.nih.gov/pubmed/25693947">seldom convinced</a> of the unbearable nature of non-physical suffering, and so will rarely administer a lethal dose in such cases. Although doctors may look to a physical diagnosis to give them confidence in their decision to hasten a patient’s death, physical symptoms are often not mentioned by the people they are assisting. Instead, the most common reason given by those who have received help to die is <a href="https://www.nejm.org/doi/full/10.1056/NEJMms1700606">loss of autonomy</a>. Other common reasons are to avoid burdening others and not being able to enjoy one’s life – the exact same reason given by Goodall. This suggests that requests from people with terminal illness, and from those who are just very old and ready to go, are not as different as both the law – and doctors’ interpretation of the law – claim them to be. <h2>Sympathetic coverage</h2> It seems that the general public does not draw a clear distinction either. Most of the media coverage of Goodall’s journey to Switzerland was sympathetic, to the dismay of <a href="http://www.carenotkilling.org.uk/press-releases/centenarians-assisted-suicide/">opponents</a> of assisted dying. Media reports about <a href="https://www.theguardian.com/tv-and-radio/2014/sep/02/mary-berry-great-british-bake-off-centenarian-assisted-dying">ageing celebrities</a> endorsing assisted dying in cases of both terminal illness and very old age, blur the distinction still further. One of the reasons for this categorical confusion is that, at root, this debate is about what a good death looks like, and this doesn’t rely on prognosis; it relies on <a href="https://www.tandfonline.com/doi/full/10.1080/01459740.2016.1255610">personality</a>. And, it’s worth remembering, the personalities of the very old are as diverse as those of the very young. Discussion of assisted suicide often focuses on concerns that some older people may be exposed to coercion by carers or family members. But older people also play another role in this debate. They make up the rank and file <a href="http://www.ep.liu.se/ej/ijal/2012/v7/i1/a01/ijal12v7i1a01.pdf">activists</a> of the global right-to-die movement. In this conflict of rights, protectionist impulses conflict with these older activists’ demands to die on their own terms and at a time of their own choosing. In light of the <a href="https://www.nih.gov/news-events/news-releases/worlds-older-population-grows-dramatically">unprecedented ageing</a> of the world’s population and increasing longevity, it is important to think about what a good death looks like in deep old age. In an era when more jurisdictions are passing laws to permit doctor-assisted dying, the choreographed death of a 104-year-old, who died listening to Ode to Joy after enjoying a last fish supper, starts to look like a socially approved good death.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/96589/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/naomi-richards-182120">Naomi Richards</a>, Lecturer in Social Science (End of Life Studies), <a href="https://theconversation.com/institutions/university-of-glasgow-1269">University of Glasgow</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-does-a-good-death-look-like-when-youre-really-old-and-ready-to-go-96589">original article</a>.

Caring

An unbroken night’s sleep is a myth. Here’s what good sleep looks like

<a href="https://theconversation.com/profiles/amy-reynolds-424346">Amy Reynolds</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/claire-dunbar-1651340">Claire Dunbar</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/gorica-micic-187159">Gorica Micic</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/hannah-scott-424633">Hannah Scott</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>, and <a href="https://theconversation.com/profiles/nicole-lovato-60684">Nicole Lovato</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> What do you imagine a good night’s sleep to be? Often when people come into our sleep clinic seeking treatment, they share ideas about healthy sleep. Many think when their head hits the pillow, they should fall into a deep and restorative sleep, and emerge after about eight hours feeling refreshed. They’re in good company – many Australians hold <a href="https://doi.org/10.1016/j.jpsychores.2014.09.011">the same belief</a>. In reality, healthy sleep is cyclic across the night, as you move in and out of the different stages of sleep, often waking up several times. Some people remember one or more of these awakenings, others do not. Let’s consider what a healthy night’s sleep looks like. <h2>Sleep cycles are a roller-coaster</h2> As an adult, our sleep moves through <a href="https://www.sleepfoundation.org/stages-of-sleep">different cycles</a> and brief awakenings during the night. Sleep cycles last roughly 90 minutes each. We typically start the night with lighter sleep, before moving into deeper sleep stages, and rising again into rapid eye movement (REM) sleep – the stage of sleep often linked to vivid dreaming. If sleeping well, we get most of our deep sleep in the first half of the night, with <a href="https://www.nhlbi.nih.gov/health/sleep/stages-of-sleep#:%7E:text=During%20REM%20sleep%2C%20your%20eyes,from%20acting%20out%20your%20dreams">REM sleep</a> more common in the second half of the night. Adults usually move through five or six sleep cycles in a night, and it is entirely <a href="https://doi.org/10.1016/j.jpsychores.2014.09.011">normal</a> to wake up briefly at the end of each one. That means we might be waking up five times during the night. This can increase with older age and still be healthy. If you’re not remembering these awakenings that’s OK – they can be quite brief. <h2>What does getting a ‘good’ sleep actually mean?</h2> You’ll often hear that adults <a href="https://www.sleephealthfoundation.org.au/sleep-topics/how-much-sleep-do-you-really-need#:%7E:text=Sleep%20requirements%20stabilise%20in%20early,their%20best%20the%20next%20day">need between seven and nine hours</a> of sleep per night. But good sleep is about more than the number of hours – it’s also about the quality. For most people, sleeping well means being able to fall asleep soon after getting into bed (within around 30 minutes), sleeping without waking up for long periods, and waking feeling rested and ready for the day. You shouldn’t be feeling excessively sleepy during the day, especially if you’re regularly getting at least seven hours of refreshing sleep a night (this is a rough rule of thumb). But are you noticing you’re feeling physically tired, needing to nap regularly and still not feeling refreshed? It may be worthwhile touching base with your general practitioner, as there a range of possible reasons. <h2>Common issues</h2> Sleep disorders are common. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/35478719/">25% of adults</a> have insomnia, a sleep disorder where it may be hard to fall or stay asleep, or you may wake earlier in the morning than you’d like. Rates of common sleep disorders such as insomnia and <a href="https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631">sleep apnoea</a> – where your breathing can partially or completely stop many times during the night – also increase with age, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/32280974/">20% of early adults</a> and 40% of people in <a href="https://pubmed.ncbi.nlm.nih.gov/35082023/">middle age</a>. There are effective treatments, so asking for help is important. Beyond sleep disorders, our sleep can also be disrupted by chronic health conditions – such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0012369218311139">pain</a> – and by <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.13075">certain medications</a>. There can also be other reasons we’re not sleeping well. Some of us are woken by children, pets or traffic noise during the night. These “<a href="https://www.tandfonline.com/doi/full/10.1080/07420528.2021.2003375">forced awakenings</a>” mean we may find it harder to get up in the morning, take longer to leave bed and feel less satisfied with our sleep. For some people, night awakenings may have no clear cause. A good way to tell if these awakenings are a problem for you is by thinking about how they affect you. When they cause feelings of frustration or worry, or are impacting how we feel and function during the day, it might be a sign to seek some help. We also may struggle to get up in the morning. This could be for a range of reasons, including not sleeping long enough, going to bed or waking up at irregular times – or even your own <a href="https://www.sleephealthfoundation.org.au/sleep-categories/circadian-rhythm-disorders#:%7E:text=The%20circadian%20rhythms%20throughout%20the,regulation%20of%20our%20sleeping%20patterns">internal clock</a>, which can influence the time your body prefers to sleep. If you’re regularly struggling to get up for work or family needs, it can be an indication you may need to seek help. Some of these factors can be explored with a sleep psychologist if they are causing concern. <h2>Can my smart watch help?</h2> It is important to remember sleep-tracking devices can <a href="https://www.nature.com/articles/s41746-024-01016-9">vary in accuracy</a> for looking at the different sleep stages. While they can give a rough estimate, they are not a perfect measure. In-laboratory <a href="https://pubmed.ncbi.nlm.nih.gov/31277862/">polysomnography</a>, or PSG, is the best standard measure to examine your sleep stages. A PSG examines breathing, oxygen saturation, brain waves and heart rate during sleep. Rather than closely examining nightly data (including sleep stages) from a sleep tracker, it may be more helpful to look at the patterns of your sleep (bed and wake times) over time. <a href="https://jcsm.aasm.org/doi/10.5664/jcsm.8356">Understanding your sleep patterns</a> may help identify and adjust behaviours that negatively impact your sleep, such as your bedtime routine and sleeping environment. And if you find viewing your sleep data is making you feel worried about your sleep, this may not be useful for you. Most importantly, if you are concerned it is important to discuss it with your GP who can refer you to the appropriate specialist sleep health provider.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/238069/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amy-reynolds-424346">Amy Reynolds</a>, Associate Professor in Clinical Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/claire-dunbar-1651340">Claire Dunbar</a>, Research Associate, Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/gorica-micic-187159">Gorica Micic</a>, Postdoctoral Research Fellow, Clinical Psychologist, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>; <a href="https://theconversation.com/profiles/hannah-scott-424633">Hannah Scott</a>, Research Fellow in Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a>, and <a href="https://theconversation.com/profiles/nicole-lovato-60684">Nicole Lovato</a>, Associate Professor, Adelaide Institute for Sleep Health, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/an-unbroken-nights-sleep-is-a-myth-heres-what-good-sleep-looks-like-238069">original article</a>.

Body

Lost touch with someone? Reach out – your friend will likely appreciate it more than you think

<a href="https://theconversation.com/profiles/peggy-liu-818769">Peggy Liu</a>, <a href="https://theconversation.com/institutions/university-of-pittsburgh-854">University of Pittsburgh</a> and <a href="https://theconversation.com/profiles/lauren-min-1354136">Lauren Min</a>, <a href="https://theconversation.com/institutions/university-of-kansas-1588">University of Kansas</a> <h2>The big idea</h2> The next time you wonder whether to reach out to a friend, family member, classmate or other person who’s been out of touch for a long time, go ahead and do it. According to <a href="https://doi.org/10.1037/pspi0000402">our just-published research</a>, it’s likely they’ll appreciate it more than you think. In a series of 13 experiments involving over 5,900 participants, we – along with colleagues <a href="https://scholar.google.com/citations?user=0Stzf1cAAAAJ&hl=en">SoYon Rim</a> and <a href="https://scholar.google.com/citations?user=TZQefJAAAAAJ&hl=en">Kate Min</a> – wanted to investigate whether people accurately predict <a href="https://doi.org/10.1037/pspi0000402">how much their social contacts appreciate being reached out to</a>. In one experiment we conducted, college students wrote a note “to check in and say hello” to a classmate they hadn’t interacted with in a while. Then we asked them how much they thought their classmate would appreciate receiving this note. Next, we delivered these notes to their classmates and asked the recipients how much they appreciated receiving them. We found that the students who received the notes were much more appreciative of the gesture than the students who wrote them had anticipated. Other experiments varied the scenario by involving older adults as participants rather than college students, switching the written message to a small gift – such as cookies or coffee – and comparing how much the sender underestimated the appreciation that an emotionally distant contact would feel compared with a close contact. Overall they yielded the same basic finding: People tended to underestimate how much others appreciated hearing from them. What drives this underestimation? Our results suggest that it’s related to how little the people reaching out factor in the surprise felt by those being contacted. When we asked recipients what they focused on when indicating how appreciative they felt, they reported paying a lot of attention to their positive feelings of surprise, which were linked to how appreciative they felt. Comparatively, potential senders did not report focusing much on recipients’ positive feelings of surprise. It also mattered whether the two parties were already in a close relationship. People’s underestimations were even greater when their contact was a distant acquaintance because these recipients were especially surprised at being contacted. <h2>Why it matters</h2> Many people can name at least one person with whom they would like to reconnect. Taking a new job, moving to a different city, becoming a parent, or the busyness of everyday life – these are just some of the life events and circumstances that can cause people to lose touch. Then, if the desire to reconnect arises on one side, doubts may arise about whether the other person may appreciate being contacted out of the blue. When people consider taking the initiative to reach out, especially after a prolonged period of no contact, they may worry about being rejected. This worry might keep them from reaching out in the first place. Our research lessens this challenge by showing that often, these gestures will be much more appreciated than one might expect. <h2>What other research is being done</h2> Our findings fit within a growing stream of research examining the tendency to underestimate others’ appreciation of various social exchanges. For example, other researchers have found that people underestimate how much <a href="https://doi.org/10.1037/pspa0000277">others appreciate receiving compliments</a> or <a href="https://doi.org/10.1177/0956797618772506">expressions of gratitude</a>. Our work adds to this area by broadening the scope of the contexts in which people underestimate how much social exchanges are appreciated. Reaching out could but need not require giving compliments or expressing gratitude – the gesture can be as simple as checking in with someone to show that one is thinking about them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/185001/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peggy-liu-818769">Peggy Liu</a>, Ben L. Fryrear Chair in Marketing and Associate Professor of Business Administration, <a href="https://theconversation.com/institutions/university-of-pittsburgh-854">University of Pittsburgh</a> and <a href="https://theconversation.com/profiles/lauren-min-1354136">Lauren Min</a>, Assistant Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-kansas-1588">University of Kansas</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lost-touch-with-someone-reach-out-your-friend-will-likely-appreciate-it-more-than-you-think-185001">original article</a>.

Relationships

I’m feeling run down. Why am I more likely to get sick? And how can I boost my immune system?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> It has been a long winter, filled with many viruses and cost-of-living pressures, on top of the usual mix of work, study, life admin and caring responsibilities. Stress is an inevitable part of life. In short bursts, our stress response has evolved as a survival mechanism to help us be more alert in <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">fight or flight situations</a>. But when stress is chronic, it weakens the immune system and makes us more vulnerable to illnesses such as the <a href="https://www.healthline.com/health/can-stress-make-you-sick#:%7E:text=The%20common%20cold&text=Inflammation%20has%20been%20linked%20to,to%20the%20cold%2Dcausing%20germs.">common cold</a>, <a href="https://journals.lww.com/psychosomaticmedicine/abstract/1999/03000/psychological_stress,_cytokine_production,_and.9.aspx">flu</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/smi.3017">COVID</a>. <h2>Stress makes it harder to fight off viruses</h2> When the immune system starts to break down, a virus that would normally have been under control starts to flourish. Once you begin to feel sick, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/">stress response</a> rises, making it harder for the immune system to fight off the disease. You may be sick more often and for longer periods of time, without enough immune cells primed and ready to <a href="https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6">fight</a>. In the 1990s, American psychology professor Sheldon Cohen and his colleagues conducted a number of <a href="https://www.cmu.edu/common-cold-project/">studies</a> where healthy people were exposed to an upper respiratory infection, through drops of virus placed directly into their <a href="https://www.nejm.org/doi/full/10.1056/NEJM199108293250903">nose</a>. These participants were then quarantined in a hotel and monitored closely to determine who became <a href="https://theconversation.com/stress-less-it-might-protect-you-from-covid-153361">ill</a>. One of the most important factors predicting who got sick was prolonged psychological <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">stress</a>. <h2>Cortisol suppresses immunity</h2> “Short-term stress” is stress that lasts for a period of minutes to hours, while “chronic stress” persists for several hours per day for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964013/#:%7E:text=Therefore%2C%20a%20major%20distinguishing%20characteristic,weeks%20or%20months%20%5B9%5D.">weeks or months</a>. When faced with a perceived threat, psychological or physical, the hypothalamus region of the brain sets off an alarm system. This signals the release of a surge of hormones, including adrenaline and <a href="https://www.embopress.org/doi/full/10.15252/msb.20209510">cortisol</a>. <figure class="align-center "><img src="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=472&fit=crop&dpr=1 600w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=472&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=472&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=593&fit=crop&dpr=1 754w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=593&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/616892/original/file-20240903-18-blrqoz.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=593&fit=crop&dpr=3 2262w" alt="Human brain illustration" /><figcaption>The hypothalamus sets off an alarm system in response to a real or perceived threat. <a class="source" href="https://www.shutterstock.com/image-illustration/hypothalamus-causes-vasoconstriction-illustration-medical-brain-435142264">stefan3andrei/Shutterstock</a></figcaption></figure> In a typical stress response, <a href="https://www.sciencedirect.com/science/article/abs/pii/S147149060300173X">cortisol levels</a> quickly increase when stress occurs, and then rapidly drop back to normal once the stress has subsided. In the short term, cortisol suppresses inflammation, to ensure the body has enough energy available to respond to an <a href="https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00245/full">immediate threat</a>. But in the longer term, chronic stress can be harmful. A Harvard University study <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">from 2022</a> showed that people suffering from psychological distress in the lead up to their COVID infection had a greater chance of experiencing long COVID. They <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">classified</a> this distress as depression, probable anxiety, perceived stress, worry about COVID and loneliness. Those suffering distress had close to a <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2796097">50% greater risk</a> of long COVID compared to other <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">participants</a>. Cortisol has been shown to be high in the most severe cases of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102614/">COVID</a>. <h2>Stress causes inflammation</h2> <a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">Inflammation</a> is a short-term reaction to an injury or infection. It is responsible for trafficking immune cells in your body so the right cells are present in the right locations at the right times and at the right <a href="https://link.springer.com/article/10.1007/s12026-014-8517-0">levels</a>. The immune cells also store a memory of that threat to respond faster and more effectively the next <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">time</a>. Initially, circulating immune cells detect and flock to the site of <a href="https://www.nature.com/articles/ni1275">infection</a>. Messenger proteins, known as pro-inflammatory cytokines, are released by immune cells, to signal the danger and recruit help, and our immune system responds to neutralise the <a href="https://stories.uq.edu.au/imb/the-edge/inflammation/what-is-inflammation/index.html">threat</a>. During this response to the infection, if the immune system produces too much of these inflammatory chemicals, it can trigger symptoms such as nasal congestion and runny <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">nose</a>. <h2>What about chronic stress?</h2> Chronic stress causes persistently high cortisol secretion, which remains high even in the absence of an immediate <a href="https://theconversation.com/no-you-cant-blame-all-your-health-issues-on-high-cortisol-heres-how-the-hormone-works-203162">stressor</a>. The immune system becomes desensitised and unresponsive to this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043661816307435">cortisol suppression</a>, increasing low-grade “silent” inflammation and the production of pro-inflammatory cytokines (the messenger proteins). Immune cells become exhausted and start to <a href="https://www.fxmedicine.com.au/blog-post/adrenal-immune-connection">malfunction</a>. The body loses the ability to turn down the inflammatory <a href="https://journals.sagepub.com/doi/full/10.1177/1745691620942516">response</a>. Over time, the immune system changes the way it responds by reprogramming to a “<a href="https://www.unimelb.edu.au/newsroom/news/2021/april/how-stress-can-stop-immune-cells-in-their-tracks">low surveillance mode</a>”. The immune system misses early opportunities to destroy threats, and the process of recovery can take <a href="https://theconversation.com/being-stressed-out-before-you-get-covid-increases-your-chances-of-long-covid-heres-why-190649">longer</a>. <h2>So how can you manage your stress?</h2> We can actively strengthen our immunity and natural defences by managing our <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">stress levels</a>. Rather than letting stress build up, try to address it early and frequently by: 1) Getting enough sleep Getting enough sleep reduces <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132857/">cortisol levels</a> and inflammation. During sleep, the immune system <a href="https://link.springer.com/chapter/10.1007/978-1-4939-6578-6_12">releases</a> <a href="https://theconversation.com/sleep-wont-cure-the-coronavirus-but-it-can-help-our-bodies-fight-it-134674">cytokines</a>, which help fight infections and inflammation. 2) Taking regular exercise Exercising helps the lymphatic system (which balances bodily fluids as part of the immune system) circulate and allows immune cells to monitor for threats, while sweating flushes <a href="https://www.healthline.com/nutrition/does-exercise-boost-immune-system">toxins</a>. Physical activity also lowers stress hormone levels through the release of positive brain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387807/">signals</a>. 3) Eating a healthy diet Ensuring your diet contains enough nutrients – such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc – during times of stress has a positive impact on overall stress <a href="https://www.ncbi.nlm.nih.gov/pubmed/22782571">levels</a>. Staying hydrated helps the body to flush out <a href="https://theconversation.com/a-strong-immune-system-helps-ward-off-colds-and-flus-but-its-not-the-only-factor-99512">toxins</a>. 4) Socialising and practising meditation or mindfulness These activities increase endorphins and serotonin, which improve mood and have <a href="https://www.sciencedirect.com/science/article/pii/S2949834123000351">anti-inflammatory effects</a>. Breathing exercises and meditation stimulate the parasympathetic nervous system, which calms down our stress responses so we can “reset” and reduce <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940234/">cortisol levels</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237456/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sathana-dushyanthen-1169328">Sathana Dushyanthen</a>, Academic Specialist & Lecturer in Cancer Sciences & Digital Health| Superstar of STEM| Science Communicator, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-feeling-run-down-why-am-i-more-likely-to-get-sick-and-how-can-i-boost-my-immune-system-237456">original article</a>. </div>

Body

What is type 1.5 diabetes? It’s a bit like type 1 and a bit like type 2 – but it’s often misdiagnosed

<a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes. Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">both type 1 and type 2 diabetes</a>. More people became aware of this condition after <a href="https://www.imdb.com/name/nm0004726/">Lance Bass</a>, best known for his role in the iconic American pop band NSYNC, <a href="https://www.foxnews.com/health/pop-singer-lance-bass-type-1-5-diabetes-know-disease">recently revealed</a> he has it. So, what is type 1.5 diabetes? And how is it diagnosed and treated? <h2>There are several types of diabetes</h2> Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually <a href="https://diabetesjournals.org/care/article/37/Supplement_1/S81/37753/Diagnosis-and-Classification-of-Diabetes-Mellitus">more than ten types</a> of diabetes, but the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01301-6/fulltext">most common</a> are type 1 and type 2. Type 1 diabetes is an <a href="https://diabetesjournals.org/care/article/44/11/2589/138492/The-Management-of-Type-1-Diabetes-in-Adults-A">autoimmune condition</a> where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production. Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995794/">insulin medication daily</a>. Type 1 diabetes usually <a href="https://www.nature.com/articles/s41390-024-03107-5">appears</a> in children or young adults. Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to <a href="https://diabetesjournals.org/care/article/47/Supplement_1/S20/153954/2-Diagnosis-and-Classification-of-Diabetes">overcome this resistance</a>. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin. Type 2 is more common in adults but is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1871402121002733">increasingly</a> seen in children and young people. Management <a href="https://www.racgp.org.au/getattachment/41fee8dc-7f97-4f87-9d90-b7af337af778/Management-of-type-2-diabetes-A-handbook-for-general-practice.aspx">can include</a> behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy. <h2>How does type 1.5 diabetes differ from types 1 and 2?</h2> Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">immediately</a> because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111528/">five years</a> of diagnosis, while those with type 1 typically require it from diagnosis. Type 1.5 diabetes is usually diagnosed in people <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">over 30</a>, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2. Type 1.5 diabetes shares <a href="https://www.nature.com/articles/nrendo.2017.99">genetic and autoimmune risk factors</a> with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as <a href="https://pubmed.ncbi.nlm.nih.gov/29589073/">obesity</a> and <a href="https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2019.00320/full">physical inactivity</a> which are more commonly associated with type 2 diabetes. <h2>What are the symptoms, and how is it treated?</h2> The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following <a href="https://www.ncbi.nlm.nih.gov/books/NBK557897/">symptoms</a>: <ul> <li>increased thirst</li> <li>frequent urination</li> <li>fatigue</li> <li>blurred vision</li> <li>unintentional weight loss.</li> </ul> Typically, type 1.5 diabetes is <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">initially treated</a> with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day. When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.959011/full">no universally accepted</a> management or treatment strategies for type 1.5 diabetes. <h2>Type 1.5 diabetes is often misdiagnosed</h2> Lance Bass said he was initially diagnosed with <a href="https://www.healthline.com/health-news/lance-bass-misdiagnosed-diabetes">type 2 diabetes</a>, but later learned he actually has type 1.5 diabetes. This is <a href="https://journals.lww.com/jaanp/abstract/2009/03000/latent_autoimmune_diabetes_of_adulthood__lada___an.4.aspx">not entirely uncommon</a>. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276018301292">5–10% of the time</a>. There are a few possible reasons for this. First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special <a href="https://journals.lww.com/jaanp/abstract/2009/03000/latent_autoimmune_diabetes_of_adulthood__lada___an.4.aspx">antibody tests</a> (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them. Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults). Third, people with <a href="https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults">type 1.5 diabetes</a> often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin. Finally, because type 1.5 diabetes has <a href="https://www.ncbi.nlm.nih.gov/books/NBK557897/">symptoms</a> that are similar to type 2 diabetes, it may initially be treated as type 2. <h2>We’re still learning about type 1.5</h2> Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in <a href="https://www.sciencedirect.com/science/article/abs/pii/S1043276018301292">non-European populations</a>. In 2023, it was estimated type 1.5 diabetes represented <a href="https://pubmed.ncbi.nlm.nih.gov/37428296/">8.9%</a> of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers. Overall, there has been a limited awareness of type 1.5 diabetes and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683931/">unclear diagnostic criteria</a> which have slowed down our understanding of this condition. A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road. Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce <a href="https://diabetesjournals.org/diabetes/article/73/Supplement_1/55-OR/155112/55-OR-Diabetes-Distress-among-Persons-Living-with">diabetes distress</a>. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237041/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Accredited Practising Dietitian and Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> and <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-type-1-5-diabetes-its-a-bit-like-type-1-and-a-bit-like-type-2-but-its-often-misdiagnosed-237041">original article</a>.

Body

Men have a biological clock too. Here’s what’s more likely when dads are over 50

<a href="https://theconversation.com/profiles/karin-hammarberg-113096">Karin Hammarberg</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> We hear a lot about women’s biological clock and how age affects the chance of pregnancy. <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">New research shows</a> men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases. Data from more than 46 million births in the <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">United States</a> between 2011 and 2022 compared fathers in their 30s with fathers in their 50s. While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications. The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a: <ul> <li>16% increased risk of preterm birth</li> <li>14% increased risk of low birth weight</li> <li>13% increase in gestational diabetes.</li> </ul> The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts. <h2>Dads are getting older</h2> In this <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821811#google_vignette">US study</a>, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022. In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%. We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased. In 1975 the <a href="https://www.abs.gov.au/statistics/people/population/births-australia/latest-release">median age of Australian dads</a> was 28.6 years. This jumped to 33.7 years in 2022. <h2>How male age affects getting pregnant</h2> As we know from <a href="https://www.businessinsider.com/celebrities-dads-first-time-over-age-50#when-he-was-54-simon-cowell-and-girlfriend-lauren-silverman-became-parents-to-their-son-eric-7">media reports</a> of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age. However, there is a noticeable decline in <a href="https://www.fertstert.org/article/S0015-0282(18)30269-3/fulltext">sperm quality</a> from about age 40. Female partners of older men take longer to achieve pregnancy than those with younger partners. A study of the effect of male age on <a href="https://www.fertstert.org/article/S0015-0282(03)00366-2/fulltext">time to pregnancy</a> showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45. Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, <a href="https://pubmed.ncbi.nlm.nih.gov/32358607/">paternal age over 45 years</a> increased the risk of miscarriage by 43%. <h2>Older men are more likely to need IVF</h2> Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner. A <a href="https://doi.org/10.1016/j.rbmo.2022.03.031">review of studies</a> in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40. Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40. <h2>How does male age affect the health outcomes of children?</h2> As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957550/">a number of conditions</a>. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years. A <a href="https://www.fertstert.org/article/S0015-0282(22)01979-3/fulltext">review of studies</a> assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments. But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of <a href="https://pubmed.ncbi.nlm.nih.gov/29471389/">the effect is modest</a>. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well. <h2>Improving your health can improve your fertility</h2> In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include <a href="https://www.fertstert.org/article/S0015-0282(23)01935-0/fulltext">obesity and diabetes</a> which affect sperm quality by lowering testosterone levels. While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include: <ul> <li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639396/">smoking</a></li> <li>recreational <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/tre.414">drug taking</a></li> <li><a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/tre.414">anabolic steroid</a> use</li> <li>heavy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5504800/">alcohol consumption</a>.</li> </ul> <h2>Get the facts about the male biological clock</h2> Research shows <a href="https://academic.oup.com/humupd/article/23/4/458/3065332?login=false">men want children</a> as much as women do. And most men want at least two children. Yet most men <a href="https://academic.oup.com/humupd/article/23/4/458/3065332?login=false">lack knowledge</a> about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies. We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies. For men wanting to improve their chance of conceiving, the government-funded sites <a href="https://healthymale.org.au/">Healthy Male</a> and <a href="https://www.yourfertility.org.au/">Your Fertility</a> are a good place to start. These offer evidence-based and accessible information about reproductive health, and <a href="https://www.yourfertility.org.au/fertility-week-2022">tips</a> to improve your reproductive health and give your children the best start in life.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236892/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/karin-hammarberg-113096">Karin Hammarberg</a>, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/men-have-a-biological-clock-too-heres-whats-more-likely-when-dads-are-over-50-236892">original article</a>.

Body

Readers response: What are you starting to like more as you get older?

As we age, we start to have a whole new appreciation for things we previously overlooked in our younger years. We asked our reader what of life's simple pleasures they are starting to enjoy more as they get older, and the response was overwhelming. Here's what you said. Wendy Turner - The beauty and companionship of dogs, the wildness of a garden, the treasured times between physical pain, and the love of family and treasured friends. SE Rosenberg - Being on my own away from people but hanging out with my cats. Lynette Miller - Taking time to enjoy sunrise and sunsets, smelling the roses and just little things that sometimes pass you by because you're too busy to enjoy them. Antoinette Devlin - Peace and quiet. Robert Edward Fleming - Not having to work for the man anymore. Janine Sarai George - Putting my feet up, a good book and my wildlife. Maureen Brown Montgomery - Finally starting not to mind living a solo life and enjoying my own company without drama. Liz Lewis - Not having to set the alarm but being able to wake up naturally and usually not having to be anywhere in a hurry. Roselyn Reincastle - Appreciating life more now that I have had the experience. Frances Bradshaw - Peace and hearing the birds sing. Margie Buckingham - Serenity, that my opinions matter, travelling, spare time & being a grandparent. Rob Anderson - Time with the grandchildren, and reflection. Wendy Hope - Travel and wonder at the diversity of people. Maya Richardson - Staying as far away from people as possible. Christine Tully - Not having to commit to anything if I don’t want to. Margaret Inglis - Doing what I want to do, although my 4 legged mate still wants to get me out of the house each morning. Image credits: Shutterstock

Retirement Life

"Felt like a criminal": Mother and disabled son "kicked out" of Pink concert

A distraught mother has taken to social media to recall the moment her and her seven-year-old son, who has Down syndrome, were asked to leave a concert venue. Vanessa Vasey, 48, spent over $1,000 to take her son Jesse to see Pink in London during her UK stadium tour, but when the pair arrived at the venue, things took a turn. Jesse struggled to stay still in his seat and was soon surrounded by "six security guards" who ordered the disabled boy to sit down, otherwise they would have to leave. She said she tried to explain her son’s condition to the guards but they ended up being “escorted from the premises” just as Pink took to the stage. On Facebook, Vasey wrote in detail about what happened, saying her son had been “robbed” of a special experience. “Music is his life and Pink is one of his absolute favourites,” she wrote. “We successfully saw her perform at BST Hyde Park last year and were thrilled to learn of her return again this year.” Vasey said she purchased more expensive “hospitality tickets” allowing people to move between bars and food outlets during the night “so that Jesse wouldn’t be pressured into remaining in one seat all night, as he gets overwhelmed in busy environments and finds it hard to sit still.” “We spent some time in the bar leading up to the main act, and Jesse was having a wonderful time, until about 45 minutes before Pink was due to come on, they suddenly shut all the blinds, obstructing us from seeing anything,” she wrote. “I tried to consult with the hospitality managers over this, and explained Jesse’s needs, but they wouldn’t budge on it. So not wanting Jesse to stare at a blind all night, we attempted to go into the seating zone." “We couldn’t get him to sit in his seat, but he was happy dancing and singing at the front railings, and even interacting with some of the other guests." “Doing no harm to anyone, or obstructing anyone’s view. This seemed OK for about half an hour or so. Then ... just as Pink dropped from the sky in her opening number, we had six security guards come into the zone and ask us to leave or sit in our seats.” Vasey said the security guards were “abrupt, intimidating and unpleasant”, as they "tried to force us to take Jesse to a sensory room which was soundproof, and watch Pink on a screen.” <div> </div> “Something we could do at home, robbing us of the whole experience, as if my son was some sort of inconvenience, and better off shut in a room out of sight.” When Vasey complained to venue staff, she claims that more security guards appeared and they had no choice but to leave. “We were escorted out of the building like criminals and saw no more of the Pink show. Jesse was utterly devastated, and they showed absolutely zero care or understanding." “Shame on you Tottenham Stadium,” she concluded. “My poor boy deserved so much better than this!” After UK media picked up Vasey's story, Tottenham Stadium released a statement explaining their actions. “Following further investigation, we can confirm that Ms Vasey was offered assistance by our Safeguarding and Welfare teams throughout the night to provide Jesse with a comfortable viewing experience, including access to our dedicated Sensory Room,” the statement read. “The offers of assistance were declined by Ms Vasey and the party chose to leave the event.” Vasey was soon set upon by online trolls who condemned her choice to take Jesse to the concert in the first place, to which she issues a lengthy statement about inclusivity and not singling people out for their disabilities. “Why do we take them [to events]? Because, as parents, we have the same dreams and aspirations for our children as any other parent,” she wrote. “We have the same desires to see our children’s faces light up, as any other parent would. Our children are exposed to the same world as other children, and they enjoy the same things." “They have the same likes and desires. The only thing that’s different is their needs, their abilities and their way of accessing their dreams." “Why should these things deny them of fulfilling these dreams and passions? This is meant to be a world of inclusion. So let’s start including!" “That means adapting, understanding, supporting and most importantly; changing the way we deliver these privileges so that they are privileges for all of us, and not just some of us.” Image credits: Facebook/Richard Isaac/Shutterstock Editorial

Caring

How to buy a home: 7 tips for negotiating like a pro

<a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> The main purpose of negotiation is to find a mutually acceptable solution for buyers and sellers. Good negotiations greatly improve relationships between buyers, sellers and agents. They also help avoid future problems and conflicts. Negotiating skills become even more important for home buyers in a “seller’s market”, where demand from buyers exceeds supply from sellers. That’s <a href="https://propertyupdate.com.au/australian-property-market-predictions/">currently the case</a> in all Australian capital cities and major regional cities such as Gold Coast, Sunshine Coast and others. Many home buyers mistakenly believe negotiation only occurs during the signing of the sale contract. However, it involves distinct stages: pre-negotiation and during negotiation. So how can people maximise their chances of successfully negotiating a purchase in a seller’s market? I offer the following tips. <h2>Be someone the seller’s agent wants to do business with</h2> Buyers often communicate solely with the seller’s agent, rather than directly with the seller. It’s crucial to ensure the agent views the buyer positively. Ultimately, it’s the agent who presents offers to the seller for their decision. It’s important, then, to understand what might motivate the seller’s agent to choose your offer. The key performance indicator for the agent often revolves around closing a property sale at a reasonable price within a certain time. This means price is a crucial factor. However, other factors can influence the seller’s agent and seller. For example, having pre-approved finance can increase the agent’s confidence in the buyer. If the buyer appears serious, can make quick decisions and makes a good impression, the agent may be more motivated to push for them, even if their offer is slightly lower than others without pre-approved finance. <h2>Be a big fish (for the seller’s agent)</h2> The next strategy is to give the seller’s agent extra incentive to favour you and your offer. <a href="https://www.emerald.com/insight/content/doi/10.1108/MIP-09-2019-0489/full/html">Our research</a> in customer behaviour suggests businesses value customers who make frequent purchases or engage them for long-term services. For example, the agent would be pleased to learn that the buyer might be interested in buying another property in the near future or in using their rental service for the new property. You have an advantage if you can position yourself as someone who could provide them with extra business. <h2>Point to competing options</h2> In a positive manner, let the seller’s agent know you are considering two or three properties, and this specific property is among those you are inclined to make an offer on. In certain situations, it may stimulate competitive pricing when multiple properties of similar quality are available in the same area. Make it clear to the agent you will choose the property that offers you the best overall value. While this strategy might not necessarily lower the price in a seller’s market, it can prompt the agent to have a fuller discussion with you. <h2>Think beyond price</h2> The next set of tips focuses on the during negotiation stages. It can be challenging for buyers to negotiate a lower price in a market with low supply and high demand. You might have to “think outside the price box”. Buyers often have a specific price range or fixed budget in mind when they start discussions with a seller. However, other factors besides price can influence a property’s overall value. So if a seller won’t adjust the price, consider negotiating for other concessions that could reduce your expenses. These may include: Settlement period Consider the expenses associated with the settlement period. A shorter settlement period could enable buyers to move into the property sooner and save on rent. For example, if a buyer is paying $600 per week in rent, an early settlement could save them around $2,400 per month. Insurance costs after contract signing In many states, buyers’ <a href="https://www.finder.com.au/home-insurance/home-insurance-cost">home insurance cover</a> is required to begin from the date of contract signing. It’s reasonable for buyers to include a special condition requesting the seller to bear the insurance costs until settlement. On average, home insurance may amount to about $140 per month. Cleaning expenses Consider negotiating a condition stipulating that the seller must ensure the property is professionally cleaned by settlement. Failure to do so could result in a $500 adjustment in the buyer’s favour at settlement. In some states, like Queensland, sellers are not obligated to deliver a clean property. Based on typical end-of-lease cleaning charges, internal cleaning of a four-bedroom property could cost <a href="https://firstcallhomeservices.com.au/service-menu/bond-exit-end-lease-cleaning/">$455 to $590</a>. Building and pest inspection costs Buyers should always include a 14-day pre-purchase inspection clause for <a href="https://www.topdogpestcontrol.com.au/building-pest-inspections-gold-coast/">building and pest inspections</a> in their offer. Although they may cost $300 to $600, these inspections provide a clear report that could lead to negotiations after contract signing if they find any issues with the property. <h2>Be careful with your first offer</h2> Don’t present the first offer in writing. It can be challenging to negotiate down the price once it has been written in an offer document. Instead, the buyer should begin by testing the expected price of the property. As well as obtaining property reports from multiple banks, the buyer could talk with the seller’s agent in person about a price range that would be agreeable to the seller. You could include phrases like “a price that will make the seller happy” or “a price that will make the seller accept the offer”. While the agent might not provide a specific price, this talk can provide a guideline for the buyer. All properties up for auction or private sale should have an expected price set, which may or may not be discussed with potential buyers. It’s also advisable to consult a solicitor before submitting an offer or signing a contract. They can offer valuable suggestions to smooth the purchase process and identify any issues. <h2>Use the power of 900</h2> Buyers often submit offers with round numbers, such as $700,000 or $750,000. In a competitive seller’s market, aim to submit an offer with a number that stands out from the rest, yet remains within your budget. An example of such a number is $900. For instance, comparing $700,000 to $700,900, the extra $900 makes the offer feel closer to $710,000. <h2>Write a personalised letter</h2> It’s true the most important point of selling a house for many sellers is price. But they are human and have emotions. Finishing a purchasing offer with a personal letter to the seller can make a difference. Often that $3,000 to $20,000 could be a lot of money for a buyer, but it may not be as much for someone selling a house for $700,000 or $1,000,000. Write the letter to express your feelings about the property in a way that makes it clear you will care for it. Most people selling their home would prefer to have someone look after it well.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226237/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-buy-a-home-7-tips-for-negotiating-like-a-pro-226237">original article</a>.

Money & Banking

4 things you’re likely doing that are damaging your hearing

Your hearing is a precious gift, so it’s important to take good care of your ears. We’ve got some advice on the things to avoid, and what you can do to protect your hearing. Using cotton tips Though they’re commonly used for the job, cotton tips should never be used to clean out your ears. In fact, no solid object should be put inside your ears. Cotton tips account for around four per cent of all ruptured eardrums. These innocuous-looking objects can also cause bleeding, scratch your ear canal, or trigger an infection. So put them down and step away. Instead, use a commercial ear cleaner, or even just a few drops of mineral oil, baby oil, or glycerine to soften the earwax. Don’t wait and see If your hearing in one or both ears suddenly disappears without cause, you need to go and see your doctor as soon as you can. It could be inflammation, infection, or a decrease in blood supply to the area. If you need treatment, you’ll likely need it immediately to have any hope of restoring your hearing. Using eardrops without advice There are many over-the-counter eardrops available to help with things like swimmer’s ear. But in extreme cases, these products can cause deafness. Before you use anything, including a home remedy, get your doctor to check that you don’t have a ruptured eardrum. Some people may be born that way, or have had surgery as a child, or suffered an injury. If the ingredients in these drops make their way inside your eardrum, it can cause a lot of pain, and permanent deafness. Always protect your ears It’s incredibly important to protect your ears from permanent damage. Tiny hairs inside your ears act as hearing receptors, and these can be broken by extremely loud noises. Once they’re gone, they don’t come back. So things like loud music, fireworks, machinery, and artillery are all risky to be around. The best thing you can do is cover up with earmuffs whenever you’re around these things – especially if it’s on a regular basis. For extra safety, use earplugs as well. Image credits: Shutterstock

Body

Drinking lots of water may seem like a healthy habit – here’s when and why it can prove toxic

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> In late 2023, actor <a href="https://www.glamour.com/story/brooke-shields-recently-experienced-a-full-blown-seizure-and-bradley-cooper-came-running?utm_source=instagram&utm_medium=social&utm_content=instagram-bio-link&client_service_id=31196&client_service_name=glamour&service_user_id=1.78e+16&supported_service_name=instagram_publishing&utm_brand=glm&utm_social_type=owned">Brooke Shields</a> suffered a seizure after “flooding” her body with water. Shields became dangerously low on sodium while preparing for her show by drinking loads of water. “I flooded my system and I drowned myself,” she would later explain. “And if you don’t have enough sodium in your blood or urine or your body, you can have a seizure.” Shields said she found herself walking around outside for “no reason at all”, wondering: “Why am I out here?” <blockquote> Then I walk into the restaurant and go to the sommelier who had just taken an hour to watch my run through. That’s when everything went black. Then my hands drop to my side and I go headfirst into the wall. </blockquote> Shields added that she was “frothing at the mouth, totally blue, trying to swallow my tongue”. Like Shields, many people may be unaware of the dangers of drinking excessive amounts of water – especially because hydration is so often associated with health benefits. Models and celebrities <a href="https://www.teenvogue.com/story/drinking-water-flawless-skin#:%7E:text=If%20you're%20reading%20a,long%20hours%20at%20a%20time.">often advocate</a> drinking lots of water to help maintain clear, smooth skin. Some <a href="https://www.independent.co.uk/life-style/75-hard-challenge-before-and-after-tiktok-b2382706.html">social media influencers</a> have promoted drinking a gallon of water daily for weight loss. But excessive water consumption can cause <a href="https://patient.info/treatment-medication/hyponatraemia-leaflet">hyponatraemia</a> – a potentially fatal condition of low sodium in the blood. <h2>Worried about hydration levels? Check your urine</h2> The body strictly regulates its water content to maintain the optimum level of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323003/">total body water</a> and “osmolality” – the concentration of dissolved particles in your blood. Osmolality increases when you are dehydrated and decreases when you have too much fluid in your blood. Osmolality is monitored by <a href="https://pubmed.ncbi.nlm.nih.gov/9074779/">osmoreceptors</a> that regulate sodium and water balance in the hypothalamus – the part of the brain that controls numerous hormones. These osmoreceptors signal the release of antidiuretic hormone (ADH), which acts on blood vessels and the kidneys to control the amount of water and salt in the body. <figure><iframe src="https://www.youtube.com/embed/Qghf7Y9ILAs?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> In healthy people, the body releases ADH when osmolality becomes high. ADH tells the kidneys to reabsorb water, which makes urine more concentrated. The reabsorbed water dilutes the blood, bringing osmolality back to normal levels. Low blood osmolality suppresses the release of ADH, reducing how much water the kidneys reabsorb. This dilutes your urine, which the body then passes to rid itself of the excess water. Healthy urine should be clear and odourless. Darker, yellower urine with a noticeable odour can indicate dehydration – although medications and certain foods, including <a href="https://pubmed.ncbi.nlm.nih.gov/3433805/">asparagus</a>, can affect urine colour and odour, too. <h2>How much is too much?</h2> Adults should consume <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/">two-to-three litres per day</a>, of which around 20% comes from food. However, we can lose <a href="https://www.ncbi.nlm.nih.gov/books/NBK236237/">up to ten litres</a> of water through perspiration – so sweating during exercise or in hot weather increases the amount of water we need to replace through drinking. Some medical conditions can cause overhydration. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616165/">one in five</a> schizophrenia patients drink water compulsively, a dangerous condition known as <a href="https://www.theguardian.com/uk-news/2024/apr/15/woman-died-mental-hospital-excessive-water-drinking-inquest#:%7E:text=Woman%20died%20at%20mental%20hospital%20after%20excessive%20water%20drinking%2C%20inquest%20told,-Parents%20of%20Lillian&text=A%20woman%20collapsed%20and%20died,water%2C%20an%20inquest%20has%20heard.">psychogenic polydipsia</a>. One long-term study found that patients with psychogenic polydipsia have a <a href="https://pubmed.ncbi.nlm.nih.gov/18984069/">“74% greater chance</a> of dying before a non-polydipsic patient”. In <a href="https://pubmed.ncbi.nlm.nih.gov/22306188/">some cases</a>, people with <a href="https://psychiatry-psychopharmacology.com/en/childhood-and-adolescence-disorders-psychogenic-polydipsia-in-an-adolescent-with-eating-disorder-a-case-report-132438">anorexia nervosa</a> can also suffer from compulsive water drinking. <figure><iframe src="https://www.youtube.com/embed/ReQew2zcN7c?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> For those suffering from polydipsia, treatment is focused on medication to reduce the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675986/">urge to drink</a>, as well as <a href="https://www.uptodate.com/contents/overview-of-the-treatment-of-hyponatremia-in-adults/print">increasing sodium levels</a>. This should be done gradually to avoid causing <a href="https://www.ncbi.nlm.nih.gov/books/NBK562251/">myelinolysis</a> – <a href="https://www.ncbi.nlm.nih.gov/books/NBK551697/">neurological damage</a> caused by rapid changes in sodium levels in nerve cells. In rare but often highly publicised cases such as that of <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/november/13/newsid_2516000/2516593.stm">Leah Betts</a> in 1995, some users of the illegal drug MDMA (also known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119400/">ecstasy)</a> have <a href="https://pubmed.ncbi.nlm.nih.gov/11265566/">died</a> after drinking copious amounts of water to rehydrate after dancing and sweating. The drug <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">increases body temperature</a>, so users drink water to avoid overheating. Unfortunately, MDMA also triggers the <a href="https://pubmed.ncbi.nlm.nih.gov/12105115/">unnecessary release of ADH</a>, causing water retention. The body becomes unable to rid itself of excess water, which affects its electrolyte levels – causing cells to swell with water. Symptoms of water intoxication start with nausea, vomiting, blurred vision and dizziness. As the condition progresses, sufferers can often display symptoms of <a href="https://www.nhs.uk/mental-health/conditions/psychosis/symptoms/">psychosis</a>, such as inappropriate behaviour, confusion, delusions, disorientation and hallucinations. These symptoms are caused by <a href="https://www.ncbi.nlm.nih.gov/books/NBK470386/">hyponatraemia</a>, where sodium levels are diluted or depleted in blood and the subsequent imbalance of electrolytes affects the nervous system. Water begins to move into the brain causing <a href="https://www.sciencedirect.com/science/article/pii/S1572349604000149">a cerebral oedema</a> – brain swelling because of excessive fluid buildup, which is usually fatal if not treated. A healthy body will tell you when it needs water. If you’re thirsty and your urine is dark with a noticeable odour, then you need to drink more. If you aren’t thirsty and your urine is clear or the colour of light straw, then you’re already doing a good job of hydrating yourself.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228715/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-lots-of-water-may-seem-like-a-healthy-habit-heres-when-and-why-it-can-prove-toxic-228715">original article</a>. </div>

Body

"Looks nothing like her": Kate Middleton portrait ridiculed

A painted portrait of Kate Middleton has gone viral for all the wrong reasons, after royal fans everywhere claimed the artwork "looks nothing like" the Princess of Wales. The image, created by artist Hannah Uzor, appeared on the front cover of UK magazine Tatler, as the artist recreated Middleton's appearance at a banquet held in South Africa in 2022. The Princess wore a white beaded Jenny Packham gown, and also donned her famous tiara, the Lover’s Knot, which was previously worn by Princess Diana. Uzor explained that in creating the artwork, she was inspired by the composure and bravery demonstrated by the royal mum-of-three in her emotional cancer diagnosis video in March. “A moment of dealing with something difficult, speaking from the heart, having the courage to tackle it head-on,” she explained in awe. However, many royal fans slated the artist on social media, simply asking, “are you kidding me?”. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Tatler (@tatlermagazine)</a> </div> </blockquote> “This is just plain weird, looks nothing like her,” one person commented. “What have they done to her face,” asked another. A third agreed: “Doesn’t look like Catherine at all. If she wasn’t wearing that dress I’d have no clue as to who it’s meant to be.” “Are you kidding me? … You must be joking,” scorned someone else. Others slated the artwork by saying they believed it looked “like it was created by a child”. “It’s absolutely dreadful and should never have seen the light of day, let alone appear on the cover,” agreed another. Hannah Uzor defended her artwork, saying she had to draw on other sources as she was not able to meet the Princess directly to create her portrait. She said, “When you can’t meet the sitter in person, you have to look at everything you can find and piece together the subtle human moments revealed in different photographs: do they have a particular way of standing or holding their head or hands? Do they have a recurrent gesture?" “[Kate] has really risen up to her role – she was born for this. She carries herself with such dignity, elegance and grace." Image credits: Tatler Magazine / Chris Jackson/WPA Pool/Shutterstock Editorial

Art

If I’m diagnosed with one cancer, am I likely to get another?

<a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health. Fear of cancer returning is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321869/">top health concerns</a>. And <a href="https://www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/fear-of-the-cancer-returning/managing-fear-of-recurrence/">managing this fear</a> is an important part of cancer treatment. But how likely is it to get cancer for a second time? <h2>Why can cancer return?</h2> While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms. This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">metastasis</a>. Actor Hugh Jackman has gone public about his <a href="https://www.skincancer.org/blog/is-basal-cell-carcinoma-serious/">multiple diagnoses</a> of basal cell carcinoma (a type of skin cancer) over the <a href="https://www.bbc.com/news/world-australia-65158945">past decade</a>. The exact reason why cancer returns differs depending on the cancer type and the treatment received. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486871/">Research</a> is <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3408">ongoing</a> to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people. <h2>What are the chances of cancer returning?</h2> The risk of cancer returning differs between cancers, and between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019423/">sub-types</a> of the same cancer. New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2812113">31-68%</a>. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning. For most types of cancer, the highest risk of cancer returning is within the <a href="https://pubmed.ncbi.nlm.nih.gov/31231898/">first three years</a> after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning. Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed. <h2>What about second, unrelated cancers?</h2> Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) <a href="https://www.bbc.com/news/uk-68047608">shortly after</a> being treated for breast cancer. Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one. Australian research from <a href="https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-11-83">Queensland</a> and <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31247">Tasmania</a> shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population. <h2>Who’s at risk of another, unrelated cancer?</h2> With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer. Reasons for such cancers <a href="https://www.cancer.net/survivorship/what-second-cancer">include</a> different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors. The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435077/">relatively small</a> when compared with the (sometimes lifesaving) benefits of these treatment and procedures. While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years. Similarly, in a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.30164">large US study</a> only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years). The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer. People diagnosed with cancer as a <a href="https://www.mja.com.au/journal/2020/212/3/second-primary-cancers-people-who-had-cancer-children-australian-childhood">child</a>, <a href="https://www.liebertpub.com/doi/10.1089/jayao.2022.0074">adolescent or young adult</a> also have a greater risk of a second, unrelated cancer. <h2>What can I do to lower my risk?</h2> Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment. <a href="https://www.lymphoma.org.au/lymphoma/treatments/maintenance-therapy/">Maintenance therapy</a> may be used to reduce the risk of some types of cancer returning. However, despite ongoing <a href="https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15626">research</a>, there are no specific treatments against cancer recurrence or developing a second, unrelated cancer. But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21719">cancer returning</a> and <a href="https://www.cancer.net/survivorship/what-second-cancer">getting a second cancer</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226386/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, Senior Lecturer in Cancer Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-im-diagnosed-with-one-cancer-am-i-likely-to-get-another-226386">original article</a>.

Body

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

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

Body

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

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

Body

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

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

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

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

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic