When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.
Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.
Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).
Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?
Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.
In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?
Four out of five said yes
This is the last article in The Conversation’s Ozempic series. Read the other articles here.
Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.
Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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52 Ways to Walk – by Annabel Streets
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Most of us learned to walk at a very young age and probably haven’t thought much about it since, except perhaps in a case where some injury made it difficult.
Annabel Streets provides a wonderful guide to not just taking up (or perhaps reclaiming) the joy of walking, but also the science of it in more aspects than most of us have considered:
- The physical mechanics of walking—what’s best?
- Boots or shoes? Barefoot?
- Roads, grass, rougher vegetation… Mud?
- Flora & fauna down to the microbiota that affect us
- How much walking is needed, to be healthy?
- Is there such a thing as too much walking?
- What are the health benefits (or risks) of various kinds of weather?
- Is it better to walk quickly or to walk far?
- What about if we’re carrying some injury?
- What’s going on physiologically when we walk?
- And so much more…
Streets writes with a captivating blend of poetic joie-de-vivre coupled with scientific references.
One moment the book is talking about neuroradiology reports of NO-levels in our blood, the impact of Mycobacterium vaccae, and the studied relationship between daily steps taken and production of oligosaccharide 3′-sialyllactose, and the next it’s all:
“As if the newfound lightness in our limbs has crept into our minds, loosening our everyday cares and constraints…”
And all in all, this book helps remind us that sometimes, science and a sense of wonder can and do (and should!) walk hand-in-hand.
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How To Avoid Self-Hatred & Learn To Love Oneself More
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Alain de Botton gives a compassionate, but realistic, explanation in this video:
The enemy within
Or rather, the collaborator within. Because there’s usually first an enemy without—those who are critical of us, who consider that we are bad people in some fashion, and may indeed get quite colorful in their expressions of this.
Sometimes, their words will bounce straight off us; sometimes, their words will stick. So what’s the difference, and can we do anything about it?
The difference is: when their words stick, it’s usually because on some level we believe their words may be true. That doesn’t mean they necessarily are true!
They could be (and it would be a special kind of hubris to assume no detractor could ever find a valid criticism of us), but very often the reason we have that belief, or at least that fear/insecurity, is simply because it was taught to us at an early age, often by harsh words/actions of those around us; perhaps our parents, perhaps our schoolteachers, perhaps our classmates, and so forth.
The problem—and solution—is that we learn emotions much the same way that we learn language; only in part by reasoned thought, and rather for the most part, by immersion and repetition.
It can take a lot of conscious self-talk to undo the harm of decades of unconscious self-talk based on what was probably a few years of external criticisms when we were small and very impressionable… But, having missed the opportunity to start fixing this sooner, the next best time to do it is now.
We cannot, of course, simply do what a kind friend might do and expect any better results; if a kind friend tells us something nice that we do not believe is true, then however much they mean it, we’re not going to internalize it. So instead, we must simply chip away at those unhelpful longstanding counterproductive beliefs, and simply build up the habit of viewing ourselves in a kinder light.
For more on all this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Escape From The Clutches Of Shame
- To Err Is Human; To Forgive, Healthy
- How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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Hair Growth: Caffeine and Minoxidil Strategies
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Hair growth strategies for men combing caffeine and minoxidil?
Well, the strategy for that is to use caffeine and minoxidil! Some more specific tips, though:
- Both of those things need to be massaged (gently!) into your scalp especially around your hairline.
- In the case of caffeine, that boosts hair growth. No extra thought or care needed for that one.
- In the case of minoxidil, it reboots the hair growth cycle, so if you’ve only recently started, don’t be surprised (or worried) if you see more shedding in the first three months. It’s jettisoning your old hairs because new ones were just prompted (by the minoxidil) to start growing behind them. So: it will get briefly worse before it gets better, but then it’ll stay better… provided you keep using it.
- If you’d like other options besides minoxidil, finasteride is a commonly prescribed oral drug that blocks the conversion of testosterone to DHT, which latter is what tells your hairline to recede.
- If you’d like other options besides prescription drugs, saw palmetto performs comparably to finasteride (and works the same way).
- You may also want to consider biotin supplementation if you don’t already enjoy that
- Consider also using a dermaroller on your scalp. If you’re unfamiliar, this is a device that looks like a tiny lawn aerator, with many tiny needles, and you roll it gently across your skin.
- It can be used for promoting hair growth, as well as for reducing wrinkles and (more slowly) healing scars.
- It works by breaking up the sebum that may be blocking new hair growth, and also makes the skin healthier by stimulating production of collagen and elastin (in response to the thousands of microscopic wounds that the needles make).
- Sounds drastic, but it doesn’t hurt and doesn’t leave any visible marks—the needles are that tiny. Still, practise good sterilization and ensure your skin is clean when using it.
See: How To Use A Dermaroller ← also explains more of the science of it
PS: this question was asked in the context of men, but the information goes the same for women suffering from androgenic alepoceia—which is a lot more common than most people think!
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- Both of those things need to be massaged (gently!) into your scalp especially around your hairline.
What is mitochondrial donation? And how might it help people have a healthy baby one day?
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Mitochondria are tiny structures in cells that convert the food we eat into the energy our cells need to function.
Mitochondrial disease (or mito for short) is a group of conditions that affect this ability to generate the energy organs require to work properly. There are many different forms of mito and depending on the form, it can disrupt one or more organs and can cause organ failure.
There is no cure for mito. But an IVF procedure called mitochondrial donation now offers hope to families affected by some forms of mito that they can have genetically related children free from mito.
After a law to allow mitochondrial donation in Australia was passed in 2022, scientists are now preparing for a clinical trial to see if mitochondrial donation is safe and works.
Jonathan Borba/Pexels What is mitochondrial disease?
There are two types of mitochondrial disease.
One is caused by faulty genes in the nuclear DNA, the DNA we inherit from both our parents and which makes us who we are.
The other is caused by faulty genes in the mitochondria’s own DNA. Mito caused by faulty mitochondrial DNA is passed down through the mother. But the risk of disease is unpredictable, so a mother who is only mildly affected can have a child who develops serious disease symptoms.
Mitochondrial disease is the most common inherited metabolic condition affecting one in 5,000 people.
Some people have mild symptoms that progress slowly, while others have severe symptoms that progress rapidly. Mito can affect any organ, but organs that need a lot of energy such as brain, muscle and heart are more often affected than other organs.
Mito that manifests in childhood often involves multiple organs, progresses rapidly, and has poor outcomes. Of all babies born each year in Australia, around 60 will develop life-threatening mitochondrial disease.
What is mitochondrial donation?
Mitochondrial donation is an experimental IVF-based technique that offers people who carry faulty mitochondrial DNA the potential to have genetically related children without passing on the faulty DNA.
It involves removing the nuclear DNA from the egg of someone who carries faulty mitochondrial DNA and inserting it into a healthy egg donated by someone not affected by mito, which has had its nuclear DNA removed.
The donor egg (in blue) has had its nuclear DNA removed. Author provided The resulting egg has the nuclear DNA of the intending parent and functioning mitochondria from the donor. Sperm is then added and this allows the transmission of both intending parents’ nuclear DNA to the child.
A child born after mitochondrial donation will have genetic material from the three parties involved: nuclear DNA from the intending parents and mitochondrial DNA from the egg donor. As a result the child will likely have a reduced risk of mito, or no risk at all.
The procedure removes the faulty DNA to reduce the chance of it passing on to the baby. Josh Willink/Pexels This highly technical procedure requires specially trained scientists and sophisticated equipment. It also requires both the person with mito and the egg donor to have hormone injections to stimulate the ovaries to produce multiple eggs. The eggs are then retrieved in an ultrasound-guided surgical procedure.
Mitochondrial donation has been pioneered in the United Kingdom where a handful of babies have been born as a result. To date there have been no reports about whether they are free of mito.
Maeve’s Law
After three years of public consultation The Mitochondrial Donation Law Reform (Maeve’s Law) Bill 2021 was passed in the Australian Senate in 2022, making mitochondrial donation legal in a research and clinical trial setting.
Maeve’s law stipulates strict conditions including that clinics need a special licence to perform mitochondrial donation.
To make sure mitochondrial donation works and is safe before it’s introduced into Australian clinical practice, the law also specifies that initial licences will be issued for pre-clinical and clinical trial research and training.
We’re expecting one such licence to be issued for the mitoHOPE (Healthy Outcomes Pilot and Evaluation) program, which we are part of, to perfect the technique and conduct a clinical trial to make sure mitochondrial donation is safe and effective.
Before starting the trial, a preclinical research and training program will ensure embryologists are trained in “real-life” clinical conditions and existing mitochondrial donation techniques are refined and improved. To do this, many human eggs are needed.
The need for donor eggs
One of the challenges with mitochondrial donation is sourcing eggs. For the preclinical research and training program, frozen eggs can be used, but for the clinical trial “fresh” eggs will be needed.
One possible source of frozen eggs is from people who have stored eggs they don’t intend to use.
A recent study looked at data on the outcomes of eggs stored at a Melbourne clinic from 2012 to 2021. Over the ten-year period, 1,132 eggs from 128 patients were discarded. No eggs were donated to research because the clinics where the eggs were stored did not conduct research requiring donor eggs.
However, research shows that among people with stored eggs, the number one choice for what to do with eggs they don’t need is to donate them to research.
This offers hope that, given the opportunity, those who have eggs stored that they don’t intend to use might be willing to donate them to mitochondrial donation preclinical research.
As for the “fresh” eggs needed in the future clinical trial, this will require individuals to volunteer to have their ovaries stimulated and eggs retrieved to give those people impacted by mito a chance to have a healthy baby. Egg donors may be people who are friends or relatives of those who enter the trial, or it might be people who don’t know someone affected by mito but would like to help them conceive.
At this stage, the aim is to begin enrolling participants in the clinical trial in the next 12 to 18 months. However this may change depending on when the required licences and ethics approvals are granted.
Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University; Catherine Mills, Professor of Bioethics, Monash University; Mary Herbert, Professor, Anatomy & Developmental Biology, Monash University, and Molly Johnston, Research fellow, Monash Bioethics Centre, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Almond Butter vs Cashew Butter – Which is Healthier?
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Our Verdict
When comparing almond butter to cashew butter, we picked the almond.
Why?
It’s not just our pro-almonds bias! And of course exact nutritional values may vary depending on the recipe, but we’re using the USDA’s standardized figures which should represent a reasonable average. Specifically, we’re looking at the USDA entries for “[Nut] butter, plain, without salt added”.
In terms of macros, almond butter takes the lead immediately with nearly 2x the protein and over 3x the fiber. In contrast, cashew butter has 1.5x the carbs, and the two nut butters are approximately equal on fat. An easy win for almond butter so far.
When it comes to vitamins, almond butter has more of vitamins A, B2, B3, B5, E, and choline, while cashew butter has more of vitamins B1, B6, and K. Thus, a 6:3 win for almond butter.
In the category of minerals, things are closer, but almond butter has more calcium, magnesium, manganese, phosphorus, and potassium, while cashew butter has more copper, iron, zinc, and selenium. So, a 5:4 win for almond butter.
In short, these three wins for almond butter add up to one total win for almond butter, unless you have a pressing reason to have different priorities in what you’re looking for in terms of nutrition.
Enjoy both, of course! Unless you are allergic, in which case, please don’t.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Demystifying Cholesterol
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All About Cholesterol
When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.
A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.
A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”
You can read more about that here:
Statins: His & Hers? ← we highly recommend reading this, especially if you are a woman and/or considering/taking statins. To be clear, we’re not saying “don’t take statins!”, because they might be the right medical choice for you and we’re not your doctors. But we are saying: here’s something to at least know about and consider.
Beyond HDL & LDL
There is also VLDL cholesterol, which as you might have guessed, stands for “very low-density lipoprotein”. It has a high, unhealthy triglyceride content, and it increases atherosclerotic plaque. In other words, it hardens your arteries more quickly.
The term “hardening the arteries” is an insufficient descriptor of what’s happening though, because while yes it is hardening the arteries, it’s also narrowing them. Because minerals and detritus passing through in the blood (the latter sounds bad, but there is supposed to be detritus passing through in the blood; it’s got to get out of the body somehow, and it’s off to get filtered and excreted) get stuck in the cholesterol (which itself is a waxy substance, by the way) and before you know it, those minerals and other things have become a solid part of the interior of your artery wall, like a little plastering team came and slapped plaster on the inside of the walls, then when it hardened, slapped more plaster on, and so on. Macrophages (normally the body’s best interior clean-up team) can’t eat things much bigger than themselves, so that means they can’t tackle the build-up of plaque.
Impact on the heart
Narrower less flexible arteries means very poor circulation, which means that organs can start having problems, which obviously includes your heart itself as it is not only having to do a harder job to keep the blood circulating through the narrower blood vessels, but also, it is not immune to also being starved of oxygen and nutrients along with the rest of the body when the circulation isn’t good enough. It’s a catch 22.
What if LDL is low and someone is getting heart disease anyway?
That’s often a case of apolipoprotein B, and unlike lipoprotein A, which is bound to LDL so usually* isn’t a problem if LDL is in “safe” ranges, Apo-B can more often cause problems even when LDL is low. Neither of these are tested for in most standard cholesterol tests by the way, so you might have to ask for them.
*Some people, around 1 in 20 people, have hereditary extra risk factors for this.
What to do about it?
Well, get those lipids tests! Including asking for the LpA and Apo-B tests, especially if you have a history of heart disease in your family, or otherwise know you have a genetic risk factor.
With or without extra genetic risks, it’s good to get lipids tests done annually from 40 onwards (earlier, if you have extra risk factors).
See also: Understanding your cholesterol numbers
Wondering whether you have an increased genetic risk or not?
Genetic Testing: Health Benefits & Methods ← we think this is worth doing; it’s a “one-off test tells many useful things”. Usually done from a saliva sample, but some companies arrange a blood draw instead. Cost is usually quite affordable; do shop around, though.
Additionally, talk to your pharmacist to check whether any of your meds have contraindications or interactions you should be aware of in this regard. Pharmacists usually know contraindications/interactions stuff better than doctors, and/but unlike doctors, they don’t have social pressure on them to know everything, which means that if they’re not sure, instead of just guessing and reassuring you in a confident voice, they’ll actually check.
Lastly, shocking nobody, all the usual lifestyle medicine advice applies here, especially get plenty of moderate exercise and eat a good diet, preferably mostly if not entirely plant-based, and go easy on the saturated fat.
Note: while a vegan diet contains zero dietary cholesterol (because plants don’t make it), vegans can still get unhealthy blood lipid levels, because we are animals and—like most animals—our body is perfectly capable of making its own cholesterol (indeed, we do need some cholesterol to function), and it can make its own in the wrong balance, if for example we go too heavy on certain kinds of (yes, even some plant-based) saturated fat.
Read more: Can Saturated Fats Be Healthy? ← see for example how palm oil and coconut oil are both plant-based, and both high in saturated fat, but palm oil’s is heart-unhealthy on balance, while coconut oil’s is heart-healthy on balance (in moderation).
Want to know more about your personal risk?
Try the American College of Cardiology’s ASCVD risk estimator (it’s free)
Take care!
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