Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Fascia Hopping: The Powerful Over-50 Exercise You’re Probably Not Doing
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A 62-year-old man reported feeling 10 years younger after just 8 days of fascia hopping. Now, anecdote ≠ data, but it seems worth investigating:
Let’s hop straight to it
Fascia is the web-like layer of connective tissue that divides your muscles and organs from each other. It simultaneously holds some stuff in place, and allows other parts to glide over each other with minimal friction.
At least, that’s what it’s supposed to do.
Like any body part, it can go wrong. And like any body part, it needs maintenance. In fascia’s case, the maintenance is to keep it slippy where it should be slippy and grippy where it should be grippy.
Here’s an exercise series for that, as described/shown in the video:
Prepping the fascia:
- Align posture: head lifted, shoulders down.
- Stretch fascia in all directions (up-down, left-right).
- Maintain a “fascia wetsuit” concept—taut but not unduly tense.
Springboard feet setup:
- Stand on balls of feet, heels slightly raised.
- Bounce gently to engage fascia elasticity.
“Fascia Strength & Power” dance:
- Move hips in a figure-eight motion.
- Keep shoulders relaxed, allowing movement to flow from the center.
Fascia hopping:
- Keep heels fixed, bounce lightly.
- Progress to small hops if possible.
- Maintain a smooth rhythm to activate elasticity.
Do these for 2 minutes daily for 7 days. It doesn’t have to be a dedicated exercise session; you can do it while you’re waiting for the water to boil in the kitchen, or things like that.
For more on these exercises plus visual demonstrations (it’s very simple), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Fascia: Why (And How) You Should Take Care Of Yours
Take care!
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The Blue Zones Kitchen – by Dan Buettner
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We’ve previously reviewed Buettner’s other book, The Blue Zones: 9 Lessons For Living Longer From The People Who’ve Lived The Longest, and with this one, it’s now time to focus on the dietary aspect.
As the title and subtitle promises, we get 100 recipes, inspired by Blue Zone cuisines. The recipes themselves have been tweaked a little for maximum healthiness, eliminating some ingredients that do crop up in the Blue Zones but are exceptions to their higher average healthiness rather than the rule.
The recipes are arranged by geographic zone rather than by meal type, so it might take a full read-through before knowing where to find everything, but it makes it a very enjoyable “coffee-table book” to browse, as well as being practical in the kitchen. The ingredients are mostly easy to find globally, and most can be acquired at a large supermarket and/or health food store. In the case of substitutions, most are obvious, e.g. if you don’t have wild fennel where you are, use cultivated, for example.
In the category of criticism, it appears that Buettner is very unfamiliar with spices, and so has skipped them almost entirely. We at 10almonds could never skip them, and heartily recommend adding your own spices, for their health benefits and flavors. It may take a little experimentation to know what will work with what recipes, but if you’re accustomed to cooking with spices normally, it’s unlikely that you’ll err by going with your heart here.
Bottom line: we’d give this book a once-over for spice additions, but aside from that, it’s a fine book of cuisine-by-location cooking.
Click here to check out The Blue Zones Kitchen, and get cooking into your own three digits!
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Strategic Wellness
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Strategic Wellness: planning ahead for a better life!
This is Dr. Michael Roizen. With hundreds of peer-reviewed publications and 14 US patents, his work has been focused on the importance of lifestyle factors in healthy living. He’s the Chief Wellness Officer at the world-famous Cleveland Clinic, and is known for his “RealAge” test and related personalized healthcare services.
If you’re curious about that, you can take the RealAge test here.
(they will require you inputting your email address if you do, though)
What’s his thing?
Dr. Roizen is all about optimizing health through lifestyle factors—most notably, diet and exercise. Of those, he is particularly keen on optimizing nutritional habits.
Is this just the Mediterranean Diet again?
Nope! Although: he does also advocate for that. But there’s more, he makes the case for what he calls “circadian eating”, optimally timing what we eat and when.
Is that just Intermittent Fasting again?
Nope! Although: he does also advocate for that. But there’s more:
Dr. Roizen takes a more scientific approach. Which isn’t to say that intermittent fasting is unscientific—on the contrary, there’s mountains of evidence for it being a healthful practice for most people. But while people tend to organize their intermittent fasting purely according to convenience, he notes some additional factors to take into account, including:
- We are evolved to eat when the sun is up
- We are evolved to be active before eating (think: hunting and gathering)
- Our insulin resistance increases as the day goes on
Now, if you’ve a quick mind about you, you’ll have noticed that this means:
- We should keep our eating to a particular time window (classic intermittent fasting), and/but that time window should be while the sun is up
- We should not roll out of bed and immediately breakfast; we need to be active for a bit first (moderate exercise is fine—this writer does her daily grocery-shopping trip on foot before breakfast, for instance… getting out there and hunting and gathering those groceries!)
- We should not, however, eat too much later in the day (so, dinner should be the smallest meal of the day)
The latter item is the one that’s perhaps biggest change for most people. His tips for making this as easy as possible include:
- Over-cater for dinner, but eat only one portion of it, and save the rest for an early-afternoon lunch
- First, however, enjoy a nutrient-dense protein-centric breakfast with at least some fibrous vegetation, for example:
- Salmon and asparagus
- Scrambled tofu and kale
- Yogurt and blueberries
Enjoy!
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Can You Reverse Gray Hair? A Dermatologist Explains
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Betteridge’s Law of Headlines states “any headline that ends in a question mark can be answered by the word no“—it’s not really a universal truth, but it’s true surprisingly often, and, as board certified dermatologist “The Beauty MD” Dr. Sam Ellis explains, it’s true in this case.
But, all is not lost.
Physiological Factors
Hair color is initially determined by genes and gene expression, instructing the body to color it with melanin (brown and black) and/or pheomelanin (blonde and red). If and when the body produces less of those pigments, our hair will go gray.
Factors that affect if/when our hair will go gray include:
- Genetics: primary determinant, essentially a programmed change
- Age: related to the above, but critically, the probability of going gray in any given year increases with age
- Ethnicity: the level of melanin in our skin is an indicator of how long we are likely to maintain melanin in our hair. Black people with the darkest skintones will thus generally go gray last, whereas white people with the lightest skintones will generally go gray first, and so on for a spectrum between the two.
- Medical conditions: immune conditions such as vitiligo, thyroid disease, and pernicious anemia promote an earlier loss of pigmentation
- Stress: oxidative stress, mainly, so factors like smoking will cause earlier graying. But yes, also chronic emotional stress does lead to oxidative stress too. Interestingly, this seems to be more about norepinephrine than cortisol, though.
- Nutrient deficiencies: the body can make a lot of things, but it needs the raw ingredients. Not having the right amounts of important vitamins and minerals will result in a loss of pigmentation (amongst other more serious problems). Vitamins B6, B9, and B12 are talked about in the video, as are iron and zinc. Copper is also needed for some hair colors. Selenium is needed for good hair health in general (but not too much, as an excess of selenium paradoxically causes hair loss), and many related things will stop working properly without adequate magnesium. Hair health will also benefit a lot from plenty of vitamin B7.
So, managing the above factors (where possible; obviously some of the above aren’t things we can influence) will result in maintaining one’s hair pigment for longer. As for texture, by the way, the reason gray hair tends to have a rougher texture is not for the lack of pigment itself, but is due to decreased sebum production. Judicious use of exogenous hair oils (e.g. argan oil, coconut oil, or whatever your preference may be) is a fine way to keep your grays conditioned.
However, once your hair has gone gray, there is no definitive treatment with good evidence for reversing that, at present. Dye it if you want to, or don’t. Many people (including this writer, who has just a couple of streaks of gray herself) find gray hair gives a distinguished look, and such harmless signs of age are a privilege not everyone gets to reach, and thus may be reasonably considered a cause for celebration
For more on all of the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
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The “Love Drug”
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Get PEA-Brained!
Today we’ll be looking at phenylethylamine, or PEA, to its friends.
Not to be mistaken for the related amino acid phenylalanine! Both ultimately have effects on the dopaminergic system, but the process and benefits are mostly quite different.
We thought we’d do this one in the week of Valentine’s Day, because of its popular association with love:
❝Phenylethylamine (PEA), an amphetamine-like substance that has been alluringly labeled the “chemical of love,” makes the best case for the love-chocolate connection since it has been shown that people in love may actually have higher levels of PEA in their brain, as surmised from the fact that their urine is richer in a metabolite of this compound. In other words, people thrashing around in the throes of love pee differently from others.❞
Source: Office for Science and Society | The Chemical of Love
What is it?
It’s an amino acid. Because we are mammals, we can synthesize it inside our bodies, so it’s not considered an “essential amino acid”, i.e. one that we need to get from our diet. It is found in some foods, though, including:
- Other animals, especially other mammals
- Various beans, legumes, nuts, seeds. In particular almonds, soybeans, lentils, and chickpeas score highly
- Fermented foods
- Chocolate (popular lore holds this to be a good source of PEA; science finds it to be a fair option, but not in the same ballpark as the other items)
Fun fact: the reason Marvel’s Venom has a penchant for eating humans and chocolate is (according to the comics) because phenylethylamine is an essential amino acid for it.
What does it do for us?
It’s a Central Nervous System (CNS) stimulant, and also helps us synthesize critical neurotransmitters such as dopamine, norepinephrine (adrenaline) and serotonin:
It works similarly, but not identically, to amphetamines:
Is it safe?
We normally do this after the benefits, but “it works similarly to amphetamines” may raise an eyebrow or two, so let’s do it here:
- It is recommended to take no more than 500mg/day, with 100mg–500mg being typical doses
- It is not recommended to take it at all if you have, or have a predisposition to, any kind of psychotic disorder (especially schizophrenia, or bipolar disorder wherein you sometimes experience mania)
- This isn’t a risk for most people, but if you fall into the above category, the elevated dopamine levels could nudge you into a psychotic/manic episode that you probably don’t want.
See for example: Does phenylethylamine cause schizophrenia?
There are other contraindications too, so speak with your doctor/pharmacist before trying it.
On the other hand, if you are considering ADHD medication, then phenylethylamine could be a safer thing to try first, to see if it helps, before going to the heavy guns of actual amphetamines (as are commonly prescribed for ADHD). Same goes for depression and antidepressants.
What can I expect from PEA?
More dopamine, norepinephrine, and serotonin. Mostly the former two. Which means, you can expect stimulation.
For focus and attention, it’s so effective that it has been suggested (as we mentioned above) as a safer alternative to ADHD meds:
β-phenylethylamine, a small molecule with a large impact
…and may give similar benefits to people without ADHD, namely improved focus, attention, and mental stamina:
It also improves mood:
❝Phenylethylamine (PEA), an endogenous neuroamine, increases attention and activity in animals and has been shown to relieve depression in 60% of depressed patients. It has been proposed that PEA deficit may be the cause of a common form of depressive illness.
Effective dosage did not change with time. There were no apparent side effects. PEA produces sustained relief of depression in a significant number of patients, including some unresponsive to the standard treatments. PEA improves mood as rapidly as amphetamine but does not produce tolerance.❞
Source: Sustained antidepressant effect of PEA replacement
Where can I get it?
We don’t sell it, but here is an example product on Amazon for your convenience 😎
Enjoy!
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Dioscorea Villosa: Hormones, Arthritis, & Skin
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On A Wild Yam Chase?
We recently came across a supplement blend that had wild yam extract as a minor ingredient. Our plucky (and usually very knowledgable) researcher had never heard of its use before, so she set about doing her thing. This is what she found…
What health claims are made?
Wild yam extract (Dioscorea villosa) is traditionally sold and used for:
- Balancing hormones
- Combating arthritis
- Anti-aging effects for the skin
Does it balance hormones?
First, as a quick catch-up, we’ll drop a previous article of ours for your convenience:
What Does “Balance Your Hormones” Even Mean?
We couldn’t find almost any studies into wild yam extract’s hormone-balancing effects, but we did find one study, and:
❝Symptom scores showed a minor effect of both placebo and active treatment on diurnal flushing number and severity and total non-flushing symptom scores, and on nocturnal sweating after placebo, but no statistical difference between placebo and active creams.
This study suggests that short-term treatment with topical wild yam extract in women suffering from menopausal symptoms is free of side-effects, but appears to have little effect on menopausal symptoms❞
…which is a very thorough, polite, sciencey way of saying “wow, this does so many different kinds of nothing”
On the one hand, this was a small study (n=23). On the other hand, it was also literally the only study we could find.
Does it combat arthritis?
Maybe! We again didn’t find much research into this but we did find two in vitro studies that suggests that diosgenin (which can be derived from wild yam extract) helps:
- Diosgenin inhibits IL-1β-induced expression of inflammatory mediators in human osteoarthritis chondrocytes
- Diosgenin, a plant steroid, induces apoptosis in human rheumatoid arthritis synoviocytes with cyclooxygenase-2 overexpression
And we also found a rodent study that found that wild yam extract specifically helped against “acetic acid-induced writhing and formalin-induced pain“, and put that down to anti-inflammatory properties:
So, none of these studies tell us much about whether it would be helpful for humans—with or without arthritis, and hopefully without “acetic acid-induced writhing and formalin-induced pain”.
However, they do suggest that it would be reasonable to test in humans next.
You might prefer:
- Tips For Avoiding/Managing Osteoarthritis
- Tips For Avoiding/Managing Rheumatoid Arthritis
- How to Prevent (or Reduce) Inflammation
Does it keep skin young?
Again, research is thin on the ground, but we did find some! A study with wild-yam-derived diosgenin found that it didn’t make anything worse, and otherwise performed a similar role to vitamin A:
Read: Novel effects of diosgenin on skin aging
That was on rats with breast cancer though, so its applicability to healthy humans may be tenuous (while in contrast, simply getting vitamin A instead is a known deal).
Summary
- Does it balance hormones? It probably does little to nothing in this regard
- Does it combat arthritis? It probably has anti-inflammatory effects, but we know of no studies in humans. There are much more well-established anti-inflammatories out there.
- Does it keep the skin young? We know that it performs a role similar to vitamin A for rats with breast cancer, and didn’t make anything worse for them. That’s the extent of what we know.
Where can I get some?
In the unlikely event that the above research review has inspired you with an urge to buy wild yam extract, here is an example product for your convenience.
Some final words…
If you are surprised that we’re really not making any effort to persuade you of its merits, please know that (outside of the clearly-marked sponsor section, which helps us keep the lights on, so please do visit those) we have no interest in selling you anything. We’re genuinely just here to inform 🙂
If you are wondering why we ran this article at all if the supplement has negligible merits, it’s because science is science, knowledge is knowledge, and knowing that something has negligible merit can be good knowledge to have!
Also, running articles like this from time to time helps you to know that when we do sing the praises of something, it’s with good reason
Take care!
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