Tourette’s Syndrome Treatment Options
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It’s Q&A Day at 10almonds!
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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
❝Is there anything special that might help someone with Tourette’s syndrome?❞
There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.
It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:
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Semaglutide for Weight Loss?
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Semaglutide for weight loss?
Semaglutide is the new kid on the weight-loss block, but it’s looking promising (with some caveats!).
Most popularly by brand names Ozempic and Wegovy, it was first trialled to help diabetics*, and is now sought-after by the rest of the population too. So far, only Wegovy is FDA-approved for weight loss. It contains more semaglutide than Ozempic, and was developed specifically for weight loss, rather than for diabetes.
*Specifically: diabetics with type 2 diabetes. Because it works by helping the pancreas to make insulin, it’s of no help whatsoever to T1D folks, sadly. If you’re T1D and reading this though, today’s book of the day is for you!
First things first: does it work as marketed for diabetes?
It does! At a cost: a very common side effect is gastrointestinal problems—same as for tirzepatide, which (like semaglutide) is a GLP-1 agonist, meaning it works the same way. Here’s how they measure up:
- Head-to-head study: Effects of subcutaneous tirzepatide versus placebo or semaglutide on pancreatic islet function and insulin sensitivity in adults with type 2 diabetes
- Head-to-head systematic review: Semaglutide for the treatment of type 2 Diabetes Mellitus: A systematic review and network meta-analysis of safety and efficacy outcomes
As you can see, both of them work wonders for pancreatic function and insulin sensitivity!
And, both of them were quite unpleasant for around 20% of participants:
❝Tirzepatide, oral and SC semaglutide has a favourable efficacy in treating T2DM. Gastrointestinal adverse events were highly recorded in tirzepatide, oral and SC semaglutide groups.❞
What about for weight loss, if not diabetic?
It works just the same! With just the same likelihood of gastro-intestinal unpleasantries, though. There’s a very good study that was done with 1,961 overweight adults; here it is:
Once-Weekly Semaglutide in Adults with Overweight or Obesity
The most interesting things here are the positive results and the side effects:
❝The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).❞
In other words: if you take this, you’re almost certainly going to get something like 6x better weight loss results than doing the same thing without it.
❝Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%])❞
~ ibid.
In other words: you have about a 3% chance of having unpleasant enough side effects that you don’t want to continue treatment (contrast this with the 20%ish chance of unpleasant side effects of any extent)!
Any other downsides we should know about?
If you stop taking it, weight regain is likely. For example, a participant in one of the above-mentioned studies who lost 22% of her body weight with the drug’s help, says:
❝Now that I am no longer taking the drug, unfortunately, my weight is returning to what it used to be. It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food. I hope that, if the drug can be approved for people like me, my [doctor] will be able to prescribe the drug for me in the future.❞
~ Jan, a trial participant at UCLH
Is it injection-only, or is there an oral option?
An oral option exists, but (so far) is on the market only in the form of Rybelsus, another (slightly older) drug containing semaglutide, and it’s (so far) only FDA-approved for diabetes, not for weight loss. See:
A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes ← for the science
FDA approves first oral GLP-1 treatment for type 2 diabetes ← For the FDA statement
Where can I get these?
Availability and prescribing regulations vary by country (because the FDA’s authority stops at the US borders), but here is the website for each of them if you’d like to learn more / consider if they might help you:
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What Most People Don’t Know About Hearing Aids
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Dr. Juliëtte Sterkens, a doctor of audiology, makes things clearer in this TEDx talk:
The sound of the future
Half of all adults experience hearing loss by the age of 75, and by 85, that goes up to two thirds. Untreated hearing loss leads to depression, social isolation, cognitive decline, and even an increased fall risk.
It’s not just about reduced volume though; Dr. Sterkens points out that for many (like this writer!) it’s more a matter of unequal pitch perception and difficulty in speech clarity. Most hearing aids just amplify sound, and don’t fully restore clarity, especially beyond a short range.
However, technology keeps marching forwards there have been improvements in the move from analog to digital, and today’s bluetooth-enabled hearing aids often do a lot better, especially in the case of things like TV transmitters and clip-on microphones.
Out and about, you might see signs sometimes saying “Hearing Loop Enabled”, and those transmit sound directly to telecoil-equipped hearing aids—venues with public address systems are legally required to provide hearing accommodations like this. Many hearing aids include telecoils, but users often aren’t informed or don’t have them activated, which is unfortunate, because telecoils improve hearing dramatically in loop-enabled venues.
Dr. Sterkens makes a plea for us to, as applicable,
- Activate telecoils and insist on them in new hearing aids.
- Advocate for assistive listening systems in public venues.
- Use available resources like the Hearing Loss Association of America for tools and information.
- Familiarize ourselves with accessibility laws and report non-compliance.
- Aim to make the world more accessible for people with hearing loss through advocacy, technology, and awareness.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
Take care!
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The Meds That Impair Decision-Making
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Impairment to cognitive function is often comorbid with Parkinson’s disease. That is to say: it’s not a symptom of Parkinson’s, but it often occurs in the same people. This may seem natural: after all, both are strongly associated with aging.
However, recent (last month, at time of writing) research has brought to light a very specific way in which medication for Parkinson’s may impair the ability to make sound decisions.
Obviously, this is a big deal, because it can affect healthcare decisions, financial decisions, and more—greatly impacting quality of life.
See also: Age-related differences in financial decision-making and social influence
(in which older people were found more likely to be influenced by the impulsive financial preferences of others than their younger counterparts, when other factors are controlled for)
As for how this pans out when it comes to Parkinson’s meds…
Pramipexole (PPX)
This drug can, due to an overlap in molecular shape, mimic dopamine in the brains of people who don’t have enough—such as those with Parkinson’s disease. This (as you might expect) helps alleviate Parkinson’s symptoms.
However, researchers found that mice treated with PPX and given a touch-screen based gambling game picked the high-risk, high reward option much more often. In the hopes of winning strawberry milkshake (the reward), they got themselves subjected to a lot of blindingly-bright flashing lights (the risk, to which untreated mice were much more averse, as this is very stressful for a mouse).
You may be wondering: did the mice have Parkinson’s?
The answer: kind of; they had been subjected to injections with 6-hydroxydopamine, which damages dopamine-producing neurons similarly to Parkinson’s.
This result was somewhat surprising, because one would expect that a mouse whose depleted dopamine was being mimicked by a stand-in (thus, doing much of the job of dopamine) would be less swayed by the allure of gambling (a high-dopamine activity), since gambling is typically most attractive to those who are desperate to find a crumb of dopamine somewhere.
They did find out why this happened, by the way, the PPX hyperactivated the external globus pallidus (also called GPe, and notwithstanding the name, this is located deep inside the brain). Chemically inhibiting this area of the brain reduced the risk-taking activity of the mice.
This has important implications for Parkinson’s patients, because:
- on an individual level, it means this is a side effect of PPX to be aware of
- on a research-and-development level, it means drugs need to be developed that specifically target the GPe, to avoid/mitigate this side effect.
You can read the study in full here:
Don’t want to get Parkinson’s in the first place?
While nothing is a magic bullet, there are things that can greatly increase or decrease Parkinson’s risk. Here’s a big one, as found recently (last week, at the time of writing):
Air Pollution and Parkinson’s Disease in a Population-Based Study
Also: knowing about its onset sooner rather than later is scary, but beneficial. So, with that in mind…
Recognize The Early Symptoms Of Parkinson’s Disease
Finally, because Parkinson’s disease is theorized to be caused by a dysfunction of alpha-synuclein clearance (much like the dysfunction of beta-amyloid clearance, in the case of Alzheimer’s disease), this means that having a healthy glymphatic system (glial cells doing the same clean-up job as the lymphatic system, but in the brain) is critical:
How To Clean Your Brain (Glymphatic Health Primer)
Take care!
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Having dense breasts is linked to cancer. But advice about breast density can depend on where you live
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Having dense breasts is a clear risk factor for breast cancer. It can also make cancers hard to spot on mammograms.
Yet you might not be aware you have dense breasts, even after mammographic screening.
In Australia, advice for women with dense breasts and their health-care professionals can be inconsistent and confusing.
This is because there’s not currently consensus on whether women who have dense breasts, but no symptoms, benefit from further imaging such as ultrasounds. Concerns include potential cost of these tests and the risk they can produce false positives.
Gorodenkoff/Shutterstock What is breast density?
Breasts are made up of fatty tissue and fibroglandular tissue (including glands that make milk, held together by fibrous tissue).
On a mammogram – an x-ray of the breast – fibroglandular tissue appears white and fatty tissue appears dark. The white areas are referred to as breast density.
Fibroglandular tissue shows up white on a mammogram. Nata Sokhrannova/Shutterstock A higher proportion of fibroglandular tissue means your breasts are dense.
There are four categories to classify breast density:
- A: almost entirely fatty
- B: scattered areas of fibroglandular density
- C: heterogeneously or consistently dense
- D: extremely dense.
Breast density is very common. Around 40% of women aged 40–74 are estimated to have “dense breasts”, meaning they fall in category C or D.
What’s the link to cancer?
Breast density is associated with the risk of breast cancer in two ways.
First, breast density usually decreases with age. But if a woman has high breast density for her age, it increases her likelihood of breast cancer.
One study looked at the risk of breast cancer over the age of 50. It found there was a 6.2% risk for the one-third of women with the lowest density. For the 5% with the highest density, the risk was 14.7%.
Second, breast density “masks” cancers if they develop. Both cancers and breast density appear white on a mammogram, making cancers very hard to see.
Breast cancer screening saves lives through early detection and improved treatment options. But we don’t yet know if telling women about their breast density leads to earlier cancer detection, or lives saved.
In Australia, screening mammography is free for all women* aged 40 and older. This is run through BreastScreen Australia, a joint national, state and territory initiative. Those aged 50-74 are invited to have a mammogram, but it’s available for free without a referral from age 40.
However, the messages Australian women currently receive about breast density – and whether it’s recorded – depends on where they live.
What does the advice say?
In 2023, the Royal Australian and New Zealand College of Radiologists updated its position statement to recommend breast density is recorded during screening and diagnostic tests in Australia and New Zealand.
Meanwhile BreastScreen Australia says it “should not routinely record breast density or provide supplemental testing for women with dense breasts”. However this position statement is from 2020 and is currently under review.
Some state and territory BreastScreen programs, including in Western Australia, South Australia and soon Victoria, notify women if they have dense breasts. Victoria is currently at an early stage of its roll-out.
While the messaging regarding breast density differs by state, none currently recommend further imaging for women with dense breasts without speaking to a doctor about individual risk.
What are the issues?
Providing recommendations for women with dense breasts is difficult.
The European Society of Breast Imaging recommends women with extremely dense breasts aged 50–70 receive an MRI every two to four years, in addition to screening mammography. This is based on a large randomised controlled trial from the Netherlands.
But the Royal Australian and New Zealand College of Radiologists describes this recommendation as “aspirational”, acknowledging cost, staffing and accessibility as challenges.
That is, it is not feasible to provide a supplemental MRI for everyone in the screening population in category D with extremely dense breasts (around 10%).
Further, there is no consensus on appropriate screening recommendations for women in the category C (heterogeneous density).
We need a national approach to breast density reporting in Australia and to do better at identifying who is most likely to benefit from further testing.
BreastScreen Australia is currently undergoing a review of its policy and funding.
One of its goals is to enable a nationally consistent approach to breast screening practices. Hopefully breast density reporting, including funding to support national implementation, will be a priority.
*This includes those recorded female at birth and who are gender diverse.
Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cherries vs Cranberries – Which is Healthier?
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Our Verdict
When comparing cherries to cranberries, we picked the cherries.
Why?
In terms of macros, cherries have a little more protein (but it’s not much) while cranberries have a little more fiber. Despite this, cherries have the lower glycemic index—about half that of cranberries.
In the category of vitamins, cherries have a lot more of vitamins A, B1, B2, B3, B9, and a little more choline, while cranberries have more of vitamins B5, B6, C, E, and K. A modest win for cherries here.
When it comes to minerals, things are more divided: cherries have more calcium, copper, iron, magnesium, phosphorus, potassium, and zinc, while cranberries have more manganese. An easy win for cherries here.
This all adds up to a total win for cherries, but both of these fruits are great and both have their own beneficial properties (see our main features below!)
Want to learn more?
You might like to read:
- Cherries’ Very Healthy Wealth Of Benefits!
- Health Benefits Of Cranberries (But: You’d Better Watch Out)
Take care!
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The Reason You’re Alone
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If you are feeling lonely, then there are likely reasons why, as Kurtzgesagt explains:
Why it happens and how to fix it
Many people feel lonely and disconnected, often not knowing how to make new friends. And yet, social connection strongly predicts happiness, while lack of it is linked to diseases and a shorter life.
One mistake that people make is thinking it has to be about shared interests; that can help, but proximity and shared time are much more important.
Another stumbling block for many is that adult responsibilities and distractions (work, kids, technology) often take priority over friendships—but loneliness is surprisingly highest among young people, worsened by the pandemic’s impact on social interactions.
And even when friendships are made, they fade without attention, often accidentally, impacting both people involved. Other friendships can be lost following big life changes such as moving house or the end of a relationship. And for people above a certain advanced age, friendship groups can shrink due to death, if one’s friends are all in the same age group.
But, all is not lost. We can make friends with people of any age, and old friendships can be revived by a simple invitation. We can also take a “build it and they will come” approach, by organizing events and being the one who invites others.
It’s easy to fear rejection—most people do—but it’s worth overcoming for the potential rewards. That said, building friendships requires time, patience, caring about others, and being open about yourself, which can involve a degree of vulnerability too.
In short: be laid-back while still prioritizing friendships, show genuine interest, and stay open to social opportunities.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Beat Loneliness & Isolation
Take care!
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Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
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