How Science News Outlets Can Lie To You (Yes, Even If They Cite Studies!)
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Each Monday, we’re going to be bringing you cutting-edge research reviews to not only make your health and productivity crazy simple, but also, constantly up-to-date.
But today, in this special edition, we want to lay out plain and simple how to see through a lot of the tricks used not just by popular news outlets, but even sometimes the research publications themselves.
That way, when we give you health-related science news, you won’t have to take our word for it, because you’ll be able to see whether the studies we cite really support the claims we make.
Of course, we’ll always give you the best, most honest information we have… But the point is that you shouldn’t have to trust us! So, buckle in for today’s special edition, and never have to blindly believe sci-hub (or Snopes!) again.
The above now-famous Tumblr post that became a meme is a popular and obvious example of how statistics can be misleading, either by error or by deliberate spin.
But what sort of mistakes and misrepresentations are we most likely to find in real research?
Spin Bias
Perhaps most common in popular media reporting of science, the Spin Bias hinges on the fact that most people perceive numbers in a very “fuzzy logic” sort of way. Do you?
Try this:
- A million seconds is 11.5 days
- A billion seconds is not weeks, but 13.2 months!
…just kidding, it’s actually nearly thirty-two years.
Did the months figure seem reasonable to you, though? If so, this is the same kind of “human brains don’t do large numbers” problem that occurs when looking at statistics.
Let’s have a look at reporting on statistically unlikely side effects for vaccines, as an example:
- “966 people in the US died after receiving this vaccine!” (So many! So risky!)
- “Fewer than 3 people per million died after receiving this vaccine!” (Hmm, I wonder if it is worth it?)
- “Half of unvaccinated people with this disease die of it” (Oh)
How to check for this: ask yourself “is what’s being described as very common really very common?”. To keep with the spiders theme, there are many (usually outright made-up) stats thrown around on social media about how near the nearest spider is at any given time. Apply this kind of thinking to medical conditions.. If something affects only 1% of the population (So few! What a tiny number!), how far would you have to go to find someone with that condition? The end of your street, perhaps?
Selection/Sampling Bias
Diabetes disproportionately affects black people, but diabetes research disproportionately focuses on white people with diabetes. There are many possible reasons for this, the most obvious being systemic/institutional racism. For example, advertisements for clinical trial volunteer opportunities might appear more frequently amongst a convenient, nearby, mostly-white student body. The selection bias, therefore, made the study much less reliable.
Alternatively: a researcher is conducting a study on depression, and advertises for research subjects. He struggles to get a large enough sample size, because depressed people are less likely to respond, but eventually gets enough. Little does he know, even the most depressed of his subjects are relatively happy and healthy compared with the silent majority of depressed people who didn’t respond.
See This And Many More Educational Cartoons At Sketchplanations.com!
How to check for this: Does the “method” section of the scientific article describe how they took pains to make sure their sample was representative of the relevant population, and how did they decide what the relevant population was?
Publication Bias
Scientific publications will tend to prioritise statistical significance. Which seems great, right? We want statistically significant studies… don’t we?
We do, but: usually, in science, we consider something “statistically significant” when it hits the magical marker of p=0.05 (in other words, the probability of getting that result is 1/20, and the results are reliably coming back on the right side of that marker).
However, this can result in the clinic stopping testing once p=0.05 is reached, because they want to have their paper published. (“Yay, we’ve reached out magical marker and now our paper will be published”)
So, you can think of publication bias as the tendency for researchers to publish ‘positive’ results.
If it weren’t for publication bias, we would have a lot more studies that say “we tested this, and here are our results, which didn’t help answer our question at all”—which would be bad for the publication, but good for science, because data is data.
To put it in non-numerical terms: this is the same misrepresentation as the technically true phrase “when I misplace something, it’s always in the last place I look for it”—obviously it is, because that’s when you stop looking.
There’s not a good way to check for this, but be sure to check out sample sizes and see that they’re reassuringly large.
Reporting/Detection/Survivorship Bias
There’s a famous example of the rise in “popularity” of left-handedness. Whilst Americans born in ~1910 had a bit under a 3.5% chance of being left handed, those born in ~1950 had a bit under a 12% change.
Why did left-handedness become so much more prevalent all of a sudden, and then plateau at 12%?
Simple, that’s when schools stopped forcing left-handed children to use their right hands instead.
In a similar fashion, countries have generally found that homosexuality became a lot more common once decriminalized. Of course the real incidence almost certainly did not change—it just became more visible to research.
So, these biases are caused when the method of data collection and/or measurement leads to a systematic error in results.
How to check for this: you’ll need to think this through logically, on a case by case basis. Is there a reason that we might not be seeing or hearing from a certain demographic?
And perhaps most common of all…
Confounding Bias
This is the bias that relates to the well-known idea “correlation ≠ causation”.
Everyone has heard the funny examples, such as “ice cream sales cause shark attacks” (in reality, both are more likely to happen in similar places and times; when many people are at the beach, for instance).
How can any research paper possibly screw this one up?
Often they don’t and it’s a case of Spin Bias (see above), but examples that are not so obviously wrong “by common sense” often fly under the radar:
“Horse-riding found to be the sport that most extends longevity”
Should we all take up horse-riding to increase our lifespans? Probably not; the reality is that people who can afford horses can probably afford better than average healthcare, and lead easier, less stressful lives overall. The fact that people with horses typically have wealthier lifestyles than those without, is the confounding variable here.
See This And Many More Educational Cartoons on XKCD.com!
In short, when you look at the scientific research papers cited in the articles you read (you do look at the studies, yes?), watch out for these biases that found their way into the research, and you’ll be able to draw your own conclusions, with well-informed confidence, about what the study actually tells us.
Science shouldn’t be gatekept, and definitely shouldn’t be abused, so the more people who know about these things, the better!
So…would one of your friends benefit from this knowledge? Forward it to them!
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How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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Is chocolate milk a good recovery drink after a workout? A dietitian reviews the evidence
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Whether you enjoy chocolate milk regularly, as a weekend treat, or as an occasional dose of childhood nostalgia, it probably wouldn’t be the first option you think of for post-workout recovery.
Unless you’re on TikTok, perhaps. According to many people on the social media platform, chocolate milk is not only delicious, but it offers benefits comparable to sports drinks after a workout.
So is there any evidence to support this? Let’s take a look.
eldar nurkovic/Shutterstock Rehydrating after a workout is important
Water accounts for somewhere between 50% and 60% of our body weight. Water has many important functions in the body, including helping to keep our body at the right temperature through sweating.
We lose water naturally from our bodies when we sweat, as well as through our breathing and when we go to the toilet. So it’s important to stay hydrated to replenish the water we lose.
When we don’t, we become dehydrated, which can put a strain on our bodies. Signs and symptoms of dehydration can range from thirst and dizziness to low blood pressure and confusion.
Athletes, because of their higher levels of exertion, lose more water through sweating and from respiration (when their breathing rate gets faster). If they’re training or competing in hot or humid environments they will sweat even more.
Dehydration impacts athletes’ performance and like for all of us, can affect their health.
So finding ways to ensure athletes rehydrate quickly during and after they train or compete is important. Fortunately, sports scientists and dietitians have done research looking at the composition of different fluids to understand which ones rehydrate athletes most effectively.
The beverage hydration index
The best hydrating drinks are those the body retains the most of once they’ve been consumed. By doing studies where they give people different drinks in standardised conditions, scientists have been able to determine how various options stack up.
To this end, they’ve developed something called the beverage hydration index, which measures to what degree different fluids hydrate a person compared to still water.
According to this index beverages with similar fluid retention to still water include sparkling water, sports drinks, cola, diet cola, tea, coffee, and beer below 4% alcohol. That said, alcohol is probably best avoided when recovering from exercise.
Beverages with superior fluid retention to still water include milk (both full-fat and skim), soy milk, orange juice and oral rehydration solutions.
This body of research indicates that when it comes to rehydration after exercise, unflavoured milk (full fat, skim or soy) is better than sports drinks.
But what about chocolate milk?
A small study looked at the effects of chocolate milk compared to plain milk on rehydration and exercise performance in futsal players (futsal is similar to soccer but played on a court indoors). The researchers found no difference in rehydration between the two. There’s no other published research to my knowledge looking at how chocolate milk compares to regular milk for rehydration during or after exercise.
But rehydration isn’t the only thing athletes look for in sports drinks. In the same study, drinking chocolate milk after play (referred to as the recovery period) increased the time it took for the futsal players to become exhausted in further exercise (a shuttle run test) four hours later.
This was also shown in a review of several clinical trials. The analysis found that, compared to different placebos (such as water) or other drinks containing fat, protein and carbohydrates, chocolate milk lengthened the time to exhaustion during exercise.
What’s in chocolate milk?
Milk contains protein, carbohydrates and electrolytes, each of which can affect hydration, performance, or both.
Protein is important for building muscle, which is beneficial for performance. The electrolytes in milk (including sodium and potassium) help to replace electrolytes lost through sweating, so can also be good for performance, and aid hydration.
Compared to regular milk, chocolate milk contains added sugar. This provides extra carbohydrates, which are likewise beneficial for performance. Carbohydrates provide an immediate source of energy for athletes’ working muscles, where they’re stored as glycogen. This might contribute to the edge chocolate milk appears to have over plain milk in terms of athletic endurance.
The added sugar in chocolate milk provides extra carbohydrates. Brent Hofacker/Shutterstock Coffee-flavoured milk has an additional advantage. It contains caffeine, which can improve athletic performance by reducing the perceived effort that goes into exercise.
One study showed that a frappe-type drink prepared with filtered coffee, skim milk and sugar led to better muscle glycogen levels after exercise compared to plain milk with an equivalent amount of sugar added.
So what’s the verdict?
Evidence shows chocolate milk can rehydrate better than water or sports drinks after exercise. But there isn’t evidence to suggest it can rehydrate better than plain milk. Chocolate milk does appear to improve athletic endurance compared to plain milk though.
Ultimately, the best drink for athletes to consume to rehydrate is the one they’re most likely to drink.
While many TikTok trends are not based on evidence, it seems chocolate milk could actually be a good option for recovery from exercise. And it will be cheaper than specialised sports nutrition products. You can buy different brands from the supermarket or make your own at home with a drinking chocolate powder.
This doesn’t mean everyone should look to chocolate milk when they’re feeling thirsty. Chocolate milk does have more calories than plain milk and many other drinks because of the added sugar. For most of us, chocolate milk may be best enjoyed as an occasional treat.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Is cold water bad for you? The facts behind 5 water myths
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We know the importance of staying hydrated, especially in hot weather. But even for something as simple as a drink of water, conflicting advice and urban myths abound.
Is cold water really bad for your health? What about hot water from the tap? And what is “raw water”? Let’s dive in and find out.
Myth 1: Cold water is bad for you
Some recent TikToks have suggested cold water causes health problems by somehow “contracting blood vessels” and “restricting digestion”. There is little evidence for this.
While a 2001 study found 51 out of 669 women tested (7.6%) got a headache after drinking cold water, most of them already suffered from migraines and the work hasn’t been repeated since.
Cold drinks were shown to cause discomfort in people with achalasia (a rare swallowing disorder) in 2012 but the study only had 12 participants.
For most people, the temperature you drink your water is down to personal preference and circumstances. Cold water after exercise in summer or hot water to relax in winter won’t make any difference to your overall health.
Myth 2: You shouldn’t drink hot tap water
This belief has a grain of scientific truth behind it. Hot water is generally a better solvent than cold water, so may dissolve metals and minerals from pipes better. Hot water is also often stored in tanks and may be heated and cooled many times. Bacteria and other disease-causing microorganisms tend to grow better in warm water and can build up over time.
It’s better to fill your cup from the cold tap and get hot water for drinks from the kettle.
Myth 3: Bottled water is better
While bottled water might be safer in certain parts of the world due to pollution of source water, there is no real advantage to drinking bottled water in Australia and similar countries.
According to University of Queensland researchers, bottled water is not safer than tap water. It may even be tap water. Most people can’t tell the difference either. Bottled water usually costs (substantially) more than turning on the tap and is worse for the environment.
What about lead in tap water? This problem hit the headlines after a public health emergency in Flint, Michigan, in the United States. But Flint used lead pipes with a corrosion inhibitor (in this case orthophosphate) to keep lead from dissolving. Then the city switched water sources to one without a corrosion inhibitor. Lead levels rose and a public emergency was declared.
Fortunately, lead pipes haven’t been used in Australia since the 1930s. While lead might be present in some old plumbing products, it is unlikely to cause problems.
Myth 4: Raw water is naturally healthier
Some people bypass bottled and tap water, going straight to the source.
The “raw water” trend emerged a few years ago, encouraging people to drink from rivers, streams and lakes. There is even a website to help you find a local source.
Supporters say our ancestors drank spring water, so we should, too. However, our ancestors also often died from dysentery and cholera and their life expectancy was low.
While it is true even highly treated drinking water can contain low levels of things like microplastics, unless you live somewhere very remote, the risks of drinking untreated water are far higher as it is more likely to contain pollutants from the surrounding area.
Myth 5: It’s OK to drink directly from hoses
Tempting as it may be, it’s probably best not to drink from the hose when watering the plants. Water might have sat in there, in the warm sun for weeks or more potentially leading to bacterial buildup.
Similarly, while drinking water fountains are generally perfectly safe to use, they can contain a variety of bacteria. It’s useful (though not essential) to run them for a few seconds before you start to drink so as to get fresh water through the system rather than what might have been sat there for a while.
We are fortunate to be able to take safe drinking water for granted. Billions of people around the world are not so lucky.
So whether you like it hot or cold, or somewhere in between, feel free to enjoy a glass of water this summer.
Just don’t drink it from the hose.
Oliver A.H. Jones, Professor of chemistry, RMIT University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?
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Are Waist Trainers Just A Waste, And Are Posture Fixers A Quick Fix?
Yesterday, we asked you for your opinions on waist trainers and posture-fixing harnesses, and got the above-depicted, below-described set of results:
- The most popular response was “Waist trainers are purely cosmetic, so useless. Posture-fixers have merit”, with a little over a quarter of the votes.
- The least popular response was “Both are great tools to help us to optimal waist size and posture, respectively!”
- The other three answers each got a little under a quarter of the vote. In terms of discrete data, these were all 7±1, so basically, there was nothing in it.
The sample size was smaller than usual—perhaps the cluster of American holiday dates yesterday and today kept people busy! But, pressing on…
What does the science say?
Waist trainers are purely cosmetic, so, useless. True or False?
True, simply. Honestly, they’re not even that great for cosmetic purposes. They will indeed cinch in your middle, and this shape will be retained for a (very) short while after uncinching, because your organs have been squished inwards and may take a short while to get back to where they are supposed to be.
The American Board of Cosmetic Surgery may not be an unbiased source, but we’re struggling to find scientists who will even touch one of these, so, let’s see what these doctors have to say:
- Waist training can damage vital organs
- You will be slowly suffocating yourself
- Waist training simply doesn’t work
- You cannot drastically change your body shape with a piece of fabric*
Read: ABCS | 4 Reasons to Throw Your Waist Trainer in the Trash
*”But what about foot-binding?”—feet have many bones, whose growth can be physically restricted. Your waist has:
- organs: necessary! (long-term damage possible, but they’re not going away)
- muscles: slightly restrictable! (temporary restriction; no permanent change)
- fat: very squeezable! (temporary muffin; no permanent change)
Posture correctors have merit: True or False?
True—probably, and as a stepping-stone measure only.
The Ergonomics Health Association (a workplace health & safety organization) says:
❝Looking at the clinical evidence of posture correctors, we can say without a doubt that they do work, just not for everyone and not in the same way for all patients.❞
Source: Do Posture Correctors Work? Here’s What Our Experts Think
That’s not very compelling, so we looked for studies, and found… Not much, actually. However, what we did find supported the idea that “they probably do help, but we seriously need better studies with less bias”:
That is also not a compelling title, but here is where it pays to look at the studies and not just the titles. Basically, they found that the results were favorable to the posture-correctors—the science itself was just trash:
❝ The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity.
The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence.❞
Since the benefit of posture correctors like this one is due to reminding the wearer to keep good posture, there is a lot more (good quality!) science for wearable biofeedback tech devices, such as this one:
Spine Cop: Posture Correction Monitor and Assistant
Take care!
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Eggs: Nutritional Powerhouse or Heart-Health Timebomb?
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Eggs: All Things In Moderation?
We asked you for your (health-related) opinion on eggs. We specified that, for the sake of simplicity, let’s say that they are from happy healthy backyard hens who enjoy a good diet.
Apparently this one wasn’t as controversial as it might have been! We (for myth-busting purposes) try to pick something polarizing and sometimes even contentious for our Friday editions, and pick apart what science lies underneath public perceptions.
However, more than half (in fact, 60%) of the subscribers who voted in the poll voted for “Eggs are nutritionally beneficial as part of a balanced diet”, which very moderate statement is indeed pretty much the global scientific consensus.
Still, we’ve a main feature to write, so let’s look at the science, and what the other 40% had in mind:
Eggs are ruinous to health, especially cardiometabolic health: True or False?
False, per best current science, anyway!
Scientific consensus has changed over the years. We learned about cholesterol, then we learned about different types of cholesterol, and now we’ve even learned about in some instances even elevated levels of “bad” cholesterol aren’t necessarily a cause of cardiometabolic disorders so much as a symptom—especially in women.
Not to derail this main feature about eggs (rather than just cholesterol), but for those who missed it, this is actually really interesting: basically, research (pertaining to the use of statins) has found that in women, higher LDL levels aren’t anywhere near the same kind of risk factor as they are for men, and thus may mean that statins (whose main job is reducing LDL) may be much less helpful for women than for men, and more likely to cause unwanted serious side effects in women.
Check out our previous main feature about this: Statins: His & Hers?
But, for back on topic, several large studies (totalling 177,000 people in long-term studies in 50 countries) found:
❝Results from the three cohorts and from the updated meta-analysis show that moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.❞
Egg whites are healthy (protein); egg yolks are not (cholesterol): True or False?
True and False, respectively. That is to say, egg whites are healthy (protein), and egg yolks are also healthy (many nutrients).
We talked a bit already about cholesterol, so we’ll not rehash that here. As to the rest:
Eggs are one of the most nutritionally dense foods around. After all, they have everything required to allow a cluster of cells to become a whole baby chick. That’s a lot of body-building!
They’re even more nutritionally heavy-hitters if you get omega-3 enriched eggs, which means the hens were fed extra omega-3, usually in the form of flax seeds.
Also, free-range is better healthwise than others. Do bear in mind that unless they really are from your backyard, or a neighbor’s, chances are that the reality is not what the advertising depicts, though. There are industry minimum standards to be able to advertise as “free-range”, and those standards are a) quite low b) often ignored, because an occasional fine is cheaper than maintaining good conditions.
So if you can look after your own hens, or get them from somewhere that you can see for yourself how they are looked after, so much the better!
Check out the differences side-by-side, though:
Pastured vs Omega-3 vs “Conventional” Eggs: What’s the Difference?
Stallone-style 12-egg smoothies are healthy: True or False?
False, at least if taken with any regularity. One can indeed have too much of a good thing.
So, what’s the “right amount” to eat?
It may vary depending on individual factors (including age and ethnicity), but a good average, according to science, is to keep it to 3 eggs or fewer per day. There are a lot of studies, but we only have so much room here, so we’ll pick one. Its findings are representative of (and in keeping with) the many other studies we looked at, so this seems uncontroversial scientifically:
❝Intake of 1 egg/d was sufficient to increase HDL function and large-LDL particle concentration; however, intake of 2-3 eggs/d supported greater improvements in HDL function as well as increased plasma carotenoids. Overall, intake of ≤3 eggs/d favored a less atherogenic LDL particle profile, improved HDL function, and increased plasma antioxidants in young, healthy adults.❞
Enjoy!
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The Case of the Armadillo: Is It Spreading Leprosy in Florida?
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GAINESVILLE, Fla. — In an open-air barn at the edge of the University of Florida, veterinarian Juan Campos Krauer examines a dead armadillo’s footpads and ears for signs of infection.
Its claws are curled tight and covered in blood. Campos Krauer thinks it was struck in the head while crossing a nearby road.
He then runs a scalpel down its underside. He removes all the important organs: heart, liver, kidneys. Once the specimens are bottled up, they’re destined for an ultra-cold freezer in his lab at the college.
Campos Krauer plans to test the armadillo for leprosy, an ancient illness also known as Hansen’s disease that can lead to nerve damage and disfigurement in humans. He and other scientists are trying to solve a medical mystery: why Central Florida has become a hot spot for the age-old bacteria that cause it.
Leprosy remains rare in the United States. But Florida, which often reports the most cases of any state, has seen an uptick in patients. The epicenter is east of Orlando. Brevard County reported a staggering 13% of the nation’s 159 leprosy cases in 2020, according to a Tampa Bay Times analysis of state and federal data.
Many questions about the phenomenon remain unanswered. But leprosy experts believe armadillos play a role in spreading the illness to people. To better understand who’s at risk and to prevent infections, about 10 scientists teamed up last year to investigate. The group includes researchers from the University of Florida, Colorado State University, and Emory University in Atlanta.
“How this transmission is happening, we really don’t know,” said Ramanuj Lahiri, chief of the laboratory research branch for the National Hansen’s Disease Program, which studies the bacteria involved and cares for leprosy patients across the country.
‘Nothing Was Adding Up’
Leprosy is believed to be the oldest human infection in history. It probably has been sickening people for at least 100,000 years. The disease is highly stigmatized — in the Bible, it was described as a punishment for sin. In more modern times, patients were isolated in “colonies” around the world, including in Hawaii and Louisiana.
In mild cases, the slow-growing bacteria cause a few lesions. If left untreated, they can paralyze the hands and feet.
But it’s actually difficult to fall ill with leprosy, as the infection isn’t very contagious. Antibiotics can cure the ailment in a year or two. They’re available for free through the federal government and the World Health Organization, which launched a campaign in the 1990s to eliminate leprosy as a public health problem.
In 2000, reported U.S. cases dropped to their lowest point in decades with 77 infections. But they later increased, averaging about 180 per year from 2011 to 2020, according to data from the National Hansen’s Disease Program.
During that time, a curious trend emerged in Florida.
In the first decade of the 21st century, the state logged 67 cases. Miami-Dade County noted 20 infections — the most of any Florida county. The vast majority of its cases were acquired outside the U.S., according to a Times analysis of Florida Department of Health data.
But over the next 10 years, recorded cases in the state more than doubled to 176 as Brevard County took center stage.
The county, whose population is about a fifth the size of Miami-Dade’s, logged 85 infections during that time — by far the most of any county in the state and nearly half of all Florida cases. In the previous decade, Brevard noted just five cases.
Remarkably, at least a quarter of Brevard’s infections were acquired within the state, not while the individuals were abroad. India, Brazil, and Indonesia diagnose more leprosy cases than anywhere, reporting over 135,000 infections combined in 2022 alone. People were getting sick even though they hadn’t traveled to such areas or been in close contact with existing leprosy patients, said Barry Inman, a former epidemiologist at the Brevard health department who investigated the cases and retired in 2021.
“Nothing was adding up,” Inman said.
A few patients recalled touching armadillos, which are known to carry the bacteria. But most didn’t, he said. Many spent a lot of time outdoors, including lawn workers and avid gardeners. The cases were usually mild.
It was difficult to nail down where people got the illness, he added. Because the bacteria grow so slowly, it can take anywhere from nine months to 20 years for symptoms to begin.
Amoeba or Insect Culprits?
Heightened awareness of leprosy could play a role in Brevard’s groundswell of cases.
Doctors must report leprosy to the health department. Yet Inman said many in the county didn’t know that, so he tried to educate them after noticing cases in the late 2000s.
But that’s not the sole factor at play, Inman said.
“I don’t think there’s any doubt in my mind that something new is going on,” he said.
Other parts of Central Florida have also recorded more infections. From 2011 to 2020, Polk County logged 12 cases, tripling its numbers compared with the previous 10 years. Volusia County noted 10 cases. It reported none the prior decade.
Scientists are honing in on armadillos. They suspect the burrowing critters may indirectly cause infections through soil contamination.
Armadillos, which are protected by hard shells, serve as good hosts for the bacteria, which don’t like heat and can thrive in the animals whose body temperatures range from a cool 86-95 degrees.
Colonists probably brought the disease to the New World hundreds of years ago, and somehow armadillos became infected, said Lahiri, the National Hansen’s Disease Program scientist. The nocturnal mammals can develop lesions from the illness just as humans can. More than 1 million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the University of Florida’s Department of Large Animal Clinical Sciences.
How many carry leprosy is unclear. A study published in 2015 of more than 600 armadillos in Alabama, Florida, Georgia, and Mississippi found that about 16% showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos west of the Mississippi River, then spread east.
Handling the critters is a known hazard. Lab research shows that single-cell amoebas, which live in soil, can also carry the bacteria.
Armadillos love to dig up and eat earthworms, frustrating homeowners whose yards they damage. The animals may shed the bacteria while hunting for food, passing it to amoebas, which could later infect people.
Leprosy experts also wonder if insects help spread the disease. Blood-sucking ticks might be a culprit, lab research shows.
“Some people who are infected have little to no exposure to the armadillo,” said Norman Beatty, an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”
Campos Krauer, who’s been searching Gainesville streets for armadillo roadkill, wants to gather infected animals and let them decompose in a fenced-off area, allowing the remains to soak into a tray of soil while flies lay eggs. He hopes to test the dirt and larvae to see if they pick up the bacteria.
Adding to the intrigue is a leprosy strain found only in Florida, according to scientists.
In the 2015 study, researchers discovered that seven armadillos from the Merritt Island National Wildlife Refuge, which is mostly in Brevard but crosses into Volusia, carried a previously unseen version of the pathogen.
Ten patients in the region were stricken with it, too. At the genetic level, the strain is similar to another type found in U.S. armadillos, said Charlotte Avanzi, a Colorado State University researcher who specializes in leprosy.
It’s unknown if the strain causes more severe disease, Lahiri said.
Reducing Risk
The public should not panic about leprosy, nor should people race to euthanize armadillos, researchers warn.
Scientists estimate that over 95% of the global human population has a natural ability to ward off the disease. They believe months of exposure to respiratory droplets is needed for person-to-person transmission to occur.
But when infections do happen, they can be devastating.
“If we better understand it,” Campos Krauer said, “the better we can learn to live with it and reduce the risk.”
The new research may also provide insight for other Southern states. Armadillos, which don’t hibernate, have been moving north, Campos Krauer said, reaching areas like Indiana and Virginia. They could go farther due to climate change.
People concerned about leprosy can take simple precautions, medical experts say. Those working in dirt should wear gloves and wash their hands afterward. Raising garden beds or surrounding them with a fence may limit the chances of soil contamination. If digging up an armadillo burrow, consider wearing a face mask, Campos Krauer said.
Don’t play with or eat the animals, added John Spencer, a scientist at Colorado State University who studies leprosy transmission in Brazil. They’re legal to hunt year-round in Florida without a license.
Campos Krauer’s team has so far examined 16 dead armadillos found on Gainesville area roads, more than 100 miles from the state’s leprosy epicenter, trying to get a preliminary idea of how many carry the bacteria.
None has tested positive yet.
This article was produced through a partnership between KFF Health News and the Tampa Bay Times.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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