Are plant-based burgers really bad for your heart? Here’s what’s behind the scary headlines
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We’re hearing a lot about ultra-processed foods and the health effects of eating too many. And we know plant-based foods are popular for health or other reasons.
So it’s not surprising new research out this week including the health effects of ultra-processed, plant-based foods is going to attract global attention.
And the headlines can be scary if that research and the publicity surrounding it suggests eating these foods increases your risk of heart disease, stroke or dying early.
Here’s how some media outlets interpreted the research. The Daily Mail ran with:
Vegan fake meats are linked to increase in heart deaths, study suggests: Experts say plant-based diets can boost health – but NOT if they are ultra-processed
The New York Post’s headline was:
Vegan fake meats linked to heart disease, early death: study
But when we look at the study itself, it seems the media coverage has focused on a tiny aspect of the research, and is misleading.
So does eating supermarket plant-based burgers and other plant-based, ultra-processed foods really put you at greater risk of heart disease, stroke and premature death?
Here’s what prompted the research and what the study actually found.
Remind me, what are ultra-processed foods?
Ultra-processed foods undergo processing and reformulation with additives to enhance flavour, shelf-life and appeal. These include everything from packet macaroni cheese and pork sausages, to supermarket pastries and plant-based mince.
There is now strong and extensive evidence showing ultra-processed foods are linked with an increased risk of many physical and mental chronic health conditions.
Although researchers question which foods should be counted as ultra-processed, or if all of them are linked to poorer health, the consensus is that, generally, we should be eating less of them.
We also know plant-based diets are popular. These are linked with a reduced risk of chronic health conditions such as heart disease and stroke, cancer and diabetes. And supermarkets are stocking more plant-based, ultra-processed food options.
How about the new study?
The study looked for any health differences between eating plant-based, ultra-processed foods compared to eating non-plant based, ultra-processed foods. The researchers focused on the risk of cardiovascular disease (such as heart disease and stroke) and deaths from it.
Plant-based, ultra-processed foods in this study included mass-produced packaged bread, pastries, buns, cakes, biscuits, cereals and meat alternatives (fake meats). Ultra-processed foods that were not plant-based included milk-based drinks and desserts, sausages, nuggets and other reconstituted meat products.
The researchers used data from the UK Biobank. This is a large biomedical database that contains de-identified genetic, lifestyle (diet and exercise) and health information and biological samples from half a million UK participants. This databank allows researchers to determine links between this data and a wide range of diseases, including heart disease and stroke.
They used data from nearly 127,000 people who provided details of their diet between 2009 and 2012. The researchers linked this to their hospital records and death records. On average, the researchers followed each participant’s diet and health for nine years.
What did the study find?
With every 10% increase of total energy from plant-sourced, ultra-processed foods there was an associated 5% increased risk of cardiovascular disease (such as heart disease or stroke) and a 12% higher risk of dying from cardiovascular disease.
But for every 10% increase in plant-sourced, non-ultra-processed foods consumed there was an associated 7% lower risk of cardiovascular disease and a 13% lower risk of dying from cardiovascular disease.
The researchers found no evidence for an association between all plant-sourced foods (whether or not they were ultra-processed) and either an increased or decreased risk of cardiovascular disease or dying from it.
This was an observational study, where people recalled their diet using questionnaires. When coupled with other data, this can only tell us if someone’s diet is associated with a particular risk of a health outcome. So we cannot say that, in this case, the ultra-processed foods caused the heart disease and deaths from it.
Why has media coverage focused on fake meats?
Much of the media coverage has focused on the apparent health risks associated with eating fake meats, such as sausages, burgers, nuggets and even steaks.
These are considered ultra-processed foods. They are made by deconstructing whole plant foods such as pea, soy, wheat protein, nuts and mushrooms, and extracting the protein. They are then reformulated with additives to make the products look, taste and feel like traditional red and white meats.
However this was only one type of plant-based, ultra-processed food analysed in this study. This only accounted for an average 0.2% of the dietary energy intake of all the participants.
Compare this to bread, pastries, buns, cakes and biscuits, which are other types of plant-based, ultra-processed foods. These accounted for 20.7% of total energy intake in the study.
It’s hard to say why the media focused on fake meat. But there is one clue in the media release issued to promote the research.
Although the media release did not mention the words “fake meat”, an image of plant-based burgers, sausages and meat balls or rissoles featured prominently.
The introduction of the study itself also mentions plant-sourced, ultra-processed foods, such as sausages, nuggets and burgers.
So it’s no wonder people can be confused.
Does this mean fake meats are fine?
Not necessarily. This study analysed the total intake of plant-based, ultra-processed foods, which included fake meats, albeit a very small proportion of people’s diets.
From this study alone we cannot tell if there would be a different outcome if someone ate large amounts of fake meats.
In fact, a recent review of fake meats found there was not enough evidence to determine their impact on health.
We also need more recent data to reflect current eating patterns of fake meats. This study used dietary data collected from 2009 to 2012, and fake meats have become more popular since.
What if I really like fake meat?
We have known for a while that ultra-processed foods can harm our health. This study tells us that regardless if an ultra-processed food is plant-based or not, it may still be harmful.
We know fake meat can contain large amounts of saturated fats (from coconut or palm oil), salt and sugar.
So like other ultra-processed foods, they should be eaten infrequently. The Australian Dietary Guidelines currently recommends people should only consume foods like this sometimes and in small amounts.
Are some fake meats healthier than others?
Check the labels and nutrition information panels. Look for those lowest in fat and salt. Burgers and sausages that are a “pressed cake” of minced ingredients such as nuts, beans and vegetables will be preferable to reformulated products that look identical to meat.
You can also eat whole plant-based protein foods such as legumes. These include beans, lentils, chickpeas and soy beans. As well as being high in protein and fibre, they also provide essential nutrients such as iron and zinc. Using spices and mushrooms alongside these in your recipes can replicate some of the umami taste associated with meat.
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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Sleep Tracking, For Five Million Nights
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5 Sleep Phenotypes, By Actual Science
You probably know people can be broadly divided into “early birds” and “night owls”:
Early Bird Or Night Owl? Genes vs Environment
…and then the term “hummingbird” gets used for a person who flits between the two.
That’s three animals so far. If you read a book we reviewed recently, specifically this one:
The Power of When – by Dr. Michael Breus
…then you may have used the guide within to self-diagnose your circadian rhythm type (chronotype) according to Dr. Breus’s system, which divides people into bears, lions, wolves, and dolphins.
That’s another four animals. If you have a FitBit, it can “diagnose” you with being those and/or a menagerie of others, such as giraffe, hedgehog, parrot, and tortoise:
How Fitbit Developed the Sleep Profile Experience (Part 2 – Sleep Animals)
Five million nights
A team of researchers recently took a step away from this veritable zoo of 11 different animals and counting, and used a sophisticated modelling system to create a spatial-temporal map of people’s sleep habits, and this map created five main “islands” that people’s sleep habits could settle on, or sometimes move from island to island.
Those “five million nights” by the way? It was actually 5,095,798 nights! You might notice that would take from the 2020s to the 15970s to complete, so this was rather a matter of monitoring 33,152 individuals between January and October of the same year. Between them, they got those 5,095,798 nights of sleep (or in some cases, nights of little or no sleep, but still, they were there for the nights).
The five main phenotypes that the researchers found were:
- What we think of as “normal” sleep. In this phenotype, people get about eight hours of uninterrupted sleep for at least six days in a row.
- As above for half the nights, but they only sleep for short periods of time in bouts of less than three hours the other half.
- As per normal sleep, but with one interrupted night per week, consisting of a 5 hour sleep period and then broken sleep for a few more hours.
- As per normal sleep generally, but with occasional nights in which long bouts of sleep are separated by a mid-sleep waking.
- Sleeping for very short periods of time every night. This phenotype was the rarest the researchers found, and represents extremely disrupted sleep.
As you might suspect, phenotype 1 is healthier than phenotype 5. But that’s not hugely informational, as the correlation between getting good sleep and having good health is well-established. So, what did the study teach us?
❝We found that little changes in sleep quality helped us identify health risks. Those little changes wouldn’t show up on an average night, or on a questionnaire, so it really shows how wearables help us detect risks that would otherwise be missed.❞
More specifically,
❝We found that the little differences in how sleep disruptions occur can tell us a lot. Even if these instances are rare, their frequency is also telling. So it’s not just whether you sleep well or not – it’s the patterns of sleep over time where the key info hides❞
…and, which gets to the absolute point,
❝If you imagine there’s a landscape of sleep types, then it’s less about where you tend to live on that landscape, and more about how often you leave that area❞
In other words: if your sleep pattern is not ideal, that’s one thing and it’d probably be good to address it, by improving your sleep. However, if your sleep pattern changes phenotype without an obvious known reason why, this may be considered an alarm bell warning of something else that needs addressing, which may be an underlying illness or condition—meaning it can be worthwhile being a little extra vigilant when it comes to regular health screenings, in case something new has appeared.
Want to read more?
You can read the paper in full here:
Five million nights: temporal dynamics in human sleep phenotypes
Take care!
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Eat Better, Feel Better – by Giada de Laurentis
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In yesterday’s edition of 10almonds, we reviewed Dr. Aujla’s “The Doctor’s Kitchen“; today we’re reviewing a different book about healing through food—in this case, with a special focus on maintaining energy and good health as we get older.
De Laurentis may not be a medical doctor, but she is a TV chef, and not only holds a lot of influence, but also has access to a lot of celebrity doctors and such; that’s reflected a lot in her style and approach here.
The recipes are clear and easy to follow; well-illustrated and nicely laid-out.
This cookbook’s style is less “enjoy this hearty dish of rice and beans with these herbs and spices” and more “you can serve your steak salad with white beans and sweet shallot dressing on a bed of organic quinoa if you haven’t already had your day’s serving of grains, of course”.
It’s a little fancier, in short, and more focused on what to cut out, than what to include. On account of that, this could make it a good contrast to yesterday’s book, which had the opposite focus.
She also recommends assorted adjuvant practices; some that are evidence-based, like intermittent fasting and meditation, and some that are not, like extreme detox-dieting, and acupuncture (which has no bearing on gut health).
Bottom line: if you like the idea of eating for good health, and prefer a touch of celebrity lifestyle to your meals, this one’s a good book for you.
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What Omega-3 Fatty Acids Really Do For Us
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What Omega-3 Fatty Acids Really Do For Us
Shockingly, we’ve not previously covered this in a main feature here at 10almonds… Mostly we tend to focus on less well-known supplements. However, in this case, the supplement may be well known, while some of its benefits, we suspect, may come as a surprise.
So…
What is it?
In this case, it’s more of a “what are they?”, because omega-3 fatty acids come in multiple forms, most notably:
- Alpha-linoleic acid (ALA)
- Eicosapentaenoic acid (EPA)
- Docosahexanoic acid (DHA)
ALA is most readily found in certain seeds and nuts (chia seeds and walnuts are top contenders), while EPA and DHA are most readily found in certain fish (hence “cod liver oil” being a commonly available supplement, though actually cod aren’t even the best source—salmon and mackerel are better; cod is just cheaper to overfish, making it the cheaper supplement to manufacture).
Which of the three is best, or do we need them all?
There are two ways of looking at this:
- ALA is sufficient alone, because it is a precursor to EPA and DHA, meaning that the body will take ALA and convert it into EPA and DHA as required
- EPA and DHA are superior because they’re already in the forms the body will use, which makes them more efficient
As with most things in health, diversity is good, so you really can’t go wrong by getting some from each source.
Unless you have an allergy to fish or nuts, in which case, definitely avoid those!
What do omega-3 fatty acids do for us, according to actual research?
Against inflammation
Most people know it’s good for joints, as this is perhaps what it’s most marketed for. Indeed, it’s good against inflammation of the joints (and elsewhere), and autoimmune diseases in general. So this means it is indeed good against common forms of arthritis, amongst others:
Read: Omega-3 fatty acids in inflammation and autoimmune disease
Against menstrual pain
Linked to the above-referenced anti-inflammatory effects, omega-3s were also found to be better than ibuprofen for the treatment of severe menstrual pain:
Don’t take our word for it: Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea
Against cognitive decline
This one’s a heavy-hitter. It’s perhaps to be expected of something so good against inflammation (bearing in mind that, for example, a large part of Alzheimer’s is effectively a form of inflammation of the brain); as this one’s so important and such a clear benefit, here are three particularly illustrative studies:
- Inadequate supply of vitamins and DHA in the elderly: implications for brain aging and Alzheimer-type dementia
- Fish consumption and cognitive decline with age in a large community study
- Fish consumption, long-chain omega-3 fatty acids and risk of cognitive decline or Alzheimer disease
Against heart disease
The title says it all in this one:
But what about in patients who do have heart disease?
Mozaffarian and Wu did a huge meta-review of available evidence, and found that in fact, of all the studied heart-related effects, reducing mortality rate in cases of cardiovascular disease was the single most well-evidenced benefit:
How much should we take?
There’s quite a bit of science on this, and—which is unusual for something so well-studied—not a lot of consensus.
However, to summarize the position of the academy of nutrition and dietetics on dietary fatty acids for healthy adults, they recommend a minimum of 250–500 mg combined EPA and DHA each day for healthy adults. This can be obtained from about 8 ounces (230g) of fatty fish per week, for example.
If going for ALA, on the other hand, the recommendation becomes 1.1g/day for women or 1.6g/day for men.
Want to know how to get more from your diet?
Here’s a well-sourced article about different high-density dietary sources:
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Most adults will gain half a kilo this year – and every year. Here’s how to stop ‘weight creep’
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As we enter a new year armed with resolutions to improve our lives, there’s a good chance we’ll also be carrying something less helpful: extra kilos. At least half a kilogram, to be precise.
“Weight creep” doesn’t have to be inevitable. Here’s what’s behind this sneaky annual occurrence and some practical steps to prevent it.
Allgo/Unsplash Small gains add up
Adults tend to gain weight progressively as they age and typically gain an average of 0.5 to 1kg every year.
While this doesn’t seem like much each year, it amounts to 5kg over a decade. The slow-but-steady nature of weight creep is why many of us won’t notice the extra weight gained until we’re in our fifties.
Why do we gain weight?
Subtle, gradual lifestyle shifts as we progress through life and age-related biological changes cause us to gain weight. Our:
- activity levels decline. Longer work hours and family commitments can see us become more sedentary and have less time for exercise, which means we burn fewer calories
- diets worsen. With frenetic work and family schedules, we sometimes turn to pre-packaged and fast foods. These processed and discretionary foods are loaded with hidden sugars, salts and unhealthy fats. A better financial position later in life can also result in more dining out, which is associated with a higher total energy intake
- sleep decreases. Busy lives and screen use can mean we don’t get enough sleep. This disturbs our body’s energy balance, increasing our feelings of hunger, triggering cravings and decreasing our energy
Insufficient sleep can increase our appetite. Craig Adderley/Pexels - stress increases. Financial, relationship and work-related stress increases our body’s production of cortisol, triggering food cravings and promoting fat storage
- metabolism slows. Around the age of 40, our muscle mass naturally declines, and our body fat starts increasing. Muscle mass helps determine our metabolic rate, so when our muscle mass decreases, our bodies start to burn fewer calories at rest.
We also tend to gain a small amount of weight during festive periods – times filled with calorie-rich foods and drinks, when exercise and sleep are often overlooked. One study of Australian adults found participants gained 0.5 kilograms on average over the Christmas/New Year period and an average of 0.25 kilograms around Easter.
Why we need to prevent weight creep
It’s important to prevent weight creep for two key reasons:
1. Weight creep resets our body’s set point
Set-point theory suggests we each have a predetermined weight or set point. Our body works to keep our weight around this set point, adjusting our biological systems to regulate how much we eat, how we store fat and expend energy.
When we gain weight, our set point resets to the new, higher weight. Our body adapts to protect this new weight, making it challenging to lose the weight we’ve gained.
But it’s also possible to lower your set point if you lose weight gradually and with an interval weight loss approach. Specifically, losing weight in small manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.
Holidays can also come with weight gain. Zan Lazarevic/Unsplash 2. Weight creep can lead to obesity and health issues
Undetected and unmanaged weight creep can result in obesity which can increase our risk of heart disease, strokes, type 2 diabetes, osteoporosis and several types of cancers (including breast, colorectal, oesophageal, kidney, gallbladder, uterine, pancreatic and liver).
A large study examined the link between weight gain from early to middle adulthood and health outcomes later in life, following people for around 15 years. It found those who gained 2.5 to 10kg over this period had an increased incidence of type 2 diabetes, heart disease, strokes, obesity-related cancer and death compared to participants who had maintained a stable weight.
Fortunately, there are steps we can take to build lasting habits that will make weight creep a thing of the past.
7 practical steps to prevent weight creep
1. Eat from big to small
Aim to consume most of your food earlier in the day and taper your meal sizes to ensure dinner is the smallest meal you eat.
A low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day.
We burn the calories from a meal 2.5 times more efficiently in the morning than in the evening. So emphasising breakfast over dinner is also good for weight management.
Aim to consume bigger breakfasts and smaller dinners. Michael Burrows/Pexels 2. Use chopsticks, a teaspoon or an oyster fork
Sit at the table for dinner and use different utensils to encourage eating more slowly.
This gives your brain time to recognise and adapt to signals from your stomach telling you you’re full.
3. Eat the full rainbow
Fill your plate with vegetables and fruits of different colours first to support eating a high-fibre, nutrient-dense diet that will keep you feeling full and satisfied.
Meals also need to be balanced and include a source of protein, wholegrain carbohydrates and healthy fat to meet our dietary needs – for example, eggs on wholegrain toast with avocado.
4. Reach for nature first
Retrain your brain to rely on nature’s treats – fresh vegetables, fruit, honey, nuts and seeds. In their natural state, these foods release the same pleasure response in the brain as ultra-processed and fast foods, helping you avoid unnecessary calories, sugar, salt and unhealthy fats.
5. Choose to move
Look for ways to incorporate incidental activity into your daily routine – such as taking the stairs instead of the lift – and boost your exercise by challenging yourself to try a new activity.
Just be sure to include variety, as doing the same activities every day often results in boredom and avoidance.
Try new activities or sports to keep your interest up. Cottonbro Studio/Pexels 6. Prioritise sleep
Set yourself a goal of getting a minimum of seven hours of uninterrupted sleep each night, and help yourself achieve it by avoiding screens for an hour or two before bed.
7. Weigh yourself regularly
Getting into the habit of weighing yourself weekly is a guaranteed way to help avoid the kilos creeping up on us. Aim to weigh yourself on the same day, at the same time and in the same environment each week and use the best quality scales you can afford.
At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.
Nick Fuller, Clinical Trials Director, Department of Endocrinology, RPA Hospital, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What are ‘collarium’ sunbeds? Here’s why you should stay away
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Reports have recently emerged that solariums, or sunbeds – largely banned in Australia because they increase the risk of skin cancer – are being rebranded as “collarium” sunbeds (“coll” being short for collagen).
Commercial tanning and beauty salons in Queensland, New South Wales and Victoria are marketing collariums, with manufacturers and operators claiming they provide a longer lasting tan and stimulate collagen production, among other purported benefits.
A collarium sunbed emits both UV radiation and a mix of visible wavelength colours to produce a pink or red light. Like an old-school sunbed, the user lies in it for ten to 20 minute sessions to quickly develop a tan.
But as several experts have argued, the providers’ claims about safety and effectiveness don’t stack up.
Why were sunbeds banned?
Commercial sunbeds have been illegal across Australia since 2016 (except for in the Northern Territory) under state-based radiation safety laws. It’s still legal to sell and own a sunbed for private use.
Their dangers were highlighted by young Australians including Clare Oliver who developed melanoma after using sunbeds. Oliver featured in the No Tan Is Worth Dying For campaign and died from her melanoma at age 26 in 2007.
Sunbeds lead to tanning by emitting UV radiation – as much as six times the amount of UV we’re exposed to from the summer sun. When the skin detects enough DNA damage, it boosts the production of melanin, the brown pigment that gives you the tanned look, to try to filter some UV out before it hits the DNA. This is only partially successful, providing the equivalent of two to four SPF.
Essentially, if your body is producing a tan, it has detected a significant amount of DNA damage in your skin.
Research shows people who have used sunbeds at least once have a 41% increased risk of developing melanoma, while ten or more sunbed sessions led to a 100% increased risk.
In 2008, Australian researchers estimated that each year, sunbeds caused 281 cases of melanoma, 2,572 cases of squamous cell carcinoma (another common type of skin cancer), and $3 million in heath-care costs, mostly to Medicare.
How are collarium sunbeds supposed to be different?
Australian sellers of collarium sunbeds imply they are safe, but their machine descriptions note the use of UV radiation, particularly UVA.
UVA is one part of the spectrum of UV radiation. It penetrates deeper into the skin than UVB. While UVB promotes cancer-causing mutations by discharging energy straight into the DNA strand, UVA sets off damage by creating reactive oxygen species, which are unstable compounds that react easily with many types of cell structures and molecules. These damage cell membranes, protein structures and DNA.
Evidence shows all types of sunbeds increase the risk of melanoma, including those that use only UVA.
Some manufacturers and clinics suggest the machine’s light spectrum increases UV compatibility, but it’s not clear what this means. Adding red or pink light to the mix won’t negate the harm from the UV. If you’re getting a tan, you have a significant amount of DNA damage.
Collagen claims
One particularly odd claim about collarium sunbeds is that they stimulate collagen.
Collagen is the main supportive tissue in our skin. It provides elasticity and strength, and a youthful appearance. Collagen is constantly synthesised and broken down, and when the balance between production and recycling is lost, the skin loses strength and develops wrinkles. The collagen bundles become thin and fragmented. This is a natural part of ageing, but is accelerated by UV exposure.
Sun-protected skin (top) has thick bands of pink collagen (arrows) in the dermis, as seen on microscopic examination. Chronically sun-damaged skin (bottom) has much thinner collagen bands.
Katie Lee/UQThe reactive oxygen species generated by UVA light damage existing collagen structures and kick off a molecular chain of events that downgrades collagen-producing enzymes and increases collagen-destroying enzymes. Over time, a build-up of degraded collagen fragments in the skin promotes even more destruction.
While there is growing evidence red light therapy alone could be useful in wound healing and skin rejuvenation, the UV radiation in collarium sunbeds is likely to undo any benefit from the red light.
What about phototherapy?
There are medical treatments that use controlled UV radiation doses to treat chronic inflammatory skin diseases like psoriasis.
The anti-collagen effects of UVA can also be used to treat thickened scars and keloids. Side-effects of UV phototherapy include tanning, itchiness, dryness, cold sore virus reactivation and, notably, premature skin ageing.
These treatments use the minimum exposure necessary to treat the condition, and are usually restricted to the affected body part to minimise risks of future cancer. They are administered under medical supervision and are not recommended for people already at high risk of skin cancer, such as people with atypical moles.
So what happens now?
It looks like many collariums are just sunbeds rebranded with red light. Queensland Health is currently investigating whether these salons are breaching the state’s Radiation Safety Act, and operators could face large fines.
As the 2024 Australians of the Year – melanoma treatment pioneers Georgina Long and Richard Scolyer – highlighted in their acceptance speech, “there is nothing healthy about a tan”, and we need to stop glamorising tanning.
However, if you’re desperate for the tanned look, there is a safer and easy way to get one – out of a bottle or by visiting a salon for a spray tan.
Katie Lee, PhD Candidate, Dermatology Research Centre, The University of Queensland and Anne Cust, Professor of Cancer Epidemiology, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What is Ryeqo, the recently approved medicine for endometriosis?
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For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.
A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.
Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.
What does Ryeqo do?
Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.
Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.
Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.
All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.
Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).
Is it really new?
The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.
But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.
Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.
In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.
The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.
You can’t take the contraceptive pill with Ryeqo but the endometriosis drug could replace it.
ShutterstockHow to take it and what not to do
Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.
It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.
Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.
Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.
The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.
It’s costly for now
Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.
While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.
Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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