Is Cutting Calories The Key To Healthy Long Life?
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Caloric Restriction with Optimal Nutrition
Yesterday, we asked you “What is your opinion of caloric restriction as a health practice?” and got the above-depicted, below-described spread of responses:
- 48% said “It is a robust, scientifically proven way to live longer and healthier”
- 23% said “It may help us to live longer, but at the cost of enjoying it fully”
- 17% said “It’s a dangerous fad that makes people weak, tired, sick, and unhealthy”
- 12% said “Counting calories is irrelevant to good health; the body compensates”
So… What does the science say?
A note on terms, first
“Caloric restriction” (henceforth: CR), as a term, sees scientific use to mean anything from a 25% reduction to a 50% reduction, compared to metabolic base rate.
This can also be expressed the other way around, “dropping to 60% of the metabolic base rate” (i.e., a 40% reduction).
Here we don’t have the space to go into much depth, so our policy will be: if research papers consider it CR, then so will we.
A quick spoiler, first
The above statements about CR are all to at least some degree True in one way or another.
However, there are very important distinctions, so let’s press on…
CR is a robust, scientifically proven way to live longer and healthier: True or False?
True! This has been well-studied and well-documented. There’s more science for this than we could possibly list here, but here’s a good starting point:
❝Calorie restriction (CR), a nutritional intervention of reduced energy intake but with adequate nutrition, has been shown to extend healthspan and lifespan in rodent and primate models.
Accumulating data from observational and randomized clinical trials indicate that CR in humans results in some of the same metabolic and molecular adaptations that have been shown to improve health and retard the accumulation of molecular damage in animal models of longevity.
In particular, moderate CR in humans ameliorates multiple metabolic and hormonal factors that are implicated in the pathogenesis of type 2 diabetes, cardiovascular diseases, and cancer, the leading causes of morbidity, disability and mortality❞
Source: Ageing Research Reviews | Calorie restriction in humans: an update
See also: Caloric restriction in humans reveals immunometabolic regulators of health span
We could devote a whole article (or a whole book, really) to this, but the super-short version is that it lowers the metabolic “tax” on the body and allows the body to function better for longer.
CR may help us to live longer, but at the cost of enjoying it fully: True or False?
True or False, contingently, depending on what’s important to you. And that depends on psychology as much as physiology, but it’s worth noting that there is often a selection bias in the research papers; people ill-suited to CR drop out of the studies and are not counted in the final data.
Also, relevant for a lot of our readers, most (human-based) studies recruit people over 18 and under 60. So while it is reasonable to assume the same benefits will be carried over that age, there is not nearly as much data for it.
Studies into CR and Health-Related Quality of Life (HRQoL) have been promising, and/but have caveats:
❝In non-obese adults, CR had some positive effects and no negative effects on HRQoL.❞
❝We do not know what degree of CR is needed to achieve improvements in HRQoL, but we do know it requires an extraordinary amount of support.
Therefore, the incentive to offer this intervention to a low-risk, normal or overweight individual is lacking and likely not sustainable in practice.❞
CR a dangerous fad that makes people weak, tired, sick, and unhealthy: True or False?
True if it is undertaken improperly, and/or without sufficient support. Many people will try CR and forget that the idea is to reduce metabolic load while still getting good nutrition, and focus solely on the calorie-counting.
So for example, if a person “saves” their calories for the day to have a night out in a bar where they drink their calories as alcohol, then this is going to be abysmal for their health.
That’s an extreme example, but lesser versions are seen a lot. If you save your calories for a pizza instead of a night of alcoholic drinks, then it’s not quite so woeful, but for example the nutrition-to-calorie ratio of pizza is typically not great. Multiply that by doing it as often as not, and yes, someone’s health is going to be in ruins quite soon.
Counting calories is irrelevant to good health; the body compensates: True or False?
True if by “good health” you mean weight loss—which is rarely, if ever, what we mean by “good health” here at 10almonds (unless we clarify such), but it’s a very common association and indeed, for some people it’s a health goal. You cannot sustainably and healthily lose weight by CR alone, especially if you’re not getting optimal nutrition.
Your body will notice that you are starving, and try to save you by storing as much fat as it can, amongst other measures that will similarly backfire (cortisol running high, energy running low, etc).
For short term weight loss though, yes, it’ll work. At a cost. That we don’t recommend.
❝By itself, decreasing calorie intake will have a limited short-term influence.❞
Source: Reducing Calorie Intake May Not Help You Lose Body Weight
See also…
❝Caloric restriction is a commonly recommended weight-loss method, yet it may result in short-term weight loss and subsequent weight regain, known as “weight cycling”, which has recently been shown to be associated with both poor sleep and worse cardiovascular health❞
Source: Dieting Behavior Characterized by Caloric Restriction
In summary…
Caloric restriction is a well-studied area of health science. We know:
- Practised well, it can extend not only lifespan, but also healthspan
- Practised well, it can improve mood, energy, sexual function, and the other things people fear losing
- Practised badly, it can be ruinous to the health—it is critical to practise caloric restriction with optimal nutrition.
- Practised badly, it can lead to unhealthy weight loss and weight regain
One final note…
If you’ve tried CR and hated it, and you practised it well (e.g., with optimal nutrition), then we recommend just not doing it.
You could also try intermittent fasting instead, for similar potential benefits. If that doesn’t work out either, then don’t do that either!
Sometimes, we’re just weird. It can often be because of a genetic or epigenetic quirk. There are usually workarounds, and/but not everything that’s right for most people will be right for all of us.
Take care!
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What’s behind rising heart attack rates in younger adults
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Deaths from heart attacks have been in decline for decades, thanks to improved diagnosis and treatments. But, among younger adults under 50 and those from communities that have been marginalized, the trend has reversed.
More young people have suffered heart attacks each year since the 2000s—and the reasons why aren’t always clear.
Here’s what you need to know about heart attack trends in younger adults.
Heart attack deaths began declining in the 1980s
Heart disease has been a leading cause of death in the United States for more than a century, but rates have declined for decades as diagnosis and treatments improved. In the 1950s, half of all Americans who had heart attacks died, compared to one in eight today.
A 2023 study found that heart attack deaths declined 4 percent a year between 1999 and 2020.
The downward trend plateaued in the 2000s as heart attacks in young adults rose
In 2012, the decline in heart disease deaths in the U.S. began to slow. A 2018 study revealed that a growing number of younger adults were suffering heart attacks, with women more affected than men. Additionally, younger adults made up one-third of heart attack hospitalizations, with one in five heart attack patients being under 40.
The following year, data showed that heart attack rates among adults under 40 had increased steadily since 2006. Even more troubling, young patients were just as likely to die from heart attacks as patients more than a decade older.
Why are more younger adults having heart attacks?
Heart attacks have historically been viewed as a condition that primarily affects older adults. So, what has changed in recent decades that puts younger adults at higher risk?
Higher rates of obesity, diabetes, and high blood pressure
Several leading risk factors for heart attacks are rising among younger adults.
Between 2009 and 2020, diabetes and obesity rates increased in Americans ages 20 to 44.During the same period, hypertension, or high blood pressure, rates did not improve in younger adults overall and worsened in young Hispanic people. Notably, young Black adults had hypertension rates nearly twice as high as the general population.
Hypertension significantly increases the risk of heart attack and cardiovascular death in young adults.
Increased substance use
Substance use of all kinds increases the risk of cardiovascular issues, including heart attacks. A recent study found that cardiovascular deaths associated with substance use increased by 4 percent annually between 1999 and 2019.
The rise in substance use-related deaths has accelerated since 2012 and was particularly pronounced among women, younger adults (25-39), American Indians and Alaska Natives, and those in rural areas.
Alcohol was linked to 65 percent of the deaths, but stimulants (like methamphetamine) and cannabis were the substances associated with the greatest increase in cardiovascular deaths during the study period.
Poor mental health
Depression and poor mental health have been linked to cardiovascular issues in young adults. A 2023 study of nearly 600,000 adults under 50 found that depression and self-reported poor mental health are a risk factor for heart disease, regardless of socioeconomic or other cardiovascular risk factors.
Adults under 50 years consistently report mental health conditions at around twice the rate of older adults. Additionally, U.S. depression rates have trended up and reached an all-time high in 2023, when 17.8 percent of adults reported having depression.
Depression rates are rising fastest among women, adults under 44, and Black and Hispanic populations.
COVID-19
COVID-19 can cause real, lasting damage to the heart, increasing the risk of certain cardiovascular diseases for up to a year after infection. Vaccination reduces the risk of heart attack and other cardiovascular events caused by COVID-19 infection.
The first year of the pandemic marked the largest single-year spike in heart-related deaths in five years, including a 14 percent increase in heart attacks. In the second year of the pandemic, heart attacks in young adults increased by 30 percent.
Heart attack prevention
Not every heart attack is preventable, but everyone can take steps to reduce their risks. The American Heart Association recommends managing health conditions that increase heart disease risk, including diabetes, obesity, and high blood pressure.
Lifestyle changes like improving diet, reducing substance use, and increasing physical activity can also help reduce heart attack risk.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Women spend more of their money on health care than men. And no, it’s not just about ‘women’s issues’
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Medicare, Australia’s universal health insurance scheme, guarantees all Australians access to a wide range of health and hospital services at low or no cost.
Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests women often spend more out-of-pocket on health services than men.
Other research has found men and women spend similar amounts on health care overall, or even that men spend a little more. However, it’s clear women spend a greater proportion of their overall expenditure on health care than men. They’re also more likely to skip or delay medical care due to the cost.
So why do women often spend more of their money on health care, and how can we address this gap?
Elizaveta Galitckaia/Shutterstock Women have more chronic diseases, and access more services
Women are more likely to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.
While men generally die earlier, women are more likely to spend more of their life living with disease. There are also some conditions which affect women more than men, such as autoimmune conditions (for example, multiple sclerosis and rheumatoid arthritis).
Further, medical treatments can sometimes be less effective for women due to a focus on men in medical research.
These disparities are likely significant in understanding why women access health services more than men.
For example, 88% of women saw a GP in 2021–22 compared to 79% of men.
As the number of GPs offering bulk billing continues to decline, women are likely to need to pay more out-of-pocket, because they see a GP more often.
In 2020–21, 4.3% of women said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to 2.7% of men.
Data from the Australian Bureau of Statistics has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.
Women are more likely to live with chronic medical conditions than men. Drazen Zigic/Shutterstock Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, 62% of women received a prescription, compared to 37% of men.
In the same period, 6.1% of women delayed getting, or did not get prescribed medication because of the cost, compared to 4.9% of men.
Reproductive health conditions
While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.
Almost half of women aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.
One in seven women will have a diagnosis of endometriosis by age 49.
Meanwhile, a quarter of all women aged 45–64 report symptoms related to menopause that are significant enough to disrupt their daily life.
All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.
Of course, conditions like endometriosis don’t just affect women. They also impact trans men, intersex people, and those who are gender diverse.
Diagnosis can be costly
Women often have to wait longer to get a diagnosis for chronic conditions. One preprint study found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.
Delays in diagnosis often result in needing to see more doctors, again increasing the costs.
Despite affecting about as many people as diabetes, it takes an average of between six-and-a-half to eight years to diagnose endometriosis in Australia. This can be attributed to a number of factors including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.
There have been recent improvements, with the introduction of Medicare rebates for longer GP consultations of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.
But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are less than a scan for the scrotum, and no rebate exists for the MRI investigation of a woman’s pelvic pain.
Management can be expensive too
Many chronic conditions, such as endometriosis, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and complementary medicine to help with symptoms.
On average, women are more likely than men to use both complementary therapies and allied health.
While women with chronic conditions can access a chronic disease management plan, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is usually around 50% or less, so there are still significant out-of-pocket costs.
In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average A$480.32 across a two-month period (across both those who have a chronic disease management plan and those who don’t).
More spending, less saving
Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, women with endometriosis and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.
Our preliminary research has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.
More women are prescribed medication than men. PeopleImages.com – Yuri A/Shutterstock Similarly, with 160,000 women entering menopause each year in Australia (and this number expected to increase with population growth), the financial impacts are substantial.
As many as one in four women may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.
How can we close this gap?
Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been done on men. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as chronic pain).
Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.
In the 2024–25 federal budget, the government committed $160 million towards a women’s health package to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.
While this reform is welcome, continued, long-term investment into women’s health is crucial.
Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University; Amelia Mardon, Postdoctoral Research Fellow in Reproductive Health, Western Sydney University; Danielle Howe, PhD Candidate, NICM Health Research Institute, Western Sydney University; Hannah Adler, PhD Candidate, Health Communication and Health Sociology, Griffith University, and Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Before You Eat Breakfast: 3 Surprising Facts About Intermittent Fasting
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Dr. William Li is well-known for his advocacy of “eating to beat disease”, and/but today he has advice for us about not eating to beat disease. In moderation, of course, thus: intermittent fasting.
The easy way
Dr. Li explains the benefits of intermittent fasting; how it improves the metabolism and gives the body a chance to do much-needed maintainance, including burning off any excess fat we had hanging around.
However, rather than calling for us to do anything unduly Spartan, he points out that it’s already very natural for us to fast while sleeping, so we only need to add a couple of hours before and after sleeping (assuming an 8 hour sleep), to make it to a 12-hour fast for close to zero effort and probably no discomfort.
And yes, he argues that a 12-hour fast is beneficial, and even if 16 hours would be better, we do not need to beat ourselves up about getting to 16; what is more important is sustainability of the practice.
Dr. Li advocates for flexibility in fasting, and that it should be done by what manner is easiest, rather than trying to stick to something religiously (of course, if you do fast for religious reasons, that is another matter, and/but beyond the scope of this today).
For more information on each of these, as well as examples and tips, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Intermittent Fasting: What’s the truth?
- 16/8 Intermittent Fasting For Beginners
- Meal Timings & Health: How Important Is Breakfast?
Take care!
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As the U.S. Struggles With a Stillbirth Crisis, Australia Offers a Model for How to Do Better
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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Series: Stillbirths:When Babies Die Before Taking Their First Breath
The U.S. has not prioritized stillbirth prevention, and American parents are losing babies even as other countries make larger strides to reduce deaths late in pregnancy.
The stillbirth of her daughter in 1999 cleaved Kristina Keneally’s life into a before and an after. It later became a catalyst for transforming how an entire country approaches stillbirths.
In a world where preventing stillbirths is typically far down the list of health care priorities, Australia — where Keneally was elected as a senator — has emerged as a global leader in the effort to lower the number of babies that die before taking their first breaths. Stillbirth prevention is embedded in the nation’s health care system, supported by its doctors, midwives and nurses, and touted by its politicians.
In 2017, funding from the Australian government established a groundbreaking center for research into stillbirths. The next year, its Senate established a committee on stillbirth research and education. By 2020, the country had adopted a national stillbirth plan, which combines the efforts of health care providers and researchers, bereaved families and advocacy groups, and lawmakers and government officials, all in the name of reducing stillbirths and supporting families. As part of that plan, researchers and advocates teamed up to launch a public awareness campaign. All told, the government has invested more than $40 million.
Meanwhile, the United States, which has a far larger population, has no national stillbirth plan, no public awareness campaign and no government-funded stillbirth research center. Indeed, the U.S. has long lagged behind Australia and other wealthy countries in a crucial measure: how fast the stillbirth rate drops each year.
According to the latest UNICEF report, the U.S. was worse than 151 countries in reducing its stillbirth rate between 2000 and 2021, cutting it by just 0.9%. That figure lands the U.S. in the company of South Sudan in Africa and doing slightly better than Turkmenistan in central Asia. During that period, Australia’s reduction rate was more than double that.
Definitions of stillbirth vary by country, and though both Australia and the U.S. mark stillbirths as the death of a fetus at 20 weeks or more of pregnancy, to fairly compare countries globally, international standards call for the use of the World Health Organization definition that defines stillbirth as a loss after 28 weeks. That puts the U.S. stillbirth rate in 2021 at 2.7 per 1,000 total births, compared with 2.4 in Australia the same year.
Every year in the United States, more than 20,000 pregnancies end in a stillbirth. Each day, roughly 60 babies are stillborn. Australia experiences six stillbirths a day.
Over the past two years, ProPublica has revealed systemic failures at the federal and local levels, including not prioritizing research, awareness and data collection, conducting too few autopsies after stillbirths and doing little to combat stark racial disparities. And while efforts are starting to surface in the U.S. — including two stillbirth-prevention bills that are pending in Congress — they lack the scope and urgency seen in Australia.
“If you ask which parts of the work in Australia can be done in or should be done in the U.S., the answer is all of it,” said Susannah Hopkins Leisher, a stillbirth parent, epidemiologist and assistant professor in the stillbirth research program at the University of Utah Health. “There’s no physical reason why we cannot do exactly what Australia has done.”
Australia’s goal, which has been complicated by the pandemic, is to, by 2025, reduce the country’s rate of stillbirths after 28 weeks by 20% from its 2020 rate. The national plan laid out the target, and it is up to each jurisdiction to determine how to implement it based on their local needs.
The most significant development came in 2019, when the Stillbirth Centre of Research Excellence — the headquarters for Australia’s stillbirth-prevention efforts — launched the core of its strategy, a checklist of five evidence-based priorities known as the Safer Baby Bundle. They include supporting pregnant patients to stop smoking; regular monitoring for signs that the fetus is not growing as expected, which is known as fetal growth restriction; explaining the importance of acting quickly if fetal movement changes or decreases; advising pregnant patients to go to sleep on their side after 28 weeks; and encouraging patients to talk to their doctors about when to deliver because in some cases that may be before their due date.
Officials estimate that at least half of all births in the country are covered by maternity services that have adopted the bundle, which focuses on preventing stillbirths after 28 weeks.
“These are babies whose lives you would expect to save because they would survive if they were born alive,” said Dr. David Ellwood, a professor of obstetrics and gynecology at Griffith University, director of maternal-fetal medicine at Gold Coast University Hospital and a co-director of the Stillbirth Centre of Research Excellence.
Australia wasn’t always a leader in stillbirth prevention.
In 2000, when the stillbirth rate in the U.S. was 3.3 per 1,000 total births, Australia’s was 3.7. A group of doctors, midwives and parents recognized the need to do more and began working on improving their data classification and collection to better understand the problem areas. By 2014, Australia published its first in-depth national report on stillbirth. Two years later, the medical journal The Lancet published the second report in a landmark series on stillbirths, and Australian researchers applied for the first grant from the government to create the stillbirth research center.
But full federal buy-in remained elusive.
As parent advocates, researchers, doctors and midwives worked to gain national support, they didn’t yet know they would find a champion in Keneally.
Keneally’s improbable journey began when she was born in Nevada to an American father and Australian mother. She grew up in Ohio, graduating from the University of Dayton before meeting the man who would become her husband and moving to Australia.
When she learned that her daughter, who she named Caroline, would be stillborn, she remembers thinking, “I’m smart. I’m educated. How did I let this happen? And why did nobody tell me this was a possible outcome?”
A few years later, in 2003, Keneally decided to enter politics. She was elected to the lower house of state parliament in New South Wales, of which Sydney is the capital. In Australia, newly elected members are expected to give a “first speech.” She was able to get through just one sentence about Caroline before starting to tear up.
As a legislator, Keneally didn’t think of tackling stillbirth as part of her job. There wasn’t any public discourse about preventing stillbirths or supporting families who’d had one. When Caroline was born still, all Keneally got was a book titled “When a Baby Dies.”
In 2009, Keneally became New South Wales’ first woman premier, a role similar to that of an American governor. Another woman who had suffered her own stillbirth and was starting a stillbirth foundation learned of Keneally’s experience. She wrote to Keneally and asked the premier to be the foundation’s patron.
What’s the point of being the first female premier, Keneally thought, if I can’t support this group?
Like the U.S., Australia had previously launched an awareness campaign that contributed to a staggering reduction in sudden infant death syndrome, or SIDS. But there was no similar push for stillbirths.
“If we can figure out ways to reduce SIDS,” Keneally said, “surely it’s not beyond us to figure out ways to reduce stillbirth.”
She lost her seat after two years and took a break from politics, only to return six years later. In 2018, she was selected to serve as a senator at Australia’s federal level.
Keneally saw this as her second chance to fight for stillbirth prevention. In the short period between her election and her inaugural speech, she had put everything in place for a Senate inquiry into stillbirth.
In her address, Keneally declared stillbirth a national public health crisis. This time, she spoke at length about Caroline.
“When it comes to stillbirth prevention,” she said, “there are things that we know that we’re not telling parents, and there are things we don’t know, but we could, if we changed how we collected data and how we funded research.”
The day of her speech, March 27, 2018, she and her fellow senators established the Select Committee on Stillbirth Research and Education.
Things moved quickly over the next nine months. Keneally and other lawmakers traveled the country holding hearings, listening to testimony from grieving parents and writing up their findings in a report released that December.
“The culture of silence around stillbirth means that parents and families who experience it are less likely to be prepared to deal with the personal, social and financial consequences,” the report said. “This failure to regard stillbirth as a public health issue also has significant consequences for the level of funding available for research and education, and for public awareness of the social and economic costs to the community as a whole.”
It would be easy to swap the U.S. for Australia in many places throughout the report. Women of Aboriginal and Torres Strait Islander backgrounds experienced double the rate of stillbirth of other Australian women; Black women in America are more than twice as likely as white women to have a stillbirth. Both countries faced a lack of coordinated research and corresponding funding, low autopsy rates following a stillbirth and poor public awareness of the problem.
The day after the report’s release, the Australian government announced that it would develop a national plan and pledged $7.2 million in funding for prevention. Nearly half was to go to education and awareness programs for women and their health care providers.
In the following months, government officials rolled out the Safer Baby Bundle and pledged another $26 million to support parents’ mental health after a loss.
Many in Australia see Keneally’s first speech as senator, in 2018, as the turning point for the country’s fight for stillbirth prevention. Her words forced the federal government to acknowledge the stillbirth crisis and launch the national action plan with bipartisan support.
Australia’s assistant minister for health and aged care, Ged Kearney, cited Keneally’s speech in an email to ProPublica where she noted that Australia has become a world leader in stillbirth awareness, prevention and supporting families after a loss.
“Kristina highlighted the power of women telling their story for positive change,” Kearney said, adding, “As a Labor Senator Kristina Keneally bravely shared her deeply personal story of her daughter Caroline who was stillborn in 1999. Like so many mothers, she helped pave the way for creating a more compassionate and inclusive society.”
Keneally, who is now CEO of Sydney Children’s Hospitals Foundation, said the number of stillbirths a day in Australia spurred the movement for change.
“Six babies a day,” Keneally said. “Once you hear that fact, you can’t unhear it.”
Australia’s leading stillbirth experts watched closely as the country moved closer to a unified effort. This was the moment for which they had been waiting.
“We had all the information needed, but that’s really what made it happen.” said Vicki Flenady, a perinatal epidemiologist, co-director of the Stillbirth Centre of Research Excellence based at the Mater Research Institute at the University of Queensland, and a lead author on The Lancet’s stillbirth series. “I don’t think there’s a person who could dispute that.”
Flenady and her co-director Ellwood had spent more than two decades focused on stillbirths. After establishing the center in 2017, they were now able to expand their team. As part of their work with the International Stillbirth Alliance, they reached out to other countries with a track record of innovation and evidence-based research: the United Kingdom, the Netherlands, Ireland. They modeled the Safer Baby Bundle after a similar one in the U.K., though they added some elements.
In 2019, the state of Victoria, home to Melbourne, was the first to implement the Safer Baby Bundle. But 10 months into the program, the effort had to be paused for several months because of the pandemic, which forced other states to cancel their launches altogether.
“COVID was a major disruption. We stopped and started,” Flenady said.
Still, between 2019 and 2021, participating hospitals across Victoria were able to reduce their stillbirth rate by 21%. That improvement has yet to be seen at the national level.
A number of areas are still working on implementing the bundle. Westmead Hospital, one of Australia’s largest hospitals, planned to wrap that phase up last month. Like many hospitals, Westmead prominently displays the bundle’s key messages in the colorful posters and flyers hanging in patient rooms and in the hallways. They include easy-to-understand slogans such as, “Big or small. Your baby’s growth matters,” and, “Sleep on your side when baby’s inside.”
As patients at Westmead wait for their names to be called, a TV in the waiting room plays a video on stillbirth prevention, highlighting the importance of fetal movement. If a patient is concerned their baby’s movements have slowed down, they are instructed to come in to be seen within two hours. The patient’s chart gets a colorful sticker with a 16-point checklist of stillbirth risk factors.
Susan Heath, a senior clinical midwife at Westmead, came up with the idea for the stickers. Her office is tucked inside the hospital’s maternity wing, down a maze of hallways. As she makes the familiar walk to her desk, with her faded hospital badge bouncing against her navy blue scrubs, it’s clear she is a woman on a mission. The bundle gives doctors and midwives structure and uniform guidance, she said, and takes stillbirth out of the shadows. She reminds her staff of how making the practices a routine part of their job has the power to change their patients’ lives.
“You’re trying,” she said, “to help them prevent having the worst day of their life.”
Christine Andrews, a senior researcher at the Stillbirth Centre who is leading an evaluation of the program’s effectiveness, said the national stillbirth rate beyond 28 weeks has continued to slowly improve.
“It is going to take a while until we see the stillbirth rate across the whole entire country go down,” Andrews said. “We are anticipating that we’re going to start to see a shift in that rate soon.”
As officials wait to receive and standardize the data from hospitals and states, they are encouraged by a number of indicators.
For example, several states are reporting increases in the detection of babies that aren’t growing as they should, a major factor in many late-gestation stillbirths. Many also have seen an increase in the number of pregnant patients who stopped smoking. Health care providers also are more consistently offering post-stillbirth investigations, such as autopsies.
In addition to the Safer Baby Bundle, the national plan also calls for raising awareness and reducing racial disparities. The improvements it recommends for bereavement care are already gaining global attention.
To fulfill those directives, Australia has launched a “Still Six Lives” public awareness campaign, has implemented a national stillbirth clinical care standard and has spent two years developing a culturally inclusive version of the Safer Baby Bundle for First Nations, migrant and refugee communities. Those resources, which were recently released, incorporated cultural traditions and used terms like Stronger Bubba Born for the bundle and “sorry business babies,” which is how some Aboriginal and Torres Strait Islander women refer to stillbirth. There are also audio versions for those who can’t or prefer not to read the information.
In May, nearly 50 people from the state of Queensland met in a large hotel conference room. Midwives, doctors and nurses sat at round tables with government officials, hospital administrators and maternal and infant health advocates. Some even wore their bright blue Safer Baby T-shirts.
One by one, they discussed their experiences implementing the Safer Baby Bundle. One midwifery group was able to get more than a third of its patients to stop smoking between their first visit and giving birth.
Officials from a hospital in one of the fastest-growing areas in the state discussed how they carefully monitored for fetal growth restriction.
And staff from another hospital, which serves many low-income and immigrant patients, described how 97% of pregnant patients who said their baby’s movements had decreased were seen for additional monitoring within two hours of voicing their concern.
As the midwives, nurses and doctors ticked off the progress they were seeing, they also discussed the fear of unintended consequences: higher rates of premature births or increased admissions to neonatal intensive care units. But neither, they said, has materialized.
“The bundle isn’t causing any harm and may be improving other outcomes, like reducing early-term birth,” Flenady said. “I think it really shows a lot of positive impact.”
As far behind as the U.S. is in prioritizing stillbirth prevention, there is still hope.
Dr. Bob Silver, who co-authored a study that estimated that nearly 1 in 4 stillbirths are potentially preventable, has looked to the international community as a model. Now, he and Leisher — the University of Utah epidemiologist and stillbirth parent — are working to create one of the first stillbirth research and prevention centers in the U.S. in partnership with stillbirth leaders from Australia and other countries. They hope to launch next year.
“There’s no question that Australia has done a better job than we have,” said Silver, who is also chair of the University of Utah Health obstetrics and gynecology department. “Part of it is just highlighting it and paying attention to it.”
It’s hard to know what parts of Australia’s strategy are making a difference — the bundle as a whole, just certain elements of it, the increased stillbirth awareness across the country, or some combination of those things. Not every component has been proven to decrease stillbirth.
The lack of U.S. research on the issue has made some cautious to adopt the bundle, Silver said, but it is clear the U.S. can and should do more.
There comes a point when an issue is so critical, Silver said, that people have to do the best they can with the information that they have. The U.S. has done that with other problems, such as maternal mortality, he said, though many of the tactics used to combat that problem have not been proven scientifically.
“But we’ve decided this problem is so bad, we’re going to try the things that we think are most likely to be helpful,” Silver said.
After more than 30 years of working on stillbirth prevention, Silver said the U.S. may be at a turning point. Parents’ voices are getting louder and starting to reach lawmakers. More doctors are affirming that stillbirths are not inevitable. And pressure is mounting on federal institutions to do more.
Of the two stillbirth prevention bills in Congress, one already sailed through the Senate. The second bill, the Stillbirth Health Improvement and Education for Autumn Act, includes features that also appeared in Australia’s plan, such as improving data, increasing awareness and providing support for autopsies.
And after many years, the National Institutes of Health has turned its focus back to stillbirths. In March, it released a report with a series of recommendations to reduce the nation’s stillbirth rate that mirror ProPublica’s reporting about some of the causes of the crisis. Since then, it has launched additional groups to begin to tackle three critical angles: prevention, data and bereavement. Silver co-chairs the prevention group.
In November, more than 100 doctors, parents and advocates gathered for a symposium in New York City to discuss everything from improving bereavement care in the U.S to tackling racial disparities in stillbirth. In 2022, after taking a page out of the U.K.’s book, the city’s Mount Sinai Hospital opened the first Rainbow Clinic in the U.S., which employs specific protocols to care for people who have had a stillbirth.
But given the financial resources in the U.S. and the academic capacity at American universities and research institutions, Leisher and others said federal and state governments aren’t doing nearly enough.
“The U.S. is not pulling its weight in relation either to our burden or to the resources that we have at our disposal,” she said. “We’ve got a lot of babies dying, and we’ve got a really bad imbalance of who those babies are as well. And yet we look at a country with a much smaller number of stillbirths who is leading the world.”
“We can do more. Much more. We’re just not,” she added. “It’s unacceptable.”
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Live Life in Crescendo – by Stephen Covey and Cynthia Covey-Haller
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Stephen Covey is of course best known for his “7 Habits of Highly Effective People“, while the dozen books he wrote afterwards, not including this one, did not get the same acclaim.
Not including this one, because this one was published posthumously and, notwithstanding the order of the names on the cover, in all likelihood his daughter wrote most of.
And yet! The very spirit of this book is in defiance of 7 Habits being his “early career” magnum opus. We say “early career”, because he was 57 already when that was published, but it was one of his earlier books.
In this work the authors lay out the case for how “your most important work is always ahead of you“, and that it is perfectly possible to “live life in crescendo“, and keep on giving whatever it is that we want to give to the world.
We also learn, mostly through storytelling, of how people are infinitely more important than things, and that it is there that we should put our investments. And that while adversity may not make us stronger, it just means we may need to change our approach, to continue to be productive in whatever way is meaningful to us.
Bottom line: if ever you wonder how your future could live up to your past (in a good way), this is the book to get you thinking.
Click here to check out Live Life in Crescendo, and figure out what your next great work will be!
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Eyes for Alzheimer’s Diagnosis: New?
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It’s Q&A Time!
This is the bit whereby each week, we respond to subscriber questions/requests/etc
Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!
Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.
(this is in response to last week’s piece on lutein, eyes, and brain health)
We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:
See also:
- Journal of Alzheimer’s Disease (mixture of free and paid content)
- Journal of Alzheimer’s Disease Reports (open access—all content is free)
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