
Should You Go Light Or Heavy On Carbs?
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Carb-Strong or Carb-Wrong?

We asked you for your health-related view of carbs, and got the above-depicted, below-described, set of responses
- About 48% said “Some carbs are beneficial; others are detrimental”
- About 27% said “Carbs are a critical source of energy, and safer than fats”
- About 18% said “A low-carb diet is best for overall health (and a carb is a carb)”
- About 7% said “We do not need carbs to live; a carnivore diet is viable”
But what does the science say?
Carbs are a critical source of energy, and safer than fats: True or False?
True and False, respectively! That is: they are a critical source of energy, and carbs and fats both have an important place in our diet.
❝Diets that focus too heavily on a single macronutrient, whether extreme protein, carbohydrate, or fat intake, may adversely impact health.❞
Source: Low carb or high carb? Everything in moderation … until further notice
(the aforementioned lead author Dr. de Souza, by the way, served as an external advisor to the World Health Organization’s Nutrition Guidelines Advisory Committee)
Some carbs are beneficial; others are detrimental: True or False?
True! Glycemic index is important here. There’s a big difference between eating a raw carrot and drinking high-fructose corn syrup:
Which Sugars Are Healthier, And Which Are Just The Same?
While some say grains and/or starchy vegetables are bad, best current science recommends:
- Eat some whole grains regularly, but they should not be the main bulk of your meal (non-wheat grains are generally better)
- Starchy vegetables are not a critical food group, but in moderation they are fine.
To this end, the Mediterranean Diet is the current gold standard of healthful eating, per general scientific consensus:
A low-carb diet is best for overall health (and a carb is a carb): True or False?
True-ish and False, respectively. We covered the “a carb is a carb” falsehood earlier, so we’ll look at “a low-carb diet is best”.
Simply put: it can be. One of the biggest problems facing the low-carb diet though is that adherence tends to be poor—that is to say, people crave their carby comfort foods and eat more carbs again. As for the efficacy of a low-carb diet in the context of goals such as weight loss and glycemic control, the evidence is mixed:
❝There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years’ follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weight-reducing diets❞
Source: Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk
❝On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences.
Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs❞
~ Dr. Joshua Goldenberg et al.
Source: Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission
❝There should be no “one-size-fits-all” eating pattern for different patient´s profiles with diabetes.
It is clinically complex to suggest an ideal percentage of calories from carbohydrates, protein and lipids recommended for all patients with diabetes.❞
Source: Current Evidence Regarding Low-carb Diets for The Metabolic Control of Type-2 Diabetes
We do not need carbs to live; a carnivore diet is viable: True or False?
False. For a simple explanation:
The Carnivore Diet: Can You Have Too Much Meat?
There isn’t a lot of science studying the effects of consuming no plant products, largely because such a study, if anything other than observational population studies, would be unethical. Observational population studies, meanwhile, are not practical because there are so few people who try this, and those who do, do not persist after their first few hospitalizations.
Putting aside the “Carnivore Diet” as a dangerous unscientific fad, if you are inclined to meat-eating, there is some merit to the Paleo Diet, at least for short-term weight loss even if not necessarily long-term health:
What’s The Real Deal With The Paleo Diet?
For longer-term health, we refer you back up to the aforementioned Mediterranean Diet.
Enjoy!
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Pregnant women can now get a free RSV shot. What other vaccines do you need when you’re expecting?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
From today, February 3, pregnant women in Australia will be eligible for a free RSV vaccine under the National Immunisation Program.
This vaccine is designed to protect young infants from severe RSV (respiratory syncytial virus). It does so by generating the production of antibodies against RSV in the mother, which then travel across the placenta to the baby.
While the RSV vaccine is a new addition to the National Immunisation Program, it’s one of three vaccines provided free for pregnant women under the program, alongside ones for influenza and whooping cough. Each offers important protection for newborn babies.
voronaman/Shutterstock The RSV vaccine
RSV is the most common cause of lower respiratory infections (bronchiolitis and pneumonia) in infants. It’s estimated that of every 100 infants born in Australia each year, at least two will be hospitalised with RSV by six months of age.
RSV infection is most common roughly between March and August in the southern hemisphere, but infection can occur year-round, especially in tropical areas.
The vaccine works by conferring passive immunity (from the mother) as opposed to active immunity (the baby’s own immune response). By the time the baby is born, their antibodies are sufficient to protect them during the first months of life when they are most vulnerable to severe RSV disease.
The RSV vaccine registered for use in pregnant women in Australia, Abrysvo, has been used since 2023 in the Americas and Europe. Real-world experience there shows it’s working well.
For example, over the 2024 RSV season in Argentina, it was found to prevent 72.7% of lower respiratory tract infections caused by RSV and requiring hospitalisation in infants aged 0–3 months, and 68% among those aged 0–6 months. This research noted three deaths from RSV, all in infants whose mothers did not receive the RSV vaccine during pregnancy.
This was similar to protection seen in a large multinational clinical trial that compared babies born to mothers who received this RSV vaccine with babies born to mothers who received a placebo. This study found the vaccine prevented 82.4% of severe cases of RSV in infants aged under three months, and 70% under six months, and that the vaccine was safe.
Vaccinating mothers during pregnancy protects the newborn baby. StoryTime Studio/Shutterstock In addition to the maternal vaccine, nirsevimab, a long-acting monoclonal antibody, provides effective protection against severe RSV disease. It’s delivered to the baby by an intramuscular injection, usually in the thigh.
Nirsevimab is recommended for babies born to women who did not receive an RSV vaccine during pregnancy, or who are born within two weeks of their mother having received the shot (most likely if they’re born prematurely). It may also be recommended for babies who are at higher risk of RSV due to a medical condition, even if their mother was vaccinated.
Nirsevimab is not funded under the National Immunisation Program, but is covered under various state and territory-based programs for infants of mothers who fall into the above categories.
But now we have a safe and effective RSV vaccine for pregnancy, all pregnant women should be encouraged to receive it as the first line of prevention. This will maximise the number of babies protected during their first months of life.
Flu and whooping cough
It’s also important pregnant women continue to receive flu and whooping cough vaccines in 2025. Like the RSV vaccine, these protect infants by passing antibodies from mother to baby.
There has been a large whooping cough outbreak in Australia in recent months, including a death of a two-month-old infant in Queensland in November 2024.
The whooping cough vaccine, given in combination with diphtheria and tetanus, prevents more than 90% of whooping cough cases in babies too young to receive their first whooping cough vaccine dose.
Similarly, influenza can be deadly in young babies, and maternal flu vaccination substantially reduces hospital visits associated with influenza for babies under six months. Flu can also be serious for pregnant women, so the vaccine offers important protection for the mother as well.
COVID vaccines are safe in pregnancy, but unless a woman is otherwise eligible, they’re not routinely recommended. You can discuss this with your health-care provider.
When and where can you get vaccinated?
Pregnant women can receive these vaccines during antenatal visits through their GP or in a specialised antenatal clinic.
The flu vaccine is recommended at any time during pregnancy, the whooping cough vaccine from 20 weeks (ideally before 32 weeks), and the RSV vaccine from 28 weeks (before 36 weeks).
It’s safe to receive multiple vaccinations at the same clinic visit.
The RSV vaccine is now available for pregnant women under the National Immunisation Program. Olga Rolenko/Shutterstock We know vaccination rates have declined in a variety of groups since the pandemic, and there’s evidence emerging that suggests this trend has occurred in pregnant women too.
A recent preprint (a study yet to be peer-reviewed) found a decrease of nearly ten percentage points in flu vaccine coverage among pregnant women in New South Wales, from 58.8% in 2020 to 49.1% in 2022. The research showed a smaller drop of 1.4 percentage points for whooping cough, from 79% in 2020 to 77.6% in 2022.
It’s important to work to improve vaccination rates during pregnancy to give babies the best protection in their first months of life.
We know pregnant women would like to receive information about new and routine maternal vaccines early in pregnancy. In particular, many pregnant women want to understand how vaccines are tested for safety, and their effectiveness, which was evident during COVID.
GPs and midwives are trusted sources of information on vaccines in pregnancy. There’s also information available online on Sharing Knowledge About Immunisation, a collaboration led by the National Centre for Immunisation Research and Surveillance.
Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney; Bianca Middleton, Senior Research Fellow, Menzies School of Health Research; Margie Danchin, Professor of Paediatrics and vaccinologist, Royal Childrens Hospital, University of Melbourne and Murdoch Childrens Research Institute (MCRI); Associate Dean International, University of Melbourne, Murdoch Children’s Research Institute; Peter McIntyre, Professor in Women’s and Children’s Health, University of Otago, and Rebecca Doyle, Adjunct Research Fellow, School of Nursing, Midwifery and Social Work, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
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Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
Out of the subscribers who engaged in the poll, it looks like we have a lot of confidence in at least some detox approaches being useful!
Celery juice is most people’s go-to, and indeed it was the only one to get mentioned in the comments added. So let’s take a look at that first…
Celery juice
Celery juice is enjoyed by many people, with many health benefits in mind, including to:
- reduce inflammation
- lower blood pressure
- heal the liver
- fight cancer
- reduce bloating
- support the digestive system
- increase energy
- support weight loss
- promote good mental health
An impressive list! With such an impressive list, we would hope for an impressive weight of evidence, so regular readers might be wondering why those bullet-pointed items aren’t all shiny hyperlinks to studies backing those claims. The reason is…
There aren’t any high-quality studies that back any of those claims.
We found one case study (so, a study with a sample size of one; not amazing) that observed a blood pressure change in an elderly man after drinking celery juice.
Rather than trawl up half of PubMed to show the lacklustre results in a way more befitting of Research Review Monday, though, here’s a nice compact article detailing the litany of disappointment that is science’s observations regards celery juice:
Why Are People Juicing Their Celery? – by Allison Webster, PhD, RD
A key take-away is: juicing destroys the fiber that is celery’s biggest benefit, and its phytochemicals are largely unproven to be of use.
If you enjoy celery, great! It (when not juiced) is a great source of fiber and water. If you juice it, it’s a great source of water.
Activated Charcoal
Unlike a lot of greenery—whose “cleansing” benefits mostly come from fiber and disappear when juiced—activated charcoal has a very different way of operating.
Activated charcoal is negatively charged on a molecular level*, and that—along with its porous nature—traps toxins. It really is a superpowered detox that actually works very well indeed.
But…
It works very well indeed. It will draw out toxins so well, that it’s commonly used to treat poisonings. “Wait”, we hear you say, “why was that a but”?
It doesn’t know what a toxin is. It just draws out all of the things. You took medicine recently? Not any more you didn’t. You didn’t even take that medication orally, you took it some other way? Activated charcoal does not care:
- The effect of activated charcoal on drug exposure following intravenous administration: A meta-analysis
- Activated charcoal for acute overdose: a reappraisal
Does this mean that activated charcoal can be used to “undo” a night of heavy drinking?
Sadly not. That’s one of the few things it just doesn’t work for. It won’t work for alcohol, salts, or metals:
The Use of Activated Charcoal to Treat Intoxications
*Fun chemistry mnemonic about ions:
Cations are pussitive
Anions (by process of elimination) are negative
Onions taste good in salad (remember also: Cole’s Law)
Bottom line on detox foods/drinks:
- Fiber is great; juicing removes fiber. Eat your greens (don’t drink them)!
- Activated charcoal is the heavy artillery of detoxing
- Sometimes it will remove things you didn’t want removed, though
- It also won’t help against alcohol, sadly
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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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Natural Remedies and Foods for Osteoarthritis
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Natural solutions for osteoarthritis. Eg. Rosehip tea, dandelion root tea. Any others??? What foods should I absolutely leave alone?❞
We’ll do a main feature on arthritis (in both its main forms) someday soon, but meanwhile, we recommend eating for good bone/joint health and against inflammation. To that end, you might like these main features we did on those topics:
- We Are Such Stuff As Fish Are Made Of (collagen for bone and joint health)
- The Bare-Bones Truth About Osteoporosis (eating for bone health generally)
- Keep Inflammation At Bay (dietary tips for minimizing inflammation—also, our all-time most popular article to date!)
Of these, probably the last one is the most critical, and also will have the speediest effects if implemented.
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Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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Yoga Therapy for Arthritis – by Dr. Steffany Moonaz & Erin Byron
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Two quick notes to start with:
- One of the problems with arthritis and exercise is that arthritis can often impede exercise.
- Another of the problems with arthritis and exercise is that some kinds of exercise can exacerbate arthritis.
This book deals with both of those issues, by providing yoga specifically tailored to living with arthritis. Indeed, the first-listed author’s PhD in public health was the result of 8 years of study developing an evidence-based yoga program for people with arthritis, including osteoarthritis and rheumatoid arthritis.
The authors take the view that arthritis is a whole-person disease (i.e. it affects all parts of you), and so addressing it requires a whole-person approach, which is what this book delivers.
As such, this is not just a book of asana (yoga postures). It does provide that, of course (as well as breathing exercises), but also its 328 pages additionally cover a lot of conscious work from the inside out, including attention to the brain, energy levels, pain, and so forth, and that the practice of yoga should not merely directly improve the joints via gentle physical exercise, but also should help to heal the whole person, including reducing stress levels, reducing physical tension, and with those two things, reducing inflammation also—and also, due to both that and the asana side of practice, better-functioning organs, which is always a bonus.
The style is interesting, as it refers to both science (8 pages of hard-science bibliography) and yogic principles (enough esoterica to put off, say, James Randi or Penn & Teller). This reviewer is very comfortable with both, and so if you, dear reader, are comfortable with both too, then you will surely enjoy this book.
Bottom line: if you or a loved one has arthritis, you’ll wish you got this book sooner.
Click here to check out Yoga Therapy For Arthritis, and live better!
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