Citicoline: Better Than Dietary Choline?
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Citicoline: Better Than Dietary Choline?
Citicoline, also known as cytidine diphosphate-choline (or CDP-Choline, to its friends, or cytidine 5′-diphosphocholine if it wants to get fancy) is a dietary supplement that the stomach can metabolize easily for all the brain’s choline needs. What are those needs?
Choline is an essential nutrient. We technically can synthesize it, but only in minute amounts, far less than we need. Choline is a key part of the neurotransmitter acetylcholine, as well as having other functions in other parts of the body.
As for citicoline specifically… it appears to do the job better than dietary sources of choline:
❝Intriguing data, showing that on a molar mass basis citicoline is significantly less toxic than choline, are also analyzed.
It is hypothesized that, compared to choline moiety in other dietary sources such as phosphatidylcholine, choline in citicoline is less prone to conversion to trimethylamine (TMA) and its putative atherogenic N-oxide (TMAO).
Epidemiological studies have suggested that choline supplementation may improve cognitive performance, and for this application citicoline may be safer and more efficacious.❞
Source: Citicoline: A Superior Form of Choline?
Great! What does it do?
What doesn’t it do? When it comes to cognitive function, anyway, citicoline covers a lot of bases.
Short version: it improves just about every way a brain’s healthy functions can be clinically measured. From cognitive improvements in all manner of tests (far beyond just “improves memory” etc; also focus, alertness, verbal fluency, logic, computation, and more), to purely neurological things like curing tinnitus (!), alleviating mobility disorders, and undoing alcohol-related damage.
One of the reasons it’s so wide in its applications, is that it has a knock-on effect to other systems in the brain, including the dopaminergic system.
Long version: Citicoline: pharmacological and clinical review, 2022 update
(if you don’t want to sit down for a long read, we recommend skimming to the charts and figures, which are very elucidating even alone)
Spotlight study in memory
For a quick-reading example of how it helps memory specifically:
Keeping dementia at bay
For many older people looking to improve memory, it’s less a matter of wanting to perform impressive feats of memory, and more a matter of wanting to keep a sharp memory throughout our later years.
Dr. Maria Bonvicini et al. looked into this:
❝We selected seven studies including patients with mild cognitive impairment, Alzheimer’s disease or post-stroke dementia
All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis.
Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses❞
The researchers concluded “yes”, and yet, called for more studies, and of higher quality. In many such studies, the heterogeneity of the subjects (often, residents of nursing homes) can be as much a problem (unclear whether the results will be applicable to other people in different situations) as it is a strength (fewer confounding variables).
Another team looked at 47 pre-existing reviews, and concluded:
❝The review found that citicoline has been proven to be a useful compound in preventing dementia progression.
Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases.
Its positive impact on learning and cognitive functions among the healthy population is also worth noting.❞
Source: Application of Citicoline in Neurological Disorders: A Systematic Review
The dopamine bonus
Remember how we said that citicoline has a knock-on effect on other systems, including the dopaminergic system? This means that it’s been studied (and found meritorious) for alleviating symptoms of Parkinson’s disease:
❝Patients with Parkinson’s disease who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech.
Citicoline allowed effective reduction of levodopa by up to 50%.
Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy.❞
Source: Citicoline as Adjuvant Therapy in Parkinson’s Disease: A Systematic Review
Where to get it?
We don’t sell it, but here’s an example product on Amazon, for your convenience
Enjoy!
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How To Boost Your Memory Immediately (Without Supplements)
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.
How To Boost Your Memory (Without Supplements)
While we do recommend having a good diet and taking advantage of various supplements that have been found to help memory, that only gets so much mileage. With that in mind…
First, how good is your memory? Take This 2-Minute Online Test
Now, that was a test of short term memory, which tends to be the most impactful in our everyday life.
It’s the difference between “I remember the address of the house where I grew up” (long-term memory) and “what did I come to this room to do?” (short-term memory / working memory)
First tip:
When you want to remember something, take a moment to notice the details. You can’t have a madeleine moment years later if you wolfed down the madeleines so urgently they barely touched the sides.
This goes for more than just food, of course. And when facing the prospect of age-related memory loss in particular, people tend to be afraid not of forgetting their PIN code, but their cherished memories of loved ones. So… Cherish them, now! You’ll struggle to cherish them later if you don’t cherish them now. Notice the little details as though you were a painter looking at a scene for painting. Involve more senses than just sight, too!
If it’s important, relive it. Relive it now, relive it tomorrow. Rehearsal is important to memory, and each time you relive a memory, the deeper it gets written into your long-term memory until it becomes indelible to all but literal brain damage.
Second tip:
Tell the story of it to someone else. Or imagine telling it to someone else! (You brain can’t tell the difference)
And you know how it goes… Once you’ve told a story a few times, you’ll never forget it later. Isn’t your life a story worth telling?
Many people approach memory like they’re studying for a test. Don’t. Approach it like you’re preparing to tell a story, or give a performance. We are storytelling creatures at heart, whether or not we realize it.
What do you do when you find yourself in a room and wonder why you went there? (We’ve all been there!) You might look around for clues, but if that doesn’t immediately serve, your fallback will be retracing your steps. Literally, physically, if needs be, but at least mentally. The story of how you got there is easier to remember than the smallest bit of pure information.
What about when there’s no real story to tell, but we still need to remember something?
Make up a story. Did you ever play the game “My granny went to market” as a child?
If not, it’s a collaborative memory game in which players take turns adding items to a list, “My granny went to market and bought eggs”, My granny went to market and bought eggs and milk”, “my granny went to market and bought eggs and milk and flour” (is she making a cake?), “my granny went to market and bought eggs and milk and flour and shoe polish” (what image came to mind? Use that) “my granny went to market and bought eggs and milk and flour and shoe polish and tea” (continue building the story in your head), and so on.
When we actually go shopping, if we don’t have a written list we may rely on the simple story of “what I’m going to cook for dinner” and walking ourselves through that story to ensure we get the things we need.
This is because our memory thrives (and depends!) on connections. Literal synapse connections in the brain, and conceptual contextual connections in your mind. The more connections, the better the memory.
Now imagine a story: “I went to Stonehenge, but in the background was a twin-peaked mountain blue. I packed a red suitcase, placing a conch shell inside it, when suddenly I heard a trombone, and…” Ring any bells? These are example items from the memory test earlier, though of course you may have seen different things in a different order.
So next time you want to remember things, don’t study as though for a test. Prepare to tell a story!
Try going through the test again, but this time, ignore their instructions because we’re going to use the test differently than intended (we’re rebels like that). Don’t rush, and don’t worry about the score this time (or even whether or not you saw a given image previously), but instead, build a story as you go. We’re willing to bet that after it, you can probably recite most of the images you saw in their correct order with fair confidence.
Here’s the link again: Take The Same Test, But This Time Make It Story-Worthy!
Again, ignore what it says about your score this time, because we weren’t doing that this time around. Instead, list the things you saw.
What you were just able to list was the result of you doing story-telling with random zero-context images while under time pressure.
Imagine what you can do with actual meaningful memories of your ongoing life, people you meet, conversations you have!
Just… Take the time to smell the roses, then rehearse the story you’ll tell about them. That memory will swiftly become as strong as any memory can be, and quickly get worked into your long-term memory for the rest of your days.
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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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A Supplement To Rival St. John’s Wort Against Depression
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.
Do You Feel The SAMe?
S-Adeonsyl-L-Methionone (SAMe) is a chemical found naturally in the body, and/but enjoyed widely as a supplement. The main reasons people take it are:
- Improve mood (antidepressant effect)
- Improve joints (reduce osteoarthritis symptoms)
- Improve liver (detoxifying effect)
Let’s see what the science says for each of those claims…
Does it improve mood?
It seems to perform comparably to St. John’s Wort (which is good; it performs comparably to Prozac).
Best of all, it does this with fewer contraindications (St. John’s Wort has so many contraindications).
Here’s how they stack up:
This looks very promising, though it’d be nice to see a larger body of research, to be sure.
Does it reduce osteoarthritis symptoms?
The good news: it performs comparably to ibuprofen, with fewer side effects!
The bad news: it also performs comparably to placebo!
Read into that what you will about ibuprofen’s usefulness vs OA symptoms.
Read all about it:
S-Adenosylmethionine for osteoarthritis of the knee or hip
If you were hoping for something for OA or similar symptoms, you might like our previous main features:
- Avoiding/Managing Osteoarthritis
- Managing Chronic Pain (Realistically!)
- The 7 Approaches To Pain Management
- (Science-Based) Alternative Pain Relief
Does it help against liver disease?
According to adverts for SAMe: absolutely!
According to science: we don’t know
The science for this is so weak that it’d be unworthy of mention if it weren’t for the fact that SAMe is so widely sold as good against hepatotoxicity.
To be clear: maybe it really is great! Science hasn’t yet disproved its usefulness either.
It is popularly assumed to be beneficial due to there being an association between lower levels of SAMe in the body (remember, it is also produced inside our bodies) and development of liver disease, especially cholestasis.
Here’s an example of what pretty much every study we found was like (inconclusive research based mostly on mice):
S-adenosylmethionine in liver health, injury, and cancer
For other options for liver health, consider:
Is it safe?
Safety trials have been done ranging from 3 months to 2 years, with no serious side effects coming to light. So, it appears quite safe.
That said, as with anything, there are contraindications, such as:
- if you have bipolar disorder, skip this unless directed by your health care provider, because it may worsen the symptoms of mania
- if you are on SSRIs or other serotonergic drugs, it may interact with those
- if you are immunocompromised, you might want to skip it can increase the risk of P. carinii growth in such cases
As always, do speak with your doctor/pharmacist for personalized advice.
Summary
SAMe’s evidence-based qualities seem to stack up as follows:
- Against depression: good
- Against osteoarthritis: weak
- Against liver disease: unknown
As for safety, it has been found quite safe for most people.
Where can I get it?
We don’t sell it, but here is an example product on Amazon, for your convenience
Enjoy!
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Reporting on psychedelics research or legislation? Proceed with caution
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More cities and states are introducing bills to decriminalize and regulate access to psychedelic drugs, which could potentially become another option to treat mental health conditions and substance use disorders. But the substances remain illegal under U.S. federal law and scientific evidence about their effectiveness is still far from conclusive.
This month alone, California lawmakers introduced a bill to allow people 21 and older to consume psychedelic mushrooms under medical supervision. In Massachusetts, lawmakers are working on a bill that would legalize psilocybin, the active ingredient of psychedelic mushrooms. And Arizona legislators have also introduced a bill that would make psychedelic mushrooms available as a mental health treatment option.
Last December, Congress passed legislation that included funding for psychedelic clinical trials for active-duty service members. And in January this year, the Department of Veterans Affairs announced that it will begin funding research on MDMA, also known as ecstasy, and psilocybin, to treat veterans with post-traumatic stress disorder and depression. This is the first time since the 1960s that the VA is funding research on such compounds, according to the department.
The rise of proposed and passed legislation in recent years necessitates more journalistic coverage. But it’s important for journalists to go beyond what the bills and lawmakers say and include research studies about psychedelics and note the limitations of those studies.
Major medical organizations, including the American Psychiatric Association, have not yet endorsed psychedelics to treat psychiatric disorders, except in clinical trials, due to inadequate scientific evidence.
The authors of a 2023 study published in the journal Therapeutic Advances in Psychopharmacology, also advise “strong caution” regarding the hype around the potential medical use of psychedelics. “There is not enough robust evidence to draw any firm conclusions about the safety and efficacy of psychedelic therapy,” they write.
Scientists are still trying to better understand how psychedelics work, what’s the best dose for treating different mental health conditions and how to reduce the risk of potential side effects such as intense emotional experiences or increased heart rate and blood pressure, the authors of a February 2024 study published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry write.
In a 2022 study published in JAMA Psychiatry, Dr. Joshua Siegel and his colleagues at Washington University in St. Louis write that while legislative reform for psychedelic drugs is moving forward rapidly, several issues have not been addressed, including:
- A mechanism for verifying the chemical content of drugs that are obtained from outside the medical establishment.
- Licensure and training criteria for practitioners who wish to provide psychedelic treatment.
- Clinical and billing infrastructure.
- Assessing potential interactions with other drugs.
- How the drugs should be used in populations such as youths, older adults and pregnant people.
“Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dose and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role that psychotherapy plays in therapeutic efficacy remain unanswered,” Siegel and colleagues write.
What are psychedelics?
Psychedelics are among the oldest class of mind-altering substances, used by humans for thousands of years in traditional or religious rituals.
In 2021, 74 million people 12 years and older reported using hallucinogens, according to the National Survey on Drug Use and Health.
The terms “psychedelics” and “hallucinogens” are used interchangeably in public discourse, but scientifically, hallucinogens fall into three groups based on chemical structure and mechanism of action, according to NIH’s National Institute on Drug Abuse:
- Psychedelic drugs, also called “classic psychedelics” or simply “psychedelics,” mainly affect the way the brain processes serotonin, a chemical that carries messages between nerve cells in the brain and the body. These drugs can bring on vivid visions and affect a person’s sense of self, according to NIDA. Drugs in this category include:
- Psilocybin is the active ingredient in psychedelic mushrooms, also known as “magic” mushrooms or shrooms. It’s a Schedule 1 drug in the U.S. under the Controlled Substances Act, which means it has a high potential for abuse and has no accepted medical use. However, some states have decriminalized it, according to NIDA. The drug has also been given the Breakthrough Therapy designation from the FDA, a process to speed up the development and review of drugs, for the treatment of major depressive disorder.
- LSD, or lysergic acid diethylamide, is a synthetic chemical made from a fungus that infects rye. It’s a Schedule 1 drug.
- DMT, or dimethyltryptamine, found in certain plants native to the Amazon rainforest, has been used in religious practices and rituals. The plants are sometimes used to make a tea called ayahuasca. DMT can also be made in the lab as a white powder. DMT is generally smoked or consumed in brews like ayahuasca. It’s a Schedule 1 drug.
- Mescaline, a chemical compound found in a small cactus called peyote, has been used by Indigenous people in northern Mexico and the southwestern U.S. in religious rituals. Mescaline can also be produced in the lab. Mescaline and peyote are Schedule 1 drugs.
- Dissociative drugs affect how the brain processes glutamate, an abundant chemical released by nerve cells in the brain that plays an important role in learning and memory. These drugs can make people feel disconnected from their bodies and surroundings. Drugs in this category include:
- PCP, or phencyclidine, was developed in the 1950s as an injectable anesthetic but was discontinued because patients became agitated and delusional. Today it is an illegal street drug. It’s a Schedule 2 drug, which means it has a high potential for abuse, but lower compared to Schedule 1 drugs.
- Ketamine, a drug developed in the 1960s and used as an anesthetic in the Vietnam War, is approved by the FDA as an anesthetic. It has been shown to play a role in pain management and treatment of depression. It is also illegally used for its hallucinogenic effects. It is a Schedule 3 drug, which means it has a moderate to low potential for physical and psychological dependence. A chemically-similar drug called esketamine is approved by the FDA for the treatment of depression that doesn’t respond to standard treatment.
- Other hallucinogens, which affect different brain functions and can cause psychedelic and potentially dissociative effects, include:
- MDMA, or ecstasy, is a synthetic drug that’s a stimulant and hallucinogen. It is a Schedule 1 drug. It has been given the Breakthrough Therapy designation from the FDA for the treatment of PTSD.
- Salvia is an herb in the mint family that has hallucinogenic effects. It is not a federally controlled drug, but it is controlled in some states, according to the DEA.
- Ibogaine is derived from the root bark of a West African shrub and is a stimulant and hallucinogen. It is a Schedule 1 drug.
Research on psychedelics
There was a wave of studies on psychedelics, particularly LSD, in the 1950s and 1960s, but they came to a halt when the U.S. declared a “War on Drugs” in 1971 and tightened pharmaceutical regulations. There was little research activity until the early 1990s when studies on drugs such as MDMA and DMT began to emerge.
In 2006, researchers at Johns Hopkins University published a seminal double-blind study in which two-thirds of participants — who had never taken psychedelics previously — said their psychedelic sessions were among the most meaningful experiences of their lives.
“These studies, among others, renewed scientific interest in psychedelics and, accordingly, research into their effects has continued to grow since,” Jacob S. Aday and colleagues write in a 2019 study published in Drug Science, Policy and Law.
In their paper, Aday and colleagues argue that 2018 may be remembered as the true turning point in psychedelic research due to “advances within science, increased public interest, and regulatory changes,” such as psilocybin receiving the “breakthrough therapy” status from the FDA.
Today, there are numerous ongoing clinical trials on the therapeutic potential of psychedelics for different conditions, including substance use disorders and mental health conditions such as depression, anxiety and post-traumatic stress disorder.
Given the growing number of studies on psychedelics, the Food and Drug Administration issued a draft guidance in June 2023 for clinical trials with psychedelic drugs, aiming to help researchers design studies that will yield more reliable results for drug development.
The systematic reviews highlighted below show that there’s a lack of robust study designs in many psychedelic clinical trials. Some have small sample sizes. Some include participants who have used psychedelics before, so when they participate in a randomized controlled clinical trial, they know whether they are receiving psychedelic treatment or a placebo. Or, some include participants who may have certain expectations due to positive coverage in the lay media, hence creating bias in the results.
If you’re covering a study about psychedelics…
It’s important for journalists to pay close attention to study design and speak with an expert who is not involved in the study.
In a February 2024 blog post from Harvard Law School’s Petrie-Flom Center, Leiden University professors Eiko I. Fried and Michiel van Elk share several challenges in psychedelic research:
- “Conclusions are dramatically overstated in many studies. This ranges from conclusions in the results sections, abstracts, and even titles of papers not consistent with the reported results.”
- “There is emerging evidence that adverse events resulting from psychedelic substances are both common and underreported.”
- Some studies don’t have control groups, which can create problems for interpreting results, “because treatments like psychedelics need to be compared against a placebo or other treatment to conclude that they work beyond the placebo effect or already existing, readily available treatments.”
- “Participants in psychedelic studies usually know if they are in the treatment or control group, which artificially increases the apparent efficacies of psychedelics in clinical studies.”
- Small sample sizes can affect the statistical power and generalizability of the findings. “Small samples also mean that results are not representative. For example, participants with severe or comorbid mental health problems are commonly excluded from psychedelic studies, and therefore results may look better in these studies than in real-world psychiatric settings.”
- Many studies do not include long-term follow-ups of participants. “Studying how these people are feeling a few days or weeks after they receive treatment is not sufficient to establish that they are indeed cured from depression.”
Fried and van Elk also have a useful checklist for assessing the quality and scientific rigor of psychedelic research in their 2023 study “History Repeating: Guidelines to Address Common Problems in Psychedelic Science,” published in the journal Therapeutic Advances in Psychopharmacology.
Journalists should also remind their audiences that the drugs are still illegal under federal law and can pose a danger to health.
In California, the number of emergency room visits involving the use of hallucinogens increased by 54% between 2016 and 2022, according to a January 2024 study published in Addiction. Meanwhile, the law enforcement seizure of psychedelic mushrooms has risen dramatically, increasing nearly four-fold between 2017 and 2022, according to a February 2024 study published in the journal Drug and Alcohol Dependence.
Below, we have curated and summarized five recent studies, mostly systematic reviews and meta-analyses, which examine various aspects of psychedelic drugs, including legislative reform; long-term effects; efficacy and safety for the treatment of anxiety, depression and PTSD; and participation of older adults in clinical trials. The research summaries are followed by recommended reading.
Research roundup
Psychedelic Drug Legislative Reform and Legalization in the US
Joshua S. Siegel, James E. Daily, Demetrius A. Perry and Ginger E. Nicol. JAMA Psychiatry, December 2022.The study: Most psychedelics are Schedule I drugs federally, but state legislative reforms are changing the prospects of the drugs’ availability for treatment and their illegal status. For a better understanding of the legislative reform landscape around Schedule I psychedelic drugs, researchers collected all bills and ballot initiatives related to psychedelic drugs that were introduced into state legislatures between 2019 and September 2022. They used publicly available sources, including BillTrack50, Ballotpedia and LexisNexis.
The findings: In total, 25 states considered 74 bills, although the bills varied widely in their framework. A majority proposed decriminalization but only a few would require medical oversight and some would not even require training or licensure, the authors write. Ten of those bills became law in seven states — Colorado, Connecticut, Hawaii, New Jersey, Oregon, Texas and Washington. As of August 1, 2022, 32 bills were dead and 32 remained active.
The majority of the bills — 67 of them — referred to psilocybin; 27 included both psilocybin and MDMA; 43 proposed decriminalization of psychedelic drugs.
To predict the future legalization of psychedelics, the authors also created two models based on existing medical and recreational marijuana reform. Using 2020 as the year of the first psychedelic decriminalization in Oregon, their models predict that 26 states will legalize psychedelics between 2033 and 2037.
In the authors’ words: “Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dosing and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role psychotherapy plays in therapeutic efficacy remain unanswered. This last point is critical, as a significant safety concern associated with drugs like psilocybin, MDMA, or LSD is the suggestibility and vulnerability of the patient while under the influence of the drug. Thus, training and clinical oversight is necessary to ensure safety and also therapeutic efficacy for this divergent class of treatments.”
Who Are You After Psychedelics? A Systematic Review and a Meta-Analysis of the Magnitude of Long-Term Effects of Serotonergic Psychedelics on Cognition/Creativity, Emotional Processing and Personality
Ivana Solaja, et al. Neuroscience & Behavioral Reviews, March 2024.The study: Many anecdotal reports and observational studies have reported that psychedelics, even at microdoses, which are roughly one-tenth of a typical recreational dose, may enhance certain aspects of cognition and/or creativity, including coming up with new, useful ideas. Cognition is a “range of intellectual functions and processes involved in our ability to perceive, process, comprehend, store and react to information,” the authors explain. There are established relationships between impaired cognitive functioning and mental health disorders.
Due to limitations such as a lack of rigorous study designs, various populations in the studies and lack of documented dosage, it’s difficult to draw any conclusions about changes that last at least one week as a result of consuming psychedelics.
The authors screened 821 studies and based on the criteria they had set, found 10 to be eligible for the review and meta-analysis. The drugs in the studies include psilocybin, ayahuasca and LSD.
The findings: Overall, there was little evidence that these psychedelics have lasting effects on creativity. Also, there was not sufficient evidence to determine if this group of psychedelics enhances cognition and creativity in healthy populations or improves cognitive deficits in the study populations.
Pooled data from three studies showed lasting improvement in emotional processing — perceiving, expressing and managing emotions.
The studies offered little evidence suggesting lasting effects of psychedelics on personality traits.
In the authors’ words: “Results from this study showed very limited evidence for any lasting beneficial effects across these three psychological constructs. However, preliminary meta-analytic evidence suggested that these drugs may have the potential to cause lasting improvement in emotional recognition time. Future studies investigating these constructs should employ larger sample sizes, better control conditions, standardized and validated measures and longer-term follow-ups.”
The Impact of Psychedelics on Patients with Alcohol Use Disorder: A Systematic Review with Meta-Analysis
Dakota Sicignano, et al. Current Medical Research and Opinion, December 2023.The study: Researchers are exploring the psychedelics’ potential for the treatment of alcohol use disorder, which affected nearly 30 million Americans in 2022. The authors of this study searched PubMed from 1960 to September 2023 for studies on the use of psychedelics to treat alcohol use disorder. Out of 174 English-language studies, they selected six studies that met the criteria for their analysis.
The findings: LSD and psilocybin are promising therapies for alcohol use disorder, the authors report. However, five of the six trials were conducted in the 1960s and 1970s and may not reflect the current treatment views. Also, four of the six studies included patients who had used psychedelics before participating in the study, increasing the risk of bias.
In the authors’ words: “Despite the existence of several clinical trials showing relatively consistent benefits of psychedelic therapy in treating alcohol use disorder, there are important limitations in the dataset that must be appreciated and that preclude a conclusive determination of its value for patient care at this time.”
Older Adults in Psychedelic-Assisted Therapy Trials: A Systematic Review
Lisa Bouchet, et al. Journal of Psychopharmacology, January 2024.The study: People 65 years and older have been underrepresented in clinical trials involving psychedelics, including the use of psilocybin for the treatment of depression and anxiety. About 15% of adults older than 60 suffer from mental health issues, the authors note. They wanted to quantify the prevalence of older adults enrolled in psychedelic clinical trials and explore safety data in this population. They searched for English-language studies in peer-reviewed journals from January 1950 to September 2023. Of 4,376 studies, the authors selected 36. The studies involved psilocybin, MDMA, LSD, ayahuasca, and DPT (dipropyltryptamine), which is a less-studied synthetic hallucinogen.
The findings: Of the 1,400 patients participating in the selected studies, only 19 were 65 and older. Eighteen received psychedelics for distress related to cancer or other life-threatening illnesses. In a trial of MDMA-assisted therapy for PTSD, only one older adult was included. Adverse reactions to the drugs among older patients, including heart and gastrointestinal issues were resolved within two days and didn’t have a long-lasting impact.
In the authors’ words: “Although existing data in older adults is limited, it does provide preliminary evidence for the safety and tolerability of [psychedelic-assisted therapy] in older patients, and as such, should be more rigorously studied in future clinical trials.”
Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
Anees Bahji, Isis Lunsky, Gilmar Gutierrez and Gustavo Vazquez. Journal of Psychoactive Drugs, November 2023.The study: LSD, psilocybin, ayahuasca and MDMA have been approved for clinical trials on psychedelic-assisted therapy of mental health conditions in Canada and the U.S. However, major medical associations, including the American Psychiatric Association, have argued that there is insufficient scientific evidence to endorse these drugs for treating mental health disorders. To better understand the current evidence, researchers reviewed 18 blinded, randomized controlled trials, spanning 2008 through 2023. Most studies were conducted in the U.S. or Switzerland.
The findings: The studies overall suggest preliminary evidence that psychedelic drugs are mostly well-tolerated. Psilocybin and MDMA therapies may offer relief from depression and PTSD symptoms for at least a year. Most studies also used therapy and psychological support along with psychedelics.
In the authors’ words: “Despite the promising evidence presented by our study and previous reviews in the field, the evidence base remains limited and underpowered. Long-term efficacy and safety data are lacking,” the authors write. “Future steps should encourage and highlight the need for more robust larger scale randomized controlled trials with longer follow-up periods, and efforts to address regulatory and legal barriers through the collaborations between researchers, healthcare professionals, regulatory bodies, and policymakers.”
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Feminist narratives are being hijacked to market medical tests not backed by evidence
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Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, such as tobacco and alcohol.
Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups.
Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women.
However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment.
In our analysis published today in the BMJ, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.
The AMH test
The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test.
Although often used in fertility treatment, the AMH test cannot reliably predict the likelihood of pregnancy, timing to pregnancy or specific age of menopause. The American College of Obstetricians and Gynaecologists therefore strongly discourages testing for women not seeking fertility treatment.
The AMH test can’t predict your chance of getting pregnant.
Anastasia Vityukova/UnsplashDespite this, several fertility clinics and online companies market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “you deserve to know your reproductive potential”, “be proactive about your fertility” and “knowing your numbers will empower you to make the best decisions when family planning”.
The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility.
Our recent study found around 30% of women having an AMH test in Australia may be having it for these reasons.
Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.
While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment.
Breast density notification
Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue.
While estimates vary, approximately 25–50% of women in the breast screening population have dense breasts.
Dense breasts can make it harder to detect cancer.
Tyler Olsen/ShutterstockStemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know such as “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification.
However, this simplistic messaging overlooks that this is a complex issue and that more data is still needed on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms.
Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the lack of robust evidence showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results.
Large international advocacy groups are also sponsored by companies that will financially benefit from women being notified.
While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought.
Ensuring feminism isn’t hijacked
Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care.
But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests.
Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.
Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney and Tessa Copp, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Make Drinking Less Harmful
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Making Drinking Less Harmful
We often talk of the many ways alcohol harms our health, and we advocate for reducing (or eliminating) its consumption. However, it’s not necessarily as easy as all that, and it might not even be a goal that everyone has. So, if you’re going to imbibe, what can you do to mitigate the harmful effects of alcohol?
There is no magical solution
Sadly. If you drink alcohol, there will be some harmful effects, and nothing will completely undo that. But there are some things that can at least help—read on to learn more!
Coffee
It’s not the magical sober-upperer that some would like it to be, but it is good against the symptoms of alcohol intoxication, and slightly reduces the harm to your body, because it is:
- Hydrating (whereas alcohol is dehydrating)
- A source of antioxidants (whereas alcohol causes oxidative stress, which has nothing to do with psychological stress, and is a kind of cellular damage)
- A stimulant, assuming it is not decaffeinated (it’s worth noting that its stimulant effects work partly by triggering vasoconstriction, which is the opposite of the vasodilation caused by alcohol)
To this end, the best coffee for anti-alcohol effects should be:
- Caffeinated, and strong
- Long (we love espresso, but we need hydration here and that comes from volume!)
- Without sugar (you don’t want to create an adverse osmotic gradient to leech water from your body)
As for milk/cream/whatever, have it or don’t, per your usual preference. It won’t make any difference to the alcohol in your system.
Antioxidants, polyphenols, flavonoids, and things with similar mechanisms
We mentioned that coffee contains antioxidants, but if you want to really bring out the heavy guns, taking more powerful antioxidants can help a lot. If you don’t have the luxury of enjoying berries and cacao nibs by the handful, supplements that have some similar benefits are a perfectly respectable choice.
For example, you might want to consider green tea extract:
L-theanine 200mg (available on Amazon)
Specialist anti-alcohol drugs
These are somewhat new and the research is still ongoing, but for example:
Dihydromyricetin (DHM) as a novel anti-alcohol intoxication medication
In short, DHM is a flavonoid (protects against the oxidative stress caused by alcohol, and has been found to reduce liver damage—see the above link) and also works on GABA-receptors (reduces alcohol withdrawal symptoms after cessation of drinking, and thus also reduces hangovers).
Once again: the marketing claims of such drugs may be bold, but there’s a lot that’s not known and they’re not a magic pill. They do NOT mean you can take them alongside drinking and drink what you like with impunity. However, they may help mitigate some of the harmful effects of alcohol. If you wish to try them, these can be purchased at pharmacies or online, for example:
Alcohol Defense Capsules (available on Amazon)
Bottom line
Alcohol is bad for your health and none of the above will eliminate the health risks. But, if you’re going to have alcohol, then having the above things as well may at least somewhat reduce the harm done.
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