Cupping: How It Works (And How It Doesn’t)
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Good Health By The Cup?
In Tuesday’s newsletter, we asked you for your opinion of cupping (the medical practice), and got the above-depicted, below-described, set of responses:
- About 40% said “It may help by improving circulation and stimulating the immune system”
- About 26% said “I have never heard of the medical practice of cupping before this”
- About 19% said “It is pseudoscience and/or placebo at best, but probably not harmful
- About 9% said “It is a good, evidence-based practice that removes toxins and stimulates health”
- About 6% said “It is a dangerous practice that often causes harm to people who need medical help”
So what does the science say?
First, a quick note for those unfamiliar with cupping: it is the practice of placing a warmed cup on the skin (open side of the cup against the skin). As the warm air inside cools, it reduces the interior air pressure, which means the cup is now (quite literally) a suction cup. This pulls the skin up into the cup a little. The end result is visually, and physiologically, the same process as what happens if someone places the nozzle of a vacuum cleaner against their skin. For that matter, there are alternative versions that simply use a pump-based suction system, instead of heated cups—but the heated cups are most traditional and seem to be most popular. See also:
National Center for Complementary and Integrative Health | Cupping
It is a dangerous practice that often causes harm to people who need medical help: True or False?
False, for any practical purposes.
- Directly, it can (and usually does) cause minor superficial harm, much like many medical treatments, wherein the benefits are considered to outweigh the harm, justifying the treatment. In the case of cupping, the minor harm is usually a little bruising, but there are other risks; see the link we gave just above.
- Indirectly, it could cause harm by emboldening a person to neglect a more impactful treatment for their ailment.
But, there’s nothing for cupping akin to the “the most common cause of death is when someone gets a vertebral artery fatally severed” of chiropractic, for example.
It is a good, evidence-based practice that removes toxins and stimulates health: True or False?
True and False in different parts. This one’s on us; we included four claims in one short line. But let’s look at them individually:
- Is it good? Well, those who like it, like it. It legitimately has some mild health benefits, and its potential for harm is quite small. We’d call this a modest good, but good nonetheless.
- Is it evidence-based? Somewhat, albeit weakly; there are some papers supporting its modest health claims, although the research is mostly only published in journals of alternative medicine, and any we found were in journals that have been described by scientists as pseudoscientific.
- Does it remove toxins? Not directly, at least. There is also a version that involves making a small hole in the skin before applying the cup, the better to draw out the toxins (called “wet cupping”). This might seem a little medieval, but this is because it is from early medieval times (wet cupping’s first recorded use being in the early 7th century). However, the body’s response to being poked, pierced, sucked, etc is to produce antibodies, and they will do their best to remove toxins. So, indirectly, there’s an argument.
- Does it stimulate health? Yes! We’ll come to that shortly. But first…
It is pseudoscience and/or placebo at best, but probably not harmful: True or False?
True in that its traditionally-proposed mechanism of action is a pseudoscience and placebo almost certainly plays a strong part, and also in that it’s generally not harmful.
On it being a pseudoscience: we’ve talked about this before, but it bears repeating; just because something’s proposed mechanism of action is pseudoscience, doesn’t necessarily mean it doesn’t work by some other mechanism of action. If you tell a small child that “eating the rainbow” will improve their health, and they believe this is some sort of magical rainbow power imbuing them with health, then the mechanism of action that they believe in is a pseudoscience, but eating a variety of colorful fruit and vegetables will still be healthy.
In the case of cupping, its proposed mechanism of action has to do withbalancing qi, yin and yang, etc (for which scientific evidence does not exist), in combination with acupuncture lore (for which some limited weak scientific evidence exists). On balancing qi, yin and yang etc, this is a lot like Europe’s historically popular humorism, which was based on the idea of balancing the four humors (blood, yellow bile, black bile, phlegm). Needless to say, humorism was not only a pseudoscience, but also eventually actively disproved with the advent of germ theory and modern medicine. Cupping therapy is not more scientifically based than humorism.
On the placebo side of things, there probably is a little more to it than that; much like with acupuncture, a lot of it may be a combination of placebo and using counter-irritation, a nerve-tricking method to use pain to reduce pain (much like pressing with one’s nail next to an insect bite).
Here’s one of the few studies we found that’s in what looks, at a glance, to be a reputable journal:
Cupping therapy and chronic back pain: systematic review and meta-analysis
It may help by improving circulation and stimulating the immune system: True or False?
True! It will improve local circulation by forcing blood into the area, and stimulate the immune system by giving it a perceived threat to fight.
Again, this can be achieved by many other means; acupuncture (or just “dry needling”, which is similar but without the traditional lore), a cold shower, and/or exercise (and for that matter, sex—which combines exercise, physiological arousal, and usually also foreign bodies to respond to) are all options that can improve circulation and stimulate the immune system.
You can read more about using some of these sorts of tricks for improving health in very well-evidenced, robustly scientific ways here:
The Stress Prescription (Against Aging!)
Take care!
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Eating Disorders: More Varied (And Prevalent) Than People Think
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Disordered Eating Beyond The Stereotypes
Around 10% of Americans* have (or have had) an eating disorder. That might not seem like a high percentage, but that’s one in ten; do you know 10 people? If so, it might be a topic that’s near to you.
*Source: Social and economic cost of eating disorders in the United States of Americ
Our hope is that even if you yourself have never had such a problem in your life, today’s article will help arm you with knowledge. You never know who in your life might need your support.
Very misunderstood
Eating disorders are so widely misunderstood in so many ways that we nearly made this a Friday Mythbusting edition—but we preface those with a poll that we hope to be at least somewhat polarizing or provide a spectrum of belief. In this case, meanwhile, there’s a whole cluster of myths that cannot be summed up in one question. So, here we are doing a Psychology Sunday edition instead.
“Eating disorders aren’t that important”
Eating disorders are the second most deadly category of mental illness, second only to opioid addiction.
Anorexia specifically has the highest case mortality rate of any mental illness:
Source: National Association of Anorexia Nervosa & Associated Disorders: Eating Disorder Statistics
So please, if someone needs help with an eating disorder (including if it’s you), help them.
“Eating disorders are for angsty rebellious teens”
While there’s often an element of “this is the one thing I can control” to some eating disorders (including anorexia and bulimia), eating disorders very often present in early middle-age, very often amongst busy career-driven individuals using it as a coping mechanism to have a feeling of control in their hectic lives.
13% of women over 50 report current core eating disorder symptoms, and that is probably underreported.
Source: as above; scroll to near the bottom!
“Eating disorders are a female thing”
Nope. Officially, men represent around 25% of people diagnosed with eating disorders, but women are 5x more likely to get diagnosed, so you can do the math there. Women are also 1.5% more likely to receive treatment for it.
By the time men do get diagnosed, they’ve often done a lot more damage to their bodies because they, as well as other people, have overlooked the possibility of their eating being disordered, due to the stereotype of it being a female thing.
Source: as above again!
“Eating disorders are about body image”
They can be, but that’s far from the only kind!
Some can be about control of diet, not just for the sake of controlling one’s body, but purely for the sake of controlling the diet itself.
Still yet others can be not about body image or control, like “Avoidant/Restrictive Food Intake Disorder”, which in lay terms sometimes gets dismissed as “being a picky eater” or simply “losing one’s appetite”, but can be serious.
For example, a common presentation of the latter might be a person who is racked with guilt and/or anxiety, and simply stops eating, because either they don’t feel they deserve it, or “how can I eat at a time like this, when…?” but the time is an ongoing thing so their impromptu fast is too.
Still yet even more others might be about trying to regulate emotions by (in essence) self-medicating with food—not in the healthy “so eat some fruit and veg and nuts etc” sense, but in the “Binge-Eating Disorder” sense.
And that latter accounts for a lot of adults.
You can read more about these things here:
Psychology Today | Types of Eating Disorder ← it’s pop-science, but it’s a good overview
Take care! And if you have, or think you might have, an eating disorder, know that there are organizations that can and will offer help/support in a non-judgmental fashion. Here’s the ANAD’s eating disorder help resource page, for example.
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Is it OK to lie to someone with dementia?
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There was disagreement on social media recently after a story was published about an aged care provider creating “fake-away” burgers that mimicked those from a fast-food chain, to a resident living with dementia. The man had such strict food preferences he was refusing to eat anything at meals except a burger from the franchise. This dementia symptom risks malnutrition and social isolation.
But critics of the fake burger approach labelled it trickery and deception of a vulnerable person with cognitive impairment.
Dementia is an illness that progressively robs us of memories. Although it has many forms, it is typical for short-term recall – the memory of something that happened in recent hours or days – to be lost first. As the illness progresses, people may come to increasingly “live in the past”, as distant recall gradually becomes the only memories accessible to the person. So a person in the middle or later stages of the disease may relate to the world as it once was, not how it is today.
This can make ethical care very challenging.
Pikselstock/Shutterstock Is it wrong to lie?
Ethical approaches classically hold that specific actions are moral certainties, regardless of the consequences. In line with this moral absolutism, it is always wrong to lie.
But this ethical approach would require an elderly woman with dementia who continually approaches care staff looking for their long-deceased spouse to be informed their husband has passed – the objective truth.
Distress is the likely outcome, possibly accompanied by behavioural disturbance that could endanger the person or others. The person’s memory has regressed to a point earlier in their life, when their partner was still alive. To inform such a person of the death of their spouse, however gently, is to traumatise them.
And with the memory of what they have just been told likely to quickly fade, and the questioning may resume soon after. If the truth is offered again, the cycle of re-traumatisation continues.
People with dementia may lose short term memories and rely on the past for a sense of the world. Bonsales/Shutterstock A different approach
Most laws are examples of absolutist ethics. One must obey the law at all times. Driving above the speed limit is likely to result in punishment regardless of whether one is in a hurry to pick their child up from kindergarten or not.
Pragmatic ethics rejects the notion certain acts are always morally right or wrong. Instead, acts are evaluated in terms of their “usefulness” and social benefit, humanity, compassion or intent.
The Aged Care Act is a set of laws intended to guide the actions of aged care providers. It says, for example, psychotropic drugs (medications that affect mind and mood) should be the “last resort” in managing the behaviours and psychological symptoms of dementia.
Instead, “best practice” involves preventing behaviour before it occurs. If one can reasonably foresee a caregiver action is likely to result in behavioural disturbance, it flies in the face of best practice.
What to say when you can’t avoid a lie?
What then, becomes the best response when approached by the lady looking for her husband?
Gentle inquiries may help uncover an underlying emotional need, and point caregivers in the right direction to meet that need. Perhaps she is feeling lonely or anxious and has become focused on her husband’s whereabouts? A skilled caregiver might tailor their response, connect with her, perhaps reminisce, and providing a sense of comfort in the process.
This approach aligns with Dementia Australia guidance that carers or loved ones can use four prompts in such scenarios:
- acknowledge concern (“I can tell you’d like him to be here.”)
- suggest an alternative (“He can’t visit right now.”)
- provide reassurance (“I’m here and lots of people care about you.”)
- redirect focus (“Perhaps a walk outside or a cup of tea?”)
These things may or may not work. So, in the face of repeated questions and escalating distress, a mistruth, such as “Don’t worry, he’ll be back soon,” may be the most humane response in the circumstances.
Different realities
It is often said you can never win an argument with a person living with dementia. A lot of time, different realities are being discussed.
So, providing someone who has dementia with a “pretend” burger may well satisfy their preferences, bring joy, mitigate the risk of malnutrition, improve social engagement, and prevent a behavioural disturbance without the use of medication. This seems like the correct approach in ethical terms. On occasion, the end justifies the means.
Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Art and Science of Connection – by Kasley Killam, MPH
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We can eat well, exercise well, and even sleep well, and we’ll still have a +53% increased all-cause mortality if we lack social connection—even if we technically have support and access to social resources, just not the real human connection itself. And as we get older, it gets increasingly easy to find ourselves isolated.
The author is a social scientist by profession, and it shows. None of what she shares in the book is wishy-washy; it has abundant scientific references coming thick and fast, and a great deal of clarity with regard to terms, something often not found in books of this genre that lean more towards the art than the science.
On which note, for the reader who may be thinking “I am indeed quite alone”, she also offers proven techniques for remedying that; not in the way that many books use the word “proven” to mean “we got some testimonials”, but rather, proven in the sense of “we did science to it and based on these 17 large population-based retrospective cohort studies, we can say with 99% confidence that this is an effective tool to mediate improved social bonds and social health outcomes”.
To this end, it’s a very practical book also, and should bestow upon any isolated reader a sense of confidence that in fact, things can be better. A particular strength is that it also looks at many different scenarios, so for the “what if I…” people with clear reasons why social connection is not abundantly available, yes, she has such cases covered too.
Bottom line: if you’d like to live more healthily for longer, social health is an underrated and oft-forgotten way of greatly increasing those things, by science.
Click here to check out The Art And Science Of Social Connection, and get connected!
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Which Gadgets Help, & Which Are A Waste Of Time?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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 😎
❝I’m a 67- year old yoga teacher and runner. A lifelong runner, I started long distance running when I was 58. One of my friends loves rucking? I recently bought a rucking vest. Your thoughts? Any risks?
As a perk of my yoga instructor job I get cryotherapy, red light therapy, infrared sauna, and Normatec boots for a nominal fee. Even though they are almost free, I don’t take advantage of them as I can’t find evidence of their value and don’t want to waste my time. Do you recommend any of them?❞On rucking and rucking vests
First, for any unfamiliar, this is about walking/running/exercising in general, with a weighted backpack or weight vest.
As for whether this is beneficial, it depends on your goals. Once upon a very long time ago when this writer was a soldier, it was vitally important to for me be able to [fall from the sky and then] run about 2km carrying a certain (hefty) amount of weight and still be able to fight at the other end of it, or else I would die. Thus, between deployments, I’d often carry a sturdy rucksack with concrete slabs in it, to keep myself accustomed to that burden (funny story: someone once tried to steal that when I had put it down while doing something—the would-be thief fell over instantly and then ran away empty-handed). And, here’s the thing: this kind of training did for me what I needed it to do for me. As a 67-year-old yoga teacher, your needs are probably very different.
A common reason to use weight vests is in an effort against osteoporosis, but the evidence is lacking (or very weak, at best), as we wrote about a while back:
Weight Vests Against Osteoporosis: Do They Really Build Bone?
With regard to risks… Let’s put it this way: my old regiment, in addition to the usual soldierly problems like hearing damage and PTSD, has quite a reputation for producing veterans with spinal compression injuries. And that’s entirely because of the whole “running with a large amount of weight strapped to us” thing. So, you probably don’t want that.
If you are going to do that though, then:
- a weight best is a lot better than a backpack (better distribution of weight)
- start with low weight and work up, and don’t push your limits
We’re not the boss of you, so by all means do as you see fit, but unless there’s a special reason why being able to run with a heavy weight is important to you, then running with a light weight is already more than good enough.
About those job perks
Again, of course, it depends on what you hope to get out of them, but in some cases there is a lot of evidence for benefit.
On cryotherapy: Ice Baths: To Dip Or Not To Dip? ← there are definite benefits for most people!
On red light therapy: Red Light, Go! Casting Yourself In A Healthier Light ← there are some caveats re people who should not do this or at least should be very wary, but for most people, this does a lot of good, and is very well-evidenced to be beneficial
On infrared saunas: we’re unaware of any special evidence in favor of these. However, traditional saunas have plenty of well-evidenced benefits: Saunas: Health Benefits (& Caveats)
On Normatec boots: for the unfamiliar, this is a brand name for compression technology. Again, it depends on what you want to get out of it, though. If you are in good health, then what it’s generally being advertised for is to prevent/reduce exercise-induced muscle damage caused by the stress that endurance training can place on skeletal muscle. Just one problem—it doesn’t seem to work:
❝Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump
Clinical Question: What are the effects of IPC on the reduction of Exercise-Induced Muscle Damage (EIMD) in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists.
All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes.❞
However! If you have lipedema and/or lymphedema and want to manage that, then compression gear may help:
Take care!
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Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
Oral retinoids taken during pregnancy can cause complications in babies. Gorodenkoff/Shutterstock The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Preventing pregnancy during oral retinoid treatment is essential. Krakenimages.com/Shutterstock Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Vegan Eager for Milk Alternatives
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It’s Q&A Day at 10almonds!
Q: Thanks for the info about dairy. As a vegan, I look forward to a future comment about milk alternatives
Thanks for bringing it up! What we research and write about is heavily driven by subscriber feedback, so notes like this really help us know there’s an audience for a given topic!
We’ll do a main feature on it, to do it justice. Watch out for Research Review Monday!
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