Ear Candling: Is It Safe & Does It Work?

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The 10almonds Team

Does This Practice Really Hold A Candle To Evidence-Based Medicine?

In Tuesday’s newsletter, we asked you your opinion of ear candling, and got the above-depicted, below-described set of responses:

  • Exactly 50% said “Under no circumstances should you put things in your ear and set fire to them”
  • About 38% said “It is a safe, drug-free way to keep the ears free from earwax and pathogens”
  • About 13% said “Done correctly, thermal-auricular therapy is harmless and potentially beneficial”

This means that if we add the two positive-to-candling answers together, it’s a perfect 50:50 split between “do it” and “don’t do it”.

(Yes, 38%+13%=51%, but that’s because we round to the nearest integer in these reports, and more precisely it was 37.5% and 12.5%)

So, with the vote split, what does the science say?

First, a quick bit of background: nobody seems keen to admit to having invented this. One of the major manufacturers of ear candles refers to them as “Hopi” candles, which the actual Hopi tribe has spent a long time asking them not to do, as it is not and never has been used by the Hopi people. Other proposed origins offered by advocates of ear candling include Traditional Chinese Medicine (not used), Ancient Egypt (no evidence of such whatsoever), and Atlantis:

Quackwatch | Why Ear Candling Is Not A Good Idea

It is a safe, drug-free way to keep the ears free from earwax and pathogens: True or False?

False! In a lot of cases of alternative therapy claims, there’s an absence of evidence that doesn’t necessarily disprove the treatment. In this case, however, it’s not even an open matter; its claims have been actively disproven by experimentation:

In a medium-sized survey (n=122), the following injuries were reported:

  • 13 x burns
  • 7 x occlusion of the ear canal
  • 6 x temporary hearing loss
  • 3 x otitis externa (this also called “swimmer’s ear”, and is an inflammation of the ear, accompanied by pain and swelling)
  • 1 x tympanic membrane perforation

Indeed, authors of one paper concluded:

❝Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk.

No evidence suggests that ear candling is an effective treatment for any condition. On this basis, we believe it can do more harm than good and we recommend that GPs discourage its use❞

~ Dr. Joy Rafferty et al.

Source: Canadian Family Physician | Ear Candling

Under no circumstances should you put things in your ear and set fire to them: True or False?

True! It’s generally considered good advice to not put objects in general in your ears.

Inserting flaming objects is a definite no-no. Please leave that for the Cirque du Soleil.

You may be thinking, “but I have done this and suffered no ill effects”, which seems reasonable, but is an example of survivorship bias in action—it doesn’t make the thing in question any safer, it just means you were one of the one of the ones who got away unscathed.

If you’re wondering what to do instead… Ear oils can help with the removal of earwax (if you don’t want to go get it sucked out at a clinic—the industry standard is to use a suction device, which actually does what ear candles claim to do). For information on safely getting rid of earwax, see our previous article:

Ear Today, Gone Tomorrow

Take care!

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  • What Menopause Does To The Heart

    The 10almonds Team

    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.

    World Menopause Day: Menopause & Cardiovascular Disease Risk

    Today, the 18th of October, is World Menopause Day.

    The theme for this year is cardiovascular disease (CVD), and if your first reaction is to wonder what that has to do with the menopause, then this is the reason why it’s being featured. Much of the menopause and its effects are shrouded in mystery; not because of a lack of science (though sometimes a bit of that too), but rather, because it is popularly considered an unimportant, semi-taboo topic.

    So, let’s be the change we want to see, and try to fix that!

    What does CVD have to do with the menopause?

    To quote Dr. Anjana Nair:

    ❝The metabolic and clinical factors secondary to menopause, such as dyslipidemia, insulin resistance, fat redistribution and systemic hypertension, contribute to the accelerated risk for cardiovascular aging and disease.

    Atherosclerosis appears to be the end result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.

    The increased cardiovascular risk in menopause stems from the exaggerated effects of changing physiology on the cardiovascular system.❞

    Source: Cardiovascular Changes in Menopause

    See also: Menopause-associated risk of cardiovascular disease

    Can we do anything about it?

    Yes, we can! Here be science:

    This (in few words: get your hormone levels checked, and consider HRT if appropriate) is consistent with the advice from gynecologist Dr. Jen Gunter, whom we featured back in August:

    What You Should Have Been Told About The Menopause Beforehand

    What about lifestyle changes?

    We definitely can do some good things; here’s what the science has to say:

    For a full low-down on all of these:

    Revealing the evidence-based lifestyle solutions to managing your menopause symptoms

    Want to know more?

    You can get the International Menopause Society’s free downloadable booklet here:

    Menopause & Cardiovascular Disease: What Women Need To Know

    You may also like our previous main feature:

    What Does “Balance Your Hormones” Even Mean?

    Take care!

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  • Black Pepper’s Impressive Anti-Cancer Arsenal

    The 10almonds Team

    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.

    Black Pepper’s Impressive Anti-Cancer Arsenal (And More)

    Piperine, a compound found in Piper nigrum (black pepper, to its friends), has many health benefits. It’s included as a minor ingredient in some other supplements, because it boosts bioavailability. In its form as a kitchen spice, it’s definitely a superfood.

    What does it do?

    First, three things that generally go together:

    These things often go together for the simple reason that oxidative stress, inflammation, and cancer often go together. In each case, it’s a matter of cellular wear-and-tear, and what can mitigate that.

    For what it’s worth, there’s generally a fourth pillar: anti-aging. This is again for the same reason. That said, black pepper hasn’t (so far as we could find) been studied specifically for its anti-aging properties, so we can’t cite that here as an evidence-based claim.

    Nevertheless, it’s a reasonable inference that something that fights oxidation, inflammation, and cancer, will often also slow aging.

    Special note on the anti-cancer properties

    We noticed two very interesting things while researching piperine’s anti-cancer properties. It’s not just that it reduces cancer risk and slows tumor growth in extant cancers (as we might expect from the above-discussed properties). Let’s spotlight some studies:

    It is selectively cytotoxic (that’s a good thing)

    Piperine was found to be selectively cytotoxic to cancerous cells, while not being cytotoxic to non-cancerous cells. To this end, it’s a very promising cancer-sniper:

    Piperine as a Potential Anti-cancer Agent: A Review on Preclinical Studies

    It can reverse multi-drug resistance in cancer cells

    P-glycoprotein, found in our body, is a drug-transporter that is known for “washing out” chemotherapeutic drugs from cancer cells. To date, no drug has been approved to inhibit P-glycoprotein, but piperine has been found to do the job:

    Targeting P-glycoprotein: Investigation of piperine analogs for overcoming drug resistance in cancer

    What’s this about piperine analogs, though? Basically the researchers found a way to “tweak” piperine to make it even more effective. They called this tweaked version “Pip1”, because calling it by its chemical name,

    ((2E,4E)-5-(benzo[d][1,3]dioxol-5-yl)-1-(6,7-dimethoxy-3,4-dihydroisoquinolin-2(1 H)-yl)penta-2,4-dien-1-one)

    …got a bit unwieldy.

    The upshot is: Pip1 is better, but piperine itself is also good.

    Other benefits

    Piperine does have other benefits too, but the above is what we were most excited to talk about today. Its other benefits include:

    Enjoy!

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  • The BAT-pause!

    The 10almonds Team

    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.

    When Cold Weather & The Menopause Battle It Out

    You may know that (moderate, safe) exposure to the cold allows our body to convert our white and yellow fat into the much healthier brown fat—also called brown adipose tissue, or “BAT” to its friends.

    If you didn’t already know that, then well, neither did scientists until about 15 years ago:

    The Changed Metabolic World with Human Brown Adipose Tissue: Therapeutic Visions

    You can read more about it here:

    Cool Temperature Alters Human Fat and Metabolism

    This is important, especially because the white fat that gets converted is the kind that makes up most visceral fat—the kind most associated with all-cause mortality:

    Visceral Belly Fat & How To Lose It ← this is not the same as your subcutaneous fat, the kind that sits directly under your skin and keeps you warm; this is the fat that goes between your organs and of which we should only have a small amount!

    The BAT-pause

    It’s been known (since before the above discovery) that BAT production slows considerably as we get older. Not too shocking—after all, many metabolic functions slow as we get older, so why should fat regulation be any different?

    But! Rodent studies found that this was tied less to age, but to ovarian function: rats who underwent ovariectomies suffered reduced BAT production, regardless of their age.

    Naturally, it’s been difficult to recreate such studies in humans, because it’s difficult to find a large sample of young adults willing to have their ovaries whipped out (or even suppressed chemically) to see how badly their metabolism suffers as a result.

    Nor can an observational study (for example, of people who incidentally have ovaries removed due to ovarian cancer) usefully be undertaken, because then the cancer itself and any additional cancer treatments would be confounding factors.

    Perimenopausal study to the rescue!

    A recent (published last month, at time of writing!) study looked at women around the age of menopause, but specifically in cohorts before and after, measuring BAT metabolism.

    By dividing the participants into groups based on age and menopausal status, and dividing the post-menopausal group into “takes HRT” and “no HRT” groups, and dividing the pre-menopausal group into “normal ovarian function” and “ovarian production of estrogen suppressed to mimic slightly early menopause” groups (there’s a drug for that), and then having groups exposed to warm and cold temperatures, and measuring BAT metabolism in all cases, they were able to find…

    It is about estrogen, not age!

    You can read more about the study here:

    “Good” fat metabolism changes tied to estrogen loss, not necessarily to aging, shows study

    …and the study itself, here:

    Brown adipose tissue metabolism in women is dependent on ovarian status

    What does this mean for men?

    This means nothing directly for (cis) men, sorry.

    But to satisfy your likely curiosity: yes, testosterone does at least moderately suppress BAT metabolism—based on rodent studies, anyway, because again it’s difficult to find enough human volunteers willing to have their testicles removed for science (without there being other confounding variables in play, anyway):

    Testosterone reduces metabolic brown fat activity in male mice

    So, that’s bad per se, but there isn’t much to be done about it, since the rest of your (addressing our male readers here) metabolism runs on testosterone, as do many of your bodily functions, and you would suffer many unwanted effects without it.

    However, as men do typically have notably less body fat in general than women (this is regulated by hormones), the effects of changes in BAT metabolism are rather less pronounced in men (per testosterone level changes) than in women (per estrogen level changes), because there’s less overall fat to convert.

    In summary…

    While menopausal HRT is not necessarily a silver bullet to all metabolic problems, its BAT-maintaining ability is certainly one more thing in its favor.

    See also:

    Dr. Jen Gunter | What You Should Have Been Told About The Menopause Beforehand

    Take care!

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  • Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help – and where it probably won’t

    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.

    Corneel Vandelanotte – CQUniversity Australia

    It’s that time of year when many people are getting started on their resolutions for the year ahead. Doing more physical activity is a popular and worthwhile goal.

    If you’re hoping to be more active in 2024, perhaps you’ve invested in an activity tracker, or you’re considering buying one.

    But what are the benefits of activity trackers? And will a basic tracker do the trick, or do you need a fancy one with lots of features? Let’s take a look.

    Why use an activity tracker?

    One of the most powerful predictors for being active is whether or not you are monitoring how active you are.

    Most people have a vague idea of how active they are, but this is inaccurate a lot of the time. Once people consciously start to keep track of how much activity they do, they often realise it’s less than what they thought, and this motivates them to be more active.

    You can self-monitor without an activity tracker (just by writing down what you do), but this method is hard to keep up in the long run and it’s also a lot less accurate compared to devices that track your every move 24/7.

    By tracking steps or “activity minutes” you can ascertain whether or not you are meeting the physical activity guidelines (150 minutes of moderate to vigorous physical activity per week).

    It also allows you to track how you’re progressing with any personal activity goals, and view your progress over time. All this would be difficult without an activity tracker.

    Research has shown the most popular brands of activity trackers are generally reliable when it comes to tracking basic measures such as steps and activity minutes.

    But wait, there’s more

    Many activity trackers on the market nowadays track a range of other measures which their manufacturers promote as important in monitoring health and fitness. But is this really the case? Let’s look at some of these.

    Resting heart rate

    This is your heart rate at rest, which is normally somewhere between 60 and 100 beats per minute. Your resting heart rate will gradually go down as you become fitter, especially if you’re doing a lot of high-intensity exercise. Your risk of dying of any cause (all-cause mortality) is much lower when you have a low resting heart rate.

    So, it is useful to keep an eye on your resting heart rate. Activity trackers are pretty good at tracking it, but you can also easily measure your heart rate by monitoring your pulse and using a stopwatch.

    Heart rate during exercise

    Activity trackers will also measure your heart rate when you’re active. To improve fitness efficiently, professional athletes focus on having their heart rate in certain “zones” when they’re exercising – so knowing their heart rate during exercise is important.

    But if you just want to be more active and healthier, without a specific training goal in mind, you can exercise at a level that feels good to you and not worry about your heart rate during activity. The most important thing is that you’re being active.

    Also, a dedicated heart rate monitor with a strap around your chest will do a much better job at measuring your actual heart rate compared to an activity tracker worn around your wrist.

    Maximal heart rate

    This is the hardest your heart could beat when you’re active, not something you could sustain very long. Your maximal heart rate is not influenced by how much exercise you do, or your fitness level.

    Most activity trackers don’t measure it accurately anyway, so you might as well forget about this one.

    VO₂max

    Your muscles need oxygen to work. The more oxygen your body can process, the harder you can work, and therefore the fitter you are.

    VO₂max is the volume (V) of oxygen (O₂) we could breathe maximally (max) over a one minute interval, expressed as millilitres of oxygen per kilogram of body weight per minute (ml/kg/min). Inactive women and men would have a VO₂max lower than 30 and 40 ml/kg/min, respectively. A reasonably good VO₂max would be mid thirties and higher for women and mid forties and higher for men.

    VO₂max is another measure of fitness that correlates well with all-cause mortality: the higher it is, the lower your risk of dying.

    For athletes, VO₂max is usually measured in a lab on a treadmill while wearing a mask that measures oxygen consumption. Activity trackers instead look at your running speed (using a GPS chip) and your heart rate and compare these measures to values from other people.

    If you can run fast with a low heart rate your tracker will assume you are relatively fit, resulting in a higher VO₂max. These estimates are not very accurate as they are based on lots of assumptions. However, the error of the measurement is reasonably consistent. This means if your VO₂max is gradually increasing, you are likely to be getting fitter.

    So what’s the take-home message? Focus on how many steps you take every day or the number of activity minutes you achieve. Even a basic activity tracker will measure these factors relatively accurately. There is no real need to track other measures and pay more for an activity tracker that records them, unless you are getting really serious about exercise.

    Corneel Vandelanotte, Professorial Research Fellow: Physical Activity and Health, CQUniversity Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    The Conversation

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  • How influencers and content creators discuss birth control on social media: What research shows

    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.

    Naseem S. Miller – The Journalist's Resource

    News articles in recent weeks have documented the spread of misinformation about hormonal birth control methods on popular social media platforms like TikTok, YouTube and X, formerly called Twitter. Influencers with large and small followings are sharing unsubstantiated claims about the side effects of contraceptives, while directly or indirectly encouraging others to stop using them.

    This trend has not escaped researchers, who for several years have been investigating what people who can get pregnant are posting on social media platforms about hormonal and non-hormonal birth control methods. Understanding the drivers of these trends is important because they have implications for policy and patient care, according to researchers. Some worry that during the post-Dobbs era, when there are continued strikes against reproductive rights in the U.S., misinformation about birth control on social media could have a negative influence on contraceptive preferences — potentially leading to more unwanted pregnancies.

    More than 90% of women of reproductive age have used at least one contraceptive method, according to a 2023 report by the U.S. National Center for Health Statistics. However, the report also finds that the use of male condoms and withdrawal methods increased between 2006 and 2019, while the use of the birth control pill decreased. Non-hormonal contraception methods, including condoms, spermicides, withdrawal and menstrual cycle tracking, are 10% or less effective than hormonal contraceptives. The only exceptions are surgical sterilization and the copper intrauterine device.

    To be sure, not all birth control-related content posted on social media platforms is negative, studies show. Health care professionals are sharing educational material with a high rate of engagement and non-health care professional users share their positive experiences with the birth control methods they use.

    But as you will see in the studies curated below, researchers also find that social media users, including influencers, share inaccurate information about hormonal contraceptives on various social media platforms, discuss their discontinuation of birth control in favor of non-hormonal methods and engage in unsubstantiated fear-mongering of hormonal contraceptives.

    Researchers also have learned that the content posted on social media platforms has changed in tone over time, mirroring the shift in the national political discourse.

    In a 2021 study published in the American Journal of Obstetrics & Gynecology, researchers analyzed more than 800,000 English-language tweets mentioning at least one contraceptive method between March 2006, when Twitter was founded, and December 2019. They coded the sentiment of tweets as positive, neutral or negative.

    “What we found over time was that the number of neutral tweets went down for each and every one of the birth control methods, and people became more polarized with regards to how they talk on these social media platforms over those 13 years,” says study co-author Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital with expertise in complex family planning and an associate professor at Harvard Medical School.

    In a February 2024 commentary in the Journal of Women’s Health, University of Delaware researchers Emily Pfender and Leah Fowler argue that ongoing dialogue about contraception on social media provides “a glimpse into public sentiment about available options” to people who can get pregnant.

    The authors also note that misinformation and disinformation about hormonal contraception may have a larger effect on health disparities, especially among historically marginalized groups who may already mistrust the medical establishment.

    “This may contribute to unintended pregnancy and delayed care, further widening health disparities and hindering progress toward equitable reproductive health outcomes,” Pfender and Fowler write.

    Side effects

    There are known side effects to hormonal birth control methods, including headaches, nausea, sore breasts and spotting. Most are mild and disappear with continued use or with switching to another method. Among hormonal contraceptives, only the Depo-Provera injection has been linked with weight gain, studies show.  

    But some social media influencers have spread false claims about the potential side effects of hormonal birth control methods, ranging from infertility to abortion to unattractiveness. Despite these false claims, physicians and professional organizations such as the American College of Obstetricians and Gynecologists find today’s contraceptive options safe and very effective.

    “They’re about the most low-risk prescription that I give,” says Dr. Megana Dwarakanath, an adolescent medicine physician in Pittsburgh. “I always joke that if something goes wrong in someone’s life, they’re within the reproductive years, it always gets blamed on birth control.”

    Dwarakanath says her young patients are most worried about two side effects: weight gain and mood. “Those are the things that they will almost always attribute to their birth control at a time that their bodies are also changing very rapidly,” she says. “Things like mental health diagnoses or personality disorders also tend to crop up during the time young people have started or have been on birth control.”

    Most research on the link between oral contraceptives and cancer risk comes from observational studies, according to the National Cancer Institute. Overall, the studies have consistently shown that the risks of breast and cervical cancer are slightly increased for women who use oral contraceptives, whereas the risk of endometrial, ovarian and colorectal cancers are reduced.

    The use of hormonal birth control has also been associated with an increase in the risk of developing blood clots, studies show. But that risk is not universal for everyone who takes hormonal birth control. This risk is higher for women 35 and older, those who smoke, are very overweight or have a history of cardiovascular disease. Overall, 3 to 9 out of 10,000 women who take the pill are at risk of developing blood clots within a given year. The risk for women who don’t take the pill is 1 to 5 out of 10,000.

    There is no association between the pill and mood disorders, according to a large body of research, including a 2021 cohort study of nearly 740,000 young women. 

    It’s worth noting the dearth of research into women’s reproductive health due to chronic underfunding of women’s health research. An analysis of funding by the U.S. National Institutes of Health finds that in nearly three-quarters of the cases where a disease affects mainly one gender, the institute’s funding pattern favored males. Either the disease affected more women and was underfunded, or the disease affected more men and was overfunded, according to the 2021 study published in the Journal of Women’s Health.

    Aside from underfunding, conducting robust research into the long-term effects of birth control is complex.

    “Historically, people haven’t felt that it’s ethically OK to randomize people to birth control methods in large part because the outcome of unintended pregnancy is greater,” for people who are given the placebo, Bartz says.

    Research on birth control misinformation on social media

    Social media use is widespread among young adults. More than 90% of Americans between 18 and 29 reported ever using YouTube, while 78% said they had used Instagram, 62% used TikTok and 42% used Twitter, according to a 2023 survey of 5,733 U.S. adults by Pew Research Center.

    These years overlap with the demographic of people who are most likely to use birth control. And because the use of contraceptives is less stigmatized today, people are more likely to talk with one another about their questions and concerns or share that information online.

    In addition to investigating the general landscape of social media posts about birth control, researchers are also interested in the type of content influencers, who typically have 20,000 or more followers, post, because of their persuasive power over their audiences.

    “When influencers disclose personal experiences and beliefs about various topics, audience members tend to form similar attitudes especially when they feel connected to the influencer,” Pfender and M. Marie Devlin write in a 2023 study published in the journal Health Communication.

    Below we have curated several studies published in recent years documenting the spread of birth control misinformation on social media. The roundup is followed by a quick reference guide on female contraceptives and their actual potential side effects.

    Contraceptive Content Shared on Social Media: An Analysis of Twitter
    Melody Huang, et al. Contraception and Reproductive Medicine, February 2024.

    The study: The authors explore how contraceptive information is shared on X and understand how those posts affect women’s decisions. They analyze a random 1% of publicly available English-language tweets about reversible prescription contraceptive methods, from January 2014 and December 2019. The 4,434 analyzed tweets included at least 200 tweets per birth control method — IUDs, implants, the pill, patch and ring.

    The findings: 26.7% of tweets about contraceptive methods discussed decision-making and 20.5% discussed side effects, especially the side effects of IUDs and the depot medroxyprogesterone acetate (DMPA or Depo-Provera) shot. Discussions about the pill, patch or ring prompted more discussions on logistics and adherence. About 6% of tweets explicitly requested information. Tweets about IUDs were most popular in terms of likes.

    More importantly, 50.6% of the tweets were posted by contraceptive users, while only 6% came from official health or news sources. Tweets from news or journalistic sources were more frequent than tweets from a health care professional or organization.

    Some tweets contained misinformation represented as facts, such as the unsubstantiated claim that IUDs can cause fertility issues. Others were outwardly misogynistic, shaming women and claiming that they wouldn’t be able to have kids because of using hormonal birth control.

    One takeaway: “While Twitter may provide valuable insight, with more tweets being created by personal contraceptive users than official healthcare sources, the available information may vary in reliability. Asking patients about information from social media can help reaffirm to patients the importance of social networks in contraceptive decision-making while also addressing misconceptions to improve contraceptive counseling,” the authors write.

    What Do Social Media Influencers Say About Birth Control? A Content Analysis of YouTube Vlogs About Birth Control
    Emily J. Pfender and M. Marie Devlin. Health Communication, January 2023.

    The study: To explore what social media influencers shared on YouTube about their experiences with hormonal and non-hormonal methods of birth control, the researchers analyzed 50 vlogs posted between December 2019 and December 2021. Most of the 50 influencers were categorized on YouTube as Lifestyle (72%) and Fitness (16%). They had between 20,000 and 2.2 million subscribers each.

    The findings: In total, 74% of the influencers talked about discontinuing hormonal birth control. About 44% said the main reason they were discontinuing birth control was to be more natural, while 32% said they wanted to improve their mental health and 20% were concerned about weight gain.

    Forty percent of influencers mentioned using non-hormonal birth control methods such as menstrual cycle tracking, condoms, non-hormonal IUDs and the pull-out method. Twenty percent reported switching from hormonal to non-hormonal methods.

    One takeaway: “Our content analysis revealed that discontinuation of hormonal birth control is commonly discussed among [social media influencers] on YouTube and sexual health information from influencers might not provide accurate educational information and tools… this is especially concerning given that social media is young adults’ primary tool for sexual health information. Future research is needed to understand the effects of SMI birth control content on sexual health behaviors,” the authors write.

    Hormonal Contraceptive Side Effects and Nonhormonal Alternatives on TikTok: A Content Analysis
    Emily J. Pfender, Kate Tsiandoulas, Stephanie R. Morain and Leah R. Fowler. Health Promotion Practice, January 2024.

    The study: The authors analyzed the content of 100 TikTok videos that used the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. Their goal was to understand the types of content about side effects of hormonal and non-hormonal contraceptives on TikTok.

    The findings: The videos averaged about 1 minute and garnered an average of 27,795 likes, 251 comments and 623 shares. For #birthcontrolsideeffects, 80% of the audience was 18 to 24 years old and videos with that hashtag had 43 million views worldwide as of July 7, 2023.

    Thirty-two percent of the videos were by regular users (non-influencers), 26 by clinicians, 13% by health coaches and 2% by companies. Only 3% had a sponsorship disclosure and 6% included a medical disclaimer, that the person was not a doctor or was not providing medical advice.

    Most of the 100 videos (71%) mentioned hormonal contraception. Among them 51% discussed unspecific hormonal contraceptives, 31% talked about the pill and 11% about hormonal IUDs. Four of the 71 creators explicitly recommended against using hormonal contraceptives.

    Claims about hormonal contraceptives were mostly based on personal experience. About 25% of the creators cited no basis for their claims, 23% included outside evidence, including unspecified studies or information from the FDA insert, and 11% used a combination of personal and outside evidence.

    Almost half (49%) mentioned discontinuing their hormonal contraception, with negative side effects cited as the most common reason.

    The creators talked about mental health issues, weight gain, headaches, and less common risks of various cancers or chronic illness, change in personality and blood clots. They were less likely to mention the positive aspects of birth control.

    About 52% of videos mentioned non-hormonal contraception, including copper IUDs and cycle tracking.

    Nine of the 100 creators expressed feeling dismissed, pressured, gaslit or insufficiently informed about contraception by medical providers.

    One takeaway: “Our findings support earlier work suggesting social media may fuel ‘hormonophobia,’ or negative framing and scaremongering about hormonal contraception and that this phobia is largely driven by claims of personal experience rather than scientific evidence,” the authors write. “Within these hashtag categories, TikTok creators frame their provider interactions negatively. Many indicate feeling ignored or upset after medical appointments, not sufficiently informed about contraceptive options, and pressured to use hormonal contraceptives. This finding aligns with previous social media research and among the general population, suggesting opportunities for improvements in contraceptive counseling.”

    Popular Contraception Videos on TikTok: An Assessment of Content Topics
    Rachel E. Stoddard, et al. Contraception, January 2024.

    The study: Researchers analyzed 700 English-language TikTok videos related to hormonal contraception, with a total of 1.2 billion views and 1.5 million comments, posted between October 2019 and December 2021. Their aim was to explore the types of contraception content on TikTok and to understand how the platform influences the information patients take into birth control counseling visits.

    The findings: More than half of the videos (52%) were about patient experiences and how to use contraceptives. Other common topics included side effects (35%) and pregnancy (39%).

    Only 19% of the videos were created by health care professionals, including midwives, physician assistants and medical doctors, although those videos garnered 41% of the total views, indicating higher engagement. While 93% of health care providers shared educational content, 23% of non-health care providers shared educational content.

    One takeaway: “Our findings show an exceptional opportunity for education around contraception for young reproductive-aged individuals, given the accessibility and popularity of these videos. This may also extend to other topics around sex education and family planning, including sexually transmitted infection prevention and treatment and procuring abortion care,” the authors write.

    TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media
    Jenny Wu, Esmé Trahair, Megan Happ and Jonas Swartz. Obstetrics & Gynecology, January 2023.

    The study: Researchers used a web-scraping application to collect the top 100 TikTok videos tagged #IUD on April 6, 2022, based on views, comments, likes and shares. Their aim was to understand the perspectives and experiences of people with IUDs shared on TikTok. The videos had a total of 471 million views, 32 million likes and 1 million shares. Their average length was 33 seconds.

    The findings: Some 89% of the creators identified as female and nearly 90% were from the United States; 37% were health care professionals; and 78% were 21 years or older.

    Video types included patients’ own experiences with IUD removal (32%), educational (30%) and humorous (25%). More videos (38%) had a negative tone compared with 19% with a positive tone. The videos that portrayed negative user experiences emphasized pain and distrust of health care professionals.

    Half of the videos were very accurate, while nearly a quarter were inaccurate (the authors did not use the term misinformation).

    One takeaway: “The most liked #IUD videos on TikTok portray negative experiences related to pain and informed consent. Awareness of this content can help health care professionals shape education given the high prevalence of TikTok use among patients,” the authors write. “TikTok differs from other platforms because users primarily engage with an algorithmically curated feed individualized to the user’s interests and demographics.”

    Types of female birth control

    Most female hormonal contraceptives contain the synthetic version of natural female hormones estrogen and progesterone. They affect women’s hormone levels, preventing mature eggs from being released by the ovaries, a process that’s known as ovulation, hence, preventing a possible pregnancy.

    Of the two hormones, progesterone (called progestin in synthetic form) is primarily responsible for preventing pregnancy. In addition to playing a role in preventing ovulation, progesterone inhibits sperm from penetrating through the cervix. Estrogen inhibits the development of follicles in the ovaries.

    The information below is sourced from the CDC, the National Library of Medicine, the Cleveland Clinic and the Mayo Clinic.

    Intrauterine contraception

    Also called Long-Acting Reversible Contraception, or LARC, this method works by thickening the cervical mucus so the sperm can’t reach an egg. There are two types of IUDs: hormonal and non-hormonal.

    • Levonorgestrel intrauterine system is a T-shaped device that’s placed inside the uterus by a doctor. It releases a small amount of progestin daily to prevent pregnancy. It can stay in place for 3 to 8 years. Its failure rate is 0.1% to 0.4%.
    • Copper T intrauterine device is also T-shaped and is placed inside the uterus by a doctor. It does not contain hormones and can stay in place for up to 10 years. Its failure rate is 0.8%.
    • Side effects: Copper IUDs may cause more painful and heavy periods, while progestin IUDs may cause irregular bleeding. In the very rare cases of pregnancy while having an IUD, there’s a greater chance of an ectopic pregnancy, which is when a fertilized egg grows outside of the uterus.

    Hormonal methods

    • The implant is a single, thin rod that’s inserted under the skin of the upper arm. It releases progestin over 3 years. Its failure rate is 0.1%, making it the most effective form of contraception available.
    • Side effects: The most common side effect of an implant is irregular bleeding.
    • The injection Depo-Provera or “shot” or “Depo” delivers progestin in the buttocks or arms every three months at the doctor’s office. Its failure rate is 4%.
    • Side effects: The shot may cause irregular bleeding. The shot is also the only contraceptive that may cause weight gain. It may also be more difficult to predict when fertility returns once the shot is stopped.
    • Combined oral contraceptives or “the pill” contain estrogen and progestin. They’re prescribed by a doctor. The pill has to be taken at the same time daily. The pill is not recommended for people who are older than 35 and smoke, have a history of blood clots or breast cancer. Its failure rate is 7%. Among women aged 15 to 44 who use contraception, about 25% use the pill.
    • The skin patch is worn on the lower abdomen, buttocks or upper body, releasing progestin and estrogen. It is prescribed by a doctor. A new patch is used once a week for three weeks. No patch is worn for the fourth week. Its failure rate is 7%.
    • Hormonal vaginal contraceptive ring releases progestin and estrogen. It’s placed inside the vagina. It is worn for three weeks and taken out on the fourth week. Its typical failure rate is 7%.
    • Side effects: Contraceptives with estrogen, including the pill, the patch and the ring, increase the risk of developing blood clots.
    • Progestin-only pill or “mini-pill” only has progestin and is prescribed by a doctor. It has to be taken daily at the same time. It may be a good option for women who can’t take estrogen. Its typical failure rate is 7%.
    • Opill is the first over-the-counter daily oral contraceptive in the U.S., approved by the Food and Drug Administration in 2023. Opill only has progestin and like other birth control pills, it has to be taken at the same time every day. It should not be used by those who have or have had breast cancer. Its failure rate is 7%.
    • Side effects: The most common side effect of progestin-only pills is irregular bleeding, although the bleeding tends to be light.

    Non-hormonal birth control methods include using barriers such as a diaphragm or sponge, condoms and spermicides, withdrawal, and menstrual cycle tracking. Emergency contraception, including emergency contraception pills (the morning-after pill), is not a regular method of birth control.

    Additional research studies to consider

    Population Attitudes Toward Contraceptive Methods Over Time on a Social Media Platform
    Allison A. Merz, et al. American Journal of Obstetrics & Gynecology, December 2020.

    Social Media and the Intrauterine Device: A YouTube Content Analysis
    Brian T. Nguyen and Allison J. Allen. BMJ Sexual and Reproductive Health, November 2017.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • Healthy Habits for Managing & Reversing Prediabetes – by Dr. Marie Feldman

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    The 10almonds Team

    The book doesn’t assume prior knowledge, and does explain the science of diabetes, prediabetes, the terms and the symptoms, what’s going on inside, etc—before getting onto the main meat of the book, the tips.

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    Click here to check out Healthy Habits For Managing & Reversing Prediabetes, and enjoy the measurable health results!

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