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.
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.
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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How Does Someone Die From Dementia?
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Dementia is most often thought of in terms of the loss of certain cognitive faculties during the disease’s progress. So how does death occur?
A quiet departure
Notwithstanding it being a widely-feared disease (or set of diseases, since we’re using the umbrella term of dementia, and not the most well-known and common kind, Alzheimer’s), death from dementia is usually a peaceful one; any distressing confusions are usually in the past by this point.
Sometimes, it is not the dementia itself that directly causes death; rather, it leaves someone much more vulnerable to infections, with pneumonia being top of the list, and UTIs also ranking highly. And while a younger healthier person might drink some cranberry juice and shrug it off, for an older person with dementia, even a UTI can be much more serious. Pneumonia, of course, is well-known for often being the final straw.
Sometimes, it is the dementia that directly causes death; the disease causes a slow decline until the person stops eating and drinking. At this time, they will also tend to sleep more, and as mentioned, experience much less agitation and confusion than previously.
In terms of caregiving at this late stage, the hospice worker in the video recommends to do one’s best to keep the person clean and safe from falls or infections, check common pressure sore sites for redness, changing their position if necessary and using pillows to relieve any undue pressure.
For more on all of this, see:
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Want to learn more?
You might also like to read:
When Planning Is A Matter of Life & Death: Managing Your Mortality
Take care!
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Cordyceps: Friend Or Foe?
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Cordyceps: friend or foe?
Cordyceps is a famously frightening fungus. It’s the one responsible for “zombie ants” and other zombie creatures, and it’s the basis for the existential threat to humanity in the TV show The Last of Us.
It’s a parasitic fungus that controls the central and peripheral nervous systems of its host, slowly replacing the host’s body, as well as growing distinctive spines that erupt out of the host’s body. Taking over motor functions, it compels the host to do two main things, which are to eat more food, and climb to a position that will be good to release spores from.
Fortunately, none of that matters to humans. Cordyceps does not (unlike in the TV show) affect humans that way.
What does Cordyceps do in humans?
Cordyceps (in various strains) is enjoyed as a health supplement, based on a long history of use in Traditional Chinese Medicine, and nowadays it’s coming under a scientific spotlight too.
The main health claims for it are:
- Against inflammation
- Against aging
- Against cancer
- For blood sugar management
- For heart health
- For exercise performance
Sounds great! What does the science say?
There’s a lot more science for the first three (which are all closely related to each other, and often overlapping in mechanism and effect).
So let’s take a look:
Against inflammation
The science looks promising for this, but studies so far have either been in vitro (cell cultures in petri dishes), or else murine in vivo (mouse studies), for example:
- Anti-inflammatory effects of Cordyceps mycelium in murine macrophages
- Cordyceps sinensis as an immunomodulatory agent
- Immunomodulatory functions of extracts from Cordyceps cicadae
- Cordyceps pruinosa inhibits in vitro and in vivo inflammatory mediators
In summary: we can see that it has anti-inflammatory properties for mice and in the lab; we’d love to see the results of studies done on humans, though. Also, while it has anti-inflammatory properties, it performed less well than commonly-prescribed anti-inflammatory drugs, for example:
❝C. militaris can modulate airway inflammation in asthma, but it is less effective than prednisolone or montelukast.❞
Against aging
Because examining the anti-aging effects of a substance requires measuring lifespans and repeating the experiment, anti-aging studies do not tend to be done on humans, because they would take lifetimes to perform. To this end, it’s inconvenient, but not a criticism of Cordyceps, that studies have been either mouse studies (short lifespan, mammals like us) or fruit fly studies (very short lifespan, genetically surprisingly similar to us).
The studies have had positive results, with typical lifespan extensions of 15–20%:
- The lifespan-extending effect of Cordyceps sinensis in normal mice
- Cordyceps sinensis oral liquid prolongs the lifespan of the fruit fly, Drosophila melanogaster
- Anti-aging activity of polysaccharides from Cordyceps militaris
- Anti-aging effect of Cordyceps sinensis extract
Against cancer
Once again, the studies here have been in vitro, or murine in vivo. They do look good though:
In vitro (human cell cultures in a lab):
In vivo (mouse studies):
Summary of these is: Cordyceps quite reliably inhibits tumor growth in vitro (human cell cultures) and in vivo (mouse studies). However, trials in human cancer patients are so far conspicuous by their absence.
For blood sugar management
Cordyceps appears to mimic the action of insulin, without triggering insulin sensitivity. For example:
The anti-hyperglycemic activity of the fruiting body of Cordyceps in diabetic rats
There were some other rat/mouse studies with similar results. No studies in humans yet.
For heart health
Cordyceps contains adenosine. You may remember that caffeine owes part of its stimulant effect to blocking adenosine, the hormone that makes us feel sleepy. So in this way, Cordyceps partially does the opposite of what caffeine does, and may be useful against arrhythmia:
Cardiovascular protection of Cordyceps sinensis act partially via adenosine receptors
For exercise performance
A small (30 elderly participants) study found that Cordyceps supplementation improved VO2 max by 7% over the course of six weeks:
However, another small study (22 young athletes) failed to reproduce those results:
Cordyceps Sinensis supplementation does not improve endurance exercise performance
In summary…
Cordyceps almost certainly has anti-inflammation, anti-aging, and anti-cancer benefits.
Cordyceps may have other benefits too, but the evidence is thinner on the ground for those, so far.
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‘Naked carbs’ and ‘net carbs’ – what are they and should you count them?
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According to social media, carbs come in various guises: naked carbs, net carbs, complex carbs and more.
You might be wondering what these terms mean or if all carbs are really the same. If you are into “carb counting” or “cutting carbs”, it’s important to make informed decisions about what you eat.
What are carbs?
Carbohydrates, or “carbs” for short, are one of the main sources of energy we need for brain function, muscle movement, digestion and pretty much everything our bodies do.
There are two classifications of carbs, simple and complex. Simple carbs have one or two sugar molecules, while complex carbs are three or more sugar molecules joined together. For example, table sugar is a simple carb, but starch in potatoes is a complex carb.
All carbs need to be broken down into individual molecules by our digestive enzymes to be absorbed. Digestion of complex carbs is a much slower process than simple carbs, leading to a more gradual blood sugar increase.
Fibre is also considered a complex carb, but it has a structure our body is not capable of digesting. This means we don’t absorb it, but it helps with the movement of our stool and prevents constipation. Our good gut bacteria also love fibre as they can digest it and use it for energy – important for a healthy gut.
What about ‘naked carbs’?
“Naked carbs” is a popular term usually used to refer to foods that are mostly simple carbs, without fibre or accompanying protein or fat. White bread, sugary drinks, jams, sweets, white rice, white flour, crackers and fruit juice are examples of these foods. Ultra-processed foods, where the grains are stripped of their outer layers (including fibre and most nutrients) leaving “refined carbs”, also fall into this category.
One of the problems with naked carbs or refined carbs is they digest and absorb quickly, causing an immediate rise in blood sugar. This is followed by a rapid spike in insulin (a hormone that signals cells to remove sugar from blood) and then a drop in blood sugar. This can lead to hunger and cravings – a vicious cycle that only gets worse with eating more of the same foods.
Naked carbs can make blood sugars spike then crash.
Pexels/Alexander GreyWhat about ‘net carbs’?
This is another popular term tossed around in dieting discussions. Net carbs refer to the part of the carb food that we actually absorb.
Again, fibre is not easily digestible. And some carb-rich foods contain sugar alcohols, such as sweeteners (like xylitol and sorbitol) that have limited absorption and little to no effect on blood sugar. Deducting the value of fibre and sugar alcohols from the total carbohydrate content of a food gives what’s considered its net carb value.
For example, canned pear in juice has around 12.3g of “total carbohydrates” per 100g, including 1.7g carb + 1.7g fibre + 1.9g sugar alcohol. So its net carb is 12.3g – 1.7g – 1.9g = 8.7g. This means 8.7g of the 12.3g total carbs impacts blood sugar.
The nutrition labels on packaged foods in Australia and New Zealand usually list fibre separately to carbohydrates, so the net carbs have already been calculated. This is not the case in other countries, where “total carbohydrates” are listed.
Does it matter though?
Whether or not you should care about net or naked carbs depends on your dietary preferences, health goals, food accessibility and overall nutritional needs. Generally speaking, we should try to limit our consumption of simple and refined carbs.
The latest World Health Organization guidelines recommend our carbohydrate intake should ideally come primarily from whole grains, vegetables, fruits and pulses, which are rich in complex carbs and fibre. This can have significant health benefits (to regulate hunger, improve cholesterol or help with weight management) and reduce the risk of conditions such as heart disease, obesity and colon cancer.
In moderation, naked carbs aren’t necessarily bad. But pairing them with fats, protein or fibre can slow down the digestion and absorption of sugar. This can help to stabilise blood sugar levels, prevent spikes and crashes and support personal weight management goals. If you’re managing diabetes or insulin resistance, paying attention to the composition of your meals, and the quality of your carbohydrate sources is essential.
A ketogenic (high fat, low carb) diet typically restricts carb intake to between 20 and 50g each day. But this carb amount refers to net carbs – so it is possible to eat more carbs from high-fibre sources.
Choose complex carbohydrates with lots of fibre.
ShutterstockSome tips to try
Some simple strategies can help you get the most out of your carb intake:
reduce your intake of naked carbs and foods high in sugar and white flour, such as white bread, table sugar, honey, lollies, maple syrup, jam, and fruit juice
opt for protein- and fibre-rich carbs. These include oats, sweet potatoes, nuts, avocados, beans, whole grains and broccoli
if you are eating naked carbs, dress them up with some protein, fat and fibre. For example, top white bread with a nut butter rather than jam
if you are trying to reduce the carb content in your diet, be wary of any symptoms of low blood glucose, including headaches, nausea, and dizziness
- working with a health-care professional such as an accredited practising dietitian or your GP can help develop an individualised diet plan that meets your specific needs and goals.
Correction: this article has been updated to indicate how carbohydrates are listed on food nutrition labels in Australia and New Zealand.
Saman Khalesi, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, CQUniversity Australia; Anna Balzer, Lecturer, Medical Science School of Health, Medical and Applied Sciences, CQUniversity Australia; Charlotte Gupta, Postdoctoral research fellow, CQUniversity Australia; Chris Irwin, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences & Social Work, Griffith University, and Grace Vincent, Senior Lecturer, Appleton Institute, CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Get The Right Help For Your Pain
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How Much Does It Hurt?
Sometimes, a medical professional will ask us to “rate your pain on a scale of 1–10”.
It can be tempting to avoid rating one’s pain too highly, because if we say “10” then where can we go from there? There is always a way to make pain worse, after all.
But that kind of thinking, however logical, is folly—from a practical point of view. Instead of risking having to give an 11 later, you have now understated your level-10 pain as a “7” and the doctor thinks “ok, I’ll give Tylenol instead of morphine”.
A more useful scale
First, know this:
Zero is not “this is the lowest level of pain I get to”.
Zero is “no pain”.
As for the rest…
- My pain is hardly noticeable.
- I have a low level of pain; I am aware of my pain only when I pay attention to it.
- My pain bothers me, but I can ignore it most of the time.
- I am constantly aware of my pain, but can continue most activities.
- I think about my pain most of the time; I cannot do some of the activities I need to do each day because of the pain.
- I think about my pain all of the time; I give up many activities because of my pain.
- I am in pain all of the time; It keeps me from doing most activities.
- My pain is so severe that it is difficult to think of anything else. Talking and listening are difficult.
- My pain is all that I can think about; I can barely move or talk because of my pain.
- I am in bed and I can’t move due to my pain; I need someone to take me to the emergency room because of my pain.
10almonds tip: are you reading this on your phone? Screenshot the above, and keep it for when you need it!
One extra thing to bear in mind…
Medical staff will be more likely to believe a pain is being overstated, on a like-for-like basis, if you are a woman, or not white, or both.
There are some efforts to compensate for this:
A new government inquiry will examine women’s pain and treatment. How and why is it different?
Some other resources of ours:
- The 7 Approaches To Pain Management ← a pain specialist discusses the options available
- Managing Chronic Pain (Realistically!) ← when there’s no quick fix, but these things can buy you some hours’ relief at least / stop the pain from getting worse in the moment
- Science-Based Alternative Pain Relief ← for when you’re maxxed out on painkillers, and need something more/different, these are the things the science says will work
Take care!
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Dr. Kim Foster’s Method For Balancing Hormones Naturally
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Not just sex hormones, but also hormones like cortisol (the stress hormone), and thyroid hormones (for metabolism regulation) too! The body is most of the time self-regulating when it comes to hormones, but there are things that we can do to help our body look after us correctly.
In short, if we give our body what it needs, it will (usually, barring serious illness!) give us what we need.
Dr. Foster recommends…
Foods:
- Healthy fats (especially avocados and nuts)
- Lean proteins (especially poultry, fish, and legumes)
- Fruits & vegetables (especially colorful ones)
- Probiotics (especially fermented foods like sauerkraut, kimchi, etc)
- Magnesium-rich foods (especially dark leafy greens, nuts, and yes, dark chocolate)
Teas:
- Camomile tea (especially beneficial against cortisol overproduction)
- Nettle tea (especially beneficial for estrogen production)
- Peppermint tea (especially beneficial for gut health, thus indirect hormone benefits)
Stress reduction:
- Breathing exercises (especially mindfulness exercises)
- Yoga (especially combining exercise with stretches)
- Spending time in nature (especially green spaces)
Dr. Foster explains more about all of these things, along with more illustrative examples, so if you can, do enjoy her video:
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You might like our main feature: What Does “Balance Your Hormones” Even Mean?
Enjoy!
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How To Unfatty A Fatty Liver
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How To Unfatty A Fatty Liver
In Greek mythology, Prometheus suffered the punishment of being chained to a rock, where he would have his liver eaten by an eagle, whereupon each day his liver would grow back, only to be eaten again the next day.
We mere humans who are not Greek gods might not be able to endure quite such punishment to our liver, but it is an incredibly resilient and self-regenerative organ.
In fact, provided at least 51% of the liver is still present and correct, the other 49% will regrow. Similarly, damage done (such as by trying to store too much fat there due to metabolic problems, as in alcoholic or non-alcoholic fatty liver disease) will reverse itself in time, given the chance.
The difference between us and Prometheus
In the myth, Prometheus had his liver regrow overnight every night. Ours don’t recover quite so quickly.
Indeed, the science has good and bad news for us:
❝Liver recolonization models have demonstrated that hepatocytes have an unlimited regenerative capacity. However, in normal liver, cell turnover is very slow.❞
~ Michalopoulos and Bhusan (2020)
Read more: Liver regeneration: biological and pathological mechanisms and implications
If it regenerates, why do people need transplants, and/or die of liver disease?
There are some diseases of the liver that inhibit its regenerative abilities, or (as in the case of cancer) abuse them to our detriment. However, in the case of fatty liver disease, the reason is usually simple:
If the lifestyle factors that caused the liver to become fatty are still there, then its regenerative abilities won’t be able to keep up with the damage that is still being done.
Can we speed it up at all?
Yes! The first and most important thing is to minimize how much ongoing harm you are still doing to it, though.
- If you drink alcohol, stop. According to the WHO, the only amount of alcohol that is safe for you is zero.
- You might like our previous article: How To Reduce Or Quit Alcohol
- Consider your medications, and find out which place a strain on the liver. Many medications are not optional; you’re taking them for an important reason, so don’t quit things without checking with your doctor. Medications that strain the liver include, but are by no means limited to:
- Many painkillers, including acetaminophen/paracetamol (e.g. Tylenol), and ibuprofen
- Some immunosuppresent drugs, including azathioprine
- Some epilepsy drugs, including phenytoin
- Some antibiotics, including amoxicillin
- Statins in general
Note: we are not pharmacists, nor doctors, let alone your doctors.
Check with yours about what is important for you to take, and what alternatives might be safe for you to consider.
Dietary considerations
While there are still things we don’t know about the cause(s) of non-alcoholic fatty liver disease, there is a very strong association with a diet that is:
- high in salt
- high in refined carbohydrates
- e.g. white flour and white flour products such as white bread and white pasta; also the other main refined carbohydrate: sugar
- high in red meat
- high in non-fermented dairy
- high in fried foods.
So, consider minimizing those, and instead getting plenty of fiber, and plenty of lean protein (not from red meat, but poultry and fish are fine iff not fried; beans and legumes are top-tier, though).
Also, hydrate. Most people are dehydrated most of the time, and that’s bad for all parts of the body, and the liver is no exception. It can’t regenerate if it’s running on empty!
Read more: Foods To Include (And Avoid) In A Healthy Liver Diet
How long will it take to heal?
In the case of alcoholic fatty liver disease, it should start healing a few days after stopping drinking. Then, how long it takes to fully recover depends on the extent of the damage; it could be weeks or months. In extreme cases, years, but that is rare. Usually if the damage is that severe, a transplant is needed.
In the case of non-alcoholic fatty liver disease, again it depends on the extent of the damage, but it is usually a quicker recovery than the alcoholic kind—especially if eating a Mediterranean diet.
Read more: How Long Does It Take For Your Liver To Repair Itself?
Take good care of yourself!
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- If you drink alcohol, stop. According to the WHO, the only amount of alcohol that is safe for you is zero.
