A form of Parkinson’s disease caused by mutations in a gene known as PINK1 has long been labelled rare. But our research shows it’s anything but – at least for some populations.

Our meta-analysis revealed that people in specific Polynesian communities have a much higher rate of PINK1-linked Parkinson’s than expected. This finding reshapes not only our understanding of who is most at risk, but also how soon symptoms may appear and what that might mean for treatment and testing.

Parkinson’s disease is often thought of as a single condition. In reality, it is better understood as a group of syndromes caused by different factors – genetic, environmental or a combination of both.

These varying causes lead to differences in disease patterns, progression and subsequent diagnosis. Recognising this distinction is crucial as it paves the way for targeted interventions and may even help prevent the disease altogether.

Why we focus on PINK1-linked Parkinson’s

We became interested in this gene after a 2021 study highlighted five people of Samoan and Tongan descent living in New Zealand who shared the same PINK1 mutation.

Previously, this mutation had been spotted only in a few more distant places –Malaysia, Guam and the Philippines. The fact it appeared in people from Samoan and Tongan backgrounds suggested a historical connection dating back to early Polynesian migrations.

One person in 1,300 West Polynesians carries this mutation. This is a frequency well above what scientists usually classify as rare (below one in 2,200). This discovery means we may be overlooking entire communities in Parkinson’s research if we continue to assume PINK1-linked cases are uncommon.

Traditional understanding says PINK1-linked Parkinson’s is both rare and typically strikes younger people, mostly in their 30s or 40s, if they inherit two faulty copies of the gene. In other words, it’s considered a recessive condition, needing two matching puzzle pieces before the disease can unfold.

Our work challenges this view. We show that even one defective PINK1 gene can cause Parkinson’s at an average age of 43, much earlier than the typical onset after 65. That’s a significant departure from the standard belief that only people with two defective gene copies are at risk.

Why this matters for people with the disease

It’s not just genetics that challenge long-held views. Historically, PINK1-linked Parkinson’s was thought to lack some of the classic features of the disease, such as toxic clumps of alpha-synuclein protein.

In typical Parkinson’s, alpha-synuclein builds up in the brain, forming sticky clumps known as Lewy bodies. Our results, contrary to prior beliefs, show that alpha-synuclein pathology is present in 87.5% of PINK1 cases. This finding opens up a promising new avenue for future treatment development.

The biggest concern is early onset. PINK1-linked Parkinson’s can begin as early as 11 years old, although a more common starting point is around the mid-30s. This early onset means living longer with the disease, which can profoundly affect education, work opportunities and family life.

Current treatments (such as levodopa, a precursor of dopamine) help manage symptoms, but they’re not designed to address the root cause. If we know someone has a PINK1 mutation, scientists and clinicians can explore therapies for specific genetic pathways, potentially delivering relief beyond symptom management.

Sex differences add a layer of complexity

In Parkinson’s, generally, men are at higher risk and tend to develop symptoms earlier. However, our findings suggest the opposite pattern for PINK1-linked cases. Particularly, women with two defective copies of the gene experience onset earlier than men.

This highlights the need to consider sex-related factors in Parkinson’s research. Overlooking them risks missing key elements of the disease.

Genetic testing could be a game-changer for PINK1-linked Parkinson’s. Because it often appears earlier, doctors may not recognise it immediately, especially if they are more familiar with the common, later-onset form of Parkinson’s.

Early genetic testing could lead to a faster, more accurate diagnosis, allowing treatment to begin when interventions are most effective. It would help families understand how the disease is inherited, enabling relatives to get tested.

In some cases, where appropriate and culturally acceptable, embryo screening may be considered to prevent the passing of the faulty gene.

Knowing you have a PINK1 mutation could also make finding the right treatment more efficient. Instead of a lengthy trial-and-error process with different medications, doctors could use emerging therapies designed to target the underlying PINK1 mutation rather than relying on general Parkinson’s treatments meant for the broader population.

Addressing research gaps

These findings underscore how crucial it is to include diverse populations in health research.

Many communities, such as those in Samoa, Tonga and other Pacific nations, have had little to no involvement in global Parkinson’s genetics studies. This has created gaps in knowledge and real-world consequences for people who may not receive timely or accurate diagnoses.

Researchers, funding bodies and policymakers must prioritise projects beyond the usual focus on European or industrialised countries to ensure research findings and treatments are relevant to all affected populations.

To better diagnose and treat Parkinson’s, we need a more inclusive approach. Recognising that PINK1-linked Parkinson’s is not as rare as previously thought – and that genetics, sex differences and cultural factors all play a role – allows us to improve care for everyone.

By expanding genetic testing, refining treatments and ensuring research reflects the full spectrum of Parkinson’s, we can move closer to more precise diagnoses, targeted therapies and better support systems for all.

Victor Dieriks, Research Fellow in Health Sciences, University of Auckland, Waipapa Taumata Rau and Eden Paige Yin, PhD candidate in Health Sciences, University of Auckland, Waipapa Taumata Rau

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

We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods.

So why do you crave these foods when you’re trying to improve your diet or lose weight? And what can you do about it?

There are many reasons for craving specific foods, but let’s focus on four common ones:

1. Blood sugar crashes

Sugar is a key energy source for all animals, and its taste is one of the most basic sensory experiences. Even without specific sweet taste receptors on the tongue, a strong preference for sugar can develop, indicating a mechanism beyond taste alone.

Neurons responding to sugar are activated when sugar is delivered to the gut. This can increase appetite and make you want to consume more. Giving into cravings also drives an appetite for more sugar.

In the long term, research suggests a high-sugar diet can affect mood, digestion and inflammation in the gut.

While there’s a lot of variation between individuals, regularly eating sugary and high-carb foods can lead to rapid spikes and crashes in blood sugar levels. When your blood sugar drops, your body can respond by craving quick sources of energy, often in the form of sugar and carbs because these deliver the fastest, most easily accessible form of energy.

2. Drops in dopamine and serotonin

Certain neurotransmitters, such as dopamine, are involved in the reward and pleasure centres of the brain. Eating sugary and carb-rich foods can trigger the release of dopamine, creating a pleasurable experience and reinforcing the craving.

Serotonin, the feel-good hormone, suppresses appetite. Natural changes in serotonin can influence daily fluctuations in mood, energy levels and attention. It’s also associated with eating more carb-rich snacks in the afternoon.

Low carb diets may reduce serotonin and lower mood. However, a recent systematic review suggests little association between these diets and risk for anxiety and depression.

Compared to men, women tend to crave more carb rich foods. Feeling irritable, tired, depressed or experiencing carb cravings are part of premenstrual symptoms and could be linked to reduced serotonin levels.

3. Loss of fluids and drops in blood sugar and salt

Sometimes our bodies crave the things they’re missing, such as hydration or even salt. A low-carb diet, for example, depletes insulin levels, decreasing sodium and water retention.

Very low-carb diets, like ketogenic diets, induce “ketosis”, a metabolic state where the body switches to using fat as its primary energy source, moving away from the usual dependence on carbohydrates.

Ketosis is often associated with increased urine production, further contributing to potential fluid loss, electrolyte imbalances and salt cravings.

4. High levels of stress or emotional turmoil

Stress, boredom and emotional turmoil can lead to cravings for comfort foods. This is because stress-related hormones can impact our appetite, satiety (feeling full) and food preferences.

The stress hormone cortisol, in particular, can drive cravings for sweet comfort foods.

A 2001 study of 59 premenopausal women subjected to stress revealed that the stress led to higher calorie consumption.

A more recent study found chronic stress, when paired with high-calorie diet, increases food intake and a preference for sweet foods. This shows the importance of a healthy diet during stress to prevent weight gain.

What can you do about cravings?

Here are four tips to curb cravings:

1) don’t cut out whole food groups. Aim for a well-balanced diet and make sure you include:

• sufficient protein in your meals to help you feel full and reduce the urge to snack on sugary and carb-rich foods. Older adults should aim for 20–40g protein per meal with a particular focus on breakfast and lunch and an overall daily protein intake of at least 0.8g per kg of body weight for muscle health
• fibre-rich foods, such as vegetables and whole grains. These make you feel full and stabilise your blood sugar levels. Examples include broccoli, quinoa, brown rice, oats, beans, lentils and bran cereals. Substitute refined carbs high in sugar like processed snack bars, soft drink or baked goods for more complex ones like whole grain bread or wholewheat muffins, or nut and seed bars or energy bites made with chia seeds and oats

2) manage your stress levels. Practise stress-reduction techniques like meditation, deep breathing, or yoga to manage emotional triggers for cravings. Practising mindful eating, by eating slowly and tuning into bodily sensations, can also reduce daily calorie intake and curb cravings and stress-driven eating

3) get enough sleep. Aim for seven to eight hours of quality sleep per night, with a minimum of seven hours. Lack of sleep can disrupt hormones that regulate hunger and cravings

4) control your portions. If you decide to indulge in a treat, control your portion size to avoid overindulging.

Overcoming cravings for sugar, salt and carbs when trying to eat healthily or lose weight is undoubtedly a formidable challenge. Remember, it’s a journey, and setbacks may occur. Be patient with yourself – your success is not defined by occasional cravings but by your ability to manage and overcome them.

Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University

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

Flavoured nicotine pouches are being promoted to young people on social media platforms such as TikTok and Instagram.

Although some viral videos have been taken down following a series of reports in The Guardian, clips featuring Australian influencers have claimed nicotine pouches are a safe and effective way to quit vaping. A number of the videos have included links to websites selling these products.

With the rapid rise in youth vaping and the subsequent implementation of several reforms to restrict access to vaping products, it’s not entirely surprising the tobacco industry is introducing more products to maintain its future revenue stream.

The major trans-national tobacco companies, including Philip Morris International and British American Tobacco, all manufacture nicotine pouches. British American Tobacco’s brand of nicotine pouches, Velo, is a leading sponsor of the McLaren Formula 1 team.

But what are nicotine pouches, and are they even legal in Australia?

Like snus, but different

Nicotine pouches are available in many countries around the world, and their sales are increasing rapidly, especially among young people.

Nicotine pouches look a bit like small tea bags and are placed between the lip and gum. They’re typically sold in small, colourful tins of about 15 to 20 pouches. While the pouches don’t contain tobacco, they do contain nicotine that is either extracted from tobacco plants or made synthetically. The pouches come in a wide range of strengths.

As well as nicotine, the pouches commonly contain plant fibres (in place of tobacco, plant fibres serve as a filler and give the pouches shape), sweeteners and flavours. Just like for vaping products, there’s a vast array of pouch flavours available including different varieties of fruit, confectionery, spices and drinks.

The range of appealing flavours, as well as the fact they can be used discreetly, may make nicotine pouches particularity attractive to young people.

Users absorb the nicotine in their mouths and simply replace the pouch when all the nicotine has been absorbed. Tobacco-free nicotine pouches are a relatively recent product, but similar style products that do contain tobacco, known as snus, have been popular in Scandinavian countries, particularly Sweden, for decades.

Snus and nicotine pouches are however different products. And given snus contains tobacco and nicotine pouches don’t, the products are subject to quite different regulations in Australia.

What does the law say?

Pouches that contain tobacco, like snus, have been banned in Australia since 1991, as part of a consumer product ban on all forms of smokeless tobacco products. This means other smokeless tobacco products such as chewing tobacco, snuff, and dissolvable tobacco sticks or tablets, are also banned from sale in Australia.

Tobacco-free nicotine pouches cannot legally be sold by general retailers, like tobacconists and convenience stores, in Australia either. But the reasons for this are more complex.

In Australia, under the Poisons Standard, nicotine is a prescription-only medicine, with two exceptions. Nicotine can be used in tobacco prepared and packed for smoking, such as cigarettes, roll-your-own tobacco, and cigars, as well as in preparations for therapeutic use as a smoking cessation aid, such as nicotine patches, gum, mouth spray and lozenges.

If a nicotine-containing product does not meet either of these two exceptions, it cannot be legally sold by general retailers. No nicotine pouches have currently been approved by the Therapeutic Goods Administration as a therapeutic aid in smoking cessation, so in short they’re not legal to sell in Australia.

However, nicotine pouches can be legally imported for personal use only if users have a prescription from a medical professional who can assess if the product is appropriate for individual use.

We only have anecdotal reports of nicotine pouch use, not hard data, as these products are very new in Australia. But we do know authorities are increasingly seizing these products from retailers. It’s highly unlikely any young people using nicotine pouches are accessing them through legal channels.

Health concerns

Nicotine exposure may induce effects including dizziness, headache, nausea and abdominal cramps, especially among people who don’t normally smoke or vape.

Although we don’t yet have much evidence on the long term health effects of nicotine pouches, we know nicotine is addictive and harmful to health. For example, it can cause problems in the cardiovascular system (such as heart arrhythmia), particularly at high doses. It may also have negative effects on adolescent brain development.

The nicotine contents of some of the nicotine pouches on the market is alarmingly high. Certain brands offer pouches containing more than 10mg of nicotine, which is similar to a cigarette. According to a World Health Organization (WHO) report, pouches deliver enough nicotine to induce and sustain nicotine addiction.

Pouches are also being marketed as a product to use when it’s not possible to vape or smoke, such as on a plane. So instead of helping a person quit they may be used in addition to smoking and vaping. And importantly, there’s no clear evidence pouches are an effective smoking or vaping cessation aid.

Further, some nicotine pouches, despite being tobacco-free, still contain tobacco-specific nitrosamines. These compounds can damage DNA, and with long term exposure, can cause cancer.

Overall, there’s limited data on the harms of nicotine pouches because they’ve been on the market for only a short time. But the WHO recommends a cautious approach given their similarities to smokeless tobacco products.

For anyone wanting advice and support to quit smoking or vaping, it’s best to talk to your doctor or pharmacist, or access trusted sources such as Quitline or the iCanQuit website.

Becky Freeman, Associate Professor, School of Public Health, University of Sydney

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