Understanding Cellulitis: Skin And Soft Tissue Infections
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What’s the difference between a minor passing skin complaint, and a skin condition that’s indicative of something more serious? Dr. Thomas Watchman explains:
More than skin-deep
Cellulitis sounds benign enough, like having a little cellulite perhaps, but in fact it means an infection of the skin and—critically—the underlying soft tissues.
Normally, the skin acts as a barrier against infections, but this barrier can be breached by physical trauma (i.e. an injury that broke the skin), eczema, fungal nail infections, skin ulcers, and other similar things that disrupt the skin’s ability to protect us.
Things to watch out for: Dr. Watchman advises we keep an eye out for warm, reddened skin, swelling, and blisters. Specifically, a golden-yellow crust to these likely indicates a Staphylococcus aureus infection (hence the name).
There’s a scale of degrees of severity:
- Class 1: No systemic toxicity or comorbidities
- Class 2: Systemic toxicity or comorbidities present
- Class 3: Significant systemic toxicity or comorbidities with risk of significant deterioration
- Class 4: Sepsis or life-threatening infection
…with antibiotics being recommended in the latter two cases there, or in other cases for frail, young, old, or immunocompromised patients. Given the rather “scorched earth” results of antibiotics (they cause a lot of collateral iatrogenic damage), this can be taken as a sign of how seriously such infections should be taken.
For more about all this, including visual guides, enjoy:
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Want to learn more?
You might also like to read:
- Of Brains & Breakouts: The Brain-Skin Doctor
- Beyond Supplements: The Real Immune-Boosters!
- Antibiotics? You Might Want To Think Thrice
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Vibration Plate, Review After 6 Months: Is It Worth It?
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Is it push-button exercise, or an expensive fad, or something else entirely? Robin, from “The Science of Self-Care”, has insights:
Science & Experience
According to the science (studies cited in the video and linked-to in the video description, underneath it on YouTube), vibration therapy does have some clear benefits, namely:
- Bone health (helps with bone density, particularly beneficial for postmenopausal women)
- Muscle recovery (reduces lactate levels, aiding faster recovery)
- Joint health (reduces pain and improves function in osteoarthritis patients)
- Muscle stimulation (helps older adults maintain muscle mass)
- Cognitive function (due to increased blood flow to the brain)
And from her personal experience, the benefits included:
- Improved recovery after exercise, reducing muscle soreness and stiffness
- Reduced back pain and improved posture (not surprising, given the need for stabilizing muscles when using one of these)
- Better circulation and (likely resulting from same) skin clarity
She did not, however, notice:
- Any reduction in cellulite
- Any change in body composition (fat loss or muscle gain)
For a deeper look into these things and more, plus a demonstration of how the machine actually operates, enjoy:
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Want to learn more?
You might also like to read:
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Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable
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People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.
The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.
The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.
It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.
Why do people want cosmetic surgery?
Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.
The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.
The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.
The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.
People don’t always get the results they expect
Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.
However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.
People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.
What’s changing?
According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.
For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.
It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.
It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.
What about the mental health assessment?
The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.
According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.
While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.
So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.
Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.
Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.
Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.
In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.
If you’re considering cosmetic surgery
The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:
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have an independent physical and mental health assessment before you commit to cosmetic surgery
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make an informed decision knowing the risks
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choose your practitioner, knowing their training and qualifications
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discuss your care after your operation and where you can go for support.
My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.
Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Make Your Saliva Better For Your Teeth
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A new study has highlighted the importance of lifestyle factors in shaping the oral microbiome—that is to say, how the things we do affect the bacteria that live in our mouths:
Nepali oral microbiomes reflect a gradient of lifestyles from traditional to industrialized
Neither the study title nor the abstract elucidate how, exactly, one impacts the other, but the study itself does (of course) contain that information; we read it, and the short version is:
In terms of the extremes of “most traditional” to “most industrialized”, foragers have the most diverse oral microbiomes (that’s good), and people with an American industrialized lifestyle had the least diverse oral microbiomes (that’s bad). Between the two extremes, we see the gradient promised by the title.
If you do feel like checking it out, Figure 3 in the paper illustrates this nicely.
Also illustrated in the above-linked Figure 3 is oral microbiome composition. In other words (and to oversimplify it rather), how good or bad our mouth bacteria are for us, independent of diversity (so for example, are there more of this or that kind of bacteria).
Once again, there is a gradient, only this time, the ends of it are even more polarized: foragers have a diverse oral microbiome rich with healthy-for-humans bacteria, while people with an American industrialized lifestyle might not have the diversity, but do have a large number of bad-for-humans bacteria.
While many lifestyle factors are dietary or quasi-dietary, e.g. what kinds of foods people eat, whether they drink alcohol, whether they smoke or use gum, etc, many lifestyle factors were examined, including everything from medications and exercise, to things like kitchen location and what fuel is predominantly used, to education and sexual activity and many other things that we don’t have room for here.
You can see how each lifestyle factor stacked up, in Figure 5.
Why it matters
Our oral microbiome affects many aspects of health, including:
- Locally: caries, periodontal diseases, mucosal diseases, oral cancer, and more
- Systemically: gastrointestinal diseases in general, IBS in particular, nervous system diseases, Alzheimer’s disease, endocrine diseases, all manner of immune/autoimmune diseases, and more
Nor are the effects it has mild; oral microbiome health can be a huge factor, statistically, for many of the above. You can see information and data pertaining to all of the above and more, here:
Oral microbiomes: more and more importance in oral cavity and whole body
What to do about it
Take care of your oral microbiome, to help it to take care of you. As well as the above-mentioned lifestyle factors, it’s worth noting that when it comes to oral hygiene, not all oral hygiene products are created equal:
Toothpastes & Mouthwashes: Which Kinds Help, And Which Kinds Harm?
Additionally, you might want to consider gentler options, but if you do, take care to opt for things that science actually backs., rather than things that merely trended on social media.
This writer (hi, it’s me) is particularly excited about the science and use of the miswak stick, which comes from the Saladora persica tree, and has phytochemical properties that (amongst many other health-giving effects) improve the quality of saliva (i.e., improve its pH and microbiome composition). In essence, your own saliva gets biochemically nudged into being the safest, most effective mouthwash.
There’s a lot of science for the use of S. persica, and we’ve discussed it before in more detail than we have room to rehash today, here:
Less Common Oral Hygiene Options
If you’d like to enjoy these benefits (and also have the equivalent of a toothbrush that you can carry with you at all times and does not require water*), then here’s an example product on Amazon 😎
*don’t worry, it won’t feel like dry-brushing your teeth. Remember what we said about what it does to your saliva. Basically, you chomp it once, and your saliva a) increases and b) becomes biological tooth-cleaning fluid. The stick itself is fibrous, so the end of it frays in a way that makes a natural little brush. Each stick is about 5”×¼” and you can carry it in a little carrying case (you’ll get a couple with each pack of miswak sticks), so you can easily use it in, say, the restroom of a restaurant or before your appointment somewhere, just as easily as you could use a toothpick, but with much better results. You may be wondering how long a stick lasts; well, that depends on how much you use it, but in this writer’s experience, each stick lasts about a month maybe, using it at least 2–3 times per day, probably rather more since I use it after each meal/snack and upon awakening.
(the above may read like an ad, but we promise you it’s not sponsored and this writer’s just enthusiastic, and when you read the science, you will be too)
Enjoy!
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Do we need animal products to be healthy?
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Do we need animal products to be healthy?
We asked you for your (health-related) perspective on plant-based vs anima-based foods, and got the above-pictured spread of answers.
“Some or all of us may need small amounts of animal products” came out on top with more votes than the two more meat-eatery options combined, and the second most popular option was the hard-line “We can all live healthily and happily on just plants”.
Based on these answers, it seems our readership has quite a lot of vegans, vegetarians, and perhaps “flexitarians” who just have a little of animal products here and there.
Perhaps we should have seen this coming; the newsletter is “10almonds”, not “10 rashers of bacon”, after all.
But what does the science say?
We are carnivores and are best eating plenty of meat: True or False?
False. Let’s just rip the band-aid off for this one.
In terms of our anatomy and physiology, we are neither carnivores nor herbivores:
- We have a mid-length digestive tract (unlike carnivores and herbivores who have short and long ones, respectively)
- We have a mouthful of an assortment of teeth; molars and premolars for getting through plants from hard nuts to tough fibrous tubers, and we have incisors for cutting into flesh and (vestigial, but they’re there) canines that really serve us no purpose now but would have been a vicious bite when they were bigger, like some other modern-day primates.
- If we look at our closest living relatives, the other great apes, they are mostly frugivores (fruit-eaters) who supplement their fruity diet with a small quantity of insects and sometimes other small animals—of which they’ll often eat only the fatty organ meat and discard the rest.
And then, there’s the health risks associated with meat. We’ll not linger on this as we’ve talked about it before, but for example:
- Processed Meat Consumption and the Risk of Cancer: A Critical Evaluation of the Constraints of Current Evidence from Epidemiological Studies
- Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities?
- Health Risks Associated with Meat Consumption: A Review of Epidemiological Studies
- Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality
- Meat consumption: Which are the current global risks? A review of recent (2010-2020) evidences
If we avoid processed and/or red meat, that’s good enough: True or False?
True… Ish.
Really this one depends on one’s criteria for “good enough”. The above-linked studies, and plenty more like them, give the following broad picture:
- Red and/or processed meats are unequivocally terrible for the health in general
- Other mammalian meats, such as from pigs, are really not much better
- Poultry, on the other hand, the science is less clear on; the results are mixed, and thus so are the conclusions. The results are often barely statistically significant. In other words, when it comes to poultry, in the matter of health, the general consensus is that you can take it or leave it and will be fine. Some studies have found firmly for or against it, but the consensus is a collective scientific shrug.
- Fish, meanwhile, has almost universally been found to be healthful in moderation. You may have other reasons for wanting to avoid it (ethics, environmentalism, personal taste) but those things are beyond the scope of this article.
Some or all of us may need small amounts of animal products: True or False?
True! With nuances.
Let’s divide this into “some” and “all”. Firstly, some people may have health conditions and/or other mitigating circumstances that make an entirely plant-based diet untenable.
We’re going light on quotations from subscriber comments today because otherwise this article will get a bit long, but here’s a great example that’s worth quoting, from a subscriber who voted for this option:
❝I have a rare genetic disease called hereditary fructose intolerance. It means I lack the enzyme, Aldolase B, to process fructose. Eating fruits and veggies thus gives me severe hypoglycemia. I also have anemia caused by two autoimmune diseases, so I have to eat meat for the iron it supplies. I also supplement with iron pills but the pills alone can’t fix the problem entirely.❞
And, there’s the thing. Popular vegan talking-points are very good at saying “if you have this problem, this will address it; if you have that problem, that will address it”, etc. For every health-related objection to a fully plant-based diet there’s a refutation… Individually.
But actual real-world health doesn’t work like that; co-morbidities are very common, and in some cases, like our subscriber above, one problem undermines the solution to another. Add a third problem and by now you really just have to do what you need to do to survive.
For this reason, even the Vegan Society’s definition of veganism includes the clause “so far as is possible and practicable”.
Now, as for the rest of us “all”.
What if we’re really healthy and are living in optimal circumstances (easy access to a wide variety of choice of food), can we live healthily and happily just on plants?
No—on a technicality.
Vegans famously need to supplement vitamin B12, which is not found in plants. Ironically, much of the B12 in animal products comes from the animals themselves being given supplements, but that’s another matter. However, B12 can also be enjoyed from yeast. Popular options include the use of yeast extract (e.g. Marmite) and/or nutritional yeast in cooking.
Yeast is a single-celled microorganism that’s taxonomically classified as a fungus, even though in many ways it behaves like an animal (which series of words may conjure an amusing image, but we mean, biologically speaking).
However, it’s also not technically a plant, hence the “No—on a technicality”
Bottom line:
By nature, humans are quite versatile generalists when it comes to diet:
- Most of us can live healthily and happily on just plants if we so choose.
- Some people cannot, and will require varying kinds (and quantities) of animal products.
- As for red and/or processed meats, we’re not the boss of you, but from a health perspective, the science is clear: unless you have a circumstance that really necessitates it, just don’t.
- Same goes for pork, which isn’t red and may not be processed, but metabolically it’s associated with the same problems.
- The jury is out on poultry, but it strongly appears to be optional, healthwise, without making much of a difference either way
- Fish is roundly considered healthful in moderation. Enjoy it if you want, don’t if you don’t.
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Stop Sabotaging Your Gut
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This is Dr. Robynne Chutkan. She’s an integrative gastroenterologist, and founder of the Digestive Center for Wellness, in Washington DC, which for the past 20 years has been dedicated to uncovering the root causes of gastrointestinal disorders, while the therapeutic side of things has been focused on microbial optimization, nutritional therapy, mind-body techniques, and lifestyle changes.
In other words, maximal health for minimal medicalization.
So… What does she want us to know?
Live dirty
While attentive handwashing is important to avoid the spread of communicable diseases*, excessive cleanliness in general can result in an immune system that has no idea how to deal with pathogens when exposure does finally occur.
*See also: The Truth About Handwashing
This goes doubly for babies: especially those who were born by c-section and thus missed out on getting colonized by vaginal bacteria, and especially those who are not breast-fed, and thus miss out on nutrients given in breast milk that are made solely for the benefit of certain symbiotic bacteria (humans can’t even digest those particular nutrients, we literally evolved to produce some nutrients solely for the bacteria).
See also: Breast Milk’s Benefits That Are (So Far) Not Replicable
However, it still goes for the rest of us who are not babies, too. We could, Dr. Chutkan tells us, stand to wash less in general, and definitely ease up on antibacterial soaps and so forth.
See also: Should You Shower Daily?
Take antibiotics only if absolutely necessary (and avoid taking them by proxy)
Dr. Chutkan describes antibiotics as the single biggest threat to our microbiome, not just because of overprescription, but also the antibiotics that are used in animal agriculture and thus enter the food chain (and thus, enter us, if we eat animal products).
Still, while the antibiotics meat/dairy-enjoyers will get from food are better avoided, antibiotics actually taken directly are even worse, and are absolutely a “scorched earth” tactic against whatever they’re being prescribed for.
See also: Antibiotics? Think Thrice ← which also brings up “Four Ways Antibiotics Can Kill You”; seriously, the risks of antibiotics are not to be underestimated, including the risks associated only with them working exactly as intended—let alone if something goes wrong.
Probiotics won’t save you
While like any gastroenterologist (or really, almost any person in general), she notes that probiotics can give a boost to health. However, she wants us to know about two shortcomings that are little-discussed:
1) Your body has a collection of microbiomes each with their own needs, and while it is possible to take “generally good” bacteria in probiotics and assume they’ll do good, taking Lactobacillus sp. will do nothing for a shortage of Bifidobacteria sp, and even taking the correct genus can have similar shortcomings if a different species of that genus is needed, e.g. taking L. acidophilus will do nothing for a shortage of L. reuteri.
It’d be like a person with a vitamin D deficiency taking vitamin B12 supplements and wondering why they’re not getting better.
2) Probiotics are often wasted if not taken mindfully of their recipient environment. For example, most gut bacteria only live for about 20 minutes in the gut. They’re usually inactive in the supplement form, they’re activated in the presence of heat and moisture and appropriate pH etc, and then the clock is ticking for them to thrive or die.
This means that if you take a supplement offering two billion strains of good gut bacteria, and you take it on an empty stomach, then congratulations, 20 minutes later, they’re mostly dead, because they had nothing to eat. Or if you take it after drinking a soda, congratulations, they’re mostly dead because not only were they starved, but also their competing “bad” microbes weren’t starved and changed the environment to make it worse for the “good” ones.
For this reason, taking probiotics with (or immediately after) plenty of fiber is best.
This is all accentuated if you’re recovering from using antibiotics, by the way.
Imagine: a nuclear war devastates the population of the Earth. Some astronauts manage to safely return, finding a mostly-dead world covered in nuclear winter. Is the addition of a few astronauts going to quickly repopulate the world? No, of course not. They are few, the death toll is many, and the environment is very hostile to life. A hundred years later, the population will be pretty much the same—a few straggling survivors.
It’s the same after taking antibiotics, just, generations pass in minutes instead of decades. You can’t wipe out almost everything beneficial in the gut, create a hostile environment there, throw in a couple of probiotic gummies, and expect the population to bounce back.
That said, although “probiotics will not save you”, they can help provided you give them a nice soft bed of fiber to land on, some is better than none, and guessing at what strains are needed is better than giving nothing.
See also: How Much Difference Do Probiotic Supplements Make, Really?
What she recommends
So to recap, we’ve had:
- Wash less, and/or with less harsh chemicals
- Avoid antibiotics like the plague, unless you literally have The Plague, for which the treatment is indeed antibiotics
- Avoid antibiotic-contaminated foods, which in the US is pretty much all animal products unless it’s, for example, your own back-yard hens whom you did not give antibiotics. Do not fall for greenwashing aesthetics in the packaging of “happy cows” and their beef, milk, etc, “happy hens” and their meat, eggs, etc… If it doesn’t explicitly claim to be free from the use of antibiotics, then antibiotics were almost certainly used.
- Dr. Chutkan herself is not even vegan, by the way, but very much wants us to be able to make informed choices about this, and does recommend at least a “plants-forward” diet, for the avoiding-antibiotics reason and for the plenty-of-fiber reason, amongst others.
- Consider probiotics, but don’t expect them to work miracles by themselves; you’ve got to help them to help you.
- Dr. Chutkan also recommends getting microbiome tests done if you think something might be amiss, and then you can supplement with probiotics in a more targetted fashion instead of guessing at what species is needed where.
She also recommends, of course, a good gut-healthy diet in general, especially “leafy green things that were recently alive; not powders”, beans, and nuts, while avoiding gut-unhealthy things such as sugars-without-fiber, alcohol, or some gut-harmful additives (such as most artificial sweeteners, although stevia is a gut-healthy exception, and sucralose is ok in moderation).
For more on gut-healthy eating, check out:
Make Friends With Your Gut (You Can Thank Us Later)
Want to know more from Dr. Chutkan?
We recently reviewed an excellent book of hers:
The Anti-Viral Gut: Tackling Pathogens From The Inside Out – by Dr. Robynne Chutkan
Enjoy!
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Low-Dose Aspirin & Anemia
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We recently wrote about…
How To Survive A Heart Attack When You’re Alone
…and one of the items was “if you have aspirin readily available, then after calling an ambulance is the time to take it—but don’t exert yourself trying to find some”.
But what of aspirin as a preventative?
Many people take low-dose aspirin daily as a way to reduce the risk of atherothrombosis specifically (and thus, indirectly, they hope to reduce the risk of heart attacks).
The science of how helpful this is both clear and complicated—that is to say, the stats are not ambiguous*, but there are complicating factors of which many people are unaware.
*it will reduce the overall risk of cardiovascular events, but will not affect CVD mortality; in other words, it may improve your recovery from minor cardiac events, but is not likely to save you from major ones.
And also, it has unwanted side effects that can constitute a more relevant threat for many people. We’ll share more on that at the end of today’s article, but first…
A newly identified threat from daily aspirin use
A large (n=313,508) study of older adults (median age 73) were sorted into those who used low-dose aspirin as a preventative, and those who did not.
The primary outcome was incidence of anemia sufficient to require treatment, and the secondary outcome was major bleeding. And, at least 1 in 5 of those who experienced anemia also experienced bleeding.
The bleeding issue was not “newly identified” and will not surprise many people; after all, the very reason that aspirin is taken as a CVD preventative is for its anti-clotting property of allowing blood to flow more freely.
The anemia, however, has been getting increasing scientific scrutiny lately, after long going unnoticed in the wild. Given that anemia also gives the symptom “dizziness”, this is also a significant threat for increasing the incidence of falls in the older population, too, which can of course lead to serious complications and ultimately death.
Here’s the paper itself:
Want to know more?
As promised, here’s what we wrote previously about some of aspirin’s other risks:
Aspirin, CVD Risk, & Potential Counter-Risks
Take care!
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