What Cannabis Does For Your Sleep (& Your Mornings)
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Many people use cannabis to help them sleep (indeed, it’s even sometimes prescribed for some sleep disorders), and we’ve written about that here: Sweet Dreams Are Made of THC (Or Are They?)
The short version is that it works to improve sleep in general, at the cost of reducing your REM sleep specifically, which has pros and cons (pro: no nightmares, in people for whom that was a problem keeping them from restful sleep; con: we do need sufficient REM sleep in order to function normally, including storing and organizing memories)
See also: The Strange Things That THC Does To Memory
However, now another interesting association has been found:
Cannabis & Cortisol
Cortisol has a bad reputation these days, as it gets blamed for a lot of ills; sometimes fairly, sometimes less so.
When it’s a problem: cortisol becomes a problem when it’s chronically elevated. This means our body is in high-stress mode at all times, and it’s the biological equivalent of driving your car in the wrong gear (alarming experience and also it’ll damage your car).
When it’s usually not a problem: cortisol is supposed to spike sometimes. One of the times it’s supposed to spike is when we wake up; this is called the “cortisol awakening response“, or “CAR”, and it’s part of what gets us ready for the day’s action, instead of remaining groggy and sleepy all morning.
Researchers (Dr. Anita Cservenka et al.) examined whether frequent cannabis use is associated with changes in the body’s stress-response system, particularly the hypothalamic-pituitary-adrenal (HPA) axis, and did this by means of a sleep (or rather, waking) study.
How they did this: the study (n=82) included 39 frequent cannabis users and 43 healthy controls. Participants collected saliva samples when they woke up, and then 30 minutes later, and then in the evening on consecutive weekdays, while also reporting their subjective stress levels.
The results, in a nutshell:
- Morning cortisol: frequent cannabis users had significantly higher cortisol levels immediately upon awakening than non-users (p=0.047).
- Cortisol awakening response (CAR): despite the higher starting cortisol level, the increase in cortisol during the first 30 minutes after waking was not significantly different between cannabis users and non-users (p=0.23).
- Stress and cortisol: among participants, higher subjective stress was associated with higher cortisol levels at awakening (p=0.001).
- Cannabis-related consequences: higher awakening cortisol in frequent cannabis users was significantly associated with greater consequences related to cannabis use (p=0.007).
How to read those p-values: it’s a way of expressing what the probability was of getting that result by chance. So p=1 would mean “this is a pre-determined guaranteed result”, p=0 would mean “this is a pre-determined impossible result”, and p=0.5 would mean “this result had a 50:50 chance of happening by chance”. In science, a result is generally considered statistically significant if p<0.05. So those in the bullet points are all statistically significant, some of them exceedingly so, apart from the CAR one (where p=0.23).
You can read the paper in full, here: Subjective Stress and Diurnal Salivary Cortisol in Adults with Frequent Cannabis Use
What this means in practical terms: while many might expect that cannabis use would lead to slower, groggier mornings much like alcohol does (just without the hangover), the reality seems to be the opposite.
Superficially, this could even have been interpreted as a benefit, if it weren’t for those “cannabis-related consequences” which, to be clear, were not good consequences. You can read about them on page 4 of the above-linked paper.
Want to try for the benefits without the downsides?
It’s worth bearing in mind that CBD alone (without THC) does seem to improve sleep, and has additional possible benefits too:
CBD Oil: What Does The Science Say?
Take care!
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Finding Peace at the End of Life – by Henry Fersko-Weiss
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This is not the most cheery book we’ve reviewed, but it is an important one. From its first chapter, with “a tale of two deaths”, one that went as well as can be reasonably expected, and the other one not so much, it presents a lot of choices.
The book is not prescriptive in its advice regarding how to deal with these choices, but rather, investigative. It’s thought-provoking, and asks questions—tacitly and overtly.
While the subtitle says “for families and caregivers”, it’s as much worth when it comes to managing one’s own mortality, too, by the way.
As for the scope of the book, it covers everything from terminal diagnosis, through the last part of life, to the death itself, to all that goes on shortly afterwards.
Stylewise, it’s… We’d call it “easy-reading” for style, but obviously the content is very heavy, so you might want to read it a bit at a time anyway, depending on how sensitive to such topics you are.
Bottom line: this book is not exactly a fun read, but it’s a very worthwhile one, and a good way to avoid regrets later.
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What is Ryeqo, the recently approved medicine for endometriosis?
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For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.
A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.
Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.
What does Ryeqo do?
Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.
Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.
Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.
All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.
Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).
Is it really new?
The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.
But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.
Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.
In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.
The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.
You can’t take the contraceptive pill with Ryeqo but the endometriosis drug could replace it.
ShutterstockHow to take it and what not to do
Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.
It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.
Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.
Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.
The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.
It’s costly for now
Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.
While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.
Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Flossing Without Flossing?
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Flossing Without Flossing?
You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.
There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.
The first part was: Toothpastes & Mouthwashes: Which Help And Which Harm?
How important is flossing?
Interdental cleaning is indeed pretty important, even though it may not have the heart health benefits that have been widely advertised:
However! The health of our gums is very important in and of itself, especially as we get older:
Flossing Is Associated with Improved Oral Health in Older Adults
But! It helps to avoid periodontal (e.g. gum) disease, not dental caries:
Flossing for the management of periodontal diseases and dental caries in adults
And! Most certainly it can help avoid a stack of other diseases:
Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence
…so in short, if you’d like to have happy healthy teeth and gums, flossing is an important adjunct, and/but not a one-stop panacea.
Is it better to floss before or after brushing?
As you prefer. A team of scientists led by Dr. Claudia Silva studied this, and found that there was “no statistical difference between brush-floss and floss-brush”:
Flossing is tedious. How do we floss without flossing?
This is (mostly) about water-flossing! Which does for old-style floss what sonic toothbrushes to for old-style manual toothbrushes.
If you’re unfamiliar, it means using a device that basically power-washes your teeth, but with a very narrow high-pressure jet of water.
Do they work? Yes:
As for how it stacks up against traditional flossing, Liang et al. found:
❝In our previous single-outcome analysis, we concluded that interdental brushes and water jet devices rank highest for reducing gingival inflammation while toothpick and flossing rank last.
In this multioutcome Bayesian network meta-analysis with equal weight on gingival inflammation and bleeding-on-probing, the surface under the cumulative ranking curve was 0.87 for water jet devices and 0.85 for interdental brushes.
Water jet devices and interdental brushes remained the two best devices across different sets of weightings for the gingival inflammation and bleeding-on-probing. ❞
~ Journal of Evidence-Based Dental Practice
You may be wondering how safe it is if you have had dental work done, and, it appears to be quite safe, for example:
BDJ | Water-jet flossing: effect on composites
Want to try water-flossing?
Here are some examples on Amazon:
- Waterpik Complete Care 9.0 ← example of a top-end water-flossing device
- Philips Sonicare Power Flosser 3000 ← top-tier not-Waterpik-brand device
- INSMART Cordless Water Dental Flosser ← very low price and still average 4.5 star reviews, so in our opinion, a fine first choice
Bonus: if you haven’t tried interdental brushes, here’s an example for that
Enjoy!
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Reduce Your Stroke Risk
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❝Each year in the U.S., over half a million people have a first stroke; however, up to 80% of strokes may be preventable.❞
~ American Stroke Association
Source: New guideline: Preventing a first stroke may be possible with screening, lifestyle changes
So, what should we do?
Some of the risk factors are unavoidable or not usefully avoidable, like genetic predispositions and old age, respectively (i.e. it is possible to avoid old age—by dying young, which is not a good approach).
Some of the risk factors are avoidable. Let’s look at the most obvious first:
You cannot drink to your good health
While overall, the World Health Organization has declared that “the only safe amount of alcohol is zero”, when it comes to stroke risk specifically, it seems that low consumption is not associated with stroke, while moderate to high consumption is associated with a commensurately increased risk of stroke:
Alcohol Intake as a Risk Factor for Acute Stroke
Note: there are some studies out there that say that a low to moderate consumption may decrease the risk compared to zero consumption. However, any such study that this writer has seen has had the methodological flaw of not addressing why those who do not drink alcohol, do not drink it. In many cases, someone who drinks no alcohol at all does so because either a) it would cause problems with some medication(s) they are taking, or b) they used to drink heavily, and quit. In either case, their reasons for not drinking alcohol may themselves be reasons for an increased stroke risk—not the lack of alcohol itself.
Smoke now = stroke later
This one is straightforward; smoking is bad for pretty much everything, and that includes stroke risk, as it’s bad for your heart and brain both, increasing stroke risk by 200–400%:
Smoking and stroke: the more you smoke the more you stroke
So, the advice here of course is: don’t smoke
Diet matters
The American Stroke Association’s guidelines recommend, just for a change, the Mediterranean Diet. This does not mean just whatever is eaten in the Mediterranean region though, and there are specifically foods that are included and excluded, and the ratios matter, so here’s a run-down of what the Mediterranean Diet does and doesn’t include:
The Mediterranean Diet: What Is It Good For? ← what isn’t it good for?!
You can outrun stroke
Or out-walk it; that’s fine too. Most important here is frequency of exercise, more than intensity. So basically, getting those 150 minutes moderate exercise per week as a minimum.
See also: The Doctor Who Wants Us To Exercise Less & Move More
Which is good, because it means we can get a lot of exercise in that doesn’t feel like “having to do” exercise, for example:
Do You Love To Go To The Gym? No? Enjoy These “No-Exercise Exercises”!
Your brain needs downtime too
Your brain (and your heart) both need you to get good regular sleep:
Sleep Disorders in Stroke: An Update on Management
We sometimes say that “what’s good for your heart is good for your brain” (because the heart feeds the brain, and also ultimately clears away detritus), and that’s true here too, so we might also want to prioritize sleep regularity over other factors, even over duration:
How Regularity Of Sleep Can Be Even More Important Than Duration ← this is about adverse cardiovascular events, including ischemic stroke
Keep on top of your blood pressure
High blood pressure is a very modifiable risk factor for stroke. Taking care of the above things will generally take care of this, especially the DASH variation of the Mediterranean diet:
Hypertension: Factors Far More Relevant Than Salt
However, it’s still important to actually check your blood pressure regularly, because sometimes an unexpected extra factor can pop up for no obvious reason. As a bonus, you can do this improved version of the usual blood pressure test, still using just a blood pressure cuff:
Try This At Home: ABI Test For Clogged Arteries
Consider GLP-1 receptor agonists (or…)
GLP-1 receptor agonists (like Ozempic et al.) seem to have cardioprotective and neuroprotective (thus: anti-stroke) activity independent of their weight loss benefits:
Of course, GLP-1 RAs aren’t everyone’s cup of tea, and they do have their downsides (including availability, cost, and the fact benefits reverse themselves if you stop taking them), so if you want a similar effect from a natural approach, there are some foods that work on the body’s incretin responses in the same way as GLP-1 RAs do:
5 Foods That Naturally Mimic The “Ozempic Effect”
Better to know sooner rather than too late
Rather than waiting until one half of our face is drooping to know that there was a stroke risk, here are things to watch out for to know about it before it’s too late:
6 Signs Of Stroke (One Month In Advance)
Take care!
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Eat to Live – by Dr. Joel Fuhrman
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It sure would be great if we could eat all that we wanted, and remain healthy without putting on weight.
That’s the main intent of Dr. Joel Fuhrman’s book, with some caveats:
- His diet plan gives unlimited amounts of some foods, while restricting others
- With a focus on nutrient density, he puts beans and legumes into the “eat as much as you want” category, and grains (including whole grains) into the “restrict” category
This latter is understandable for a weight-loss diet (as the book’s subtitle promises). The question then is: will it be sustainable?
Current scientific consensus holds for “whole grains are good and an important part of diet”. It does seem fair that beans and legumes should be able to replace grains, for grains’ carbohydrates and fiber.
However, now comes the double-edged aspect: beans and legumes contain more protein than grains. So, we’ll feel fuller sooner, and stay fuller for longer. This means we’ll probably lose weight, and keep losing weight. Or at least: losing fat. Muscle mass will stay or go depending on what you’re doing with your muscles.
If you want to keep your body fat percentage at a certain level and not go below it, you may well need to reintroduce grains to your diet, which isn’t something that Dr. Fuhrman covers in this book.
Bottom line: this is a good, science-based approach for healthily losing weight (specifically, fat) and keeping it off. It might be a little too good at this for some people though.
Click here to check out Eat To Live and decide what point you want to stop losing weight at!
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Finally! Chronic Fatigue Syndrome Biomarkers Identified
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And other items from this week’s health news:
Good news for Chronic Fatigue Syndrome sufferers
Historically considered a syndrome that has no observable signs (only symptoms reported by the sufferer), chronic fatigue syndrome (CFS) now has some biomarkers identified, achieving 90% diagnostic accuracy—offering objective proof for a disease often dismissed due to a lack of lab evidence.
How it was done: researchers (Dr. Julia Oh et al.) showed how the gut microbiome, immune cells, and metabolites correlate with symptoms like fatigue, pain, and sleep disturbances. ME/CFS patients had reduced butyrate (a gut-beneficial fatty acid), elevated tryptophan and benzoate (indicators of microbial imbalance), and increased inflammatory responses, especially in cells linked to gut health. In terms of which parts did what, immune cell data best predicted overall symptom severity, while gut microbiome data correlated most with gastrointestinal, emotional, and sleep-related symptoms. Meanwhile, symptoms like dizziness, sleep disturbances, and headaches were linked directly to disruptions in gut-immune-metabolic networks, offering a systems-level disease view.
In other words, a lot of data.
It was also worthy of note that biological disruptions were less extensive in patients ill for under four years compared to those ill over a decade, implying worsening dysregulation over time.
Which makes it all the more important that we now have ways to categorically identify and thus usefully diagnose it:
Read in full: Previously undetectable biomarkers in gut microbiome may predict “invisible” chronic fatigue syndrome, long COVID
Related: How To Be 7.5x More Likely To Develop Chronic Fatigue Syndrome
Texas is taking the lead!
But not in good ways, unfortunately. This time it’s not about measles, though, and rather is about STI rates, especially on a county level. For example, Dallas county ranked 7th (in the US), with 1,314.5 STI cases per 100,000 people.
You might be wondering what STIs specifically, and: chlamydia and gonorrhea dominate case numbers, but syphilis and HIV are steadily rising, particularly in urban areas.
The report identified the following factors as being the main reasons the rates are rising so much:
- inadequate sex education
- limited access to affordable care and regular testing
- high infection rates among youth lacking primary care
- stigma and misinformation
- racial and economic disparities (impacting accessibility of testing and treatment)
In Texas, people aged 15–29 represent the largest portion of new infections, but before you write that off as “young people nowadays” who cannot contain their hormones, note that that’s new infections—the only reason older demographics score lower is because each instance of infection is less likely to be one’s first, the further one goes through life. Overall infection rates (i.e., not just “new infections”) are rising the highest in adults over 50.
Read in full: Texas counties have some of the highest STD rates in US, new report says
Related: Why STIs Are On The Rise In Older Adults
The change
Prostate cancer is one of the major killers of men, the top cancer for men by prevalence, and affects over 60% of men over the age of 60 (with that percentage then rising each year thereafter). Note that this means “if something else doesn’t kill you first, you are more likely to get this than not”.
Prostate cancer is also something where the early stages of it are often described “nothing to worry about for now; let’s keep an eye on it”.
Happily, researchers have now discovered how prostate cancer evolves into its most lethal form, neuroendocrine prostate cancer (NEPC). This was a win for medical AI (while both are called “AI”, this is incredibly different from ChatGPT et al.), and specifically, it was a 3d genome mapping breakthrough; using advanced genomic tools, they created the first 3D map of how prostate cancer cells rewire their DNA structure to enable and promote the aforementioned shift to NEPC.
Some technical bits for those who want it:
- The key proteins involved have been identified: FOXA2 and NKX2-1 drive the transformation by reprogramming the cancer cells; FOXA2 opens inaccessible DNA regions, allowing NKX2-1 to activate NEPC-related genes.
- The role of cbp and p300 enzymes have been identified: these enzymes help activate oncogenes crucial to the NEPC transformation, acting as co-drivers of the aggressive cancer form.
- A potential treatment has been identified: the drug CCS1477, a CBP/p300 inhibitor in clinical trials, successfully halted NEPC tumor growth in lab studies.
The latter is particularly important, as it allows for new treatment avenues for prostate cancers that become resistant to hormone therapy, by preventing or reversing the NEPC transition.
Read in full: Study uncovers how prostate cancer becomes deadly, offers hope for new treatments
Related: Prostate Health: What You Should Know
Take care!
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