Why scrapping the term ‘long COVID’ would be harmful for people with the condition
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The assertion from Queensland’s chief health officer John Gerrard that it’s time to stop using the term “long COVID” has made waves in Australian and international media over recent days.
Gerrard’s comments were related to new research from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.
But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.
A bit about the research
The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease.
Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year.
The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection.
Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.
After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, Steven Faux, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings.
In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.
The authors of the research have acknowledged some of these and other limitations in their study.
Ditching the term ‘long COVID’
Based on the research findings, Gerrard said in a press release:
We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.
But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.
New Africa/Shutterstock
In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He said:
To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.
Another clinician and researcher, Philip Britton, criticised Gerrard’s conclusion about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.
A cruel irony
An ever-growing body of research continues to show how COVID can cause harm to the body across organ systems and cells.
We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study or paid work. It can also harm relationships with their friends, family members, and even their partners.
Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been dismissed or turned away.
Last Friday – the day Gerrard’s comments were made public – was actually International Long COVID Awareness Day, organised by activists to draw attention to the condition.
The response from people with long COVID was immediate. They shared their anger on social media about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.
Since the start of the COVID pandemic, patient communities have fought for recognition of the long-term symptoms many people faced.
The term “long COVID” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through.
The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates the possibilities of patient-led expertise. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are psychosomatic.
Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.
Terminology matters
The words we use to describe illnesses and conditions are incredibly powerful. Naming a new condition is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.
The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable medical journal articles.
Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.
Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cheeky diet soft drink getting you through the work day? Here’s what that may mean for your health
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Many people are drinking less sugary soft drink than in the past. This is a great win for public health, given the recognised risks of diets high in sugar-sweetened drinks.
But over time, intake of diet soft drinks has grown. In fact, it’s so high that these products are now regularly detected in wastewater.
So what does the research say about how your health is affected in the long term if you drink them often?
Breakingpic/Pexels What makes diet soft drinks sweet?
The World Health Organization (WHO) advises people “reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (six teaspoons) per day would provide additional health benefits.”
But most regular soft drinks contain a lot of sugar. A regular 335 millilitre can of original Coca-Cola contains at least seven teaspoons of added sugar.
Diet soft drinks are designed to taste similar to regular soft drinks but without the sugar. Instead of sugar, diet soft drinks contain artificial or natural sweeteners. The artificial sweeteners include aspartame, saccharin and sucralose. The natural sweeteners include stevia and monk fruit extract, which come from plant sources.
Many artificial sweeteners are much sweeter than sugar so less is needed to provide the same burst of sweetness.
Diet soft drinks are marketed as healthier alternatives to regular soft drinks, particularly for people who want to reduce their sugar intake or manage their weight.
But while surveys of Australian adults and adolescents show most people understand the benefits of reducing their sugar intake, they often aren’t as aware about how diet drinks may affect health more broadly.
Diet soft drinks contain artificial or natural sweeteners. Vintage Tone/Shutterstock What does the research say about aspartame?
The artificial sweeteners in soft drinks are considered safe for consumption by food authorities, including in the US and Australia. However, some researchers have raised concern about the long-term risks of consumption.
People who drink diet soft drinks regularly and often are more likely to develop certain metabolic conditions (such as diabetes and heart disease) than those who don’t drink diet soft drinks.
The link was found even after accounting for other dietary and lifestyle factors (such as physical activity).
In 2023, the WHO announced reports had found aspartame – the main sweetener used in diet soft drinks – was “possibly carcinogenic to humans” (carcinogenic means cancer-causing).
Importantly though, the report noted there is not enough current scientific evidence to be truly confident aspartame may increase the risk of cancer and emphasised it’s safe to consume occasionally.
Will diet soft drinks help manage weight?
Despite the word “diet” in the name, diet soft drinks are not strongly linked with weight management.
In 2022, the WHO conducted a systematic review (where researchers look at all available evidence on a topic) on whether the use of artificial sweeteners is beneficial for weight management.
Overall, the randomised controlled trials they looked at suggested slightly more weight loss in people who used artificial sweeteners.
But the observational studies (where no intervention occurs and participants are monitored over time) found people who consume high amounts of artificial sweeteners tended to have an increased risk of higher body mass index and a 76% increased likelihood of having obesity.
In other words, artificial sweeteners may not directly help manage weight over the long term. This resulted in the WHO advising artificial sweeteners should not be used to manage weight.
Studies in animals have suggested consuming high levels of artificial sweeteners can signal to the brain it is being starved of fuel, which can lead to more eating. However, the evidence for this happening in humans is still unproven.
You can’t go wrong with water. hurricanehank/Shutterstock What about inflammation and dental issues?
There is some early evidence artificial sweeteners may irritate the lining of the digestive system, causing inflammation and increasing the likelihood of diarrhoea, constipation, bloating and other symptoms often associated with irritable bowel syndrome. However, this study noted more research is needed.
High amounts of diet soft drinks have also been linked with liver disease, which is based on inflammation.
The consumption of diet soft drinks is also associated with dental erosion.
Many soft drinks contain phosphoric and citric acid, which can damage your tooth enamel and contribute to dental erosion.
Moderation is key
As with many aspects of nutrition, moderation is key with diet soft drinks.
Drinking diet soft drinks occasionally is unlikely to harm your health, but frequent or excessive intake may increase health risks in the longer term.
Plain water, infused water, sparkling water, herbal teas or milks remain the best options for hydration.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Gluten: What’s The Truth?
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Gluten: What’s The Truth?
We asked you for your health-related view of gluten, and got the above spread of results. To put it simply:
Around 60% of voters voted for “Gluten is bad if you have an allergy/sensitivity; otherwise fine”
The rest of the votes were split fairly evenly between the other three options:
- Gluten is bad for everyone and we should avoid it
- Gluten is bad if (and only if) you have Celiac disease
- Gluten is fine for all, and going gluten-free is a modern fad
First, let’s define some terms so that we’re all on the same page:
What is gluten?
Gluten is a category of protein found in wheat, barley, rye, and triticale. As such, it’s not one single compound, but a little umbrella of similar compounds. However, for the sake of not making this article many times longer, we’re going to refer to “gluten” without further specification.
What is Celiac disease?
Celiac disease is an autoimmune disease. Like many autoimmune diseases, we don’t know for sure how/why it occurs, but a combination of genetic and environmental factors have been strongly implicated, with the latter putatively including overexposure to gluten.
It affects about 1% of the world’s population, and people with Celiac disease will tend to respond adversely to gluten, notably by inflammation of the small intestine and destruction of enterocytes (the cells that line the wall of the small intestine). This in turn causes all sorts of other problems, beyond the scope of today’s main feature, but suffice it to say, it’s not pleasant.
What is an allergy/intolerance/sensitivity?
This may seem basic, but a lot of people conflate allergy/intolerance/sensitivity, so:
- An allergy is when the body mistakes a harmless substance for something harmful, and responds inappropriately. This can be mild (e.g. allergic rhinitis, hayfever) or severe (e.g. peanut allergy), and as such, responses can vary from “sniffly nose” to “anaphylactic shock and death”.
- In the case of a wheat allergy (for example), this is usually somewhere between the two, and can for example cause breathing problems after ingesting wheat or inhaling wheat flour.
- An intolerance is when the body fails to correctly process something it should be able to process, and just ejects it half-processed instead.
- A common and easily demonstrable example is lactose intolerance. There isn’t a well-defined analog for gluten, but gluten intolerance is nonetheless a well-reported thing.
- A sensitivity is when none of the above apply, but the body nevertheless experiences unpleasant symptoms after exposure to a substance that should normally be safe.
- In the case of gluten, this is referred to as non-Celiac gluten sensitivity
A word on scientific objectivity: at 10almonds we try to report science as objectively as possible. Sometimes people have strong feelings on a topic, especially if it is polarizing.
Sometimes people with a certain condition feel constantly disbelieved and mocked; sometimes people without a certain condition think others are imagining problems for themselves where there are none.
We can’t diagnose anyone or validate either side of that, but what we can do is report the facts as objectively as science can lay them out.
Gluten is fine for all, and going gluten-free is a modern fad: True or False?
Definitely False, Celiac disease is a real autoimmune disease that cannot be faked, and allergies are also a real thing that people can have, and again can be validated in studies. Even intolerances have scientifically measurable symptoms and can be tested against nocebo.
See for example:
- Epidemiology and clinical presentations of Celiac disease
- Severe forms of food allergy that can precipitate allergic emergencies
- Properties of gluten intolerance: gluten structure, evolution, and pathogenicity
However! It may not be a modern fad, so much as a modern genuine increase in incidence.
Widespread varieties of wheat today contain a lot more gluten than wheat of ages past, and many other molecular changes mean there are other compounds in modern grains that never even existed before.
However, the health-related impact of these (novel proteins and carbohydrates) is currently still speculative, and we are not in the business of speculating, so we’ll leave that as a “this hasn’t been studied enough to comment yet but we recognize it could potentially be a thing” factor.
Gluten is bad if (and only if) you have Celiac disease: True or False?
Definitely False; allergies for example are well-evidenced as real; same facts as we discussed/linked just above.
Gluten is bad for everyone and we should avoid it: True or False?
False, tentatively and contingently.
First, as established, there are people with clinically-evidenced Celiac disease, wheat allergy, or similar. Obviously, they should avoid triggering those diseases.
What about the rest of us, and what about those who have non-Celiac gluten sensitivity?
Clinical testing has found that of those reporting non-Celiac gluten sensitivity, nocebo-controlled studies validate that diagnosis in only a minority of cases.
In the following study, for example, only 16% of those reporting symptoms showed them in the trials, and 40% of those also showed a nocebo response (i.e., like placebo, but a bad rather than good effect):
This one, on the other hand, found that positive validations of diagnoses were found to be between 7% and 77%, depending on the trial, with an average of 30%:
Re-challenge Studies in Non-celiac Gluten Sensitivity: A Systematic Review and Meta-Analysis
In other words: non-Celiac gluten sensitivity is a thing, and/but may be over-reported, and/but may be in some part exacerbated by psychosomatic effect.
Note: psychosomatic effect does not mean “imagining it” or “all in your head”. Indeed, the “soma” part of the word “psychosomatic” has to do with its measurable effect on the rest of the body.
For example, while pain can’t be easily objectively measured, other things, like inflammation, definitely can.
As for everyone else? If you’re enjoying your wheat (or similar) products, it’s well-established that they should be wholegrain for the best health impact (fiber, a positive for your health, rather than white flour’s super-fast metabolites padding the liver and causing metabolic problems).
Wheat itself may have other problems, for example FODMAPs, amylase trypsin inhibitors, and wheat germ agglutinins, but that’s “a wheat thing” rather than “a gluten thing”.
That’s beyond the scope of today’s main feature, but you might want to check out today’s featured book!
For a final scientific opinion on this last one, though, here’s what a respected academic journal of gastroenterology has to say:
From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten-free?
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The Coffee-Cortisol Connection, And Two Ways To Tweak It For Health
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Health opinions on coffee vary from “it’s an invigorating, healthful drink” to “it will leave you a shaking frazzled wreck”. So, what’s the truth and can we enjoy it healthily? Dr. Alan Mandell weighs in:
Enjoy it, but watch out!
Dr. Mandell is speaking only for caffeinated coffee in this video, and to this end, he’s conflating the health effects of coffee and caffeine. A statistically reasonable imprecision, since most people drink coffee with its natural caffeine in, but we’ll make some adjustment to his comments below, to disambiguate which statements are true for coffee generally, and which are true for caffeine:
- Drinking
coffeecaffeine first thing in the morning may not be ideal due to dehydration from overnight water loss. Coffeecaffeine is a diuretic, which means an increase in urination, thus further dehydrating the body.- Coffee contains great antioxidants, which are of course beneficial for the health in general.
- Cortisol, the body’s stress hormone, is generally at its peak in the morning. This is, in and of itself, good and correct—it’s how we wake up.
Coffeecaffeine consumption raises cortisol levels even more, leading to increased alertness and physical readiness, but it is possible to have too much of a good thing, and in this case, problems can arise because…- Elevated cortisol from early
coffeecaffeine drinking can build tolerance, leading to the need for morecoffeecaffeine over time. - It’s better, therefore, to defer drinking
coffeecaffeine until later in the morning when cortisol levels naturally drop. - All of this means that drinking
coffeecaffeine first thing can disrupt the neuroendocrine system, leading to fatigue, depression, and general woe. - Hydrate first thing in the morning before consuming
coffeecaffeine to keep the body balanced and healthy.
What you can see from this is that coffee and caffeine are not, in fact, interchangeable words, but the basic message is clear and correct: while a little spike of cortisol in the morning is good, natural, and even necessary, a big spike is none of those things, and caffeine can cause a big spike, and since for most people caffeine is easy to build tolerance to, there will indeed consistently be a need for more, worsening the problem.
In terms of hydration, it’s good to have water (or better yet, herbal tea) on one’s nightstand to drink when one wakes up.
If coffee is an important morning ritual for you, consider finding a good decaffeinated version for at least your first cup (this writer is partial to Lavazza’s “Dek Intenso”—which is not the same as their main decaf line, by the way, so do hold out for the “Dek Intenso” if you want to try my recommendation).
Decaffeinated coffee is hydrating and will not cause a cortisol spike (unless for some reason you find coffee as a concept very stressful in which case, yes, the stressor will cause a stress response).
Anyway, for more on all of this, enjoy:
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- Drinking
Why You Can’t Skimp On Amino Acids
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Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize (thus called: “essential”) and absolutely must get from food. Normally, we get these amino acids from protein in our diet, and we can also supplement them by taking amino acid supplements if we wish.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
Why this matters
A lot of attention is given to protein, and making sure we get enough of it, especially as we get older, because the risk of sarcopenia (muscle mass loss) increases with age:
However, not every protein comes with a complete set of essential amino acids, and/or have only trace amounts of of some amino acids, meaning that a dietary deficiency can arrive if one’s diet is too restrictive.
And, if we become deficient in even just one amino acid, then bad things start to happen quite soon. We only have so much space, so we’re going to oversimplify here, but:
- Histidine: is needed to produce histamine (vital for immune responses, amongst other things), and is also important for maintaining the myelin sheaths on nerve cells.
- Isoleucine: is very involved in muscle metabolism and makes up the bulk of muscle tissue.
- Leucine: is critical for muscle synthesis and repair, as well as wound healing in general, and blood sugar regulation.
- Lysine: is also critical in muscle synthesis, as well as calcium absorption and hormone production, as well as making collagen.
- Methionine: is very important for energy metabolism, zinc absorption, and detoxification.
- Phenylalanine: is a necessary building block of a lot of neurotransmitters, as well as being a building block of some amino acids not listed here (i.e., the ones your body synthesizes, but can’t without phenylalanine).
- Threonine: is mostly about collagen and elastin production, and is also very important for your joints, as well as fat metabolism.
- Tryptophan: is the body’s primary precursor to serotonin, so good luck making the latter without the former.
- Valine: is mostly about muscle growth and regeneration.
So there you see, the ill effects of deficiency can range from “muscle atrophy” to “brain stops working” and “bones fall apart” and more. In short, any essential amino acid deficiency not remedied will ultimately result in death; we literally become non-viable as organisms without these 9 things.
What to do about it (the “life hack” part)
Firstly, if you eat a lot of animal products, those are “complete” proteins, meaning that they contain all 9 essential amino acids in sensible quantities. The reason that all animal products have these, is because they are just as essential for the other animals as they are for us, so they, just like us, must consume (and thus contain) them.
However, a lot of animal products come with other health risks:
Do We Need Animal Products To Be Healthy? ← this covers which animal products are definitely very health-risky, and which are probably fine according to current best science
…so many people may prefer to get more (or possibly all) dietary protein from plants.
However, plants, unlike us, do not need to consume all 9 essential amino acids, and this may or may not contain them all.
Soy is famously a “complete” protein insofar as it has all the amino acids we need.
But what if you’re allergic to soy?
Good news! Peas are also a “complete” protein and will do the job just fine. They’re also usually cheaper.
Final note
An oft-forgotten thing is that some other amino acids are “conditionally essential”, meaning that while we can technically synthesize them, sometimes we can’t synthesize enough and must get them from our diet.
The conditions that trigger this “conditionally essential” status are usually such things as fighting a serious illness, recovering from a serious injury, or pregnancy—basically, things where your body has to work at 110% efficiency if it wants to get through it in one piece, and that extra 10% has to come from somewhere outside the body.
Examples of commonly conditionally essential amino acids are arginine and glycine.
Arginine is critical for a lot of cell-signalling processes as well as mitochondrial function, as well as being a precursor to other amino acids, including creatine.
As for glycine?
Check out: The Sweet Truth About Glycine
Enjoy!
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The 5 Resets – by Dr. Aditi Nerurkar
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What this book isn’t: an advice to go on a relaxing meditation retreat, or something like that.
What this is: a science-based guide to what actually works.
There’s no need to be mysterious, so we’ll mention that the titular “5 resets” are:
- What matters most
- Quiet in a noisy world
- Leveraging the brain-body connection
- Coming up for air (regaining perspective)
- Bringing your best self forward
All of these are things we can easily lose sight of in the hustle and bustle of daily life, so having a system for keeping them on track can make a huge difference!
The style is personable and accessible, while providing a lot of strongly science-backed tips and tricks along the way.
Bottom line: if life gets away from you a little too often for comfort, this book can help you keep on top of things with a lot less stress.
Click here to check out “The 5 Resets”, and take control with conscious calm!
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Cashew Nuts vs Coconut – Which is Healthier?
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Our Verdict
When comparing cashew nuts to coconut, we picked the cashews.
Why?
It can be argued this isn’t a fair comparison, as coconuts aren’t true nuts, but it’s at the very least a useful comparison, because they have very similar (often the same) culinary uses, so deciding between one or the other is something people will often do.
In terms of macros, cashews have 6x the protein and more than 2x the fiber, as well as slightly more fat (but the fats are healthy, as are those of coconut, by the way) and 2x the carbs. Depending on what you’re looking for, this head-to-head could come out differently, but we say it’s a win for cashews.
You may be wondering: if cashews have more of all those things, what are coconuts made of? And the answer is that coconuts have 8x the water (and yes, this is counting the coconut meat only, not including the milk inside). Of course, if you get dessicated coconut, then it won’t have that, but we’re comparing fresh to fresh.
In the category of vitamins, cashews have a lot more of vitamins B1, B2, B3, B5, B6, E, and K. Meanwhile, coconut has more vitamin C, but it’s not a lot. An easy win for cashews here.
When it comes to minerals, cashews have rather more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. On the other hand, coconut has more sodium. Another easy win for cashews.
Cashews also have the lower glycemic index.
All in all, cashews win the day.
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