Monday, March 30, 2020
mental health

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

Sexual problems are more common in postmenopausal women, which suggests that menopause can reduce libido.

The reduced sex drive is often caused by decreased estrogen levels, which can dampen arousal and result in sex being more painful.

In this article, we look at how menopause might affect someone’s sex drive, along with what can be done to improve libido.

Menopause and libido

What is menopause?

Menopause refers to when a woman stops having her period permanently, but it can affect more than a woman’s menstrual cycle.

Menopause can cause physical and emotional changes that impact a woman’s life, including her sex life.

Some symptoms and side effects associated with menopause include:

  • anxiety
  • bladder control issues
  • decreased sex drive and desire (libido)
  • depression
  • difficulty sleeping
  • thinning hair
  • weight gain

Each of these effects can impact a woman’s quality of life and relationship with her partner.

What is libido?

Libido refers to sexual interest and sexual enjoyment.

Some women going through menopause report reduced libido, but the causes vary from person to person.

According to one review, the reported rates of sexual problems in postmenopausal women are between 68 and 86.5 percent.

This range is much higher than in all women in general, which is estimated to be between 25 and 63 percent.

Why does menopause affect libido?

Decreased estrogen levels can result in reduced blood flow to the vagina, which can cause the tissues of the vagina and labia to become thinner. If this happens, they become less sensitive to sexual stimulation.

Decreased blood flow also affects vaginal lubrication and overall arousal. As a result, a woman may not enjoy sex as much and may have difficulty achieving orgasm. Sex may be uncomfortable or even painful.

Fluctuating hormone levels during perimenopause and menopause can also affect a woman’s mental health, which in turn, may cause a decrease in her libido.

Stress can also impact a woman’s libido, as she may be juggling a job, parenting, and be caring for aging parents. The changes in hormone levels a woman may experience during menopause may make her irritable or depressed, so dealing with everyday stress may feel more difficult.

According to an article published in the Journal of Women’s Health, women who have more significant side effects associated with menopause are more likely to report lower libido levels.

Examples of these side effects include hot flashes, depression, anxiety, trouble sleeping, and fatigue.

Other factors that make a woman going through menopause more likely to experience a reduced libido include:

  • history of chronic health conditions, such as heart disease, diabetes, or depression
  • history of smoking
  • engaging in low levels of physical activity

A woman should talk to her doctor about how these conditions could affect her sex drive.

Tips for improving libido

There are several steps a woman can take to increase her libido. These include medical treatments, lifestyle changes, and home remedies.

Medical treatments

middle aged couple enjoying a bike ride
Spending time together on shared hobbies, exercising, and planned dates will help increase a couple’s intamacy.

If a woman experiences changes to her vaginal tissue, such as thinning and dryness, she may wish to consider estrogen therapy.

Prescription estrogen can be applied directly to the vagina in the form of creams, pills, or vaginal rings. These usually contain lower doses of estrogen than regular birth control pills.

Some women may wish to take estrogen pills that contain higher levels of hormones. This treatment, known as hormone replacement therapy, might help reduce symptoms, such as hot flashes and mood changes, but may also carry risks.

A woman thinking about hormone replacement therapy should discuss it with her doctor before starting to take any medication.

One study found that women using hormone therapies reported higher levels of sexual desire compared with women who did not.

Less commonly, a doctor may prescribe testosterone therapy. However, not all women respond to this treatment, and the United States Food and Drug Administration (FDA) do not approve it for treating sexual disorders in women.

A woman may not experience any changes in her sex drive after using estrogen or testosterone therapies.

A woman may also choose to see a therapist who specializes in sexual dysfunction or enhancing sex. Sometimes, couples may want to attend therapy together.

Lifestyle changes

Some women may benefit from using water-soluble lubricants during sex. These can be purchased over-the-counter at most drugstores.

However, women should avoid non-water soluble and silicone-based lubricants, as these can break down condoms used to protect against sexually transmitted infections (STIs).

Increasing physical activity, such as getting 30 minutes or more of exercise on a routine basis, may help reduce menopause-related symptoms, including a low libido. Eating a healthful diet can also enhance a person’s overall sense of well being.

Changing sexual habits

There are many ways a person can foster a sense of intimacy with their partner, including:

  • Changing sexual routines: Try spending extended periods on foreplay, use vibrators or other sex toys to enhance an intimate experience, or engage in sexual activity or touching without the goal of orgasm.
  • Relieving stress together: There are many stress-relieving techniques a couple can do outside of the bedroom to increase intimacy. Examples include going on planned dates together, taking a walk, or spending time doing hobbies together, such as exercise, crafts, or cooking.
  • Practicing masturbation: Spending time alone and exploring what types of touch and sexual stimulation work well for an individual can help them talk to a partner about their needs and preferences. It can also help a person feel more comfortable with sexual activity without the pressure of a partner.

Natural remedies

Some women use natural supplements to try to increase their libido. It is important to keep in mind that the FDA do not regulate herbs and supplements, so women should be sure to choose a reputable brand.

Some natural remedies used to increase libido in women include:

  • black cohosh
  • red clover
  • soy

A woman should discuss these remedies with a doctor before taking them to ensure they will not interact negatively with other prescriptions and supplements she may be taking. Soy contains estrogen, so it may react with other estrogen therapies.

When to see a doctor

A woman should speak to her doctor whenever perimenopause or menopause is having a significant impact on her day-to-day activities, including sexual activity.

Sometimes, a doctor can recommend changes in health habits as well as discuss whether prescription medications may help relieve the symptoms, including a low libido.

Speaking with a doctor can also rule out any other underlying medical conditions that may cause a reduced libido. These conditions include urinary tract infections, uterine prolapse, endometriosis, or pelvic floor dysfunction.

Outlook

While some women do experience a decreased libido in menopause, others do not.

Some women may even experience a heightened libido after menopause. This can be due to reduced stresses over pregnancy and fewer child-rearing responsibilities.

If a woman’s libido is impacted after menopause, she should talk to her doctor about treatments that could enhance her quality of life.

A recent review and meta-analysis have investigated whether a plant pigment called quercetin could reduce the risk of cardiovascular disease. In particular, the authors identified that quercetin reduced blood pressure.

Chopped red onion
A compound that occurs naturally in a range of fruits and vegetables, including red onion, may help reduce blood pressure.

Globally, cardiovascular disease is responsible for about 17.3 million deaths each year. As the population’s average age increases, experts expect cardiovascular disease to rise in step.

Researchers have identified a range of lifestyle factors that increase the risk of cardiovascular disease, such as poor diet, low physical activity, smoking, and consuming alcohol. Certain biological markers, including high blood pressure, raised serum lipids, and high blood glucose levels, also predict cardiovascular disease.

Although lifestyle and medical interventions benefit most individuals, they do not work for everyone. For this reason, some researchers are focused on identifying novel ways to reduce cardiovascular risk.

Introducing quercetin

Researchers from Dongguan Shilong People’s Hospital of Southern Medical University in China are interested in quercetin. Quercetin is a flavonoid that naturally occurs in a range of foods, including vegetables, fruits, wine, nuts, red onions, kale, and black tea.

According to the authors of the recent review, “Accumulating evidence indicates that quercetin possesses protective anti-inflammatory as well as antioxidant effects and may be useful in treating a myriad of chronic conditions.”

However, despite some encouraging results, human studies — rather than animal studies or experiments on tissues — have produced inconsistent results. To date, researchers have carried out few meta-analyses to examine the pooled findings of these studies.

To address this issue, the authors of the current paper analyzed studies that investigated quercetin’s influence over a range of cardiovascular risk factors, including blood pressure, lipid profiles, and glucose levels. They published their findings in the journal Nutrition Reviews.

Reanalyzing recent studies

In their analysis, the scientists only included research papers that met certain criteria. All of the studies were randomized placebo-controlled clinical trials that had investigated the effect of quercetin for 2 weeks or more and had involved adults.

The scientists identified 17 relevant papers, which involved a total of 896 participants. The studies took place in six countries: Iran, United States, United Kingdom, Germany, Italy, and Korea.

Overall, they identified no significant effect of quercetin on glucose levels or lipid profiles. However, when they only analyzed data from trials that used a parallel design and lasted 8 weeks or longer, quercetin did appear to improve levels of high-density lipoprotein (HDL or “good”) cholesterol and triglycerides.

A study with a parallel design is one in which researchers compare two or more treatments; for instance, comparing the effects of quercetin against those of a control.

The greatest benefit of quercetin, however, was its effect on blood pressure. The findings showed that quercetin lowered both systolic and diastolic blood pressure. The authors write:

“The main conclusion was that dietary intake of quercetin significantly lowered [blood pressure].”

Benefits for blood pressure

Systolic blood pressure is the pressure in the arteries as the heart contracts, and diastolic blood pressure is the blood pressure when the heart is resting between beats. As an example, if someone’s blood pressure is 120/80 millimeters of mercury (mm Hg), the first number refers to systolic pressure, and the second number denotes diastolic pressure.

On average, quercetin reduced systolic blood pressure by 3.09 mm Hg and diastolic blood pressure by 2.86 mm Hg.

The authors explain that “a reduction in [blood pressure] of more than 10 mm Hg lowers cardiovascular risk by 50% for heart failure, by 35–40% for stroke, and by approximately 20–25% for myocardial infarction.”

The authors believe that “[t]he favorable effects of quercetin on [blood pressure] found in the current investigation support the use of quercetin as an adjunctive therapy in patients with hypertension.”

In other words, quercetin might enhance the benefits of taking hypertension medication and making lifestyle changes, thus helping reduce cardiovascular risk.

Limitations and holes

As the authors explain, the results are not yet conclusive, and many questions remain. They note that the changes in blood pressure varied depending on the type of quercetin formulation and how long the trials lasted.

The authors also noticed substantial differences among the findings of the studies. These differences might be, in part, due to the size of the trials in the analysis: Four of the 17 trials included fewer than 30 participants.

There were also differences in the design of the studies and the age, sex, and body mass index (BMI) of the participants. These differences make it difficult to generalize and compare among experiments.

Overall, the results are promising, but scientists need to conduct larger, longer-term clinical trials before they can confirm the full benefits of quercetin. If the compound eventually proves to reduce cardiovascular risk, it could benefit vast swathes of the population.

People who lose their sense of smell are at risk of dying but doctors do not take the issue seriously, researchers have found. Scientists questioned 71 people who were living without a sense of smell, a condition known as anosmia, to find out about their experiences.

Many were suffering from depression because they could no longer smell freshly cut grass or loved ones; with one woman even saying the condition ended her marriage. The scientists said people who couldn’t smell were faced with the dangers of being unable to smell gas, smoke or rotten food.

The research was published in the journal Clinical Otolaryngology. Anosmia is surprisingly common and thought to affect around five per cent of the United Kingdom (U.K.) population, which are approximately 3.25 million people.

In the United States (U.S.) around three per cent of people are affected – almost 10million – according to the Department of Health. There are many causes, including infections such as sinusitis and diseases like Alzheimer’s, Parkinson’s and multiple sclerosis.

Injuries and some medications can also cause people to lose their sense of smell. The author of the new study, Professor Carl Philpott from the University of East Anglia, hoped the research would prompt doctors to take the issue more seriously.

He and colleagues worked with patients aged between 31 and 80 who were being treated at a taste and smell clinic at the James Paget University Hospital, in Norfolk.

Losing the sense of smell also reduces the sense of taste and can make people taste food differently or not at all. Some participants said they no longer enjoyed eating so had lost weight, while others had become so put off by food that they were too self-conscious to serve meals to family or friends.

And some parents felt like failures because they could not tell when their child’s nappy needed changing. “One mother found it difficult bonding with her new baby because she couldn’t smell him,” Philpott said.

Certain foods and drinks contain compounds that may improve vaginal health and symptoms of vaginal conditions. These include probiotics, prebiotics, and fermented food and beverages.

The vagina uses natural secretions, immune defenses, and “good” bacteria to keep itself healthy. Eating a healthful, balanced diet might also further prevent infections and improve vaginal conditions.

This article discusses what little research there is into the effects of diet on vaginal health, looks at dietary choices for common vaginal conditions, and identifies other ways to improve vaginal health.

People should speak to a doctor before using diet to address any health concerns.

Balancing pH levels

The vagina is a moderately acidic environment with a pH of around 4.5. This acidity helps healthful bacteria to grow and prevents harmful microbes from developing.

Some good bacteria, such as probiotics, may help balance vaginal acidity levels.

Probiotics

Lactobacillus species bacteria is the most dominant type of “good” bacteria found in a healthy vagina.

Research has suggested that Lactobacillus could benefit vaginal health in the following ways:

  • regulating the microflora in the vagina
  • improving the vagina’s acidity levels
  • stopping harmful microbes from attaching to the vaginal tissues
  • working with the body’s immune system

2016 study indicated that using vaginal Lactobacillus supplements after taking antibiotics hindered bacteria growth in people with bacterial vaginosis (BV), and significantly reduced vaginal pH.

2015 review study found “no significant evidence” that probiotics were more beneficial than using a placebo or no treatment. However, the authors noted that due to a lack of evidence, “a benefit cannot be ruled out.”

Probiotic supplements are available, but some nutritionists recommend getting them from fermented foods and drinks, such as:

  • yogurt and kefir
  • kimchi and sauerkraut
  • pickles
  • tempeh
  • kombucha

Prebiotics

Prebiotic compounds may also help stabilize vaginal pH by promoting the growth of healthy bacterial populations. Foods rich in prebiotics include:

  • leeks and onions
  • asparagus and Jerusalem artichoke
  • garlic
  • whole wheat products
  • oats
  • soybeans
  • bananas

It is important to note that prebiotics can worsen bowel conditions, such as irritable bowel syndrome (IBS).

Preventing UTIs

Urinary tract infections (UTIs) occur when bacteria enter parts of the urethra, bladder, or kidneys, causing symptoms such as burning or pain during urination and bad smelling or cloudy urine. According to the Urology Care Foundation, about 60% of women will experience a UTI at some point.

Drinking lots of fluids might help prevent a UTI.

Cranberry juice

According to the Urology Care Foundation, drinking cranberry juice or taking cranberry tablets may prevent UTIs from developing.

Research supports this idea — in a 2016 study, researchers found that drinking 8 ounces (oz), or 240 milliliters (ml) of a 27% cranberry juice drink each day for 24 weeks lowered the rate of UTIs in adult women who had recently had a UTI.

Cranberries are rich in antibacterial compounds that kill bacteria. These include antioxidants and organic acids, such as:

  • proanthocyanidins and anthocyanins
  • organic and phenolic acids
  • vitamin C
  • flavanols and flavonols

Research into diet and UTIs has mainly focused on cranberries, but many fruits, especially citrus fruits and berries, are also rich in antioxidants and may have similar effects.

Reducing candida infections

Candida infections, or yeast infections, are the second most common cause of vaginitis, or vaginal inflammation.

There is no scientific proof that any foods can reduce candida infections. However, some foods contain ingredients that the fungus uses to grow. These ingredients include refined sugar, preservatives, yeasts, fungi, allergens, and trace antibiotics. People may benefit from avoiding these foods.

Researchers are studying the possible benefits of natural remedies with antifungal, anti-inflammatory, or antioxidant properties for candida infection, including tea tree oil, coconut oil, and garlic.

Other ways to improve vaginal health

Regularly eating a healthful, balanced diet that contains fermented products with probiotics and prebiotics can improve vaginal health.

Following some of these lifestyle habits might also help:

  • cleaning the genital region with mild, unscented soap before rinsing well and patting dry daily or as needed during menstruation
  • wiping from front to back
  • using antibiotics appropriately and only when necessary
  • reducing sweat around the vagina
  • exercising regularly
  • maintaining a healthy weight
  • staying hydrating
  • reducing stress
  • wearing loose-fitting cotton underwear

Avoiding or limiting things that can imbalance the body’s systems or irritate the vagina can help, such as:

  • douching
  • holding in urine or rushing urination
  • personal care products with dyes, flavors, or fragrances
  • spermicidal foam or diaphragms
  • tight pants or underwear
  • smoking
  • prolonged exposure to moisture
  • alcohol
  • processed or heavily refined foods
  • foods or drinks with artificial hormones

Summary

Many nutrients contribute to vaginal health. Eating a healthful, nutrient-rich diet can improve all body systems.

Certain nutrients, antioxidants, and probiotics may have particular benefits for vaginal health. However, researchers need to do more studies to work out which nutrients help boost vaginal health and prevent vaginal infections.

Asthma is a chronic lung condition in which the airways narrow and become inflamed, which leads to wheezing, coughing, and chest tightness. Extrinsic asthma and intrinsic asthma are subtypes of asthma.

The symptoms of these subtypes are the same, but they have different triggers:

  • Extrinsic asthma symptoms occur in response to allergens, such as dust mites, pollen, and mold. It is also called allergic asthma and is the most common form of asthma.
  • Intrinsic asthma has a range of triggers, including weather conditions, exercise, infections, and stress. People may call it nonallergic asthma.

In this article, we discuss the causes, symptoms, and treatment of intrinsic and extrinsic asthma.

Intrinsic vs. extrinsic asthma

Intrinsic and extrinsic asthma are two subtypes of asthma, which people more commonly refer to as allergic and nonallergic asthma.

Both types cause the same symptoms. The difference between the two subtypes is what causes and triggers asthma symptoms. The treatments are similar for each type, although the prevention strategies differ.

Triggers

Woman taking inhaler for asthma whilst playing football. Intrinsic and extrinsic asthma have the same symptoms but different triggers
Intrinsic and extrinsic asthma have the same symptoms but different triggers.

In people with extrinsic asthma, allergens trigger the respiratory symptoms. Common triggers for extrinsic asthma include:

  • pollen
  • mold
  • dust mites
  • pet dander
  • cockroaches
  • rodents

In some cases, a person is allergic to more than one substance, and several allergens trigger asthma symptoms.

In people with intrinsic asthma, allergies are not responsible for the symptoms. Instead, the following triggers cause symptoms:

  • cold
  • humidity
  • stress
  • exercise
  • pollution
  • irritants in the air, such as smoke
  • respiratory infections, such as colds, the flu, and sinus infections

In some cases, intrinsic asthma can occur with no known cause.

Prevalence

Extrinsic or allergic asthma is the most common form of the disease. According to the Asthma and Allergy Foundation of America, about 60% of people with asthma have allergic asthma.

Less commonly, intrinsic or nonallergic asthma occurs. Research in The Journal of Allergy and Clinical Immunologyindicates that intrinsic asthma occurs in anywhere from 10% to 33% of people with asthma.

It occurs more often in females than males and typically develops later in life than extrinsic asthma.

Causes

In all types of asthma, a person has overly sensitive airways and airway inflammation, which produces asthma symptoms.

Inflammation causes swelling in the airways that narrows the tubes and makes breathing difficult. The body also produces excess mucus, which further impairs breathing. These factors decrease the amount of air that can get into the lungs.

The inflammatory processes are similar in extrinsic and intrinsic asthma. In both, the immune system releases cells called T-helper cells and mast cells.

Research has found that there may be more similarities between the two types of asthma than researchers previously thought. Both types of asthma involve the production of IgE locally at the airways in response to the relevant triggers:

  • Extrinsic asthma occurs when the immune system overreacts to a harmless substance, such as pollen or dust. The body releases an antibody called immunoglobin E (IgE). The release of this antibody leads to inflammation and asthma symptoms.
  • Intrinsic asthma occurs when something other than allergens triggers an immune system response. People are not always able to identify the trigger.

Symptoms

The symptoms of extrinsic and intrinsic asthma are the same and may include:

  • wheezing
  • chest tightness
  • shortness of breath
  • coughing
  • increased mucus production
  • trouble breathing

Symptoms can vary in severity and may develop suddenly. Ignoring the signs and symptoms of an asthma attack can lead to a life-threatening situation. Recognizing symptoms as soon as possible and following an asthma action plan can help decrease the severity of an attack and reduce complications.

Treatments

The treatment options for intrinsic and extrinsic asthma are similar and include medications, lifestyle changes, and the avoidance of triggers. Since the triggers are different, the prevention strategies may differ.

Reducing triggers

It may be easier to identify the triggers for extrinsic asthma because allergies are the culprit. With both types of asthma, the identification of triggers allows an individual to take steps to reduce exposure and decrease symptoms.

The following steps can help reduce asthma symptoms in people with extrinsic asthma:

  • fixing leaky pipes to prevent mold buildup
  • keeping doors and windows closed when the pollen count is high
  • vacuuming often to reduce dust
  • keeping pets out of the bedroom

Triggers of intrinsic asthma do not involve a specific allergen. Due to the variability of triggers, it can take a little longer to determine the cause of flare-ups. People may find that avoiding humid, dry, or cold weather can prevent symptoms.

Medications

People can use the following medications to treat flare-ups of both intrinsic and extrinsic asthma:

Short-acting bronchodilators

Short-acting bronchodilators, also called quick relief medications, reduce symptoms fast. They work by relaxing the muscles of the airways.

Long-acting medications

People take long-acting bronchodilators daily, and they also open up the airways. Long-acting bronchodilators do not treat sudden symptoms as they take longer to work than short-acting bronchodilators.

Corticosteroids

Corticosteroids decrease inflammation in the airways. People take steroids daily to prevent symptoms.

Omalizumab

Omalizumab is an anti-IgE antibody therapy that prevents the release of IgE. Reducing IgE decreases the allergic response and prevents asthma symptoms.

People usually use omalizumab to treat extrinsic asthma, but it may also help with intrinsic asthma.

Lifestyle changes

Lifestyle changes might also help decrease symptoms of both types of asthma.

People with asthma may wish to consider adopting the following lifestyle practices:

  • maintaining a healthy weight
  • quitting smoking
  • avoiding secondhand smoke
  • reducing stress
  • getting a flu vaccine each year
  • washing the hands frequently to decrease the risk of infection

Outlook

Although there is currently no cure for either extrinsic or intrinsic asthma, people can manage the symptoms with medications, prevention methods, and lifestyle changes.

Intrinsic asthma is often harder to control than extrinsic asthma, as identifying its triggers is sometimes difficult. People can work closely with a doctor to determine the causes of asthma symptoms and find an effective treatment.

Previous research has suggested that there is a link between depression and tea drinking. Now, a new study is investigating this relationship further.

Depression is common among older adults, with 7% of those over the age of 60 years reporting “major depressive disorder.”

Accordingly, research is underway to identify possible causes, which include genetic predisposition, socioeconomic status, and relationships with family, living partners, and the community at large.

A study by researchers from the National University of Singapore (NUS) and Fudan University in Shanghai raises another possibility. It finds a statistically significant link between regular tea drinking and lower levels of depression in seniors.

While the researchers have not yet established a causal relationship between tea and mental health, their findings — which appear in BMC Geriatrics — show a strong association.

Reading the tea leaves

Tea is popular among older adults, and various researchers have recently been investigating the potential beneficial effects of the beverage.

A separate study from the NUS that appeared in Aging last June, for example, found that tea may have properties that help brain areas maintain healthy cognitive function.

“Our study offers the first evidence of the positive contribution of tea drinking to brain structure and suggests a protective effect on age-related decline in brain organization.”

Junhua Li, lead author

That earlier paper also cites research showing that tea and its ingredients — catechin, L-theanine, and caffeine — can produce positive effects on mood, cognitive ability, cardiovascular health, cancer prevention, and mortality.

However, defining the exact role of tea in preventing depression is difficult, especially due to the social context in which people often consume it. Particularly in countries such as China, social interaction may itself account for some or even all of the drink’s benefits.

Feng Qiushi and Shen Ke led the new study, which tracks this covariate and others, including gender, education, and residence, as well as marital and pension status.

The team also factored in lifestyle habits and health details, including smoking, drinking alcohol, daily activities, level of cognitive function, and degree of social engagement.

In addition, the authors write, “The study has major methodological strength,” citing a few of its attributes.

Firstly, they note, it could more accurately track an individual’s tea-drinking history because “instead of examining tea-drinking habit [only] at the time of survey or in the preceding month/year, we combined the information on frequency and consistency of tea consumption at age 60 and at the time of assessment.”

Once the researchers had classified each person as one of four types of tea drinker according to how often they drank the beverage, they concluded:

“[O]nly consistent daily drinkers, those who had drunk tea almost every day since age 60, could significantly benefit in mental health.”

13,000 study participants

The researchers analyzed the data of 13,000 individuals who took part in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2005 and 2014.

They discovered a virtually universal link between tea drinking and lower reports of depression.

Other factors seemed to reduce depression as well, including living in an urban setting and being educated, married, financially comfortable, in better health, and socially engaged.

The data also suggested that the benefits of tea drinking are strongest for males aged 65 to 79 years. Feng Qiushi suggests an explanation: “It is likely that the benefit of tea drinking is more evident for the early stage of health deterioration. More studies are surely needed in regard to this issue.”

Looking at the connection the other way around, tea drinkers appeared to share certain characteristics.

Higher proportions of tea drinkers were older, male, and urban residents. In addition, they were more likely to be educated, married, and receiving pensions.

Tea drinkers also exhibited higher cognitive and physical function and were more socially involved. On the other hand, they were also more likely to drink alcohol and smoke.

Qiushi previously published the results of the effect of tea drinking on a different population, Singaporeans, finding a similar link to lower rates of depression. The new study, while more detailed, supports this earlier work.

Currently exploring new CLHLS data regarding tea drinking, Qiushi wishes to understand more about what tea can do, saying, “This new round of data collection has distinguished different types of tea, such as green tea, black tea, and oolong tea so that we could see which type of tea really works for alleviating depressive symptoms.”

Adnexal masses are lumps that occur in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or nongynecological.

An adnexal mass could be:

  • an ovarian cyst
  • an ectopic pregnancy
  • a benign tumor
  • a malignant tumor

A family doctor can usually manage benign masses. However, prepubescent and postmenopausal individuals will need to see a gynecologist or oncologist.

Malignant adnexal masses require treatment from a specialist.

In this article, we discuss the characteristics of adnexal masses. We also review how doctors diagnose and treat adnexal them.

Symptoms

People report different symptoms, depending on the cause of the adnexal mass.

People with an adnexal mass may report:

  • severe lower abdominal or pelvic pain that is usually on one side
  • abnormal bleeding from the uterus
  • pain during sexual intercourse
  • worsening pain during a period
  • painful periods
  • abnormally heavy bleeding during periods
  • abdominal symptoms, including a feeling of fullness, bloating, constipation, difficulty eating, increased abdominal size, indigestion, nausea, and vomiting
  • urinary urgency, frequency, or incontinence
  • weight loss
  • lack of energy
  • fatigue
  • fever
  • vaginal discharge

Different causes of adnexal masses may have similar symptoms, so doctors usually conduct further investigations to determine the exact cause.

Once the doctor has worked out the cause of the adnexal mass, they can recommend treatment and management.

Causes

Adnexal masses include a variety of different conditions that range in severity from benign growths to malignant tumors.

The cause of adnexal masses could be gynecological or nongynecological.

Some of the causes of adnexal masses include:

  • Ectopic pregnancy: A pregnancy where the fertilized egg implants somewhere outside the uterus.
  • Endometrioma: A benign cyst on the ovary that contains thick, old blood that appears brown.
  • Leiomyoma: A benign gynecological tumor, also known as a fibroid.
  • Ovarian cancer: These tumors of the ovary may be ovarian epithelial cancers that begin in the cells on the surface of the ovary or malignant germ cell cancers that begin in the eggs.
  • Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. It occurs due to an infection.
  • Tubo-ovarian abscess: An infectious adnexal mass that forms because of pelvic inflammatory disease.
  • Ovarian torsion: A gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts off blood flow to the ovary.

Diagnosis

A doctor may diagnose an adnexal mass by:

  • taking a complete medical history
  • asking questions about symptoms
  • conducting a physical examination
  • obtaining blood samples

Most of the time, people will need a transvaginal ultrasound to allow doctors to evaluate the characteristics of an adnexal mass.

Females who have had a positive pregnancy test result and report abdominal or pelvic pain and vaginal bleeding might have an ectopic pregnancy. An ovarian torsion causes sudden, severe pain with nausea and vomiting. Immediate medical attention is necessary to treat both an ectopic pregnancy and ovarian torsion.

People with pelvic inflammatory disease or a tubo-ovarian abscess may experience gradual pelvic pain with nausea and vaginal bleeding.

Early ovarian cancer may sometimes present with nonspecific symptoms. Sometimes, doctors may only detect cancer when the tumor has become malignant.

Malignant tumors may have one or several of the following characteristics:

  • a solid component of the tumor
  • parts of the tumor have thick divisions larger than 2–3 centimeters separating them
  • they are present on both sides of the reproductive tract
  • the presence of fluid filled lumps

Treatment

A doctor will choose the most appropriate treatment depending on the cause of the adnexal mass. Women with an ectopic pregnancy will have to end their pregnancy. A doctor may choose one of the following procedures:

  • the administration of a single or two-dose intramuscular methotrexate
  • laparoscopic surgery
  • a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes

Doctors have not yet determined the optimal management of an endometrioma, according to a study that featured in Obstetrical & Gynecological Survey.

Currently, the possible treatments for an endometrioma include:

  • watchful waiting
  • medical therapy
  • surgical intervention
  • inducing ovulation and using assisted reproductive technology in females with infertility

People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include:

  • cefotetan (Cefotan)
  • cefoxitin (Mefoxin)
  • clindamycin (Cleocin)

Some people can receive treatment outside of the hospital setting with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).

In the past, tubo-ovarian abscesses required surgical removal of the uterus, ovaries, and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.

Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes.

People with leiomyomas or fibroids may receive hormonal treatments or nonsteroidal anti-inflammatory drugs to control the symptoms. Once a person stops taking medication, the symptoms may return, and the fibroids may continue to grow. Surgery is the most successful treatment for fibroids.

The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:

  • the type of ovarian cancer and how much cancer is present
  • the stage and grade of the cancer
  • whether the person has a buildup of fluid in the abdomen causing swelling
  • whether surgery can remove the whole tumor
  • genetic changes
  • the person’s age and general health status
  • whether it is a new diagnosis, or if cancer has come back

Risk factors

Risk factors depend on the cause of the adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More than 80% of females with ovarian torsion have masses of 5 cm or larger.

Doctors diagnose fibroids in about 70% of white females and more than 80% of black females by the age of 50 years. Other factors may increase a person’s risk of developing fibroids, such as:

  • starting periods early in life
  • using oral contraceptives before 16 years of age
  • an increase in body mass index (BMI)

Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:

  • inherited genetic changes
  • hereditary nonpolyposis colorectal cancer
  • endometriosis
  • postmenopausal hormonal therapy
  • obesity
  • tall height

The likelihood of developing cancer also tends to increase with age.

Summary

Adnexal masses are lumps that doctors may find in the adnexal of the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous, and they do not all require treatment.

Different types of adnexal mass can share many of the same symptoms. As a result, doctors need to collect a full medical history and data from physical examinations, blood tests, and medical imaging, including transvaginal ultrasounds.

Doctors need to pinpoint the location and cause of an adnexal mass to determine the appropriate management and treatment.

New research in pigs finds that sugar intake alters the reward-processing circuitry of the brain in a similar way to addictive drugs.

Whenever we learn something new or experience something pleasurable, our brain’s reward system becomes activated. With the help of natural brain chemicals, several brain areas communicate with each other to help us learn and repeat behaviors that improve our knowledge and well-being.

Relying heavily on the neurotransmitter dopamine, the reward system helps explain several quintessential human experiences, such as falling in love, sexual pleasure, and enjoying time with friends.

However, certain substances, such as drugs, hijack the brain’s reward system, “artificially” activating it. Telling the brain to repeat pleasure-seeking behavior constantly is the mechanism behind addiction.

But is sugar such a substance? And if so, does it help explain sugary food cravings?

A United States scientist named Theron Randolph coined the term “food addiction” in the 1950s to describe the compulsive consumption of certain foods, such as milk, eggs, and potatoes.

Since then, the studies exploring this concept have yielded mixed results, and some experts argue that speaking of food addiction is a bit of a stretch.

New research helps shed some light on the matter, as Michael Winterdahl, associate professor at the Department of Clinical Medicine at Aarhus University in Denmark, and his colleagues examined the effect of sugar intake on the reward circuitry in the brains of pigs.

The researchers published their findings in the journal Scientific Reports.

‘Major changes’ after 12 days

The scientists analyzed the effects of sugar intake on seven female Göttingen minipigs, using complex PET imaging techniques with opioid receptor agonists and dopamine receptor antagonists to examine the animals’ brain reward systems.

The team gave the minipigs access to a sucrose solution for 1 hour on 12 consecutive days and then retook the scans 24 hours after the last sugar dose.

In a subgroup of five minipigs, the team applied an additional PET scanning session after the first exposure to sugar.

“After just 12 days of sugar intake, we could see major changes in the brain’s dopamine and opioid systems,” reports Winterdahl.

“In fact, the opioid system, which is that part of the brain’s chemistry that is associated with well-being and pleasure, was already activated after the very first intake,” adds the study’s lead author.

Specifically, there were alterations in the “striatum, nucleus accumbens, thalamus, amygdala, cingulate cortex, and prefrontal cortex” after the sugar intake.

Why sugar may be addictive after all

The findings, conclude the researchers, imply that “foods high in sucrose influence brain reward circuitry in ways similar to those observed when addictive drugs are consumed.”

The lead researcher explains that the findings contradicted his initial expectations. “There is no doubt that sugar has several physiological effects, and there are many reasons why it is not healthy.”

“But I have been in doubt of the effects sugar has on our brain and behavior, [and] I had hoped to be able to kill a myth.” He continues by emphasizing the addictive aspects of sugar intake.

“If sugar can change the brain’s reward system after only 12 days, as we saw in the case of the pigs, you can imagine that natural stimuli, such as learning or social interaction, are pushed into the background and replaced by sugar and/or other ‘artificial’ stimuli.”

Michael Winterdahl

“We’re all looking for the rush from dopamine, and if something gives us a better or bigger kick, then that’s what we choose,” he explains.

Are pig models relevant?

The researchers also explain their choice of minipigs as a model in which to study the effects of sugar on the brain.

They say that previous studies have used rats, but even if these rodents do have a penchant for sugar, their homeostatic mechanisms — which help regulate weight gain and metabolism — “differ significantly from those of humans.”

“It would, of course, be ideal if the studies could be done in humans themselves, but humans are hard to control, and dopamine levels can be modulated by a number of different factors,” explains Winterdahl.

“They are influenced by what we eat, whether we play games on our phones, or if we enter a new romantic relationship in the middle of the trial, with potential for great variation in the data.”

“The pig is a good alternative because its brain is more complex than a rodent and […] large enough for imaging deep brain structures using human brain scanners.”

The muscles, ligaments, and tissues of the pelvic floor support the bladder, rectum, and sexual organs. When the supportive structures weaken or become especially tight, doctors describe it as pelvic floor dysfunction. It is a common health issue.

When a person has pelvic floor dysfunction, the organs in the pelvis may drop. They often press down on the bladder or rectum, causing a leakage of urine or stool. Or, a person with this condition may have trouble urinating or passing stool.

Keep reading to learn more about pelvic floor dysfunction — including the symptoms, treatments, and some exercises that may help.

What is pelvic floor dysfunction?

The pelvic floor is made up of muscles, ligaments, and tissues that surround the pelvic bone. The muscles attach to the front, back, and sides of the bone, as well as to the lowest part of the spine, called the sacrum.

The function of the pelvic floor is to support the organs in the pelvis, which can include the:

  • bladder
  • rectum
  • urethra
  • uterus
  • vagina
  • prostate

People with pelvic floor dysfunction may have weak or especially tight pelvic floor muscles.

When the muscles tighten, or spasm, people may have trouble urinating or passing stool. When they weaken, the organs within the pelvis may drop and press down on the rectum and bladder.

The table below outlines several common types of pelvic floor dysfunction.

Type of pelvic floor dysfunctionDescription
Obstructed defecationThis occurs when stool enters the rectum, but the body cannot fully evacuate the bowels.
RectoceleThis involves tissue from the rectum protruding into the vagina. Stool may get caught in this pocket, forming a bulge in the vagina.
Pelvic organ prolapseThis refers to the pelvic floor stretching and the pelvic organs dropping as a result of age, childbirth, or a collagen disorder.
Paradoxical puborectalis contractionThis involves a pelvic floor muscle called the puborectalis contracting. When it happens, trying to pass stool may feel like pushing against a closed door.
Levator syndromeThis involves the pelvic floor muscles spasming after bowel movements. It can cause lasting dull pain or achy pressure high in the rectum.
CoccygodyniaThis refers to pain in the tailbone that worsens during and after bowel movements.
Proctalgia fugaxThis involves painful spasms of the rectum and muscles in the pelvic floor.
Pudendal neuralgiaThis refers to irritation or damage to the pudendal nerves, which help the pelvis function.
UrethroceleThis refers to the urethra pressing into the vagina.
EnteroceleThis involves the small intestine descending and pushing into the vagina, forming a bulge.
CystoceleThis involves the bladder dropping and pushing into the vagina.
Uterine prolapseThis refers to the uterus descending and pushing into the vagina.

Symptoms

Pelvic floor dysfunction can cause a variety of symptoms, and some can interfere with daily life.

Depending on the type of pelvic floor dysfunction, a person may experience:

  • pelvic pain
  • pressure
  • a bulge somewhere in the lower pelvic region
  • stress urinary incontinence, which involves a small amount of urine leaking from the body due to an activity such as coughing
  • involuntary leakage of stool
  • incomplete urination
  • bowel movement dysfunction
  • pain during sexual intercourse

Also, some people who see their doctors about bladder overactivity find that pelvic floor dysfunction is responsible.

Causes

Many issues can cause the structures of the pelvic floor to weaken, including:

  • age
  • systemic diseases
  • lasting health issues that cause increased pressure in the abdomen and pelvis, such as a chronic cough
  • pregnancy
  • trauma during delivery
  • multiple deliveries
  • large babies
  • operative delivery

Research indicates that stress urinary incontinence, pelvic organ prolapse, or both occur in about half of all women who have given birth. These issues are closely associated with birth-related injury to the pelvic floor muscles.

The pelvic floor muscles can also stretch naturally with age. Stress urinary incontinence and pelvic organ prolapse become more common with increasing age in females, for example.

Collagen disorders can also affect the muscles’ ability to support the pelvic organs.

Meanwhile, coccygodynia usually stems from trauma to the tailbone, such as from a fall. That said, in about one-third of people with the condition, the cause of coccygodynia is unknown. The pain can make having a bowel movement difficult.

Exercises

Doctors recommend pelvic floor exercises in various situations.

They may particularly benefit pregnant women because the pelvic floor muscles can stretch and weaken during labor. Strengthening these muscles may help prevent incontinence after the baby is born. Some doctors recommend that women who wish to become pregnant start the exercises ahead of time.

Males can also benefit from pelvic floor exercises, though the dysfunction is more common in females. In males, these exercises can help prevent pelvic organ prolapse and urinary incontinence and improve sexual intercourse.

To exercise these muscles, a person should be sitting comfortably. Then, they should attempt to squeeze their pelvic muscles without holding their breath.

It is important to isolate the correct muscles without tightening those of the stomach, buttocks, or and thighs.

Doctors recommend that females aim to do 10 long squeezes — holding each for 10 seconds — followed by 10 short squeezes. However, initially, it may be a good idea to practice holding a squeeze for a few seconds at a time.

By practicing frequently, a person should be able to add more contractions to their routine week by week. It is important to do this gradually and to avoid overworking the muscles.

Within a few months, a person may notice a reduction in their symptoms. Even if symptoms resolve completely, a person should continue strengthening these muscles.

There are physical therapists who specialize in pelvic floor dysfunction. A person may find that consulting one of these professionals leads to a better outcome.

Treatment

Doctors determine the cause of pelvic floor dysfunction before recommending treatment because different types of dysfunction require different approaches.

The purpose of treatment is to relieve or reduce symptoms and improve the person’s quality of life. For some people, a combination of treatment methods works best.

Doctors may recommend:

  • Dietary changes: For example, eating more fiber, drinking more fluids, and taking certain medications can make bowel movements easier.
  • Laxatives: Taking a daily laxative may help people with pelvic floor dysfunction pass stool, but it is important to consult a healthcare provider first because not all laxatives are equally effective.
  • Pain relief: Some people require injections of pain relief or anti-inflammatory medication to relieve their symptoms.
  • Biofeedback: This involves electrical stimulation, ultrasound therapy, or massage of the pelvic floor muscles to help improve rectal sensation and muscle contraction.
  • Pessary: A doctor or nurse inserts a pessary into the vagina to support prolapsed organs. This type of device can help treat various symptoms of pelvic floor dysfunction, either as an alternative to surgery or while a person awaits surgery.
  • Surgery: When prolapse interferes with daily activities, a doctor may recommend surgery. Large rectoceles also require surgery if the person experiences symptoms.

Stem cell therapies

Researchers behind a 2016 study investigated whether a stem cell-based therapy could resolve pelvic floor dysfunction in rats.

The researchers engineered the stem cells to produce and release elastin and collagen into the pelvic floor and injected them into rats with pelvic floor dysfunction.

The elastin and collagen promoted the repair of pelvic floor structures and decreased signs of stress urinary incontinence.

In a final component of the study, the researchers developed stem cells that blocked a factor that stops the production of elastin. This promoted increased production and release of elastin into the pelvic floor.

With further studies, researchers may find that similar therapies are effective in humans.

When to see a doctor

Anyone who experiences painful bowel movements, difficulty urinating or passing stool, pelvic pain, or pain during sexual intercourse should speak with a doctor.

An unusual bulge in the lower pelvic region may also be a reason to see a doctor, though a bulge alone may not be a cause for concern.

People with pelvic floor dysfunction have plenty of treatment options. While the topic may be uncomfortable to bring up with a doctor, it is important to seek professional advice about these symptoms.

While some family doctors may not be familiar with pelvic floor dysfunction, specialists such as colorectal doctors, urologists, and gynecologists can help diagnose the issue and recommend the best course of action.

Summary

Pelvic floor dysfunction can affect anyone, but pregnant women have the highest risk.

The various types of pelvic floor dysfunction stem from different causes, and a doctor must identify the underlying issue before developing a treatment plan.

Exercises can help some people with pelvic floor dysfunction. Depending on the cause, a doctor may also recommend dietary changes, medication, a pessary, biofeedback, or surgery.