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Friday, April 26, 2024
mental health

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Stressful events — such as sitting an exam, giving a presentation, or attending a job interview — temporarily increase heart rate and blood pressure and dilate arteries.

This is a normal part of the body’s “fight-or-flight” response, but the lining of blood vessels, known as the endothelium, can take up to 90 minutes to recover after this kind of stress.

This may help to explain why a single episode of stress temporarily increases the risk of an acute cardiovascular event, such as a heart attack.

On the other hand, experts know that eating a diet rich in fruits and vegetables reduces a person’s risk of cardiovascular disease, heart attacks, and cardiovascular mortality.

Among the healthy nutrients found in fruits and vegetables are polyphenolic compounds known as flavanols. In the long term, these improve endothelial function and lower blood pressure.

The effects of flavanols during stress and in its immediate aftermath are unknown, however.

Scientists at the University of Birmingham in the United Kingdom have conducted the first study to investigate this question.

Their research suggests that drinking cocoa, which is rich in flavanols, in the hours before a stressful event can improve blood flow during the experience and help restore endothelial function in males aged under 45 years old afterward.

“Our findings are significant for everyday diet, given that the daily dosage administered could be achieved by consuming a variety of foods rich in flavanols — particularly apples, black grapes, blackberries, cherries, raspberries, pears, pulses, green tea, and unprocessed cocoa,” says senior author Dr. Catarina Rendeiro, Ph.D., of the university’s School of Sport, Exercise and Rehabilitation Sciences.

“This has important implications for measures to protect the blood vessels of those individuals who are more vulnerable to the effects of mental stress,” she adds.

The research, conducted by postgraduate student Rosalind Baynham, appears in the journal Nutrients.

Stress tests

The scientists recruited 30 healthy males between 18 and 45 years who underwent tests at the lab on two separate occasions at least 7 days apart.

The research involved them fasting for 12 hours before each session and abstaining from alcohol, vigorous exercise, and polyphenol-rich food and drink for 24 hours beforehand.

At the start of each visit, while the participants were relaxed, researchers assessed their “brachial flow-mediated dilatation,” which is a measure of endothelial function.

They also measured their blood pressure, heart rate, and blood flow.

On one of these visits, the participants drank regular cocoa, which is rich in flavanols, and on the other visit, they drank a special cocoa drink that was low in flavanols.

About 90 minutes later, they took a competitive test of mental arithmetic designed to elicit stress.

For example, during the test, the researchers filmed the participants, and they had to watch their performance on a screen. The researchers told the participants that “body language assessors” would assess them.

The arithmetic task got progressively faster, and the participants lost points whenever they got an answer wrong.

An experimenter in the room marked their responses and sounded an alarm when they made a mistake, or once every 10 answers if they did not.

At 30 and 90 minutes after the stress test, the researchers remeasured the participants’ endothelial function and blood pressure.

The results showed that 30 minutes after the stress test, all participants had impaired endothelial function. This measure remained significantly higher 90 minutes after the stress test.

However, participants who drank the high-flavanol cocoa saw smaller declines in endothelial function than those who consumed the low-flavanol cocoa.

In addition, high-flavanol cocoa increased blood flow during and after the test compared with low-flavanol cocoa.

Other cardiovascular and blood pressure measures were similar for both conditions.

Future investigations

The researchers note that the main limitation of their study was that it excluded females.

They report that, for the sake of consistency, they wanted to avoid the impact of hormonal fluctuations during the female menstrual cycle on the vascular changes under investigation.

This means that it is not possible to apply the outcomes of this study to females. Researchers remain unclear on the impact of flavanols on stress response in females.

However, existing evidence shows there are gender differences in how a body responds to stress. So, future studies should focus on females.

The researchers also write that a more in-depth investigation would include molecular measures of cardiovascular function. These should consist of nitric oxide, which is a signaling molecule that dilates blood vessels, and the stress hormone cortisol.

Finally, they write that future research should explore the effect of flavanol intake on stress responses in individuals at higher risk of cardiovascular diseases, such as high blood pressure, and people who experience mental stress, such as care workers.

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Researchers have found that a 2-week increase in fiber intake can significantly alter a person’s gut microbiome, including increasing species of bacteria that break down fiber.

However, the quantity of short-chain fatty acids (SCFAs) did not increase. SCFAs are the result of bacteria breaking down fiber, and they have diverse roles within the body.

For instance, SCFAs are used as a source of energy for the cells of the colon and are involved in cell signaling. Some SCFAs also have anti-inflammatory properties and might influence insulin sensitivity and body weight.

The research, which appears in the journal mSystems, lays the groundwork for future studies to explore in more detail the relationship between fiber intake, gut bacteria, and SCFAs.

Benefits of fiber

Fiber plays an important role in human health. For example, a recent review of various meta-analyses found that people who eat the most fiber significantly reduce their chances of dying due to a cardiovascular event.

However, only 1 in 20 people in the United States consume the recommended amount of fiber.

According to Dr. Katrine Whiteson, associate professor of molecular biology and biochemistry, co-director of the University of California, Irvine (UCI) Microbiome Initiative, and co-author of the present study:

“The lack of fiber intake in the industrialized world is starving our gut microbes, with important health consequences that may be associated with increases in colorectal cancer, autoimmune diseases, and even decreased vaccine efficacy and response to cancer immunotherapy.”

The small intestine cannot digest fiber. Instead, according to the authors of the present study, it passes into the colon, where microbes are able to break the fiber down.

This process results in the production of SCFAs. Experts believe they are important for a range of factors affecting a person’s health.

The authors of the present study wanted to study the relationship between a short-term increase in dietary fiber, the makeup of the gut microbiome, and the presence of SCFAs.

Two-week diet

To investigate, the researchers conducted a study involving 26 undergraduate students enrolled on a biology course at UCI, as well as their instructors.

In week 1, participants ate their normal diet and provided three stool samples for analysis.

In week 2, the participants started a high fiber diet. They tracked their nutritional intake using a fitness app, aiming for 40 grams (g) of fiber each day. To assist, the researchers provided them with 10 meals each week that were high in fiber from a range of different plants.

In the third week, the participants were encouraged to increase their fiber intake to 50 g per day. During this week, participants provided another three stool samples.

According to graduate student Andrew Oliver, a teaching assistant for the course, “students raised their fiber intake by an average of 25 g per day, but the variability of pre-intervention fiber intake was substantial.”

“A few students had to go from nearly zero to 50 g daily by the end of the study. We all became a little obsessed with how much fiber was in the food we were eating.”

The researchers then analyzed the samples using DNA sequencing to identify the makeup of the bacteria. They used gas chromatography to measure SCFAs.

Microbiome composition

The researchers found that the composition of the participants’ gut microbiomes changed by around 8% following the dietary intervention.

This was largely due to increases in bacteria known for breaking down fiber, including Bifidobacterium, Bacteroides, and Prevotella.

However, the researchers saw no statistically significant increase in SCFAs. They speculate that this may be because stool samples do not accurately represent levels of SCFAs in the gut, which are primarily found in the cell walls of the intestines.

The researchers also suggest that the 2-week intervention may not have been long enough to see any difference in SCFAs.

According to Dr. Whiteson, “we hope to carry out longer dietary fiber interventions and study how fiber can support the gut microbiome and promote health.”

“At this time during a pandemic, when we need our immune health and healthy vaccine responses, we encourage everyone to think about the plant diversity of their diets and add some beans, berries, and avocados where they can.”

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Previous research has shown the community of bacteria and other microorganisms that lives in our gut, known as the gut microbiota, to affect our health and well-being in a multitude of ways, many of them positive.

Much of the information on the bacteria that make their home in our mouths, however, focuses on gum disease and its knock-on inflammatory effects around the body.

The role of oral bacteria in producing nitric oxide, which benefits cardiovascular and cognitive health, is much less well-known.

Many species of oral bacteria convert the inorganic nitrateTrusted Source in vegetables into nitrite. Nitrite is a precursor for nitric oxide, a signaling molecule that dilates blood vessels and transmits messages between neurons in the brain.

In older people, reduced availability of nitric oxide may contribute to hypertension (high blood pressure) and a decline in cognitive function.

A new study suggests that drinking beetroot juice, which is rich in inorganic nitrate, can alter the balance of bacteria in the mouth in favor of species that promote better cognitive and cardiovascular health.

The findings of this study help explain the proven benefits of beetroot juice for lowering blood pressure in people with hypertension.

Other vegetables that contain a lot of nitrates, including cabbage, lettuce, spinach, and celery, could offer similar benefits.

Scientists at the University of Exeter in the United Kingdom led the research, which features in the journal Redox Biology.

“We are really excited about these findings, which have important implications for healthy aging,” says lead author Prof. Anni Vanhatalo.

“Maintaining this healthy oral microbiome in the long term might slow down the negative vascular and cognitive changes associated with aging,” she adds.

Juice with or without nitrate

The study involved 26 individuals aged 70–80 years.

The researchers randomly assigned these participants to one of two groups. While they asked both groups to drink 140 milliliters of beetroot juice per day for 10 days, the experimental group drank a nitrate-rich juice, while the control group drank a nitrate-depleted juice.

The smell and taste of the two drinks were the same.

After a washout period of 3 days, the groups switched, and the participants consumed the other drink for 10 days.

The researchers asked the participants not to use mouthwash during the study.

Before, during, and after the experiment, they administered a battery of physiological and cognitive tests. They also identified bacterial species by sequencing genetic material in saliva samples from the participants.

Compared with the placebo condition, subjects who drank ordinary beetroot juice had larger numbers of oral bacteria associated with good vascular and cognitive health.

Their saliva also contained lower numbers of bacteria linked to inflammation.

On average, the participants’ systolic blood pressure fell by 5 millimeters of mercury after 10 days of drinking nitrate-rich beetroot juice. In addition, the tests indicated a greater availability of nitric oxide in their blood.

Those drinking the nitrate-rich juice also performed better on tests of sustained attention.

Clusters of bacterial species

The researchers used a statistical technique to identify two distinct clusters of bacterial species that flourished in the participants’ mouths when they drank regular beetroot juice.

These two clusters or “modules” (labeled MM5 and MM6) not only tended to co-occur in the same mouths but were also associated with improvements in cognitive function and blood pressure, respectively.

The authors propose that these nitrate-sensitive oral bacteria would make suitable probiotics to redress age-related declines in cardiovascular and cognitive health.

A third cluster of species, which previous research has associated with inflammation, failed to thrive in the mouths of participants drinking regular, high-nitrate beetroot juice.

This cluster included various disease-causing species, including Clostridium difficile.

Prof. Vanhatalo cautions that further research will be necessary to determine whether these findings apply to other groups of people.

“Our participants were healthy, active, older people with generally good blood pressure,” she explains.

“Dietary nitrate reduced their blood pressure on average, and we are keen to find out whether the same would happen in other age groups and among people in poorer health,” she adds.

The authors also note that the technique they used to identify bacteria, called 16S ribosomal sequencing, determines the relative abundance of the organisms rather than their absolute amounts or metabolic activity.

The latter quantities will influence the extent of nitrite production in the mouth and, therefore, the availability of nitric oxide.

In addition, the authors write that 16S sequencing (which effectively reads the sequence of a single gene) is not very good at identifying individual species of bacteria.

To develop probiotics, they say, researchers will need to use a technique called whole genome sequencing, which is more expensive but more accurate.

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April is Parkinson’s Awareness Month. With this in mind, this week’s edition of Medical Myths tackles the many misunderstandings that surround Parkinson’s disease. We discuss the symptoms and treatment, the outlook for people with the condition, and more.

Parkinson’s disease is a neurodegenerative movement disorder. Over time, dopamine-producing cells in a part of the brain called the substantia nigra deteriorate.

This deterioration, which leads to a reduction in dopamine, produces symptoms. The symptoms tend to develop slowly over time, often starting with a slight tremor in one hand or stiffness in movement.

Aside from tremor and stiffness, other symptoms include difficulties coordinating movements, changes in posture, a fixed facial expression, a reduced sense of smell, mood changes, and sleep problems.

As the disease progresses, some people with Parkinson’s develop dementia.

In 2016, an estimated 6.1 millionTrusted Source people worldwide had Parkinson’s disease. The number of cases has more than doubled in the last 25 years.

In this article, we dispel some of the most common myths associated with Parkinson’s disease.

1. Parkinson’s only affects movement

It is true that the medical community considers Parkinson’s disease a motor disorder. However, people with the condition often also experience nonmotor symptoms, which can begin before the motor symptoms.

Nonmotor symptoms can include cognitive impairment or dementia, depression and anxiety, sleep dysfunction, pain, apathy, sexual dysfunction, and bowel incontinence.

People often overlook these symptoms, but they are important. As the authors of one paper on the topic explain:

“[N]onmotor symptoms dominate the clinical picture of advanced Parkinson’s disease and contribute to severe disability, impaired quality of life, and shortened life expectancy.”

2. Treatment only works for a few years

Although there is no cure for Parkinson’s disease, drugs can help people manage the condition. One of the most effective drugs is levodopa, which the body converts into dopamine once it enters the brain.

There is a long standing myth that levodopa can only relieve symptoms for about 5 years before it stops working. This is a myth. Levodopa can be effective for decades. However, over time, its effectiveness might reduce.

Medical News Today spoke with James Beck, Senior Vice President and Chief Scientific Officer of the Parkinson’s Foundation. He explained why levodopa becomes less potent:

“One of the cruel ironies about Parkinson’s disease is that the key enzyme that converts levodopa to dopamine (aromatic acid decarboxylase or AADC) is predominantly found in the dopamine neurons of the substantia nigra, which are lost during progression of the disease. So, the main way to make dopamine available to the Parkinson’s brain declines as the disease advances.”

In other words, it is not that levodopa stops being effective. Instead, the supply of the enzyme that it needs to be effective becomes more limited.

In the past, doctors and people with Parkinson’s have held off starting treatment because of fears that levodopa would slowly stop working. We now know, though, that this reduction in potency is due not to the length of time that a person takes levodopa but to the progression of the disease.

However, it is true that over time, each dose of levodopa might improve symptoms for a shorter period. This so-called wearing-off means that symptoms start to return before the next dose is due.

3. Levodopa makes symptoms worse

Another misconception about levodopa is that it can make Parkinson’s disease symptoms worse. This is not true.

It is important to note that levodopa can cause other motor symptoms, such as dyskinesia, which refers to involuntary jerky movements. However, the onset of dyskinesia is related to the progress of the underlying disease rather than how long an individual has been taking levodopa.

Therefore, doctors no longer recommend holding off on taking levodopa until later in the disease.

According to the American Parkinson’s Disease Association (APDA), dyskinesia does not generally appear until the individual has been taking levodopa for 4–10 years. The APDA also writes:

“Dyskinesia in its milder form may not be bothersome, and the mobility afforded by taking levodopa may be preferable to the immobility associated with not taking levodopa. People with Parkinson’s must weigh the benefits from using levodopa versus the impact of dyskinesia on their quality of life.”

4. Tremor always signifies Parkinson’s

Tremor is the most well-known symptom of Parkinson’s disease. However, it can also occur as part of other conditions, including drug-induced parkinsonism, vascular parkinsonism, dystonic or essential tremor, psychogenic disease, and dopa-responsive dystonia.

5. Doctors can always provide an accurate outlook

Although doctors understand the range of symptoms that are associated with Parkinson’s, it is very difficult to predict how an individual’s disease will progress. Parkinson’s varies substantially among individuals.

As the authors of one study explain, there are “radical differences in clinical manifestations and progression between patients.”

“The [reason for the] differences observed in how individuals experience Parkinson’s disease and its progression remains unknown.” Dr. Beck explained to MNT. “It could be based on how Parkinson’s began with each individual.”

Scientists are currently investigating ways of making better predictions. Hopefully, in the future, doctors will be able to provide a clearer idea of how an individual’s condition will progress.

6. Everyone with Parkinson’s has tremor

Tremor is perhaps one of the most recognizable symptoms of Parkinson’s disease. However, some people develop nonmotor symptoms before tremor appears.

Also, some individuals do not experience tremor at any point during the disease’s progression.

Speaking with MNT, Dr. Beck explained, “About 20% of people with Parkinson’s disease do not develop a tremor.” Although scientists do not know why this is the case, Dr. Beck believes that tremor severity, in general, might depend on which brain regions the disease affects.

He noted that some scientists think “that people who have a strong tremor have lost more dopamine neurons in an area adjacent to the substantia nigra called the retrorubral area. It is these dopamine neurons (or their loss) that contribute to Parkinson’s tremor.”

7. People might experience ‘flare-ups’

In some conditions, such as multiple sclerosis, people can experience exacerbations, or flare-ups, of their symptoms. Parkinson’s disease, however, does not tend to work in this way.

The symptoms, overall, progress very slowly, although they might fluctuate throughout the day.

If someone’s symptoms do worsen suddenly, it is likely due to other factors. For instance, one study investigated these types of exacerbations in 120 people with Parkinson’s over an 18-month period.

The most common cause was infection, accounting for more than 1 in 4 (25.6%) exacerbations. Other factors included anxiety, medication errors, poor adherence to medications, medication side effects, and a decline in health following surgery.

According to the authors, 81.4% of these episodes were “attributable to reversible or treatable causes.”

8. Beyond drugs, nothing can help

There is a persistent myth that drugs are the only way to ease symptoms or slow disease progression. This is a myth.

There is mounting evidence that staying physically active can reduce symptoms and potentially even slow disease progression.

The Parkinson’s Foundation explains that people with Parkinson’s “who start exercising earlier and [for] a minimum of 2.5 hours a week experience a slowed decline in quality of life compared [with] those who start later. Establishing early exercise habits is essential to overall disease management.”

Research suggests that exercise does not just reduce the motor symptoms of Parkinson’s. For instance, studies have found that exercise helps improve associated sleep problems and cognitive function in people with the condition.

9. Parkinson’s is fatal

This is a misconception. Parkinson’s is not fatal in the same way that a heart attack might be. People with Parkinson’s can live long and meaningful lives.

Compared with individuals who do not have Parkinson’s, those who do have the disease are likely to have a reduced life expectancy. This reduction is more significant for people who develop the disease at a younger age but less pronounced in those who do not develop dementia.

Although Parkinson’s is not fatal, it increases the risk of falls. Serious falls can be fatal, or they can require surgery, which increases the risk of complications or infections.

Another substantial risk is pneumonia. As people with Parkinson’s may have difficulty swallowing, they can inhale particles of food into the lungs. People with Parkinson’s also have weaker cough reflexes, so the food might stay in the lungs, where it can spark an infection.

The inability to cough out the infected material means that these infections can be fatal.

As the APDA explains, “Most patients die with Parkinson’s disease and not from it.”

Moving forward

Although there are still gaps in our knowledge about Parkinson’s disease, researchers continue to dive into the details. When MNT asked Dr. Beck about promising avenues of research, he said:

“I think genetic forms of Parkinson’s disease offer the best hope for treatments that may alter the course of the disease.” Scientists estimate that genetics are responsible for 10–15% of Parkinson’s cases.

“However, in order for any trial to succeed in targeting genetic Parkinson’s, we (patients and clinicians) need to know who carries disease-related mutations. Currently, no one really knows,” explained Dr. Beck.

“That is why the Parkinson’s Foundation launched PD GENEration, a national initiative that offers genetic testing and counseling at no cost for people with Parkinson’s disease. While this is not a cure for Parkinson’s now, our goals for PD GENEration are to accelerate clinical trials for the disease, improve Parkinson’s care and research, and empower people with Parkinson’s and their care teams.”

Slowly, researchers are unpicking the mechanisms at work in Parkinson’s, and, hopefully, they will one day identify more effective treatments and perhaps even a cure.

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Various common chemicals may harm the immune system, causing it to malfunction. This is known as immunotoxicity. These harmful effects may be temporary or permanent.

Possible immunotoxic effects include:

  • hypersensitivity
  • chronic inflammation
  • immunosuppression, or an impairment of the body’s ability to fight off infections
  • immunostimulation, which can cause tissue damage through immune responses
  • autoimmunity

In particular, if an immunotoxic substance causes the body to produce fewer antibodies, it can have an effect on the fight against active infections and the protection against future ones.

The FDA currently require immunotoxicity testing for food additives. However, most food additives received approval decades ago, and the FDA do not mandate updated testing on previously approved additives.

TBHQ and PFAS

TBHQ is a common preservative that manufacturers use to prolong their products’ shelf lives.

According to the Environmental Working Group (EWG), it is present in almost 1,250 processed foods, including Cheez-It crackers, Pop-Tarts, Reese’s Peanut Butter Cups, and Little Debbie Swiss Rolls.

However, this chemical has had immunotoxic effects in animal studies.

Chemicals may also leach from packaging or food processing equipment into food. Some bags, boxes, and food wrappers are coated with per- and polyfluoroalkyl substances (PFAS).

PFAS-based materials are also common in non-stick coatings on cookware, gaskets in food processing equipment, and repeat-use plastics.

The FDATrusted Source require immunotoxicity testing only for food contact substances with a high daily exposure. The immunotoxicity of many food additives and food contact substances is largely unknown.

The Environmental Protection Agency (EPA) use high throughput in-vitro testing in their ToxCast program. This type of testing exposes living cells, proteins, or biological molecules in a laboratory environment to chemicals to assess and identify any potential toxic effects. This potentially limits the need for animal testing.

The sparsity of current immunotoxicity data prompted the researchers from the EWG to conduct a study to evaluate the immunotoxic effects of common food additives and food contact substances. They also assessed the utility of ToxCast data in screening for immunotoxicity.

Lead study author Dr. Olga Naidenko, Ph.D., EWG’s vice president for science investigations, emphasizes the urgency of this research:

“The pandemic has focused public and scientific attention on environmental factors that can impact the immune system. Before the pandemic, chemicals that may harm the immune system’s defense against infection or cancer did not receive sufficient attention from public health agencies. To protect public health, this must change.”

The researchers analyzed a total of 63 direct food additives present on more than 10 product labels sold in the U.S. in 2018–2020. They also specifically assessed nine identified PFAS that migrate from food packaging to food.

The findings now appear in the International Journal of Environmental Research and Public Health.

The study evaluated these substances, concentrating on those with the highest number of active ToxCast assays. It focused further analyses on those substances with activity toward multiple immune-related targets and proteins involved in immune response, inflammation, and defense mechanisms.

The study compared the results of high throughput ToxCast data with available data from animal and epidemiological studies.

Altered immune responses

Strong data from both ToxCast testing and immunological laboratory animal studies indicate that TBHQ may cause immune functioning changes.

However, ToxCast screening yielded data that did not always agree with existing data: There were cases wherein ToxCast data conflicted with previous data or indicated risks that previous data had not found.

Three different situations happened with the food colorant FD&C Red 3 and PFAS such as perfluoroundecanoic acid (PFUnDA) and perfluorooctanoic acid (PFOA).

In the study, the ToxCast data indicated that FD&C Red 3 affected multiple immune parameters, but the researchers did not find reference to any animal or epidemiological study into the immunotoxicity of this food colorant.

ToxCast, laboratory animal, and human study data demonstrated that PFUnDA affected multiple immune parameters and increased immune suppression risk.

However, the ToxCast data did not show strong activity for immune targets with PFOA, whereas animal and human studies demonstrated immunosuppressive effects.

The study attributed the lack of consistency in the findings to a lack of understanding of the exact mechanism of PFAS toxicity. The limitations of currently available high throughput testing to capture the full extent of the potential mechanism for immunotoxicity may also have had an impact.

The researchers conclude that both ToxCast and study data suggest that chemicals indirectly or directly added to foods, such as THBQ and PFAS, may adversely affect immune system functioning.

The EWG stress that the FDA should prioritize and integrate updated immunotoxicity testing to identify harmful chemicals into standard safety assessments to protect public health and well-being.

Scott Faber, senior vice president for government affairs at the EWG, adds, “Food manufacturers have no incentive to change their formulas. Too often, the FDA [allow] the food and chemical industry to determine which ingredients are safe for consumption.”

“Our research shows how important it is that the FDA take a second look at these ingredients and test all food chemicals for safety.”

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Vitamin D plays a wide range of roles in the body, including regulating calcium levels, maintaining healthy bones and teeth, and supporting the immune system.

In addition to getting vitamin D from dietary sources, the body can make its own in the skin through exposure to sunlight.

However, it can be difficult for people with dark skin and those with low exposure to sunlight to maintain sufficiently high levels of the vitamin, especially during the winter months.

One studyTrusted Source found that, overall, about 42% of people in the United States were deficient in vitamin D. The figure rose to 82% among Black people and 70% among Hispanic people.

Accumulating evidence has shown that people with deficient vitamin D levels are more likely to test positive for SARS-CoV-2, which is the virus that causes COVID-19. They may also be more likely to develop severe disease.

This association may partly explain why the pandemic has disproportionately affected Black, Hispanic, and other non-white populations.

Clinical trialsTrusted Source have found that vitamin D supplements can help protect people against other respiratory infections resulting from viruses.

The research suggests that taking a vitamin D supplement can even reduce viral infections among people who are not deficient in the vitamin, based on the recommended intake in the current guidelines. These recommendations are based on the levels necessary to maintain healthy bones.

Dr. David Meltzer, Ph.D., and his colleagues at the University of Chicago, IL, wondered whether the same could be true of vitamin D and COVID-19.

Vitamin D blood tests

The researchers analyzed the medical records of 4,638 individuals who had a vitamin D blood test in the 12 months before having a PCR test for SARS-CoV-2 at the University of Chicago Medical Center (UChicago Medicine).

The researchers used the length of time since the vitamin D test and subsequent treatments to estimate the participants’ vitamin D levels 14 days before the PCR test.

In addition, they accounted for factors that are known to increase a person’s risk of COVID-19, such as age, sex, race, and medical conditions.

In total, 211 Black participants and 102 white participants tested positive for SARS-CoV-2.

The researchers discovered that among Black participants, the risk of testing positive was 2.64 times as high for those with a serum vitamin D level of 30–39.9 nanograms per milliliter (ng/ml) — a “sufficient” level — as it was for those with a level of at least 40 ng/ml.

In other words, there appeared to be a significant protective effect from having levels above the range that experts consider to be sufficient.

Among Black participants with a vitamin D level of at least 30 ng/ml, every incremental 1 ng/ml increase in the level of the vitamin led to a 5% decrease in the risk of testing positive for SARS-CoV-2.

“These new results tell us that having vitamin D levels above those normally considered sufficient is associated with decreased risk of testing positive for [SARS-CoV-2], at least in Black individuals,” says Dr. Meltzer, who is chief of hospital medicine at UChicago Medicine and lead author of the study.

“This supports arguments for designing clinical trials that can test whether or not vitamin D may be a viable intervention to lower the risk of the disease, especially in Persons of Color,” he adds.

There were no statistically significant associations between vitamin D levels and the risk of testing positive for SARS-CoV-2 among white individuals.

The researchers attribute this to the relatively low number of positive SARS-CoV-2 tests among white people in their sample.

Similarly, the numbers of participants from other racial groups, including Hispanic people, were too small to yield statistically significant results.

The study appears in the journal JAMA Network OpenTrusted Source.

Case for high dose supplements

“These results increase the urgency to consider whether increased sun exposure or vitamin D supplementation could reduce COVID-19 risk,” say the researchers in their paper.

They write that less than 5–10% of adults in the U.S. are likely to have vitamin D levels greater than 40 ng/ml. To attain these levels from taking a supplement — without increased sun exposure — would require more than the currently recommended daily dose.

“Lifeguards, surfers; those are the kinds of folks who tend to have more than sufficient vitamin D levels,” says Dr. Meltzer. “Most folks living in Chicago in the winter are going to have levels that are well below that.”

The National Institutes of Health (NIH) recommend 600 international units (IU), which equates to 15 micrograms (mcg), daily for adults aged 19–70 years. For adults aged 71 years and older, the recommended amount rises to 800 IU (20 mcg) daily.

In the United Kingdom, the National Health Service (NHS) recommends 400 IU (10 mcg) daily. It advises everyone to consider supplementing the vitamin during the fall and winter months but notes that those at high risk of deficiency should do so all year round.

Dr. Meltzer notes that although some studies have found that vitamin D improves immune function and decreases inflammation, the evidence has been mixed.

He believes this may be because researchers have been testing doses that are too low to boost the immune system.

“Based on these results, we think that earlier studies may have given doses that were too low to have much of an effect on the immune system, even if they were sufficient for bone health,” he says.

“It may be that different levels of vitamin D are adequate for different functions,” he adds.

A key limitation of the current study is that while it can demonstrate an association between vitamin D levels and SARS-CoV-2 infection risk, it cannot demonstrate that one causes the other.

To address this problem, researchers from the University of Chicago and Rush University in Chicago, IL, are conducting two clinical studies to learn whether taking a daily vitamin D supplement can help prevent COVID-19 or decrease the severity of its symptoms.

Socioeconomic inequality

Some of the results of the study were surprising. For instance, Black individuals with a vitamin D level of 20–30 ng/ml were not at an increased risk of COVID-19 compared with those with a level over 40 ng/ml.

Moreover, those with a level below 20 ng/ml seemingly had a lower COVID-19 risk than those with a level of 30–40 ng/ml. The authors suggest that potential variations in vitamin D treatment may explain these discrepancies, but they highlight that ongoing research is necessary in this area.

The authors of the new study also emphasize that social and economic inequities play a role in the increased susceptibility of Black people to COVID-19.

They write:

“The significant association of vitamin D levels with COVID-19 risk in Black individuals that was not found in white individuals could reflect their higher COVID-19 risk, to which socioeconomic factors and structural inequities clearly contribute.”

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By 2030, experts predict that nearly half of all adults in the United States will have obesity.

There are well-known links between obesity and a wide range of physical illnesses, including type 2 diabetesTrusted Source, hypertensionTrusted Source, rheumatoid arthritisTrusted Source, and some forms of cancerTrusted Source.

However, there is also a complex two-way relationship between obesity and mental illness.

According to a report from the Centers for Disease Control and Prevention (CDC), 43%Trusted Source of the U.S. adults aged 20 years and over who are living with depression also have obesity. There is also an association between mental illness in general and obesity.

Weight gain is a recognized side effect of many antidepressant medications. Conversely, research suggests that obesity can have a psychological effect on people that predisposes them to depression.

But researchers believe that there may also be a more direct, physiological link between the two conditions.

Among the possible causes that obesity and mental illness may have in common are:

  • inflammation
  • hormonal disturbances
  • genetic factors

Brain circuitry

There is also a possibility that certain neural circuits in the brain predispose people to both obesity and mental health conditions. However, exactly where these circuits are and how they work have been unclear.

Researchers from Baylor College of Medicine in Houston, TX, recently led a team of researchers that may have discovered such a circuit in mice.

The team found that feeding mice a high fat diet disrupted the circuit, which led not only to weight gain but also to signs of anxiety and depression on standard behavioral tests.

When the researchers used genetic techniques to restore the normal functioning of nerve receptors in the circuit, this resulted in weight loss and eliminated the animals’ signs of anxiety and depression.

Remarkably, despite still having a healthy appetite, the mice reduced their food intake and were no longer interested in high fat food.

“We were surprised to see that the animals lost weight not because they lost their appetite but because genetically aided readjustment of the mental states changed their feeding preference from high fat to low fat food,” says Dr. Guobin Xia, a postdoctoral associate at Baylor who is co-first author of the study.

Two drugs that target the same nerve receptors in this brain circuit had similar beneficial effects on the mice and their feeding preferences.

The research appears in the journal Molecular PsychiatryTrusted Source.

Appetite and emotions

The newly identified brain circuit comprises connections between neurons in the hypothalamus and those in another brain region called the bed nucleus of the stria terminalis (BNST)Trusted Source.

Whereas the hypothalamus plays a central role in the hormonal regulation of appetite and physiology, among other functions, the BNST is involved in stress and fear responses.

The researchers showed that in mice, eating a high fat diet disrupted the circuit, dulling its ability to regulate appetite and emotions.

“This newly discovered circuit was malfunctioning in mice that were both obese and depressed,” says Dr. Xia.

The scientists found that they could restore the circuit by tweaking the activity of two nerve receptors in the BNST, either genetically or with drugs that target the receptors.

This reversed the negative effects of the high fat diet, eliminating signs of anxiety and depression and reducing body weight.

Drug combination

The Food and Drug Administration (FDA) has already approved the two drugs, zonisamide and granisetron, as treatments for epilepsy and for preventing nausea, respectively.

Dr. Qi Wu, who is the corresponding author of the new study, explains:

“We discovered that the combination of two clinically approved drugs, zonisamide and granisetron, profoundly reduced anxiety and depression in mice and promoted weight loss by synergistically acting upon two different molecular targets within our newly identified brain circuit.”

The researchers believe that their findings could lead to future clinical trials of this drug combination for treating the link between obesity and mental health conditions.

Until other researchers have confirmed the findings and conducted clinical trials, however, these early results from a study in animals remain tentative and may not translate to humans.

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According to existing data, at least one in every 10 women live with endometriosis. Although this condition can have a serious impact on the quality of life, it often takes women years to have it diagnosed. Medical News Today speak to women living with this condition to find out more about their long journey to a diagnosis.

This issue can affect all people assigned as female at birth, but it often goes undiagnosed, partly due to gender stereotyping.

Available data indicate that around 10–15%Trusted Source of all women live with endometriosis, a chronic condition in which tissue similar to uterine lining grows outside the uterus.

The severe pain and bleeding and other incapacitating symptoms that often accompany endometriosis mean that the life quality of those who live with this condition is impacted in serious ways.

Despite this, it can take anywhere between 4 and 11 years for women to receive the correct diagnosis, and as many as six out of every 10 cases of endometriosis may remain undiagnosed.

Medical News Today have spoken to three women with diagnosed endometriosis to find out more about their experience of obtaining a diagnosis: what made it difficult, whether the treatment they received was helpful, and how this chronic condition has been affecting their lives.*

For an informed perspective on the difficulties that accompany the task of raising awareness of the facts versus myths about endometriosis, we have also spoken to Jenneh Rishe, a registered nurse and founder of the nonprofit organization The Endometriosis Coalition.

Why does it take so long to diagnose?

The most recognizable symptomTrusted Source that accompanies endometriosis is debilitating pain, not just in the pelvic area but also of the lower back, during bowel movements and during or after sexual intercourse with vaginal penetration.

While the pain often occurs during menstruation, it can also occur between periods due to the lesions and scarringTrusted Source caused by endometriosis.

Alma, one of the women who spoke to MNT about their experience, said that she realized she might have endometriosis when “[t]he pain had moved from just my ovaries to my intestines and overall stomach area.”

“[A]fter many MRIs and ultrasound scans, they concluded that I must have endometriosis, based on symptoms alone,” she added.

“Some common misconceptions [about this chronic condition] are that endometriosis is just a bad period, when, in reality, it is a highly inflammatory, full-body disease,” Rishe told MNT.

“To date, endometriosis has been found in every single organ in the body. The symptoms range from abdominal pain to brain fog and fatigue, to chest pain and shortness of breath, to nerve pain and pain with urinating. The symptoms are all over the map, and they don’t only happen during someone’s period. They can be every single day,” she explained.

Because endometriosis can affect so many parts of the body — including the vagina and rectum, intestines, bladder, and diaphragm — doctors may misdiagnose it as a different chronic condition.

Another woman, Martha, also told us that it was only when she started to experience chronic pain between periods that she realized she might have a gynecologic condition.

“I’ve had painful periods my entire life, but for a long time, I’d never heard of endometriosis. Around my mid-20s, I started to experience pain more often, not just during my period,” she said.

“I just happened to hear about endometriosis online, on social media. At first, I didn’t identify with it, because I’d been told that period pain is normal. But as the severity of my symptoms increased, I started to wonder if maybe this wasn’t so normal. I believe I was 28 years old when the pain and other symptoms started happening daily and just didn’t stop. That was when I started looking into endometriosis more seriously and began to suspect that I had it.” – Martha

Another contributor, Lisa, told us that she had a similar experience: “I realized that I might have endometriosis after receiving abnormal results from a transvaginal ultrasound. I visited my general OB-GYN after experiencing abnormal bleeding and increasingly debilitating pelvic pain during both ovulation and menstruation.”

In her case, too, it took many attempts at a diagnosis until she received the correct one — and only then, it was after specifically seeking the advice of an expert in endometriosis.

“I was told that the shape of my uterus was suggestive of adenomyosis, and while doing some research with the help of […] various online support communities, I learned about the relationshipTrusted Source between adenomyosis and endometriosis. My symptoms aligned with the most common symptoms of endometriosis, so I found an endometriosis excision expert in my area and sought his care.” – Lisa

Currently, the generally accepted way of diagnosing endometriosis with certainty is through a laparoscopic surgery, which allows doctors to see the endometriosis lesions.

‘Everyone assumed it was just a painful period’

The misdiagnoses and wide array of symptoms may contribute to how long it takes healthcare professionals to diagnose this condition.

In Martha’s case, “it was almost 3 years between beginning to pursue a diagnosis and finally getting one.” For Alma and Lisa, it took well over a decade to receive a formal diagnosis.

“I was formally diagnosed with [endometriosis] around the age of 30, despite the fact that I’d had extremely painful periods since the age of 14,” Alma told us.

For her part, Lisa said: “I first sought care for the debilitating nature of my periods when I was around 16, and did not receive my diagnosis until I was 25. It’s hard to say when my symptoms officially started, but looking back, I would guess that I experienced them for well over 10 years before being diagnosed.”

Yet the complexity of endometriosis symptoms is only half of the story when it comes to the delays in diagnosing the condition.

When women seek help for chronic pain associated with or triggered by their periods, they often hear that this experience is “normal,” just a “bad period” that they have to find ways to cope with.

This was Alma’s experience, which she recalled with frustration. Even upon diagnosis, she said:

“I was offered no treatment apart from very strong pills, many of which [have] been discontinued since due to their dangerous side effects. […] Mostly, I was just told to deal with it. Everyone just assumed it was just ‘a painful period.’ Nobody seemed to think it was a condition, nobody regarded it as something that was even worthy of treatment. […] And I have seen a lot of gynecologists in my life, particularly in my teens and early 20s. It was just assumed that it was a ‘normal’ albeit very painful period, despite the fact that I would have pain and vomiting to the point of faint[ing] and [experiencing] visual hallucination[s].”

Alma’s experience ties in with worldwide reports of a gender pain gap — the phenomenon whereby women report more instances of chronic pain than men but are less likelyTrusted Source to be offered timely pain relief by healthcare professionals.

Why should this be so? One review of the existing literature, published in Pain Research and Management in 2018, suggests that the answer may lie in the persistence of gender stereotyping the experience of pain.

Studies about pain and healthcare, the review shows, tended to make questionable value judgments about men versus women and their subjective perception of pain.

“[M]en were presented as being stoic, in control, and avoiding seeking healthcare. Women, on the other hand, were presented as being more sensitive to pain and more willing to show and to report pain, compared [with] men,” the review authors write.

This suggests that women’s experience of chronic pain may get dismissed as exaggerated, a result of subjective, emotional oversensitivity rather than an objective physical experience.

Elusive treatments and management

There are many misconceptions about treatments and causes as well. Rishe told MNT that one misconception is “that pregnancy or hysterectomy are treatments for endometriosis.”

Another “major misconception is that [endometriosis] only affects those [in] their childbearing years, when, in reality, many adolescents and teens show signs of endo,” she noted.

Treatments for the management of endometriosis do exist, although they are far from perfect.

After receiving a diagnosis, women may be offeredTrusted Source an excision surgery, which will remove the abnormal growths of endometrial-like tissue. This excision does not stop the tissue from growing back, however, and repeated surgeries may follow to keep removing these growths.

Doctors may also offer an endometriosis management plan, depending on how much pain and bleeding a person experiences as a result of endometriosis.

In the first instance, doctors may prescribe the same drugs they would advise for the management of menstrual cramps: nonsteroidal anti-inflammatory drugs (NSAIDs)Trusted Source, which are over-the-counter pain relievers, such as ibuprofen.

Other prescribed treatments to manage endometriosis include hormone therapy, such as birth control pills, or the insertion of an intrauterine device (IUD).

None of these options, however, are ideal. NSAIDs often do not reduce the severe pain that endometriosis can cause, and both birth control pills and IUDs can produce side effects that further impact quality of life.

Martha told MNT that the treatments and coping strategies that her physicians offered kept falling short of their aim and did not help with her symptoms.

“When I told doctors I was having a hard time [with endometriosis] and needed treatment, they’d suggest trying a different form of birth control to help reduce cramps or lighten my period, but no birth control ever fully addressed my symptoms,” she recounted.

“Some doctors just suggested things like exercise and ibuprofen (which never even touched my pain). I was at the point where I could hardly even get out of bed some days, and I was just about ready to give up trying, because the ‘treatment’ options offered were so unhelpful.” – Martha

Martha told us that only excision surgery helped, but in the long term, she needed a solid management plan.

“Since [the surgery], treatments have included other forms of birth control, like an IUD and then Depo-Provera, changing my diet, and mindfulness tools like meditation,” she said.

Yet none of the formally offered options and treatments proved to be enough.

Martha felt she had to go beyond the doctor’s office and come up with her own coping strategies: “I’ve never really had options that addressed my symptoms completely, but my most consistently helpful treatments have been home remedies, like heating pads, TENS units, and medical cannabis.”

To go or not to go on ‘the pill’?

Birth control pills may help slow down the growth of endometrial-like tissue outside the uterus. However, they can have many side effects — including bleeding between periods, migraine, decreased libido, and mood changes.

Finding “the right pill” may feel like a gamble with high stakes: it could take months and trying various types of oral contraceptives until a woman lands on the one that causes her the least distress. With endometriosis, matters get even more complicated.

For some, birth control could work wonders. That was the case for Alma, who “was […] told [by doctors to] try the minipill to see if the symptoms [of endometriosis] go away, and if they do, then they can conclude that it was indeed endometriosis.”

“I did take the minipill, and the symptoms went away,” she said. Alma is still taking the “minipill” — a progestin-only birth control drug that may cause fewer side effects than regular combined pills, which contain both progesterone and estrogen.

For her, this strategy is successfully keeping endometriosis symptoms at bay. Lisa, however, did not experience the same relief and worried that birth control might mask symptoms rather than address them.

“I took birth control pills for 7 years and found no relief,” Lisa told us. “I also received minimal relief when using the NuvaRing,” she added.

“I refused IUDs and Nexplanon due to fear of side effects and inability to get the devices removed in a timely manner, if needed, which is something that folks with endometriosis and adenomyosis experience all too frequently. I want to stress that oral contraception and hormonal suppression are not effective treatments for endometriosis and that they often mask symptoms and delay formal diagnosis,” Lisa commented.

Why these differences? A 2018 study published in The Journal of Clinical Endocrinology and Metabolism found that it may all come down to the type of endometrial-like tissue growing outside of the uterus.

The study authors found a link between the progesterone receptor (PR) status of endometriosis lesions and whether or not they responded to progestin therapy.

In short, PR-positive lesions tended to respond to progestin therapy, and PR-negative lesions responded much less. This led the authors to suggest analyzing these lesions upon excision, to find out what kind of hormonal treatment they were most likely to respond to.

Pain, missed work, chronic fatigue

However, research on endometriosis — its mechanisms, causes, and treatments — continues to be very limited, which has prompted an outcry from those living with this chronic condition and researchers interested in studying it alike.

In 2017, a team of researchers from the Faculty of Health, Education, and Life Sciences at Birmingham City University in the United Kingdom interviewed women with endometriosis about their experiences in seeking a diagnosis and treatment for the condition.

The findings were stark. Study participants spoke of feeling “desperate,” having severe side effects from the treatments they received, and not being believed by those around them when they told of their experiences.

Dr. Annalise Weckesser, one of the researchers involved in this study, commented:

“Endometriosis has long been a neglected area of research and funding. We know that the average waiting time for women to receive a diagnosis is 7 years, which is unacceptable. Our pilot study shows that even once women receive a diagnosis, for some, their struggle with managing their symptoms has only begun.”

These symptoms are as many as they are severe. Each of the women who spoke to MNT about their experiences living with endometriosis emphasized this.

When asked how this chronic condition had impacted her quality of life, Martha said that, ironically, “[i]t might be easier to answer how it hasn’t affected my quality of life.”

“From the time I started menstruating at 12 years old, my periods have been debilitating. I’d throw up and pass out from the pain and often had to miss school because of it,” she told us.

“Once the pain became chronic, it really affected every part of my day. I couldn’t sleep, [I] had a hard time standing or sitting for long periods of time, sex was painful, and it also affected my mental health. I was really depressed and anxious — a few times, I had panic attacks when a flare-up started, because I knew the pain might get unbearable, and there was nothing I could do about it.” – Martha

“I had to stop working for a while and had a hard time finding work again because I needed flexibility to work from home during bad flare-ups,” she said. Add to this “a number of related physical problems, including leg pain and sciatica, bowel issues, and food sensitivities,” and the picture of pain is complete.

Self-reported data published in The Journal of Managed Care + Specialty PharmacyTrusted Source in 2017 indicate that, in a representative cohort of women aged 18–49 years with endometriosis, participants “lost an average of 1.1 hours of employment productivity because of absenteeism,” that is, missing work because of endometriosis symptoms, “and an average of 5.3 hours because of presenteeism,” or attending work while experiencing symptoms, per week.

“The most important and adverse impact [of endometriosis] was the fact that I had to explain to my bosses at work why I couldn’t function for 5 days a month or [why I] required working from home arrangements. When I used to work as a teacher, working from home wasn’t an option, so a lot of the time, I had to drag myself to class in immense pain,” Alma told MNT.

Lisa also spoke of the many days of school and work that she was forced to miss because of endometriosis symptoms.

“This disease has affected my life in so many ways,” she said. “On a very surface level, the disease has caused me to miss a lot of school, work, and time with loved ones.”

This has led her to come up with complex, multitiered coping strategies to try and minimize the impact on her daily activities:

“It has forced me to learn to budget my time and plan out everything that I do. Will eating at a certain restaurant aggravate my digestive symptoms? Will walking around a park or a store send me into a pain flare? Will going to class in the morning make me unable to stay awake long enough to complete my homework tonight?”

Fatigue is not a rare effect of endometriosis, and it may not just be due to the invisible planning and emotional work required to cope with this condition.

A study published in Human Reproduction in 2018 found that many women with endometriosis experience fatigue but that healthcare professionals rarely address or account for it.

One of the study authors, Prof. Brigitte Leeners, commented that their “findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease.”

“Although chronic fatigue is known to be one of the most debilitating symptoms of endometriosis, it is not widely discussed, and few large studies have investigated it,” she added.

Endometriosis can also cause severe abdominal pain during and after intercourse with vaginal penetration, which can put women off having sex or cause them anxiety about being intimate with their partners.

“One of the biggest effects of endometriosis has been its impact on my relationship and my sex life,” Lisa told MNT.

“Before surgery, sex was incredibly painful for me, and [my partner and I] were forced to completely abstain from sex for that reason,” she noted.

The impact of experiencing severe pain during sex for years is unrelenting, Lisa went on to tell us. “Even after surgery, I still experience a lot of pain and a lot of fear and anxiety regarding sex and the pain it can cause for me,” she admitted.

‘My family doctor mocked me’

Beyond its physical effects, perhaps the greatest impact endometriosis has is how it affects women’s ability to navigate the world freely and with confidence.

This is not just because they have to plan everything and prepare for the days they know they will have to spend in excruciating pain or experiencing serious and unsettling blood loss.

More than anything, women who live with endometriosis face the constant frustration of being misbelieved by their doctors, managers, teachers, and even family and friends, who often still think of this chronic condition in terms of “a bad period.”

“When I submitted my master’s thesis, I was in tremendous pain on the day of the deadline,” Alma recalled.

“I asked my [family doctor] for a doctor’s note, and he mocked me, repeating several times the phrase ‘you want a doctor’s note … for period pain. A doctor’s note … for … period pain,’ as if it was the most shocking thing he’d ever heard in his life, and how could I dare ask for such a thing.” – Alma

“Many people reach out to me and say their doctor doesn’t think they have [endometriosis], because their symptoms don’t fit the outdated profile of someone who just had bad cramps around their period,” Rishe told MNT.

“Another [misconception healthcare professionals have] is the belief that hysterectomy is a cure for endometriosis. By definition, endometriosis occurs when cells similar to the uterine lining end up outside of the uterus, in other parts of the body,” she went on to explain.

“[B]y definition, a hysterectomy wouldn’t cure endometriosis, since the [endometrial-like] cells are not in the uterus. Additionally, there are no studies to date that show hysterectomy treats endometriosis, yet it is still commonly recommended,” Rishe pointed out.

The women who spoke to MNT all emphasized the need for a better understanding of this condition. The general public needs to be better informed about the realities of endometriosis.

Family should also shed their misconceptions, they all told us. Employers and educators must pay attention, too.

“I wish employers knew how hard it is to live with such a condition, and accommodate their employees,” Alma told MNT.

“I wish employers, partners, etc., wouldn’t blame the person living with [endometriosis] for not having ‘planned’ better around it — this was a frequent thing I would get, the attitude of ‘Well, but you know you’re gonna have a period, and you won’t be able to do much during it, so why didn’t you plan better for said deadline.’” – Alma

‘We desperately need better treatment options’

The lack of satisfactory care for and research into endometriosis is also a major barrier for women living with this condition.

“We desperately need better treatment options,” Martha told MNT. “I have medical debt from pursuing treatment options that weren’t covered by my insurance, and sometimes those treatments didn’t even help,” she said.

Moreover, she added, “[s]ome of the most effective treatment options also come with the risk of severe and long-term side effects, so we often have to weigh whether it’s worth trying or not.”

“It’s also shocking to realize how few medical professionals actually have a working knowledge of endometriosis. […] A few times I went to the emergency room because of the pain, and nobody could help me.” – Martha

Research published in the American Journal of Obstetrics and Gynecology in 2019 emphasizes that women who seek care for endometriosis face a barrage of obstacles, including poor doctor-patient dynamics and a lack of effective treatments.

One of the study authors, Dr. Rebecca Nebel, straightforwardly confirmed that “[d]espite its significant burden on women, their families, and society as a whole, endometriosis is underfunded and under-researched, greatly limiting understanding of the disease and slowing much-needed innovation in diagnostic and treatment options.”

“What bothers me the most,” Lisa told MNT, “is that ‘reputable’ sources are still promoting definitions of endometriosis that are not correct. […] We cannot begin to effectively diagnose and treat a disease that we can’t even define correctly.”

“All medical professionals, not just minimally invasive gynecologic surgeons, need to be educated on endometriosis symptoms, diagnosis, and treatment,” she added.

“Doctors need to stop perpetuating the myth that painful periods are ‘normal’ and ‘part of being a woman.’ […] Mental health professionals need to be educated on the impact of endometriosis and its symptoms on the mental health of patients. The medical community as a whole must recognize that endometriosis does not just affect cisgender women and that the disease affects people of all genders.” – Lisa

A long and exhausting journey

The women who spoke to MNT noted that the perpetuation of myths and stereotypes about endometriosis, as well as the lack of satisfactory treatments, can independently impact quality of life.

For her part, Martha said: “I’ve experienced the mental and physical toll of the lack of information and treatment options, and I’ve seen it in others, too.”

“I’m part of some tight-knit endo communities online, and we’ve lost more than one friend to suicide and had too many others attempt to take their own lives,” she told us. “The impact is far more severe than what you’d expect from something that’s often just characterized as ‘bad periods,’ and it really shows how badly we need more help.”

Knowing they could be misbelieved by doctors may also discourage women from seeking a diagnosis and treatment in the first place.

Rishe commented that some might also be put off by the prospect of surgery.

“The fact that the only way to 100% diagnose [endometriosis] is via a laparoscopy surgery [may prevent some people from seeking a diagnosis]. Some may think that is too invasive of a procedure to go through,” she told us.

For those who do want to seek a diagnosis and treatment plan, the journey is likely to be long and difficult. Rishe had some suggestions as to how an individual could best advocate for their health.

“The best thing a person can do,” she said, “is do their research about the disease so that they have a good understanding to be able to ask the right questions and know when they may be in the best hands.”

She recommended some useful places online: “Some great resources with reliable information are The Endometriosis Coalition, Endo What?, the Center for Endometriosis Care, and The Endometriosis Summit.”

“The next [step] would be to try to see a doctor who specializes in endometriosis. These doctors have a higher level [of] understanding of the disease and are able to provide adequate treatment. I also always encourage people to keep a diary of their symptoms so that they have an accurate account of everything they’d like to explain to their doctor.”– Jenneh Rishe

The onus, however, should not fall on patients to research the mechanisms behind their condition, and potential treatments. Physicians and researchers have a responsibility to find the best path forward.

Society at large, however, has a responsibility, too: to stay informed and nurture empathy.

“The main thing that I’d like people to know is that pain that is so disruptive that you’re missing out on life, work, school, etc., is not normal,” said Rishe.

“As a society, we’ve normalized period-related pain, and I believe that makes people with suspected [endometriosis] feel [that] what they are dealing with is normal,” she added.

Our contributor Alma also had a heartfelt plea for her peers who do not live with endometriosis.

“[A] word of advice for fellow women or vagina bearers everywhere: please don’t tell women with endometriosis that you ‘also have very painful cramps.’ […] [O]ftentimes, pain for women living with endometriosis means you’re on the floor or in your bed, unable to move or do anything else but moan with pain,” she said, asking that each of us stop trivializing chronic pain.

* We have changed the names of these contributors to protect their identities.

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For decades, scientists have been hunting for a cure for the common cold, with little success.

However, recent research hints that this bothersome — though usually mild — infection may be a hidden ally in the fight against pandemic viruses such as influenza and SARS-CoV-2.

Human rhinoviruses (HRVs), which cause more than half of all common colds, are the most widespread respiratory viruses in humans.

Previous researchTrusted Source suggests that HRVs may have inhibited the spread of the influenza A virus subtype H1N1 across Europe during the 2009 flu pandemic.

Experts believe that the HRVs did this by inducing human cells to produce interferon, which is part of the body’s innate immune defenses against viral infection.

Research has shown that SARS-CoV-2 is susceptibleTrusted Source to the effects of interferon.

This finding led scientists at the MRC-University of Glasgow Centre for Virus Research in the United Kingdom to speculate whether HRVs could help combat the spread of SARS-CoV-2 and limit the severity of infections.

Human respiratory cells

To find out, the researchers infected cultures of human respiratory cells in the lab with either SARS-CoV-2, an HRV, or both viruses at the same time.

The cultures closely mimicked the outer layer of cells, called the epithelium, that lines the airways of the lungs.

SARS-CoV-2 steadily multiplied in the cells that the team had infected with this virus alone. However, in cells also infected with HRV, the number of SARS-CoV-2 virus particles declined rapidly until they were undetectable just 48 hours after the initial infection.

In further experiments, the scientists found that HRV suppressed the replication of SARS-CoV-2, regardless of which virus infected the cells first.

Conversely, SARS-CoV-2 had no effect on the growth of HRV.

To test their hunch that HRV was inhibiting SARS-CoV-2 by triggering the cells’ innate immune response, the researchers repeated their experiments in the presence of a molecule that blocks the effects of interferon.

Sure enough, the molecule restored the ability of SARS-CoV-2 to replicate in cells infected with HRV.

“Our research shows that human rhinovirus triggers an innate immune response in human respiratory epithelial cells, which blocks the replication of the COVID-19 virus, SARS-CoV-2,” says senior author Prof. Pablo Murcia.

“This means that the immune response caused by mild, common cold virus infections could provide some level of transient protection against SARS-CoV-2, potentially blocking transmission of SARS-CoV-2 and reducing the severity of COVID-19,” Prof. Murcia adds.

Mathematical simulation

The researchers used a mathematical simulation to predict how different numbers of HRV infections of varying lengths might affect the spread of SARS-CoV-2 through a population.

The results showed that the number of new SARS-CoV-2 infections in a population is inversely proportional to the number of HRV infections.

The model predicts that if the common cold virus were to become sufficiently widespread and persistent, it could temporarily prevent SARS-CoV-2 from spreading.

“The next stage will be to study what is happening at the molecular level during these virus-virus interactions to understand more about their impact on disease transmission,” says Prof. Murcia.

“We can then use this knowledge to our advantage, hopefully developing strategies and control measures for COVID-19 infections,” he adds.

The research appears in The Journal of Infectious Diseases.

In their paper, the researchers speculate that mild HRV infections might be mutually beneficial for the virus and its human hosts.

They write that the immune system may have evolved to allow HRV to replicate and transmit to new hosts. In return, the virus keeps more severe and potentially lethal viral infections at bay.

Real-world limitations

At the Science Media Centre in London in the United Kingdom, other scientists welcomed the research but flagged some potential limitations.

Gary McLean, who is a professor in molecular immunology at London Metropolitan University in the U.K., said that the major limitation was that the study involved just one of the 160 or more possible strains of rhinovirus.

He said there was no guarantee that each strain would have the same effect on SARS-CoV-2 infections.

He added that translating results from a lab experiment to real life is “very tricky,” saying:

“Although it is likely that a common cold virus, such as rhinovirus, would induce a strong innate immune response that could block SARS-CoV-2 infections, it would still require both infections to occur at a similar time.”

In addition, he pointed out that intensive infection control measures over the past year have made the common cold less prevalent, reducing the potential for HRV-triggered innate immunity to combat the spread of SARS-CoV-2.

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Mindfulness is a mental practice in which a person directs their attention to the present moment, having a nonjudgmental awareness of their immediate surroundings, thoughts, and feelings.

A study by researchers at Wake Forest School of Medicine in Winston-Salem, NC, investigates the therapeutic value of online mindfulness sessions for people who have found that the COVID-19 pandemic has affected their emotional health.

After an experimental online mindfulness session, 89% of participants reported that the experience had been helpful.

The principal investigator for the research is Dr. Rebecca Erwin Wells, M.P.H., of Wake Forest School of Medicine, who says:

“We are all born with the capacity for mindfulness. It can help reduce stress and anxiety, and mindfulness meditation practice can help enhance this ability.”

The inspiration for the study comes from a program of free daily mindfulness sessions called “Mindfulness for Milan,” which Italian physician Dr. Licia Grazzi presented during the lockdown period. Dr. Grazzi is one of the recent study’s co-authors.

The results appear in the journal Global Advances in Health and Medicine.

Trying online mindfulness

From March 23 to August 4, 2020, the researchers recruited healthcare professionals, individuals with migraine, and the general public to participate in their study.

Of the 233 participants, 203 came from 116 different zip codes in the United States. In addition, there were 20 participants from other countries and 10 people who participated from unknown locations.

The researchers asked each of the participants to complete a pre-session survey, take part in a 15-minute online video mindfulness session, and then respond to a post-session survey.

Of those taking part, 63% had never practiced mindfulness before.

The session began with a white coat-wearing female instructor providing an overview of mindfulness. A guided practice followed that instructed individuals to bring their attention to the present moment, their breathing, and simply “being.”

The practice encouraged the gentle release of thoughts, feelings, and sensations throughout the session. A bell sound signaled the start and end of the session.

The effect of the class

Of the 144 individuals who completed the post-session survey, 76% said that the experience reduced their anxiety, while 80% reported feeling less stressed.

Slightly more than half of the participants — 55% — said that the class allayed their concerns about COVID-19.

Overall, 89% of people felt that the session helped them, with the same percentage considering the online format to be effective. In total, 74% said that they would recommend online mindfulness sessions to their friends and family. Individuals were also interested in more sessions, either weekly (48%), daily (36%), or monthly (17%).

Just under two-thirds of the participants — 65% — were interested in learning more about mindfulness. An additional 24% said that they might be interested.

The researchers note that 21% of participants were retirees, suggesting that age does not limit the value of mindfulness practice.

Limitations of the study

The study’s authors note several limitations of the research.

Firstly, the completion of the post-session survey may have been affected by some participants continuing to meditate after the session, which would give too much weight to the opinions of non-meditators. Participants may also have become distracted after the session or experienced technical issues.

Secondly, most of the sessions occurred in the early months of the pandemic, possibly artificially heightening people’s emotions and the effect of the session.

Finally, the participants in the study were overwhelmingly white (84%). The authors note:

“Further investigation is needed to understand the reasons behind lack of participant diversity: recruitment methods vs. lack of interest or access. While online programs improve accessibility, lack of internet or low technological proficiency may create disparities for some populations.”

Online mindfulness resources

The researchers also conducted an analysis of interest in mindfulness online. They collected the results of Google searches for the Boolean phrase “mindfulness + COVID” on both May 19, 2020 — toward the start of the pandemic — and August 23, 2020.

On the first date, searches yielded 63.5 million results, whereas there were 96.4 million results on the second date. This 52% increase in the number of sites on which the search phrase appeared suggests a growing interest in mindfulness as the pandemic continued.

The study also contains a list of recommended online mindfulness resources.

A Google search for “mindfulness-based stress reduction” classes led the authors to extensive online mindfulness resources, guided recordings, and external links that members of the Academic Consortium for Integrative Medicine and Health had provided.

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