Whooping cough cases (also known as the ‘100 day cough’) are rising sharply across England. Between January and March 2024 there have sadly been 5 infant deaths. Vaccination is the best protection.
In this blog post, Catherine Hughes, Founding Director at The Immunisation Foundation of Australia, shares the story of her son Riley Hughes and how their family lost Riley to Whooping cough (pertussis)

• Independent presidential candidate Robert F. Kennedy Jr. told the New York Times that a parasitic worm infected his brain and may have caused some of his past health problems.
• The pork tapeworm can cause a condition called neurocysticercosis, which leads to symptoms such as seizures and headaches and can occasionally be fatal.
• While neurocysticercosis is common in many parts of the world, only 1,300 to 5,000 new cases are reported in the United States each year. Some cases, though, may not cause any symptoms.

Some of Independent presidential candidate Robert F. Kennedy Jr.’s past health issues may be due to a parasitic worm that entered his brain and died, The New York Times reported on May 8.

His symptoms, which occurred in 2010, included severe memory loss and mental fog. These were severe enough to affect his earning power, according to the Times.

A New York doctor who reviewed a scan of Kennedy’s brain told him his health issues could be “caused by a worm that got into my brain and ate a portion of it and then died,” the Times reported. The parasite did not require treatment, he told the paper, and his memory loss and brain fog cleared up. 

Around the same time, the Times reported, Kennedy suffered from mercury poisoning, which can lead to movement issues, memory loss, and vision, hearing, and speech problems.

Kennedy didn’t indicate which parasite had infected his brain.

However, the pork tapeworm can cause a condition called neurocysticercosis, which can lead to symptoms such as seizures and headaches. In some cases, people may experience cognitive problems, although this is less common.

What is neurocysticercosis?

Cysticercosis is a parasitic infection caused by the larvae, or juvenile form, of the pork tapeworm, also known as Taenia solium. This infection can occur in the muscle, brain or other parts of the body. When it affects the brain and spinal cord, it is known as neurocysticercosis.

“The main manifestation of neurocysticercosis is seizures,” said Clinton White, MD, a professor of infectious diseases at the University of Texas Medical Branch at Galveston in Texas. “It also is associated with headaches, and in a minority of cases, can cause what’s called hydrocephalus.”

Hydrocephalus is a blockage that causes the accumulation of cerebrospinal fluid in the brain, a potentially fatal condition.

The symptoms of neurocysticercosis are mainly due to the body’s inflammatory response to the worm rather than the parasite itself.

“When the parasite gets into the brain, it usually doesn’t cause any problems. It sits there and tries to prevent the inflammatory response from attacking it,” White told Healthline. “But eventually, when the inflammation attacks the parasite, it can cause some damage in the brain associated with seizures and headaches.”

This condition “can range from something that is asymptomatic — meaning the patient is not aware of it — to causing severe cases and sometimes death,” said Walavan Sivakumar, MD, a neurosurgeon and director of neurosurgery at Pacific Neuroscience Institute-South Bay in Torrance, Calif.

In some people, when the parasite dies, it can form a calcified cyst, or scar, in the brain. “When this scarring is present, it can be associated with seizures that recur over a long period of time,” said White. “So, in essence, people have a chronic epilepsy.”

Memory loss or other cognitive problems are not a common occurrence with neurocysticercosis, said White, unless someone had recent seizures or hydrocephalus, both of which can damage the brain.

How do you get it?

Cysticercosis occurs when someone swallows the eggs of the pork tapeworm, which are present in the feces of someone with a tapeworm in their small intestine. 

The eggs are spread through food, water and surfaces contaminated with feces. For example, this can happen if a person infected with a tapeworm doesn’t wash their hands properly while preparing food for others. People living in the same household with someone with an intestinal tapeworm are at higher risk of infection.

Once in the intestine, the eggs develop into spheres that pass through the wall of the intestine and into the bloodstream. These travel to the muscles, brain, or other tissues and form larval cysts.

Pigs can also get cysticercosis by eating the feces of a person with an intestinal tapeworm, with the larval cysts ending up in the pigs’ muscles and other tissues.

In fact, “neurocysticercosis is found pretty much anywhere in the world where pigs are raised and have access to human fecal material,” said White.

However, you can’t get cysticercosis by eating raw or undercooked pork. But if the pork contains larval cysts, those cysts can attach to the wall of the small intestine and develop into a tapeworm. Cooking pork fully kills the parasite.

“So, getting the tapeworm in your [gastrointestinal] tract really isn’t going to pass worms to your head,” said Sharon Nachman, MD, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital in Stony Brook, New York. “You have to eat the eggs of someone else’s worms.”

A person with an intestinal tapeworm can also develop cysticercosis by eating worm eggs passed in their own feces, what’s known as auto-infection. However, Nachman said this is less likely to occur.

How common is it?

Tapeworm infection and cysticercosis are more common in parts of Latin America, Asia, and Africa where free-roaming pigs have access to human feces and there is poor sanitation. In low-income countries, neurocysticercosis is a major cause of seizures that begin in adulthood.

“[Cysticercosis] is a common disease around the world, and we should be able to eradicate it,” said White. “We have the tools to do that. But so far, there hasn’t been the political will because it mainly affects poor people and large rural populations in poorer countries.”

A program in northern Peru, funded by the Bill and Melinda Gates Foundation and others, showed that elimination of cysticercosis from communities is possible. The strategies used by public health officials included vaccinating all pigs for the tapeworm and treating people who may be carrying the tapeworm.

In the United States, an estimated 1,300 to 5,000 new cases of neurocysticercosis occur every year, although accurate information is not available because people with no symptoms or mild symptoms may not realize they are infected.

“Most of the [U.S.] cases are in immigrants [from areas where neurocysticercosis is endemic],” said White, “and a few are in people who have lived extensively overseas.”

Nachman said the low rate of this condition in the United States is due, in part, to government oversight of the food industry. All meat sold commercially in the country undergoes inspections, as does meat being imported.

In addition, in this country, “people who prepare food, for the most part, have to be healthy, have to wash their hands, and have to wear gloves,” she told Healthline, “and those things are all going to prevent the passing of any worms to other people.”

So, “unless you have your own farm and are killing your own pork and then eating it raw or undercooked, [neurocysticercosis] is not really an issue,” said Nachman.

How is it diagnosed?

If you have possible symptoms of neurocysticercosis, your doctor will ask about your travel history and what foods you ate, said Nachman.

Your eating history is important because, in some countries, there may not be a lot of oversight of how street vendors prepare food. So “thinking about where you’re going and what you’re eating is probably the best way to protect yourself,” she said.

Blood tests or imaging tests may also be needed. This condition is usually diagnosed by MRI or CT scan, although Nachman said sometimes both tests are needed.

“These exams reveal different things about the brain,” she said. “Together, they will tell us if it’s one or more worms present, if they’re dead or alive, where they are located, and if there is inflammation around them.”

How is it treated?

Treatment for neurocysticercosis depends upon several factors, but in general, has multiple phases, said Nachman.

“We almost always give you steroids because the inflammation around the dead worm is causing the headaches and seizures,” she said. “Steroids will cool that [inflammation] down.”

A doctor may also prescribe an anticonvulsant to help control the seizures. Or other medication to treat symptoms such as headache.

And if the worm is still alive, “we’ll give you something called albendazole,” said Nachman, “which is available in pharmacies across the country.”

This drug, which is taken by mouth, works by killing the worms. It is usually taken for eight to 30 days. However, “in some patients, longer, or repeat, courses of medication may be needed, depending on how extensive their disease is,” said Nachman.

After treatment, your doctor will monitor you to see how you are progressing. Steroids are not usually given long-term, she said, although some people may need to stay on anti-seizure medication longer.

In some cases, surgery is necessary to remove cysts from the brain. “That’s where I get involved,” Sivakumar told Healthline.

“Because the infection can happen anywhere in the brain, there can be risks with surgery,” he said, “but we use minimally invasive approaches to minimize the collateral damage to the brain.”

In general, people recover well after surgery, although it depends on how extensive the infection and inflammation were.

“Oftentimes, you can have a near complete or complete recovery after surgery,” said Sivakumar, especially “if you get to them early enough and the surgery goes well, meaning you remove the cause of the infection, the inflammation, and the blockages of spinal fluid flow that can be caused by the cysts.”

With medical treatment, “for the most part, the long-term outlook is [also] excellent,” said Nachman. “We know how to treat it, we know how to cool [your inflammatory response] down, and we know how to treat the side effects of the inflammation.”

Takeaway

The New York Times reported that Independent presidential candidate Robert F. Kennedy Jr.’s past health issues may be due to a parasitic worm that infected his brain. Kennedy’s symptoms included memory loss and brain fog.

While Kennedy didn’t indicate which parasitic worm had infected his brain, the pork tapeworm can cause a condition called neurocysticercosis. The main manifestation of this condition is seizures, although headaches and more serious symptoms can also occur.

Treatment for this condition involves using steroids to reduce inflammation in the brain, which is the main cause of seizures and headaches. Some people may also need medication to kill the tapeworm.

The outlook for most people is good, although some people may require surgery, which also generally has good outcomes.

• “Ozempic breasts” is the latest reported side effect of GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound.
• The term is being used to refer to unexpected changes in breast size or shape as a result of rapid, extreme weight loss.
• The most common symptoms include loss of volume, sagging, and tenderness.

GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound have become popular weight loss tools.

However, people can also experience a wide variety of side effects while taking these drugs, including some that are associated with extreme weight loss.

Like “Ozempic face” and “Ozempic butt,” “Ozempic breasts” is the latest term gaining popularity as a way to describe a loss in volume and decrease in skin elasticity that people often experience while taking GLP-1 drugs, which can lead to a change in shape and appearance in specific parts of the body.

What are “Ozempic breasts,” and what causes them?

“Ozempic breasts” isn’t a clinical term, but it has entered the public lexicon.

“Ozempic breasts is a newer term that people are using now to refer to unexpected changes in breast size or shape as a result of rapid weight loss induced by Ozempic,” says Christopher Costa MD, MPH, the founder of Platinum Plastic Surgery.

According to Elie Levine, MD FACS, the director of plastic surgery at Plastic Surgery & Dermatology of NYC PLLC, “The most common symptoms include loss of volume, sagging, tenderness, and rarely, some will describe size fluctuations including swelling.”

While more research is needed, each expert Healthline spoke with pointed to the same likely cause for breast changes.

“In the breast area, rapid fat loss can leave the skin envelope empty, causing the breasts to look deflated and the nipples facing downward,” says Ronald F. Rosso, MD, the medical director at Peninsula Plastic Surgery. “This appearance is very similar to what happens after patients have had more traditional weight loss procedures such as gastric bypass.”

Levine points out that there isn’t research backing breast changes, but that doesn’t mean they don’t happen. In fact, Levine says they likely occur for some patients and echoed Rosso’s sentiments.

“Ozempic can affect weight and hormones in your body,” Levine says. “As a result of shifts in weight and hormones, other changes may occur, such as in the appearance of your breasts. Mostly, however, if one loses considerable weight, it is reasonable to think that the weight loss will include all parts of the body, including the breasts.”

Hormonal effects of GLP-1 drugs

Ozempic and Wegovy use the active ingdedient, semaglutide, a GLP-1 hormone receptor agonist. 

“The hormone, which is naturally produced in the body, plays a strong role in regulating blood sugar levels, appetite, and body weight,” Costa says. “So basically, the medication makes you feel fuller longer, experience no cravings, and not eat as much because you’re less hungry.”

Hormonal changes, such as during pregnancy and a person’s menstrual cycle, can cause temporary breast changes, such as swelling. Since GLP-1 drugs mimic a hormone, could the same be true for these medications?

It’s unclear.

“The effects of Ozempic on testosterone and estrogen are being studied currently, but there is no definitive data on their interactions at this time,” Costa says. “More research is needed to directly link hormonal changes affecting breast tissue to the use of this medication because it is currently understood to primarily affect blood sugar and appetite hormones.”

How to manage or treat “Ozempic breasts”

Costa notes that breast changes don’t appear to be a cause for concern at this time.

“Every individual is different,” Costa says. “However, the changes in breasts are typically correlated to overall weight changes as opposed to Ozempic specifically.”

However, some people may experience physical and emotional discomfort related to these changes and want solutions. First, it’s best to wait before seeking professional procedures.

“I advise my patients to wait until they are able to maintain their desired weight before making any decisions,” Costa says.

Also, doctors only recommend stopping medication after speaking to a healthcare professional first.

Research from 2022 indicated that those who stopped using semaglutide regained about two-thirds of their lost weight within a year. This is commonly referred to as Ozempic rebound.

Still, there are ways to manage physical discomfort while taking GLP-1 medications and, if and when the time is right for a patient, breast appearance, too.

Experts offered the following tips:

At-home care

While procedures may help with breast changes, experts share some remedies for both appearance and pain that can be handled at home.

“Wearing a supportive bra 24/7 except when showering can be helpful in limiting the effects of weight loss combined with the stretch and sagging caused by gravity,” Levine says.

Swelling can also be reduced with minimally invasive steps.

“Although there might be some discomfort with this, massaging the breasts can help increase circulation and reduce swelling,” Levine says. “Furthermore, ibuprofen or Tylenol or applying a cool compress can help relieve some of the discomfort.”

Procedures 

Patients may also consider or opt for a procedure. These may include:

• Breast lift (mastopexy)
• Breast augmentation
• Breast lift with implants

“A breast lift helps to raise and firm the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour,” Costa says. “I notice that patients who feel insecure due to their breasts sagging after rapid weight loss will opt for this procedure to perk up their breasts and give them a full shape.”

Additionally, people who aren’t happy with a smaller breast size may opt for an augmentation to restore volume, Costa says. 

“[It can help people] to feel like themselves again,” Costa says.

Others may opt for both.

“Many patients feel very deterred when I tell them that a breast lift will cause them to lose a cup size,” Costa says. As such, these patients will opt for a combination of a lift and augmentation implants to achieve their desired aesthetic. This is usually the case when the patient has a significant loss of volume and sagging.”

That said, procedures aren’t the best fit for each patient.

“While surgery often addresses the concerns of patients, it is not for everyone,” Levine says.  “I highly recommend speaking to a board certified plastic surgeon to discuss your options even if, in the end, you decide it is not for you or not for you at the current time. There is power in knowledge.”

Embrace it

Doing nothing is a perfectly acceptable solution to “Ozempic breasts.”

“Your body after Ozempic may be completely different,” Costa says. “That means accepting that overall breast volume and shape may be affected. If you’re not ready for a cosmetic procedure, it’s OK to embrace your new look. Go shopping for new clothes to fit your new size and bust to create the best version of yourself.”

Takeaway

“Ozempic breasts” is the latest reported side effect of GLP-1 medications like Ozempic.

The term is being used to refer to unexpected changes in breast size or shape as a result of extreme weight loss triggered by GLP-1 medications.

Sagging, tenderness, and volume loss are among the most common symptoms people are reporting.

Hormonal changes may also trigger swelling, but health experts say they should be temporary.

Surgical procedures like breast lifts and implants can alter the appearance of sagging and lost volume.

Antimicrobial resistance (AMR) occurs when medicines used to fight infections lose their effectiveness because the organisms they target – whether bacteria, fungi, viruses or parasites – have evolved or acquired adaptations to survive. In 2019, AMR was directly responsible for …

• The U.S. government has two candidate vaccine viruses for H5N1 bird flu that could be used to make vaccines.
• Studies suggest vaccines based on these would offer good protection against the bird flu virus circulating among cattle in the U.S.
• It would take months to produce and ship millions of doses, but experts worry that uptake will still be low.

The H5N1 bird flu circulating in the U.S. remains far more dangerous for birds than for people.

Currently, this strain of the flu that circulated in cows has led to just a single person being affected in the last few months. But the strain of influenza has the potential to mutate, so federal health officials are already thinking ahead toward a potential vaccine.

The country has two candidate vaccine viruses available to manufacturers for the production of a bird flu vaccine, the Centers for Disease Control and Prevention (CDC) said on its website.

How U.S. could make millions of bird flu vaccines within weeks

“These [candidate vaccine viruses] are like seed stock that are kept in reserve in case there is an outbreak of that particular strain,” said David Diemert, MD, a professor of medicine in the School of Medicine and Health Sciences at George Washington University, and director of the GW Vaccine Research Unit.

If bird flu started easily spreading to people, “[the candidate vaccine virus] can be sent to manufacturers to make millions of doses of vaccine,” he said, “using the existing hen egg technology that we normally use for the regular seasonal vaccine.”

A candidate vaccine virus is attenuated, or weakened version of the virus. As a result, it is unlikely to lead to active infections in people who get the vaccine.

This type of weakened virus is able to grow well in hen eggs, which is what most manufacturers use to produce seasonal flu vaccine. 

The candidate vaccine would also have the surface proteins — known as hemagglutinin — of the virus circulating in the community. This enables a vaccine to generate a protective immune response.

Would these bird flu vaccines work?

The U.S. National Pre-Pandemic Influenza Vaccine Stockpile (NPIVS) has four types of H5N1 candidate vaccine viruses, reported STAT News. The bird flu affecting dairy cows is a strain of H5N1.

Only two of these candidate vaccine viruses are a good match for the currently circulating strain of bird flu.

Studies suggest that vaccines based on these two candidate vaccine viruses “will offer good cross-protection against cattle outbreak viruses,” Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, said on a call on May 1.

However, Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, cautioned that the candidate vaccine viruses are not a “perfect match” for the currently circulating strain of H5N1. This means they may not produce vaccines very effective at preventing disease.

In addition, research done in the mid-2000s found that H5N1 vaccines don’t trigger a strong immune response in people unless it is given in a large enough dose; or if it is given with a compound known as an adjuvant, which boosts the immune response.

Adalja pointed out that the H5N1 vaccines that we have in the stockpile are really not that good at provoking an immune response.

“Even for the viruses they are targeted against,” said Adalja. “In clinical trials, the protective antibody levels that people had were modest.”

One of these existing H5N1 vaccines in the NPIVS is made by CSL Seqirus, which supplies flu vaccine to the U.S. market.

Still, Diemert thinks a bird flu vaccine based on the two candidate vaccine viruses in the NPIVS would be effective and potentially more effective than seasonal influenza vaccines.

This is because a bird flu vaccine would likely only have to target a single virus strain.

In contrast, during seasonal flu season, there may be multiple strains of influenza that spread. Seasonal flu vaccines are developed to target certain strains of influenza every year. The vaccines are developed in the summer and early fall by looking at common strains in the Southern Hemisphere. But during flu season the strains that become more common in North America may not be the strains the vaccine was primed to target.

As a result, seasonal flu vaccines may end up targeting strains of influenza virus that are not the ones in circulation that year.

“That’s one of the reasons that [seasonal flu vaccines] are not 100% effective because they’re not a perfect match,” said Diemert.

Would vaccines need FDA approval?

Before bird flu vaccines could be rolled out, they would need to be approved by the Food and Drug Administration (FDA) but the agency has a process for approving updated seasonal flu vaccines each year.

So this should go fairly smoothly, said Diemert, “especially since the [bird flu] vaccines would be made using the same manufacturing process that they use every year [for seasonal flu vaccines].”

Also, “I’m sure if there was a massive outbreak of this particular strain, then the FDA would speed things up,” he said. “So I don’t see regulatory approval being a rate-limiting step.”

How quickly could the vaccine be rolled out?

In terms of getting the vaccine to the people who need it the most, “all of the pieces are in place to be able to roll out a vaccine relatively quickly,” said Diemert. 

However, “when you send [the candidate vaccine virus] to the manufacturer, it still takes weeks to months to make all the doses you need,” he said.

This is especially difficult in a “fast-moving situation” such as a pandemic, said Peter Chin-Hong, MD, an infectious disease physician at UCSF Health.

Federal health officials estimate that over 100 million doses could be shipped within three to four months. However, they expect people to need two doses, so this would only cover 50 million people.

Vaccine production could also be affected by the same virus the vaccine would be designed to protect against.

Manufacturers most often use hen eggs to produce flu vaccines, but chickens are also susceptible to the bird flu virus that is affecting cattle.

So, “if you have a global [influenza] pandemic, and you have birds dying too, that may constrain supplies such as chicken eggs,” said Adalja.

As of May 6, over 5 million chickens and other commercial or backyard poultry birds in the United States have been affected by highly pathogenic avian influenza (HPAI). which includes H5N1, reports the U.S. Department of Agriculture. 

The big question is whether enough vaccine doses could be rolled out in time to make a difference.

“With the 2009 H1N1 pandemic, by the time the vaccine came out, the pandemic had already dissipated,” said Chin-Hong.

During that outbreak, tens of millions of Americans were vaccinated, but by the time the vaccine doses were available, the fall wave had subsided.

However, “this is 2024 and things have changed,” said Chin-Hong, referring to the fast development and rollout of the COVID-19 vaccines. “When people put their mind to it, it could be done fast … But the devil is in the details.”

Overall, “it’s going to take some time to actually gear up to be able to vaccinate everybody who’s at risk for flu,” said Adalja. “And as I said, the candidate vaccine virus that is stockpiled is not a perfect match. And even if it were a perfect match, [the H5N1 vaccine] is not a great vaccine to begin with.”

mRNA vaccines and other options

Federal health officials said the government is also pursuing an mRNA bird flu vaccine, based on the same technology as Pfizer’s and Moderna’s COVID-19 vaccines.

Chin-Hong said this type of vaccine could potentially be updated more quickly to match the currently circulating strains of the virus. But these vaccines have their own challenges, he said, such as needing to be stored at extremely cold temperatures.

In addition, given that these vaccines would be a new use of the mRNA vaccine technology, the FDA may require clinical trials which could delay the roll-out to the greater population.

There are other options for dealing with an outbreak of bird flu in people, including antivirals such as Tamiflu, which would be given to people who are already infected.

“Different interventions speak to different people,” said Chin-Hong. “In general, Americans prefer to treat something rather than prevent it, which can be a challenge.”

Vaccine hesitancy may slow uptake

As seen during the COVID-19 pandemic, it’s not just how many vaccine doses you can ship that matters, but also how many people receive the vaccines.

“The problem we may have is that there is more vaccine hesitancy now, so people may not be as willing to get vaccinated,” said Diemert. “I don’t know if that will be different because the [hen egg] flu vaccine technology has been around for decades and there’s a lot of evidence of its safety.”

Chin-Hong pointed to the poor current COVID-19 vaccination rates among American adults as a sign of vaccine fatigue.

Around 22% of all American adults have received the updated COVID-19 vaccine, with a slightly better rate (38%) among older adults, according to the CDC. Both rates are much lower than health officials would like to see.

“That shows how fatigued people are [with vaccination campaigns],” said Chin-Hong. “This [hesitancy] would need to be addressed in the same breath as having a well-oiled plan [for rolling out the vaccines].”

Adalja is concerned not just about vaccine hesitancy, but with growing public opposition to vaccines, in general.

“In 2009 with H1N1, vaccination uptake was subpar because concerns raised by the anti-vaccine community — which were unwarranted concerns — dissuaded people from getting vaccinated,” he said.

But “after COVID-19, the anti-vaccine movement is more powerful than it has been in decades,” he added. “So I think mounting a vaccination campaign in an [future] emergency is going to be very difficult to do in the current political environment.”

Takeaway

There is no sign that the H5N1 bird flu circulating in dairy cow herds is developing the ability to spread easily to people. But federal health officials are planning for the rollout of a bird flu vaccine as a precaution.

The federal government has two candidate vaccine viruses stockpiled. These are weakened so they cannot infect people or cause illness, but they grow well in hen eggs, which is how flu vaccine are most often made.

The candidate vaccine viruses are not a “perfect match” for the bird flu virus currently circulating, but they should offer good protection, say health officials. However, experts are concerned that vaccine fatigue will deter uptake.

• Healthy, older men with higher concentrations of testosterone were more likely to develop atrial fibrillation, according to a new study.
• The findings follow a landmark 2023 trial that found that men using testosterone-replacement therapy had a higher incidence of atrial fibrillation.
• Maintaining testosterone in a healthy, normal range appears to mitigate atrial fibrillation risk.

Higher natural testosterone levels are associated with an increased risk of atrial fibrillation (AFib).

The findings, published April 29 in The Lancet, substantiate prior research that identified a higher incidence of AFib among men who used testosterone-replacement therapy (TRT). In 2023, researchers published a landmark study, known as the TRAVERSE trial, that found that men with pre-existing or high risk of cardiovascular disease using TRT were not at increased risk of death from cardiovascular disease. However, it did find that men prescribed TRT did have slightly higher rates of AFib. 

Using that research as a jumping-off point, the authors of The Lancet study wanted to investigate whether they could identify an association between testosterone and AFib in men who were not prescribed TRT, using only natural testosterone levels.

“Amongst 4,570 initially healthy older aged men aged 70 years or older, those with testosterone concentrations at the higher end of the clinical normal range had nearly double the risk of developing AFib compared to men in the middle of the range,” Cammie Tran, MPH, a researcher at the Monash University School of Public Health in Australia, and First Author of the study, told Healthline.

The risk factors for AFib

Tran and her team utilized data from the ASPREE clinical trial, a long-term study that looks at the effects of aspirin on health in older adults for their study. They included 4,570 males with an average age of 74 years old with no history of cardiovascular disease (including AFib). Participants had their circulating testosterone concentrations measured at baseline. During an average 3-5 year follow-up period, researchers observed that 286 participants, or around 6%, developed AF.

They found that men who developed AFib had higher baseline testosterone levels compared to those that did not. The average testosterone concentration for the men who developed AFib was 17 nmol/L compared to 15.7 nmol/L. They also tended to be current or former tobacco smokers and had a higher baseline BMI. However, the association between testosterone and AFib persisted after controlling for these factors.

“Male sex has been recognized as a risk factor for AFib for a long time, but it’s been hard to determine whether that was due to the effect of testosterone directly, or just other risk factors that are more common in men. This study found that higher testosterone levels conferred a higher risk for [AFib] even when other clinical risk factors like age, BMI, smoking, and alcohol use were accounted for. This suggests a direct role for testosterone,” M. Ben Shoemaker, MD, the Director of Vanderbilt University’s Atrial Fibrillation Precision Medicine Program, told Healthline. Shoemaker wasn’t affiliated with the research.

The ideal testosterone level

Another important finding of the study was that the association between testosterone concentrations and AFib was not linear. That means what they found isn’t as simple as: higher testosterone equals a higher risk of atrial fibrillation. 

Men in the high-normal of testosterone concentration did have higher risk of AFib, but so did men below the normal range. 

“This study suggests that testosterone levels need to be ‘just right,’” said Shoemaker.

Prior related studies have come to similar conclusions.

A 2017 study published in the Journal of the American Heart Association found that men with low testosterone had a higher incidence of AFib compared to men within a normal range. But, when their testosterone levels were normalized through TRT, the prevalence of AFib dropped.

“Men with higher testosterone concentrations had a higher risk of atrial fibrillation, but there was no reduction of risk in men with lower testosterone. Our results would suggest that being within the mid-range of the clinical normal range would be best for lower risk of [AFib],” said Tran.

Testosterone and TRT: what to know

Despite the findings, the mechanism for why testosterone outside of normal ranges is associated with AFib is still not known.

“Originally, the focus was on testosterone’s role in regulating gene expression- a process that slowly increases the risk of [AFib] over time. Now, it’s recognized that testosterone can directly bind to receptors in the heart that regulate its electrical activity, and those changes promote AFib,” said Shoemaker.

Maintaining testosterone in a healthy range is therefore important due to AFib risk, but overall health as well. 

Low testosterone, also called low T and testosterone deficiency, is defined as a concentration of less than 300 ng/dl, according to the American Urology Association. Testosterone production and circulating concentration typically decrease with age.

Signs and symptoms of low T include:

• Low sex drive
• Erectile dysfunction
• Decreased muscle mass
• Increased body fat
• Low energy
• Smaller testicle and penis size

For individuals with low T, a doctor may prescribe TRT, or testosterone replacement therapy, to increase the circulating concentration of testosterone.

TRT is also frequently used off-label for various non-medical issues like gaining muscle mass, losing weight, and boosting sexual performance. It is also popularly believed to have “anti-aging” properties. However, the use of TRT for these purposes may be illegal and without scientific merit.

Risks of high testosterone from TRT include:

• Acne
• High blood pressure
• Difficulty urinating
• Shrinking of testicles
• Fluid retention

“Recreational or off-label use of testosterone needs to be strongly discouraged. There are risks of harm, including heart-related complications in androgen abusers. Testosterone should only be prescribed to men with medical conditions necessitating this treatment, with appropriate medical supervision and monitoring,” said Tran.

The bottom line

In healthy older men, abnormal testosterone levels were associated with a greater risk of developing AFib, according to a new study.

The findings follow the findings of the 2023 TRAVERSE trial that identified men using testosterone-replacement therapy as having higher incidence of AFib, but not other cardiovascular disease risks.

Experts say that maintaining testosterone concentrations in a normal range — neither too high nor too low — is optimal to minimize AFib risk.

• A new review has found that ancient grains like oats and brown rice can improve type 2 diabetes.
• More research is needed to better understand the association between these grains and diabetes.
• Aside from incorporating more ancient grains in your diet, experts recommend portion control and eating more heart-healthy fats and lean protein.

A new meta-analysis found that ancient grains (oats, brown rice, and millet) can improve health outcomes in people with type 2 diabetes.

The findings were published in the journal Nutrition, Metabolism and Cardiovascular Diseases this week.

The review included 29 randomized controlled trials and 13 were meta-analyzed. 

Results showed for those with type 2 diabetes, oat consumption could improve cholesterol levels. However, further research is needed to learn more about the relationship between ancient grains and diabetes.

How ancient grains can improve heart health

Oats, brown rice, millet, and all other “ancient grains” are considered whole grains. Whole grains include not only starch, but also fiber, vitamins, minerals, and healthy fats. 

“When we consume starch, it’s quickly digested into sugars and then absorbed into our bloodstream,” said Dr. Nate Wood, physician at the Yale School of Medicine and culinary school graduate. “This can cause a blood sugar spike. Over time, we know that these blood sugar spikes can lower our body’s sensitivity to insulin, which is the problem in type 2 diabetes.”

However the healthy fats and especially the fiber contained in whole grains like oats, brown rice, and millet work to slow the speed with which the sugar from the grain is absorbed into our bloodstream, reducing glucose spikes. 

Reducing the number of glucose spikes in the blood can help preserve our body’s insulin sensitivity, which helps reduce the risk of developing diabetes. This is one big reason that eating whole grains is linked to lower rates of type 2 diabetes, Wood explained.

How fiber helps your heart

Oats, brown rice and millet are also good dietary sources of soluble fiber.  

“Soluble fiber has been found in studies to have a positive impact on T2D [type 2 diabetes] and blood lipids [cholesterol and triglycerides,]” said Nancy M. Ryan, MS, RD, inpatient diabetes coordinator at Greenwich Hospital. “Soluble fiber absorbs water in the intestinal tract and the gel that forms can slow gastric emptying. This may decrease the after-meal rise in blood glucose in T2D.”  

Soluble fiber also binds with bile salts in the intestinal tract, reducing absorption of these salts back into the body and reducing the amount of bile salts available to the liver to manufacture cholesterol, Ryan explained.

Additionally, soluble fiber also supports a healthy microbiome, the beneficial bacteria in the intestinal tract.  

“These bacteria have a positive impact on the immune system and anti-inflammatory effects,” Ryan stated.

Dr. Marie-Pierre St-Onge, associate professor of nutritional medicine at Columbia University Vagelos College of Physicians and Surgeons explained, “These grains are typically whole grains, which means that they have not been stripped of their bran and therefore provide more fiber than refined counterparts. Higher fiber intakes produce more stable blood glucose patterns with less pronounced spikes upon consumption.”

More study needed

While the research found positive benefits of the grains for overall health, the different studies examined different types of grains and over a variety of time periods. As a result, experts said more studies will be needed to verify the findings.

The authors note that most of the studies indicated a positive impact on measures of blood sugar management and lipid profiles.

However, the small number of studies for each of the grains limited the ability to come to a definitive conclusion that ancient grains improve blood sugar management and blood lipid control in individuals with type 2 diabetes.

Reducing type 2 diabetes symptoms with dietary and lifestyle changes

Experts say to help manage type 2 diabetes staying on track with diet is key, especially by monitoring the intake of simple carbohydrates. These carbohydrates can break down quickly leading to blood sugar spikes.

“Reducing overall sugar intakes not only from refined grain products (bakery products, sweets, desserts) but also from beverages, is a longstanding recommendation to reduce blood sugar swings in patients with [diabetes,]” St-Onge stated.

“But, aside from diet, patients should also consider other lifestyle behaviors that are important for health, including obtaining sufficient sleep and exercise.”

In managing type 2 diabetes, Ryan explained it is important to consider three treatment goals to monitor: blood sugar, blood lipids, and blood pressure.  Dietary modifications should take these three goals into account.  

The American Diabetes Association does not promote one specific diet or way of eating.  

“The emphasis is on supporting an eating pattern and food choices that support these three goals, including a variety of nutrient-rich foods, incorporating preferred foods and foods with cultural meaning/value,” said Ryan.

There are many strategies to achieve these goals.

“The first step is knowing which foods contain carbohydrates as that is the nutrient that will raise blood glucose the most after eating.  With that knowledge, portion management can be very helpful,” Ryan stated. 

Additionally, including heart-healthy fat (such as nuts, nut butters, avocado, olive oil) and/or lean protein (such as chicken, turkey, fish, lower fat cheese) at meals and snacks blunts the after-meal rise in blood glucose, Ryan explained.  Slowing down our eating pace also reduces the after-meal rise in blood glucose.  

Also, the order in which we eat the foods on our plate can make a difference.  

“If we eat vegetables (cooked vegetables and/or salad) first, then our protein (chicken, turkey, fish, lean meat) and finally our starch (potato, rice, pasta), slows down the rise in blood glucose after eating,” said Ryan.

If the person with diabetes is not meeting their personal management goals, meeting with a registered dietitian/nutritionist can be very helpful. Collaboratively, a plan can be developed to support diabetes goal attainment. The contact information for a registered dietitian/nutritionist near you can be found on the website for the Academy of Nutrition and Dietetics.

Takeaway

A new review showed ancient grains can improve cholesterol levels in people with type 2 diabetes.

Aside from incorporating more ancient grains in your diet, experts recommend portion control, and eating more heart-healthy fats and lean protein.

• A small study has found that combining time-restricted eating and high intensity exercise may improve cardiometabolic health and contribute to weight loss.
• Participants who combined this diet and exercise approach achieved the most noticeable body composition changes.
• Experts say this is because time-restricted eating can create a calorie deficit, and exercise can lead to an increase in lean muscle mass.

A new study has found that time-restricted eating and high intensity exercise can work together to improve health and help people achieve fat loss. 

Time-restricted eating, also known as intermittent fasting, involves limiting the hours for eating to a specific number of hours each day. 

The research published in the PLOS ONE Journal found that, when combined, time-restricted eating and high intensity exercise could contribute to weight loss and improve markers of cardiometabolic health, including cholesterol, blood glucose, and lipid levels. 

How the study was conducted

64 women with obesity were assigned to one of three groups: time-restricted eating (diet only), high intensity functional training (exercise only), or time-restricted eating plus high intensity functional training (diet + exercise).

Participants ate only between 8:00 am and 4:00 pm, and those in the functional training groups worked out three days per week with an instructor.

After 12 weeks, all three groups had achieved significant weight loss and body composition improvements. Favorable changes were also found in lipid and glucose levels.

Participants in the diet+exercise group achieved more noticeable body composition changes and cardiometabolic parameters compared to the other two groups. 

The authors said, “Combining time-restricted eating with High-Intensity Functional Training is a promising strategy to improve body composition and cardiometabolic health.”

However, they note that this is a small study and more research is needed. 

The benefits of time-restricted eating and high intensity exercise 

Registered dietitian Emma Shafqat, who was not involved in the research, says she isn’t surprised by the findings of this study, even though time-restricted eating doesn’t seem to restrict your total calorie intake – which is necessary for weight loss to occur. 

She said that studies have found that people often spontaneously reduce their energy intake when following an intermittent fasting plan, inducing a mild (1%–4%) body weight loss over periods of time lasting from 1 week to 3 months.

Likewise, celebrity personal trainer Michael Baah says the combo of time-restricted eating and high intensity experience tend to work well together.

“When we limit the time we eat and do intense workouts, our bodies get better at using energy and processing sugar, and it’s like they become more efficient at staying healthy,” he explains.

Intense exercise has added benefits when it comes to fat loss. “Time-restricted eating helps us burn fat, and intense exercise helps us build muscle,” Baah surmises. 

This is good news for anyone wanting to sustain their weight loss in the long term as lean muscle mass increases your body’s metabolic rate, meaning you burn more calories. 

As well as triggering weight loss, the combination of time-restricted eating and high intensity exercise can also lead to improvements in cardiometabolic health. 

“Cardiometabolic disease describes a range of conditions starting with insulin resistance, progressing to the metabolic syndrome, prediabetes, and finally to more severe conditions including cardiovascular disease and type 2 diabetes,” Shafqat explains. 

She notes that time-restricted eating improves cardiometabolic health in lots of ways, for example, improving glucose tolerance, reducing blood pressure, and enhancing gut function. 

Risks and challenges of time-restricted eating to consider

However, time-restricted eating won’t be the right weight loss tool for everyone. 

“The only way to lose fat is to be in a calorie deficit. For some people, time-restricted eating is simply a tool that allows them to achieve that goal,” says Baah. “If they restrict their time eating window, it [often] reduces their overall calories for the day, which puts them in a calorie deficit.” 

While this works for some, it may not fit with your lifestyle or may feel too restrictive. Time-restricted eating is not the only way to lose fat. However, if you are planning to follow a time-restricted eating plan, Shafqat says ensuring you feel adequately fuelled and satiated is key. 

“I recommend starting your day with a breakfast that is high in fiber, protein, and some fruit, for example, full-fat yogurt with seeds and fruit or porridge with added seeds and fruit,” she says. “I’d also recommend eating a good balanced meal before 4 pm, which includes fiber-rich carbohydrates, protein, and plenty of vegetables to help prevent hunger before bedtime.” 

Shafqat says planning is key when it comes to time-restricted eating. 

“In this study, there appears to be an 8-hour schedule in which participants can eat, so if you’re following this schedule. I recommend scheduling your meal and snack times and preparing your food in advance.” 

How to get started with high intensity exercise for beginners

However you plan to lose weight, factoring exercise into your schedule is a good idea. If high intensity exercise sounds intimidating, don’t worry, says Baah.

“Start with simple exercises and focus on using good form,” he advises. 

Ideally, you should aim for a mix of strength and cardio exercises. Some exercises Baah recommends include skipping or jumping jacks, bent-over rows, weighted crunches, and dumbbell reverse lunges. 

The term ‘high intensity’ can conjure up images of grueling workouts, but Baah says it’s important to give your body time to rest and recover. Take a rest period of about 60 seconds between each set and plan rest days into your schedule. 

The key to making progress, according to Baah, is to ensure you lift heavier weights over time. 

Takeaway 

Combining time-restricted eating and high intensity exercise appears to contribute to fat loss and improve other health markers related to cardiometabolic health.

However, if you have a goal of losing weight, a calorie deficit is the most important factor, and if you find time-restricted eating too restrictive, you should consider something else.

• A study has found that psilocybin appears to have antidepressant properties.
• Experts say it activates serotonin receptors.
• It might also work by increasing the brain’s neuroplasticity.
• Side effects are minimal, and it is regarded as non-addictive.

“Magic mushrooms” are often used by people seeking their hallucinogenic effects.

However, psilocybin, a compound found in magic mushrooms, might also have applications in treating depression, according to a study published on May 1, 2024, in BMJ.

This is significant since an estimated 5% of adults around the world are affected by this common mood disorder.

The authors of the study note that it appears to reduce symptoms after only one or two doses.

Additionally, there are minimal side effects and it is regarded as non-addictive.

Studying whether psilocybin relieves depression

To learn more about how well psilocybin works for depression, the researchers searched various databases for randomized controlled trials comparing the drug with controls, such as microdoses of psychedelics, niacin or a placebo.

The review also included any studies in which psychotherapy was used in both the experimental and control groups. This allowed them to distinguish between the effects of psychotherapy and psilocybin.

Altogether, they were able to gather seven trials, including 436 participants with depression. A little over half were women, while most (90%) were white.

After analyzing changes in depression scores, they found that psilocybin had a large effect size, meaning that it had a strong positive effect on depression symptoms when compared with the control groups.

The team of scientists also found that factors like having depression secondary to another health condition, being assessed using a self-reported scale, being older, and having previously used psychedelics were associated with larger improvements in scores.

Psilocybin’s potential as a treatment for depression

Padam Bhatia, MD, FAPA, Chief Executive Officer at Elevate Psychiatry in Miami, Florida, commented on the research saying that the large effect size was the most “impressive” part of the study.

“While most studies answer a single question (“Did the medication work or not?”), effect size goes a step further and looks at how well the medication worked,” he said.  

“For this study, the effect size was huge, much greater than any oral antidepressant that has ever been studied.”

However, he did point out that while the results are promising, the individual studies were small and had significantly different methods and results.

Bhatia said that more studies would need to be done to reach a conclusive answer.

Before it becomes an accepted treatment for depression, there would also need to be a change in the legal landscape of the country to allow its medicinal use.

According to Psychedelic Alpha, while several cities throughout the U.S. have decriminalized the personal use of psilocybin, only two states, Oregon and Colorado, have decriminalized psilocybin in general and have legalized psilocybin use at licensed service centers.

However, several other states have active legislation or working groups to study its use.

Why psilocybin might be effective for depression

Alex Dimitriu, MD, who is double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine, explained that researchers are still learning why psilocybin might have an antidepressant effect.

He said one possible mechanism “is increased neuroplasticity, allowing the brain to make new connections, known as synaptogenesis.”

Dimitriu went on to explain that neuroplasticity might allow a patient to develop new ways of looking at old problems. It might also allow them to make connections to life events and behaviors that previously did not exist.

“Put more briefly,” he said, “the effects are likely biological as well as psychological and rooted in improvement in the function of the serotonin system, as well as higher-level changes in thought patterns.”

Risks associated with psilocybin treatment

Bhatia noted that while research is growing on the potential mental health benefits of the therapeutic use of psilocybin, magic mushrooms should still be used with caution since being in an altered state of mind can be challenging

“An extreme version of these side effects, sometimes called a ‘bad trip,’ can be associated with confusion, disorganized thinking, and severe panic,” said Bhatia.

“Although this is temporary, it is certainly disturbing to the individual and can lead to physical aggression or [in rare cases] seeking emergency treatment.”

Dimitriu agreed with Bhatia, noting that while there are minimal physiological risks with psychedelic use, the “power and intensity of these substances and experiences cannot be underestimated.”

He noted that while some experiences “can be very positive and uplifting,” others can be scary or temporarily destabilizing.

Dimitriu advised that you should seek out guidance and support before, during, and after using psilocybin for the best outcome.

Using an analogy, he added, “You would never willingly fly an airplane alone for the first time,” noting that you should not attempt to treat yourself as it could be “catastrophic.”

“Of particular concern is people with any history of psychosis, bipolar disorder, and possibly panic attacks,” he concluded.

Takeaway

A new study published in BMJ has found that psilocybin, the active compound in magic mushrooms, could have applications as an antidepressant.

In a meta-analysis of seven studies, they found it had a strong positive effect on depression symptoms.

It might exert its antidepressant effect by increasing serotonin receptor sensitivity or by increasing brain neuroplasticity.

However, while the findings of the meta-analysis are promising, the selected studies were small, and more research is needed to determine whether psilocybin is an effective antidepressant.

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