On May 19, Sujata Ghadke was wheeled into an operation theatre in Pune, western Maharashtra.

A non-cancerous tumour near her intestine needed surgery.

Doctors at the private hospital had assured her husband, Seelove Ghadke, that it was not an uncommon procedure and Sujata had no other health complications to worry about.

The 4.5 cm tumour was “successfully removed” and a biopsy report confirmed that it was benign.

But as she lay on the hospital bed over the next few days, the 46-year-old homemaker complained of an acute headache and lower body pain. Ghadke flagged her condition to doctors several times, as their teenage daughter Shrushti looked on helplessly. She was given medicines for her pain.

In the early hours of May 25, Sujata fell unconscious.

“That was the last time I spoke with her,” Ghadke, 51, recollects, medical documents spread on his lap and the sofa at his one-storey Pune residence.

In the days that followed, Sujata’s family was told that she had contracted an infection. Doctors put her on antibiotics, conducted a battery of tests, and the hospital bill kept rising.

Ghadke borrowed money from relatives and paid Rs 7.75 lakh. “I earn Rs 25,000 a month at a private firm,” he said. “I don’t have a lot of money saved. But saving my wife was more important. Money I could earn later and return to people,” he said.

But on June 6, Sujata passed away due to septic shock that spurred a multi-organ failure.

A grief-stricken Ghadke, in deep debt and a young daughter to care for, was left stunned. “I kept thinking that her surgery had gone well. It was not a cancerous tumour. Then what went wrong?”

He began to pore over her medical reports.

In Sujata’s blood culture report dated May 26, Ghadke saw mention of “Burkholderia cepacia”.

It was, he found out, a highly resistant rod-shaped bacteria on which at least 10 commonly used antibiotics fail to work.

The doctors had never mentioned how she had got this infection. “Why would they hide it?” he said.

Ghadke began approaching lawyers and trying to track other patients admitted in the same intensive care unit as Sujata to check if they had been infected too.

Over the course of his research, Ghadke came across a medical phrase – healthcare-associated infection, which is also called a hospital-acquired infection or nosocomial infection.

A healthcare-associated infection, or HAI, occurs when a patient gets an infection 48 hours after being admitted to a hospital or within a month of discharge. It is not an infection a patient is originally admitted for.

Sujata’s treating physician, Dr Anjali Pillay, confirmed to Scroll over phone that Sujata caught the Burkholderia infection post surgery. But Pillay refused to comment further, redirecting us to Inamdar hospital, where Sujata was treated.

Scroll sent emails to Inamdar hospital twice – first in July and followed it up in October. We also contacted the hospital management through phone and text messages.

We asked if the hospital had concluded that Sujata’s case was a hospital-acquired infection, if other patients admitted in the ICU with her had contracted similar infections, if the hospital has taken remedial steps after Sujata’s death, and if patients who contract infections get concessions in bills from the hospital. Our emails elicited no response. The story will be updated if and when the hospital responds.

Underreported crisis

Thousands of Indians admitted to hospitals for treatment find themselves saddled with infections that they did not originally have. Not only does this lengthen their hospital stay and increase healthcare costs, for some it even leads to serious medical complications and death.

While there is no official data on hospital-acquired infections in India, several studies have found that the rate of prevalence is amongst the highest globally.

But this remains a massively underreported crisis. Most healthcare-associated infections in India are not traced to source partly because of a lack of awareness among patients. And even when they are, hospitals fail to take responsibility for them.

In this three-part series, Scroll investigates how patients bear the burden of such infections, why they have frustratingly few options of redressal, and how the complete lack of regulation allows hospitals to get away with poor standards of infection control. We spoke to 27 doctors and infection control experts, and filed several Right to Information requests to shine a light on this silent, unacknowledged affliction.

A baby on ventilator

Forty-two-year-old homemaker Barbara Nunes gave birth to a baby girl in November 2020 in Nagaland.

As Adrianna had been born premature, she was shifted to the neonatal intensive care unit at a private hospital in Chumukedima.

In the next three months, Adrianna caught one infection after another – first, meningitis and then pneumonia.

The hospital doctors would tell Nunes that as Adrianna was a pre-term baby, her immune system was weak, making her prone to infections.

But one day in 2020, a specialist doctor from outside was called to examine her. He told Nunes that Adrianna’s vision was impaired.

Till then, she told Scroll, no one in the hospital had told her about this.

Nunes contacted the doctor and met him outside the hospital. The doctor said that he suspected the baby had caught an infection in the hospital which affected her vision.

That is when Nunes decided to dig further.

Over the next two years, Adrianna was in and out of the hospital. But since March 2021, she has been in the hospital on ventilator support due to global cortical atrophy, an infection of the central nervous system that leads to loss of brain cells.

Adrianna, who is fed by a tube, is unlikely to ever recover.

Nunes is convinced that the doctor who had alerted her to a hospital-acquired infection was right.

“Adrianna was in the neonatal ICU on a ventilator, had central line catheters and other devices connected to her, making her extremely vulnerable to infections,” Nunes said.

She claimed that her daughter caught at least 10 different bugs during her stay in hospital.

Over the last couple of years, Nunes has collected laboratory reports that she says prove her charges. Scroll has seen laboratory reports that confirm that Adrianna contracted at least eight infections in the hospital.

“One of the infections she caught developed into meningitis,” Nunes claimed.

But proving that the hospital erred in its infection control protocol has been difficult. “Doctors (from outside) are not willing to testify against the hospital,” Nunes said.

Several doctors told Scroll that confirming a hospital-associated infection is difficult if culture reports of devices or tubes inserted into a patient and instruments used during treatment are missing. Even if such reports are available, a doctor is wary of testifying against another from his fraternity.

Nunes and her husband have decided to fight legally. They filed a civil petition against the multi-specialty hospital in Chumukedima. The hospital has filed a counter case in the district court over unpaid bills of Rs 1 crore.

Adrianna remains admitted in the same hospital. Scroll has withheld the hospital’s name since the matter is in the courts.

“Before all this, I did not [even] know what a hospital associated infection was,” Nunes said.

What is a hospital-acquired infection?

A healthcare-associated infection can be of two kinds, explained Dr Rohini Kelkar, an expert in infection control. “It could be due to endogenous or exogenous factors,” she told Scroll.

In the former, microorganisms naturally present within the human body grow uncontrollably. This is how people with low immunity end up with multiple infections during their hospital stay.

In exogenous infections, bugs present in the environment infect the human body.

A hospital is a breeding ground of such bugs.

They can enter the human body through a device, like the urinary catheter or a saline drip, or during a surgery when your body is cut open and infected instruments are used, or when ventilator tubes are pushed down through the nose and mouth. They can also enter the bloodstream through a central line, a tube inserted in the chest, neck or arms.

Kelkar, who has contributed to World Health Organisation’s guidelines on hospital infection control and trained doctors in infection control, said that not all healthcare associated infections are avoidable, especially if they involve patients at higher risk – for instance, cancer patients with extremely poor immunity, senior citizens with multiple co-morbidities, or those on prolonged ventilator support.

But in a majority of cases, “such infections can be prevented by following good infection prevention and control practices”, said Dr Camilla Rodrigues, head of microbiology at PD Hinduja Hospital in Mumbai.

Kelkar agreed: “The hospital can do a lot to prevent most of them by following simple practices like washing hands, and cleaning and sterilising instruments used for surgery.”

How India compares on infection control

Awareness about healthcare-associated infections and their surveillance began in the 1950s and 1960s in the United States and Europe.

One of the earliest records of a critical healthcare-associated infection in India comes from Tata Memorial hospital in Mumbai.

In 1988, three children with leukaemia died at the hospital and five more contracted meningitis within 18 hours of chemotherapy. “When we began to investigate, we found that the likely source of infection was the injection needle used for drawing the drug administered to them. This was likely contaminated,” said Kelkar, who was then the head of the hospital’s microbiology department.

Traces of a pathogen, Acinetobacter calcoaceticus, were found on one of the needles. “The hospital immediately switched to single-use disposable needles. We put a whole lot of sterilisation protocols in place after that incident,” Kelkar said.

But to this day, infection control is not a priority for many Indian hospitals, especially nursing homes and smaller hospitals that have limited resources.

“How many hospitals use quality disinfectants? How many follow hand hygiene? How many have state-of-the-art sterilisers? Not many,” Kelkar told Scroll.

The Union health ministry neither maintains records nor mandates hospitals to report such infections.

But the limited studies available indicate that the rates of healthcare associated infection in India is significantly higher than in countries like the US, Europe or Australia.

In the US, the Centers for Disease Control and Prevention records that 3.2% patients get healthcare-associated infections. In Australia, a 2019 study of 19 hospitals found a rate of 9.9% HAI in patients. In Europe, 7.1% patients get HAI, according to the European Centre for Disease Prevention and Control.

A 2014 study in the Indian Journal of Basic and Applied Medical Research put HAI rates between a wide window of 11% and 83% in Indian hospitals.

In India, the Indian Council of Medical Research is at the helm of the HAI Surveillance Network, which monitors infection rates of 90 public and private hospitals.

Scroll filed a Right to Information request with the ICMR, asking for infection rates recorded by the network.

We sought data on urinary tract infections, ventilator-associated pneumonia and bloodstream infections that are caused by the presence of germs in tubes or central lines inserted in the body – for example, an intravenous catheter used to deliver medicines or fluids to the patient.

While ICMR said it did not have data on individual hospitals, its response showed that overall infection rates were far higher than the benchmark set by the US’s Centers for Disease Control.

For instance, between July 2024 and June 2025, bloodstream infections in the 90 hospitals that were part of the ICMR network was at 5.08 per 1,000 line days.

This figure was derived by dividing the number of patients with bloodstream infections by the total number of days for which any central line is inserted on all patients and multiplying this by 1,000.

Similarly, urinary tract infections, which is an infection in the bladder, urethra or kidneys due to germs that enter through urinary catheter, were at 2.82 per 1,000 line days, and the rate of ventilator associated pneumonia – lung infection caused by ventilators – was at 8.13 per 1,000 ventilator days.

The benchmark set by the Centers for Disease Control and Prevention for bloodstream infection is 0.9 per 1,000 line days, urinary tract infection is 1.3 per 1,000 line days and ventilator associated pneumonia is 1.1 per 1,000 ventilator days.

Some argue that the CDC’s standards are hard to meet for a developing economy like India.

A more rational benchmark has been set by International Nosocomial Infection Control Consortium for low and middle-income countries: 4.9 per 1,000 line days for bloodstream infection, 5.3 per 1,000 line days for urinary tract infection and 13.1 per 1,000 ventilator days for ventilator associated pneumonia. Even here, Indian hospitals fail to meet the benchmark for bloodstream infections.

A more recent study in the Lancet looked at infections in blood specifically caused by central lines in 54 Indian hospitals over seven years. It found the rate of infection to be 8.8 per 1,000 device days, 10 times higher than the figure in ICUs of the USA, at 0.87 per 1,000 device days.

Longer hospital stays, patients unaware

Most Indian hospitals are unwilling to reveal information about suspected healthcare-acquired infections to patients’ families, nor do they take financial responsibility for lapses in infection control practices. As a result, families have few ways to seek redressal.

For instance, in Sujata’s case, the bacteria found in her reports – Burkholderia cepacia – is mostly known to spread through contaminated instruments or use of non-sterile water.

But since the hospital did not divulge information to Ghadke or respond to Scroll, the route of infection in her case is difficult to ascertain.

When Scroll showed Sujata’s reports to an independent infection control expert, she said it was difficult to ascertain the route of infection since the hospital never sent the instruments used on Sujata and tubes inserted in her body for tests to look for pathogens. If they did, the reports were not shared with Ghadke.

In many cases, patients do not even come to know that an infection they acquired in a hospital has resulted in a prolonged stay and increased their hospital bills.

A study from Bhopal’s AIIMS found that such infections led to an increased ICU stay – 13.8 days on an average – compared to 8.2 days amongst patients who do not acquire such an infection. In private hospitals, the stay is longer.

“A longer stay means that the cost of treatment also increases,” Santenna Chenchula, the study’s lead author, told Scroll.

In a government hospital, that could mean an additional cost of Rs 35,000 to Rs 85,000, and in a private hospital about Rs 2 lakh more, according to various studies of HAI treatment in India that Scroll assessed.

But Scroll found that in reality patients had to shell out much more in private hospitals.

For Sujata, the treatment that began with a simple tumour removal surgery costing Rs 1.69 lakh and scheduled hospital stay of six days rose by seven times to Rs 11.5 lakh in 20 days. Till date, Ghadke has not cleared the entire bill.

The fight for compensation

For a patient who has contracted a hospital acquired infection, there are few remedies. There is no law to govern such cases in India. They cannot approach medical councils.

Dr Shivkumar Utture, national chairman of Indian Medical Association, and former member of the Maharashtra Medical Council, said, “Medical councils only look at cases of negligence against a doctor, not an entire hospital. A healthcare-associated infection involves a hospital, not a doctor. It falls outside our purview.”

In some cases, patients’ families have approached state medical councils and been turned down. The police are also wary of registering first information reports unless a government hospital or a district civil surgeon confirms a hospital-acquired infection in writing.

Raghvendra Rao, a patient rights activist, said the biggest challenge is to get another doctor to certify that the infection is hospital acquired. “It is a conspiracy of silence,” Rao said. “Seldom do doctors agree to certify against members of their own fraternity.”

“There are very few cases where patients succeed in getting compensation,” said Amulya Nidhi, an activist with Jan Arogya Abhiyaan, an umbrella association of not-for-profit health organisations.

One route is approaching the National Consumer Disputes Redressal Commission. “Even they usually ask for an outside doctor’s report,” Nidhi said.

Aalim Javeri, now 33, was 10 years old when his father, Sadruddin Hashimali Javeri, died of septicaemia in a private corporate hospital in Hyderabad following a bypass surgery conducted to clear blockages in his artery.

Through his medical documents, the family realised that 64-year-old Javeri, who was an advisor to the scion of Hyderabad’s former royal Nizam family, Mukarram Jah, had contracted multiple infections during his post-operative care.

Laboratory test records at the hospital showed that the tip of the catheter inserted in Javeri, had Staphylococcus sciuri, a gram positive bacteria that is resistant to a wide range of drugs.

Another report found that the fluids in the endotracheal tube, which is inserted in the throat of ventilated patients, had gram positive bacteria. A third tube called intercostal drainage tube, which is used to extract fluids from around the lungs, had Staphylococcus bacteria growing on it.

“The hospital staff did not change the catheter frequently,” Aalim said. “The post-operative care was shambolic.”

The insurance company refused to clear the claim because the hospital did not provide original bills, Aalim claimed.

It took three years, during which the family collected evidence, contacted experts, and finally approached the National Consumer Disputes Redressal Commission in 2005 to seek compensation from Care hospital in Banjara Hills, a part of the Quality Care India Limited.

During the hearing in the commission, the hospital maintained that it “took all necessary precautions and administered appropriate antibiotics based on culture sensitivity reports” and that the patient had a medical history that made him susceptible to infections. The hospital did not respond to Scroll’s email.

It took 19 years for the commission to pass an order identifying the hospital’s negligence and asking it to pay a compensation of Rs 10 lakh to the Javeri family.

The hospital has appealed the decision at the Supreme Court. Javeri, too, has approached the apex court stating that the compensation is not adequate.

Javeri’s mother, Begum Scheherazade Javeri, passed away in March this year. “She didn’t get to see justice delivered,” Aalim said, recounting the innumerable visits they had made to Delhi for hearings, and the adjournments that delayed the case for two decades.

“If this can happen to us,” Aalim told Scroll, referring to the influence the family has due to its closeness to the Nizam’s descendants, “imagine what could happen to others?”

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.

The basic principle of weight loss is straightforward: if you consume fewer calories than you burn, you’ll lose weight. In practice though, this isn’t usually so easy or simple.

Alongside counting calories or eating smaller portions, many people add exercise into the equation when trying to lose weight to help tip the balance. Yet research shows that exercise may only have modest effects on weight loss.

But before you ditch your workouts, it’s important to note that exercise still plays a really important role when it comes to health – perhaps especially in keeping the pounds off after reaching your goal weight.

There are several processes that help explain why exercise doesn’t always result in huge amounts of weight loss.

Exercise can stimulate appetite, leading to increased food intake. People may also subconsciously move less throughout the rest of the day after doing a workout, which means exercise may have less impact on their overall calorie deficit.

The body also becomes more efficient over time – burning fewer calories while doing the same activity. This process, sometimes called “metabolic adaptation”, reflects the body’s tendency to defend against weight loss.

From an evolutionary perspective, conserving energy during periods of intense physical activity probably protected our ancestors from starvation. But in today’s world, metabolic adaptation is one of many factors that can make weight loss difficult.

Importance of exercise

Although exercise may not be the main driver of weight loss, it seems it might play a role in maintaining weight loss.

In a study of over 1,100 people, physical activity was shown to have little effect on the amount of weight a person initially lost. However, doing higher levels of activity after losing weight was strongly linked to maintaining the weight loss.

It’s worth noting that exercise was also associated with measurable health improvements – including better cholesterol, lower inflammation, better blood sugar control and insulin sensitivity, all of which are associated with lower risk of health problems, such as heart disease and type 2 diabetes.

These many health benefits show just how important it is to exercise both while losing weight and maintaining weight loss.

Evidence also suggests that combining exercise with weight loss drugs (such as Saxenda), may help people maintain their weight loss better than using the drug alone.

Why exercise works

It may seem confusing that exercise isn’t especially effective for losing weight but can help prevent regain. The reasons behind this paradox aren’t fully understood, but several mechanisms may offer an explanation.

The first has to do with our resting energy expenditure (the amount of calories our body burns when doing nothing).

When we lose weight, our resting energy expenditure decreases by more than you would expect for the amount of weight lost. This is thought to contribute to weight regain. But exercise raises total daily energy expenditure, which can help to partially offset this.

A second factor relates to muscle mass.

Weight loss usually results in the loss of both fat and muscle. Losing muscle lowers resting energy expenditure, which can contribute to weight regain.

But exercise, especially resistance training (such as Pilates or lifting weights), can help preserve or even rebuild muscle mass. This can boost our metabolism, which may aid in long-term weight maintenance.

Physical activity also helps our body to maintain its ability to burn fat. After losing weight, the body often becomes less efficient at using fat for energy.

But intense exercise can improve fat burning and metabolic flexibility – the ability to switch between burning carbohydrates and fat depending on what’s available. This helps the body continue burning fat even when calorie intake is low or weight is lost.

Exercise improves insulin sensitivity as well. This reduces the amount of insulin required to regulate blood sugar. This is beneficial as higher insulin levels can promote fat storage and reduce fat breakdown.

Exercise has many indirect effects on us that can aid in weight maintenance. For instance, exercise can improve sleep, mood and reduce stress levels. These all reduce levels of the stress hormone cortisol, which could lower the amount of fat the body stores.

Regular activity can also help regulate appetite and blood glucose, which may help reduce cravings and limit overeating.

It’s important to acknowledge that everyone is different. This means we all respond differently to exercise in terms of how many calories we burn or whether a workout makes us feel hungrier later in the day.

Different types of workouts also confer their own benefits when it comes to health and weight maintenance.

Aerobic exercise (such as brisk walking, cycling or running) burns calories and, at higher intensities, may also enhance the body’s ability to burn fat for fuel.

Resistance training, on the other hand, helps build and preserve muscle mass. This supports a higher resting energy expenditure, aiding long-term weight maintenance.

Exercise may not be the most powerful tool for losing weight, but it could help sustain hard-earned weight loss. Perhaps most importantly, it offers many physical and mental health benefits that go far beyond the numbers on the scale.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln.

This article was first published on The Conversation.

India’s healthcare system faces major challenges in accessibility, quality, and cost. With only 1.3 hospital beds per 1,000 people in 2024 – well below the World Health Organization’s recommendation of three per 100 – the country struggles to provide adequate care, especially in rural areas. Over the past two decades, private equity has played a significant role in addressing these gaps.

Private equity investments in India’s healthcare and pharmaceutical sector reached $5.5 billion in 2023, a 25% increase from the previous year. The country’s healthcare market including diagnostics, outpatient consultations, retail pharmacies and hospitals was valued at $180 billion in 2023, and is expected to reach about $320 billion by 2028. Major investments in hospital chains have led to expanded and upgraded facilities, particularly in tier 2 and tier 3 cities, improving healthcare access for millions.

As of 2024, India had 44,100 private hospitals and approximately 1.18 million beds in private hospitals, with an expected addition of more than 22,000 beds in the next few years. However, the focus on high-margin services has sparked concerns about rising healthcare costs and inequities in access, as wealthier urban populations benefit more from these investments while rural and low-income communities face continued barriers. These disparities raise questions about how private equity investments align with public health objectives and the need for equity in healthcare.

Indian healthcare Sector

India’s healthcare sector is a mix of public and private entities, with the private sector playing an increasingly dominant role. Historically, the public system has been underfunded, with health spending accounting for only 1.2% to 1.5% of gross domestic product, well below the 5% recommended in order to achieve universal health coverage.

Public facilities are often overstretched and under-resourced, leaving large gaps in service delivery. In contrast, the private sector, consisting of nursing homes to large hospitals, offers better services for those who can afford it. Their exorbitant cost, however, runs the risk of exacerbating inequality in healthcare access.

Since economic liberalisation in 1991, the private sector’s role has expanded through market reforms and government policies like the National Health Policies of 2002 and 2017. These policies encouraged public-private partnerships to enhance healthcare delivery, focusing on infrastructure, specialised services and universal health coverage. The 2017 policy, in particular, facilitated private investments, integrating private providers into government initiatives like Ayushman Bharat Yojana, which aims to increase healthcare access for underserved populations.

However, this reliance on the private sector has raised concerns about rising healthcare costs and unequal access, particularly for marginalised groups, as private investments are often concentrated in urban areas. In 1986-’87, hospitalisation in private hospitals cost 2.3 times more than public hospitals in rural areas and 3.1 times more in urban areas. By 2017-’18, these gaps widened to 6.4 times in rural areas and 8.0 times in urban areas. This profit-driven healthcare system has widened inequalities, forcing rural areas to depend on poorly funded government hospitals, which often lack doctors, medical equipment, and essential services.

Expanding private sector

Private investments have significantly boosted India’s healthcare infrastructure over the past decade. Around 63% of India’s 70,000 operational hospitals and 60% of its 1.9 million hospital beds are in the private sector. Projections indicate that over 22,000 new hospital beds will be added in private hospitals in the next three-five years, tripling the number added between 2019 and 2024.

Private equity-backed hospital chains like Manipal Hospitals, Fortis Healthcare, and Care Hospitals have expanded their networks and improved services using private equity funds. For instance, in 2024, Fortis announced plans to invest $156 million to expand its facilities, while Manipal Hospitals has, over the last five years, spent $251 million to expand its network through acquisitions. US-based private equity firm Blackstone has, since 2023, reportedly committed nearly $1 billion to the sector.

Between 2021 and 2024, healthcare accounted for 17%-18% of total private equity exits in India. While these firms have invested to tap into India’s expanding healthcare market, their ability to divest in response to global market dynamics creates instability, underscoring the need for regulatory oversight to ensure that healthcare infrastructure remains resilient, regardless of market fluctuations or geopolitical shifts.

Beyond physical infrastructure, private equity investments have fueled growth in digital health platforms such as Practo, which secured $193 million in funding by 2022. The expansion of telemedicine and online pharmacies has improved access to healthcare services, especially during the Covid-19 pandemic.

Healthcare costs

The commercialisation of healthcare services has resulted in markedly higher medical bills, especially for tertiary care and diagnostic services. In 2024, out-of-pocket health expenditure constituted approximately 54.8% of current health expenditure (45.98% in 2022) in India, one of the highest rates globally, with private hospitals contributing significantly to this figure.

This situation threatens the viability of universal healthcare objectives and fosters indebtedness among families reliant on expensive medical treatments. As of 2023, healthcare expenses pushed 8%-9% of all Indian households below the poverty line.

In addition, the increased reliance on private equity in healthcare impacts the overall system. Private equity-backed entities may overlook less profitable, yet essential services such as preventive and primary healthcare. Despite the expansion of healthcare infrastructure in India, inequities in access to quality services remain a significant challenge.

Private equity investments typically focus on high-return markets, prioritising urban and affluent populations while neglecting rural and marginalised communities.

Nearly 70% of India’s population lives in rural areas, where healthcare resources are scarce and access to quality care is limited. Private equity investments do little to change that. Research shows that private equity-backed hospitals and diagnostic centres are predominantly located in urban areas, with few established in rural regions. This concentration not only reinforces socioeconomic divides but also forces rural residents to travel long distances for medical attention, resulting in delayed treatment and worsening health outcomes.

Meanwhile, the emphasis on specialised treatments and elective procedures comes at the expense of comprehensive primary care, which is essential for addressing public health needs and reducing disparities.

This model diverts attention and funding from foundational services that can prevent illnesses and promote community health. Consequently, access limitations for vulnerable populations – rural or urban – perpetuate a cycle of inequality where health outcomes closely align with socioeconomic status.

One effort to address this was built into the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in 2018, in which private hospitals (including in Tier 2 and Tier 3 cities) were encouraged to empanel themselves under the scheme to provide services at affordable rates. However, since then, 609 private hospitals have opted out of the scheme, citing low reimbursement tariffs and delayed payments from the government.

Conclusion

Private equity investments are reshaping India’s healthcare sector, enhancing infrastructure and services. However, this transformation presents challenges related to equity, access, and rising costs. The profitability-driven focus of private equity-backed healthcare entities has led to increased healthcare expenses and disparities in access. While urban and affluent populations benefit from improved services, rural and low-income communities often face barriers to quality care.

To address these challenges, regulatory policy interventions are essential to ensure that healthcare remains accessible and equitable for all. Indian regulators and policymakers need to do more to understand the influence of profit motives on healthcare access in order to critically assess existing policies that prioritise financial returns over patient care.

Even as the private sector invests in expanding India’s healthcare infrastructure, policymakers must assess these developments against a framework that encourages public investment in healthcare, expands the availability of comprehensive services, and ensures that marginalised communities receive the care they need.

Additionally, recognising the systemic barriers created by market-driven approaches allows policymakers to advocate for reforms prioritising health equity and social justice. Ultimately, fostering a more inclusive dialogue around healthcare can promote a system that values human well-being over profit, paving the way for a more equitable healthcare landscape in India.

Vivek ND is an Adjunct Faculty in the School of Legal Studies and Governance, Vidyashilp University, Bangalore. He has a PhD in Political Science from the University of Hyderabad. He can be found on X @viveknenmini and on Bluesky @viveknd.bsky.social.

The article was first published in India in Transition, a publication of the Center for the Advanced Study of India, University of Pennsylvania.

When María Branyas Morera died in 2024 at the age of 117, she left more than memories. She left science a gift: samples of her microbiome.

Researchers discovered her gut was as diverse as someone decades younger: rich in beneficial bacteria linked to resilience and longevity. Her daily yoghurt habit and Mediterranean diet may have helped. While we can’t all inherit “lucky genes”, nurturing our microbiome may be one way to support lifelong health.

In a recent paper in Cell Reports Medicine, researchers presented what may be the most detailed scientific investigation of a supercentenarian (a person aged 110 or older). Before her death, Branyas agreed to participate in research aimed at uncovering how she lived such a long and healthy life.

When scientists compared her samples with those of people who had not reached such exceptional ages, the genetic results were unsurprising: Branyas carried protective variants that guard against common diseases. But they also looked at something over which we have more control – the gut microbiome.

This microbiome is the vast community of bacteria, fungi and other microorganisms that live in the intestines. They help digest food, produce vitamins, influence our immune system and even communicate with the brain. While our genes play only a small role in shaping our microbiome, diet and lifestyle are far more important.

Normally, as people age, gut microbiomes lose diversity – the variety of microbial species – and beneficial microbes such as Bifidobacterium decline. This reduction in diversity has been linked to frailty.

Branyas’s gut told a different story. Her microbiome was as diverse as that of a much younger adult and was especially rich in the bacterial family Bifidobacteriaceae, including the genus Bifidobacterium. In most older people these bacteria decline, but Branyas’s levels matched previous reports of elevated Bifidobacterium in other centenarians and supercentenarians. The researchers concluded that this unusually youthful microbiome may have supported her gut and immune health, contributing to her extraordinary longevity.

Bifidobacteria are among the first microbes to colonise an infant’s gut and are generally considered beneficial throughout life. Studies link them to supporting immune function, protecting against gastrointestinal disorders and helping regulate cholesterol.

Her diet offered a clue to why she maintained such high levels of Bifidobacterium. Branyas reported eating three yoghurts every day, each containing live bacteria that are known to support the growth of Bifidobacterium. She also followed a largely Mediterranean diet, a pattern of eating consistently linked to gut microbiome diversity and good health.

Other foods that encourage Bifidobacterium include kefir, kombucha and fermented vegetables such as kimchi and sauerkraut. These contain probiotics – live bacteria that can settle in the gut and confer health benefits. But probiotics need fuel. Prebiotics – dietary fibres we can’t digest but that our microbes thrive on – are found in foods like onions, garlic, leeks, asparagus, bananas, oats and legumes. Together, probiotics and prebiotics help maintain a balanced microbiome.

Of course, this was a study of a single individual, and the scientists are not claiming that her microbiome alone explains her long life. Her extraordinary longevity was almost certainly the result of many interwoven factors: protective genes, efficient metabolism, low inflammation – and, quite possibly, the support of a diverse gut microbiome.

Microbiome research is advancing rapidly, but no one yet knows what the “perfect” microbiome looks like. Greater diversity is generally associated with better health, but there is no single recipe for a long life. Even so, Branyas’s case reinforces a growing consensus: nurturing a diverse, beneficial microbiome is linked to better health and resilience.

While we cannot choose our genes, we can support our gut microbes. Simple steps include eating fermented foods, such as live yoghurts, kefir, kimchi and sauerkraut, as well as fruit, vegetables, legumes and whole grains, which supply the prebiotics that healthy microbes need.

Following a Mediterranean-style diet – built around vegetables, fruits and whole grains, with olive oil as the main fat, fish and legumes eaten regularly, and red meat, processed foods and added sugars kept to a minimum – has been repeatedly linked to both microbiome diversity and reduced disease risk.

These habits will not guarantee a lifespan beyond 110, but they are associated with lower risks of cancer, type 2 diabetes and cardiovascular disease.

María Branyas Morera’s life is a reminder that longevity depends on a delicate balance of genetics, lifestyle and biology. We cannot control every factor, but tending to our gut microbiome is one meaningful step toward lasting health.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln

This article was first published on The Conversation.

It was a harsh winter morning in October 2019 in a Jammu village, when Makhno Devi took her 11-year-old son, Rutav, to the nearest sub-district hospital.

For three days, Rutav had stopped urinating, his body temperature had risen and he was refusing to eat.

But doctors at the hospital in Ramnagar town struggled to treat the boy. By evening, they referred him to the district hospital in Udhampur and gave Makhno an ambulance.

Udhampur was 36 km away, a ride over hilly terrain. Rutav died on the way.

Thirty-eight-year-old Makhno, who grows maize on a small farmland in Kirmoo village, said that the ambulance driver left the family on the road with the body. For the next three months, no health team visited her to ask about Rutav’s death.

Then in February 2020, she was told that her son’s death had been caused by a contaminated cough syrup she had forced him to gulp down for three days, a syrup she had bought off the counter from a chemist in Ramnagar.

Thirteen more children died in Jammu’s Ramnagar district after Rutav – all of them had consumed Coldbest-PC cough syrup. Six who survived were left with permanent disabilities.

The syrup had been manufactured 500 km away in Himachal Pradesh’s Sirmaur district by pharmaceutical company Digital Vision.

Makhno’s statement was recorded by the local police. That was all. She did not get any compensation, since Rutav’s death occurred on the road with no medical certification.

Rutav is one of 172 children who have been killed since 2020 by contaminated cough syrups manufactured by Indian pharmaceutical companies. The deaths have been reported from India, The Gambia and Uzbekistan. Even censure from international agencies like the World Health Organisation has failed to stop the deaths.

Most recently, 22 children in Madhya Pradesh’s Chhindwara died after having cough syrup that had been adulterated by the toxic industrial solvent, diethylene glycol, which led to kidney failure in the children – the same solvent that had led to the deaths in Jammu.

Over the last few weeks, as Makhno heard of the deaths in Chhindwara, it seemed to her as if nothing had changed. “Even after our children died, if this is happening, what was the government doing?” she asked.

Makhno said she has no hope that the Himachal Pradesh manufacturer responsible for her son’s death will be punished. Her pessimism is not without basis.

Since 2020, four different manufacturers have been held responsible for using the toxic industrial solvent, diethylene glycol, in the syrups that led to kidney failure in the deceased children. Three of them are still in business.

Scroll went back to the Jammu families who lost their children in 2020 to find a recurring pattern of injustice – cases stuck in an excruciatingly slow judicial system, pharmaceutical companies that get away.

The firm, Digital Vision, has not only gone on to resume production, but also found guilty of more drug quality violations, data accessed by Scroll shows. But the trial against it in the 2020 case has not proceeded because of a stay order by the Jammu bench of the High Court of Jammu and Kashmir.

“I keep remembering him,” Makhno said, talking of Rutav, her first-born. “We didn’t get justice.”

Delay in detection

Two months after Rutav’s death, Murfa Begum, a 25-year-old woman from a village in Ramnagar district in Jammu, lost her three-month-old child. The infant died after consuming two doses of the toxic Coldbest cough syrup.

Begum alleged that for several weeks, the health department did not respond. “We cried, we raised the alarm but they began an investigation too late,” she said.

The Ramnagar district administration began testing water samples, food grains and blood samples only in January 2020 – three months after the first death. “By then more children were dying,” Murfa said.

On February 17, 2020, Chandigarh’s Regional Drug Testing laboratory found that samples of Coldbest had 34.34% of diethylene glycol, which causes kidney failure in children.

“Ye to katal hua,” said Murfa. This is murder.

A similar delay was seen in Chhindwara where it took a month for the district authorities to suspect a contaminated cough syrup was causing the deaths of children.

A slew of first information reports were filed in Ramnagar, Ambala and Sirmaur. The FIR in Ramnagar invoked sections involving culpable homicide not amounting to murder, adulteration of drugs, sale of adulterated drugs, and causing grievous hurt and several sections of the Drugs and Cosmetics Act that deal with sale of harmful drugs and its punishment.

The accused included the Ambala-based owners of Digital Vision, Purushottam Goyal and his two sons Konic and Manic Goyal, the company that distributed the cough syrup and the chemist who sold it. The state drug controller also registered four cases of drug safety violations against Digital Vision.

A social activist from Jammu who followed these cases, Sukesh Khajuria, said the Goyals got bail within an hour of arrest while the chemist’s bail kept getting rejected. “The rich and powerful always get away,” Khajuria said.

The company that got away

Ashok Kumar obsessively watches the last video of his son, Aniruddh, from January 2020. It shows the two-year-old boy in a hospital in Jammu, and his mother trying to distract and feed him.

Aniruddh caught a chest infection in late December 2019. By then accounts of children dying mysteriously had already flooded households, Kumar, a government school teacher in Ramnagar town, said.

Like Makhno, Kumar had gone to the same chemist for medical advice. “There was no child specialist in Ramnagar. So we all used to go to this one chemist who prescribed drugs,” Kumar said. Aniruddh was administered Coldbest syrup for two days. By the second night, he began vomiting and getting loose motions.

Ashok Kumar took his son to three different hospitals before he arrived at Chandigarh’s Post Graduate Institute. He died of acute kidney injury and a brain haemorrhage soon after.

Kumar was one of 12 families that received compensation of Rs 3 lakh. But he seeks more. “I want those accountable to be punished,” he told Scroll.

What enrages Kumar is that Digital Vision, the manufacturer of Coldbest, continues to make drugs. The firm has branched into making antibiotics, antioxidants, protein powders, analgesics, and orthopaedic medicines, according to its website. Its products are exported to Afghanistan, Sri Lanka, Nigeria, Sudan, Ghana, Congo, Myanmar, Nepal, Cambodia, Vietnam, Ireland and Spain.

Digital Vision did not respond to an email asking them what corrective steps they had taken after the Jammu case.

Tellingly, the company had been red-flagged even before the Jammu deaths.

Between 2012 and 2020, 12 drugs manufactured by the Himachal-based firm, including syrup-based formulations and tablets, were found to be “not of standard quality”, shows data accessed by Scroll from an online database on which state drug controllers report cases of substandard drugs. Not all states are meticulous about uploading this data on the portal.

Moreover, even after the Jammu deaths, on five different occasions, officials from Maharashtra’s Food and Drug Administration found Digital Vision’s drugs to be “not of standard quality” during random tests.

Of these, Azithromycin oral suspension, a common antibiotic it produced, was found to be “not of standard quality” on three occasions.

Maharashtra’s joint commissioner of drugs, DR Gahane, told Scroll that they had issued a showcause notice to the manufacturer and informed the Himachal Pradesh drug controller about the violations.

Asked about action taken against the firm, Himachal Pradesh’s assistant drug controller Sunny Kushal told Scroll he is “not interested in discussing Digital Vision”.

As recently as December 2024, the Himachal Pradesh excise commissioner in an order reported that the firm was manufacturing morphine tablets without a proper licence and exporting it to Sri Lanka. It notified the state drug controller to look into violations under the Drugs and Cosmetics Act. Scroll has seen the order. Kaushal did not respond to Scroll’s messages on the action taken.

Meanwhile, the firm continues operations. Sushil Yadav, general manager, marketing, at Digital Vision, refused to comment on the violations. The company did not reply to an email.

Slow trial

The slow judicial process has also thwarted the course of justice for the Jammu families.

In 2023, three years after the deaths of the children, a 742-page chargesheet was filed by a Special Investigation Team tasked with the probe and the trial began in Udhampur sessions court.

In February 2024, the sessions court judge asked certain aspects of the case to be investigated further. In March 2024, the manufacturer approached the Jammu High Court for a stay on reinvestigation. The court granted its request.

“Since then, the case is stuck,” Khajuria said. “Every time there is a hearing, their counsel mentions the High Court stay and a new date is given,” he said.

The stay has also affected the trial of cases against Digital Vision lodged by the Food and Drug Administration in a special court in Jammu meant for cases filed under the Drugs and Cosmetics Act. A drug official said they have submitted objections but the trial is dragging on.

“Sometimes for simple prosecution cases, it can take 15 years or more for conviction to come,” the drug official said.

Khajuria said that he had approached the National Human Rights Commission to seek compensation for the families of children who died.

In 2021, the NHRC directed Jammu and Kashmir to pay Rs 3 lakh compensation. This was immediately contested by the state at the High Court but their petition was dismissed. Later, the state government appealed to the Supreme Court.

In a judgement by the apex court in November 2022, a two-judge bench observed that “it was specially found that the officers of the drug and food control department were negligent and therefore ultimately the state will be liable to pay compensation”.

“Your officers are found to be negligent. They ought to have been vigilant. Don’t compel us to say things about food and industry department. They don’t perform duties at all,” the judges observed, PTI reported.

Despite the strong words from the court, no action has been taken against drug inspectors in Jammu.

Drug inspectors are bound to inspect a manufacturing unit at least once a year to ensure compliance to rules. But as a parliamentary standing committee report on chemicals and fertilisers pointed out last December, there is a 60% vacancy in sanctioned posts of drug inspectors – 303 out of 504 are vacant.

High vacancies affect not only the number of inspections a drug inspector can undertake but also the number of convictions. The same report found out that between 2015-’16 and 2018-’19, of the 2.3 lakh drug samples examined by state drug controllers, 593 were declared spurious and 9,266 were of substandard quality. But that resulted in only 35 convictions by the courts – a rate of 5.9%.

However, former drug controller of Jammu and Kashmir Lotika Khajuria told Scroll the department in fact worked “promptly to gather all evidence against Digital Vision and filed a case”. But the parents of the children who died question the government’s intent. “The investigation in this case is not satisfactory,” Kumar, the schoolteacher, told Scroll. “It is an eyewash.”

Disabled for life

At least six children who survived the deadly cough syrup in Jammu live with multiple disabilities.

Sapna Kumar was less than a year old when she had the Coldbest syrup in 2020.

She survived but has 40% disability. She has difficulty in movement, moderate intellectual impairment and disability in vision and hearing.

Pavan Kumar was in hospital for over three months in 2020, after consuming the cough syrup, of which 50 days were on ventilator support.

Now seven years old, the child has partial vision, high blood pressure and cannot hear from one ear, his father Shambhu Ram told Scroll.

“We have to visit Chandigarh’s PGI hospital every month. I have to borrow money regularly for his treatment,” Ram, a daily-wage labourer, said.

None of the children who were disabled received any compensation. “This is the value of a poor person’s life in India,” Ram said.

Most people know roughly what kind of lifestyle they should be living to stay healthy.

Think regular exercise, a balanced diet and sufficient sleep. Yet, despite all the hacks, trackers and motivational quotes, many of us still struggle to stick with our health goals.

Meanwhile, people worldwide are experiencing more lifestyle-associated chronic disease than ever before.

But what if the missing piece in your health journey wasn’t more discipline – but more stillness?

Research shows that mindfulness meditation can help facilitate this pursuit of health goals through stillness, and that getting started is easier than you might think – no Buddhist monk robes or silent retreats required.

Given how ubiquitous and accessible mindfulness resources are these days, I have been surprised to see mindfulness discussed and studied only as a mental health tool, stopping short of exploring its usefulness for a whole range of lifestyle choices.

I am a psychologist and behavioral scientist researching ways to help people live healthier lives, especially by moving more and regulating stress more efficiently.

My team’s work and that of other researchers suggests that mindfulness could play a pivotal role in paving the way for a healthier society, one mindful breath at a time.

Mindfulness unpacked

Mindfulness has become a buzzword of late, with initiatives now present in schools, boardrooms and even among first responders. But what is it, really?

Mindfulness refers to the practice or instance of paying careful attention to one’s present-moment experience – such as their thoughts, breath, bodily sensations and the environment – and doing so nonjudgmentally. Its origins are in Buddhist traditions, where it plays a crucial role in connecting communities and promoting selflessness.

Over the past 50 years, however, mindfulness-based practice has been Westernised into structured therapeutic programs and stress-management tools, which have been widely studied for their benefits to mental and physical health.

Research has shown that mindfulness offers wide-ranging benefits to the mind, the body and productivity.

Mindfulness-based programmes, both in person and digitally delivered, can effectively treat depression and anxiety, protect from burnout, improve sleep and reduce pain.

The impacts extend beyond subjective experience too. Studies find that experienced meditators – that is, people who have been meditating for at least one year – have lower markers of inflammation, which means that their bodies are better able to fight off infections and regulate stress. They also showed improved cognitive abilities and even altered brain structure.

But I find the potential for mindfulness to support a healthy lifestyle most exciting of all.

How can mindfulness help you build healthy habits?

My team’s research suggests that mindfulness equips people with the psychological skills required to successfully change behaviour. Knowing what to do to achieve healthy habits is rarely what stands in people’s way. But knowing how to stay motivated and keep showing up in the face of everyday obstacles such as lack of time, illness or competing priorities is the most common reason people fall off the wagon – and therefore need the most support. This is where mindfulness comes in.

Multiple studies have found that people who meditate regularly for at least two months become more inherently motivated to look after their health, which is a hallmark of those who adhere to a balanced diet and exercise regularly.

A 2024 study with over 1,200 participants that I led found more positive attitudes toward healthy habits and stronger intentions to put them into practice in meditators who practiced mindfulness for 10 minutes daily alongside a mobile app, compared with nonmeditators. This may happen because mindfulness encourages self-reflection and helps people feel more in tune with their bodies, making it easier to remember why being healthier is important to us.

Another key way mindfulness helps keep momentum with healthy habits is by restructuring one’s response to pain, discomfort and failure. This is not to say that meditators feel no pain, nor that pain during exercise is encouraged – it is not!

Mild discomfort, however, is a very common experience of novice exercisers. For example, you may feel out of breath or muscle fatigue when initially taking up a new activity, which is when people are most likely to give up. Mindfulness teaches you to notice these sensations but see them as transient and with minimal judgment, making them less disruptive to habit-building.

Putting mindfulness into practice

A classic mindfulness exercise includes observing the breath and counting inhales up to 10 at a time. This is surprisingly difficult to do without getting distracted, and a core part of the exercise is noticing the distraction and returning to the counting. In other words, mindfulness involves the practice of failure in small, inconsequential ways, making real-world perceived failure – such as a missed exercise session or a one-off indulgent meal – feel more manageable. This strengthens your ability to stay consistent in pursuit of health goals.

Finally, paying mindful attention to our bodies and the environment makes us more observant, resulting in a more varied and enjoyable exercising or eating experience. Participants in another study we conducted reported noticing the seasons changing, a greater connection to their surroundings and being better able to detect their own progress when exercising mindfully. This made them more likely to keep going in their habits.

Luckily, there are plenty of tools available to get started with mindfulness practice these days, many of them free. Mobile applications, such as Headspace or Calm, are popular and effective starting points, providing audio-guided sessions to follow along. Some are as short as five minutes. Research suggests that doing a mindfulness session first thing in the morning is the easiest to maintain, and after a month or so you may start to see the skills from your meditative practice reverberating beyond the sessions themselves.

Based on our research on mindfulness and exercise, I collaborated with the nonprofit Medito Foundation to create the first mindfulness program dedicated to moving more. When we tested the program in a research study, participants who meditated alongside these sessions for one month reported doing much more exercise than before the study and having stronger intentions to keep moving compared with participants who did not meditate. Increasingly, the mobile applications mentioned above are offering mindful movement meditations too.

If the idea of a seated practice does not sound appealing, you can instead choose an activity to dedicate your full attention to. This can be your next walk outdoors, where you notice as much about your experience and surroundings as possible. Feeling your feet on the ground and the sensations on your skin are a great place to start.

For people with even less time available, short bursts of mindfulness can be incorporated into even the busiest of routines. Try taking a few mindful, nondistracted breaths while your coffee is brewing, during a restroom break or while riding the elevator. It may just be the grounding moment you need to feel and perform better for the rest of the day.

Masha Remskar is Psychologist and Postdoctoral Researcher in Behavioral Science, Arizona State University.

This article was first published on The Conversation.

We spend nearly a third of our lives asleep, yet sleep is anything but wasted time. Far from being passive downtime, it is an active and essential process that helps restore the body and protect the brain. When sleep is disrupted, the brain feels the consequences – sometimes in subtle ways that accumulate over years.

In a new study, my colleagues and I examined sleep behaviour and detailed brain MRI scan data in more than 27,000 UK adults between the ages of 40 and 70. We found that people with poor sleep had brains that appeared significantly older than expected based on their actual age.

What does it mean for the brain to “look older”? While we all grow chronologically older at the same pace, some people’s biological clocks can tick faster or slower than others. New advances in brain imaging and artificial intelligence allow researchers to estimate a person’s brain age based on patterns in brain MRI scans, such as loss of brain tissue, thinning of the cortex and damage to blood vessels.

In our study, brain age was estimated using over 1,000 different imaging markers from MRI scans. We first trained a machine learning model on the scans of the healthiest participants – people with no major diseases, whose brains should closely match their chronological age. Once the model “learned” what normal ageing looks like, we applied it to the full study population.

Having a brain age higher than your actual age can be a signal of departure from healthy ageing. Previous research has linked an older-appearing brain to faster cognitive decline, greater dementia risk and even higher risk of early death.

Sleep is complex, and no single measure can tell the whole story of a person’s sleep health. Our study, therefore, focused on five aspects of sleep self-reported by the study participants: their chronotype (“morning” or “evening” person), how many hours they typically sleep (seven to eight hours is considered optimal), whether they experience insomnia, whether they snore and whether they feel excessively sleepy during the day.

These characteristics can interact in synergistic ways. For example, someone with frequent insomnia may also feel more daytime sleepiness, and having a late chronotype may lead to shorter sleep duration. By integrating all five characteristics into a “healthy sleep score”, we captured a fuller picture of overall sleep health.

People with four or five healthy traits had a “healthy” sleep profile, while those with two to three had an “intermediate” profile, and those with zero or one had a “poor” profile.

When we compared brain age across different sleep profiles, the differences were clear. The gap between brain age and chronological age widened by about six months for every one point decrease in healthy sleep score. On average, people with a poor sleep profile had brains that appeared nearly one year older than expected based on their chronological age, while those with a healthy sleep profile showed no such gap.

We also considered the five sleep characteristics individually: late chronotype and abnormal sleep duration stood out as the biggest contributors to faster brain ageing.

A year may not sound like much, but in terms of brain health, it matters. Even small accelerations in brain ageing can compound over time, potentially increasing the risk of cognitive impairment, dementia and other neurological conditions.

The good news is that sleep habits are modifiable. While not all sleep problems are easily fixed, simple strategies: keeping a regular sleep schedule; limiting caffeine, alcohol and screen use before bedtime; and creating a dark and quiet sleep environment can improve sleep health and may protect brain health.

How exactly does the quality of a person’s sleep affect their brain health?

One explanation may be inflammation. Increasing evidence suggests that sleep disturbances raise the level of inflammation in the body. In turn, inflammation can harm the brain in several ways: damaging blood vessels, triggering the buildup of toxic proteins and speeding up brain cell death.

We were able to investigate the role of inflammation thanks to blood samples collected from participants at the beginning of the study. These samples contain a wealth of information about different inflammatory biomarkers circulating in the body. When we factored this into our analysis, we found that inflammation levels accounted for about 10% of the connection between sleep and brain ageing.

Other processes

Another explanation centres on the glymphatic system – the brain’s built-in waste clearance network, which is mainly active during sleep. When sleep is disrupted or insufficient, this system may not function properly, allowing harmful substances to build up in the brain.

Yet another possibility is that poor sleep increases the risk of other health conditions that are themselves damaging for brain health, including type 2 diabetes, obesity and cardiovascular disease.

Our study is one of the largest and most comprehensive of its kind, benefiting from a very large study population, a multidimensional measure of sleep health, and a detailed estimation of brain age through thousands of brain MRI features. Though previous research connected poor sleep to cognitive decline and dementia, our study further demonstrated that poor sleep is tied to a measurably older-looking brain, and inflammation might explain this link.

Brain ageing cannot be avoided, but our behaviour and lifestyle choices can shape how it unfolds. The implications of our research are clear: to keep the brain healthier for longer, it is important to make sleep a priority.

Abigail Dove is Postdoctoral Researcher, Neuroepidemiology, Karolinska Institutet.

This article was first published on The Conversation.

Research has revealed a steep increase in liver disease in recent years. Meanwhile, there is growing evidence of health harms from alcohol, including drinking at levels that were previously considered “moderate.” These developments make a persuasive case for viewing alcohol consumption from a public health perspective.

As an internal medicine physician and alcohol epidemiologist, I’m interested in the overlap between liver disease and alcohol use among patients and in the general population. As it turns out, these topics are closely related, but maybe in surprising ways.

The liver is essential: humans need it to live. The liver contributes to metabolism and food storage, produces proteins that help with blood clotting and plays a vital role in the immune system.

At the cellular level, alcohol is a toxic substance that is metabolised (broken down) primarily in the liver. When the dose of alcohol is too high, liver cells become inflamed and damaged (liver inflammation is called hepatitis).

Over time, inflamed or damaged cells are replaced by fibrosis, which is the replacement of normal liver tissue with scar tissue, resulting in cirrhosis, or severe scarring and liver dysfunction. Cirrhosis can be fatal on its own and can also lead to liver cancer.

How does alcohol contribute to liver disease

Liver disease caused by alcohol is referred to as alcohol-related liver disease or ALD, previously called alcoholic liver disease. The heaviest drinkers, often those who have alcohol use disorder (AUD), can develop cirrhosis and liver failure.

But alcohol-related liver disease does not only affect people with AUD/heavy drinking. A growing body of evidence suggests chronic alcohol use at lower levels may also impact liver function and lead to disease, particularly among those with other risk factors for liver disease.

Patterns of alcohol consumption are also important, including among those who may not consume high amounts of alcohol on average. For example, binge drinking (defined as men consuming five or more drinks or women consuming four or more drinks per occasion) is a pattern of consumption that is very damaging to the liver because it results in high blood alcohol concentrations.

Binge drinking can be harmful to the liver, even among people who don’t drink very much on average or don’t have an alcohol use disorder.

Why are deaths from liver disease increasing

Deaths from liver disease have been increasing dramatically in Canada and the United States over the past two decades. A key factor is increased alcohol consumption during the same period, but this has been trending down over the past couple of years. Between 2016 and 2022, Canadian deaths from alcohol-caused liver disease increased by 22%.

But alcohol isn’t the only key contributor to the rise in deaths from liver disease. Another is the rise of a condition called metabolic dysfunction-associated steatotic liver disease, or MASLD.

Despite the complicated name, MASLD is a type of liver disease that is caused by the same metabolic disturbances that have accompanied the rise of overweight and obesity coupled with inadequate physical activity. This is the same set of risk factors that have led to the increase in diabetes. So one can conceive of MASLD as the liver equivalent of diabetes.

Hepatitis C, which is a blood-borne viral infection that can be acquired through injection drug use and needle sharing, is another important contributor to liver disease and cirrhosis.

Even though medical terminology has historically differentiated between alcohol and non-alcohol-related liver diseases, alcohol contributes to the progression of supposedly non-alcoholic liver disease, including MASLD and hepatitis C.

My colleagues and I studied patients with MASLD from the US-based Framingham Heart Study. We found that even among non-heavy drinkers, there was a dose-dependent relationship between the amount of alcohol use and the severity of both liver inflammation and fibrosis.

Similarly, even low levels of alcohol use can hasten the development of liver cirrhosis among those with hepatitis C. For example, research has shown that in patients with hepatitis C, there is an 11% increase in risk of cirrhosis with each one-drink increase in average drinks per day.

Preventing and reducing alcohol-related harm

Beyond providing medical care for individual patients with known liver disease, steps need to be taken upstream within the health system. These include screening around alcohol use in primary care, counselling interventions for those with risky drinking habits and treatment for those with alcohol use disorders. To do this effectively, there needs to be more resources available for all of these interventions.

However, treating individuals does not address the larger public health issue: measures are needed to lower alcohol consumption at the population level.

This is a cornerstone of preventing and reducing liver disease and its resulting disability, hospitalisations and death. And the most effective way to reduce alcohol consumption is through alcohol control policies that:

• Make alcohol more expensive (for example, alcohol taxes and minimum prices);

• Less available (such as restrictions on hours of sale, or the number of locations that sell alcohol), or

• Less desirable socially (such as limits on advertising and marketing or sports sponsorships).

In previous research, we found that states with 10 per cent stronger or more restrictive alcohol policies had lower ALD mortality rates. Furthermore, states that increased restrictiveness by even five per cent showed subsequent reductions in ALD.

Liver harm caused by alcohol is a public health problem. Collectively, we need to take better care of our livers by taking steps to reduce alcohol consumption in the population.

Timothy Naimi is Director, Canadian Institute for Substance Use Research; Professor, Division of Medical Sciences, University of Victoria.

This article was first published on The Conversation.

Following Tamil Nadu, Madhya Pradesh and Kerala, five more states have banned the sale and distribution of Coldrif cough syrup, which is allegedly linked to the death of 16 children.

The states are Karnataka, Punjab, Himachal Pradesh, Uttar Pradesh and Puducherry.

This came after 16 children, aged between one and seven, died due to kidney failure in the past month in Madhya Pradesh and Rajasthan after consuming the cough syrup.

The Madhya Pradesh government had asked authorities in Tamil Nadu to look into the safety of the formulation. On October 2, a report by the Tamil Nadu director of drug control found that samples of Coldrif cough syrup manufactured at a plant of Sresan Pharmaceuticals in the state’s Kancheepuram district were found to be “NSQ”, or not of standard quality.

The report said that the samples contained 48.6% diethylene glycol, which can cause acute kidney and liver failure.

Following Tamil Nadu's finding, on October 5, Madhya Pradesh also reported that one sample of Coldrif had 48.6% of diethylene glycol in it.

The permissible limit of diethylene glycol as an impurity is 0.1%. However, drug officials Scroll spoke to said that the chemical is unsafe even in trace amounts and should ideally be completely absent from an ingestible syrup. Its presence is a serious quality compliance issue, the officials said.

On Sunday, the Uttar Pradesh government banned the sale, import and export of Coldrif cough syrup, ANI reported.

The Karnataka government followed suit on Monday and banned the use of any cold and cough syrup for children below the age of two, while prohibiting the use of Coldrif cough syrup, The Indian Express reported.

On the same day, the Punjab Food and Drugs Administration also banned the sale, distribution and use of Coldrif cough syrup, PTI reported.

In Himachal Pradesh, authorities have completely banned the use of Coldrif cough syrup, while another syrup produced in the state, by the name Nastro-DS, is under scrutiny despite a clean chit from the Madhya Pradesh food and drugs administration, The New Indian Express reported.

“The lab analysis of Nastro-DS cough syrup samples has shown the presence of diethylene glycol within permissible limits,” Himachal Pradesh Drug Controller Manish Kapoor was quoted as saying. “Aqunova Pharma voluntarily decided to put on hold the production of Nastro-DS cough syrup after the Madhya Pradesh FDA took the samples.”

The Puducherry Drug Control Department has also prohibited the purchase, distribution and sale of a specific batch of Coldrif syrup.

In 2023, an inquiry by the World Health Organization had found diethylene glycol in India-made cough syrups allegedly linked to the deaths of 70 children in The Gambia.

In the wake of the deaths, the Directorate General of Health Services on Friday issued an advisory to all states and Union Territories, reiterating the “judicious prescribing and dispensing” of cough syrups for children.

The department, which reports to the Union health ministry, said that most “acute cough illnesses in children are self-limiting and resolve without pharmacological intervention”, adding that cough and cold medications should not be prescribed for children under two years.

Gujarat bans two other cough syrups

On Tuesday, the Gujarat Food and Drugs Control Administration banned the use of Respifresh TR and Relife – two other cough syrups that were found to have diethylene glycol beyond permissible levels.

On Monday, the Madhya Pradesh drug controller had labelled the two syrups that were manufactured in Gujarat as “not of standard quality”.

Of the 13 samples of the cough syrups collected by the Chhindwara drug inspector, 10 were assessed as being of “standard quality”, while three were found to be “not of standard quality”.

PIL before SC urges probe into deaths

Meanwhile, a lawyer has filed a public interest litigation before the Supreme Court seeking an independent, court-monitored probe into the deaths of multiple children in Rajasthan and Madhya Pradesh, Bar and Bench reported on Tuesday.

The petition highlighted that “no nationwide recall was initiated by the Union Ministry of Health and Family Welfare or the Central Drugs Standard Control Organisation, thereby allowing continued sale of the toxic drug in other states”.

The plea called for a look into forming a national drug recall policy in the country.

Two days before Rishika Peepre came down with a cough and cold on August 27, she was doing what five-year-olds do – dancing and playing.

That day, her father Suresh Peepre Khatik, a resident of Madhya Pradesh’s Sethiya village, took her to a local doctor who prescribed her cough syrup.

Rishika vomited the entire night after taking the medicine.

Three days later, she complained of severe stomach pain. Khatik admitted her to a hospital in Chhindwara.

Rishika had always been a healthy child but her condition deteriorated within a week. She was diagnosed with kidney failure and advised dialysis.

As no paediatric dialysis facility existed in Chhindwara, Khatik took her 120 km away to Nagpur’s Nelson hospital, where she underwent nine cycles of dialysis.

By September 16, Khatik ran out of funds. “Doctors said they cannot treat her if I don’t pay. So we got her discharged that day.”

Ten minutes after they left the hospital, Rishika died.

Since August, 11 children in Parasia – the tehsil in MP’s Chhindwara where Rishika lived – have died of kidney failure after consuming cough syrups. All were between the ages of one and six years. At least 10 others have been hospitalised.

All the children had been administered one of two cough syrups – Coldrif, manufactured by the Tamil Nadu-based Sresan Pharmaceutical and Nastro-DS, which was made by Himachal Pradesh-based Aquinnova Pharmaceuticals.

As the death toll increased, officials in Madhya Pradesh told Scroll that in late September they began to suspect that the cough syrup had been contaminated.

Their doubts were confirmed on October 2 when Tamil Nadu found the control batch of Coldrif cough syrup “adulterated” with 48.6% of diethylene glycol, a highly toxic chemical. Tamil Nadu drug inspectors had picked up the samples from Sresan’s Kancheepuram plant.

While the initial findings by Madhya Pradesh’s drug inspectors contradicted the Tamil Nadu report, on October 5 the state’s drug testing laboratory in Bhopal also found 46.28% of diethylene glycol in a sample of Coldrif cough syrup collected from a distributor.

This is not the first time cough syrups made in India and contaminated by diethylene glycol or DEG have led to deaths of children.

In 2023, 70 children had died in The Gambia after consuming cough syrups made in India. An inquiry by the World Health Organization had found the medicines adulterated with diethylene glycol. The same year, Uzbekistan blamed India-made cough syrups for the death of 18 children.

The tragedy in Chhindwara has left behind not just grieving families, but also a trail of debt.

“We not only lost our daughter, we also lost our entire savings in her treatment,” said Khatik, who spent Rs 9 lakh on Rishika’s treatment.

Khatik, who runs a meat shop, said all the women in his family mortgaged their jewellery to raise money for her treatment.

Several other families told Scroll that they had run out of money after paying lakhs in treatment. They complained of inaction and apathy from the state health department.

Nilesh Suryavanshi, whose three-year-old son Mayank is on a ventilator, alleged that the government has offered no financial assistance to the families. “Parents are struggling and taking their children to hospitals without any support,” he added.

Two cough syrups, two probes

A cough syrup requires a solvent to dissolve all its active ingredients – the compounds that make a drug effective – and to add sweetness and act as a lubricant. Usually, the solvent used is pharma-grade glycerine or propylene glycol, a clear, sweet and viscous liquid.

To cut corners, manufacturers knowingly or accidentally use a cheaper solvent called industrial glycerine, which is used to make cosmetics, a Maharashtra-based drug official told Scroll.

The industrial-grade glycerine can contain diethylene glycol and ethylene glycol, which if consumed can lead to vomiting, abdominal pain, kidney failure and often death.

All the children in Parasia who died showed these symptoms.

The use of diethylene glycol, or DEG, is banned in cough syrups. In its report, Tamil Nadu stated that DEG “is a poisonous substance which may render the contents injurious to health”.

Tamil Nadu’s findings were significant, since initially both the Union government and the Madhya Pradesh government found no anomalies in the cough medicine.

Six samples of the two syrups tested by Central Drugs Standard Control Organisation and three samples tested by the state drug laboratory in Madhya Pradesh initially were found “free of diethylene glycol/ethylene glycol”. The samples picked by CDSCO and the state government were from the same batch of drugs that the children consumed.

On October 3, Tamil Nadu issued a stop production notice to Sresan Pharma and banned the sale of Coldrif with immediate recall of the batches of medicine that had gone out to shops. Madhya Pradesh, Kerala, Rajasthan and Maharashtra followed suit.

Tamil Nadu also notified various states where the batch was distributed to stop its use. Sresan Pharmaceutical did not respond to an email from Scroll.

While Tamil Nadu was swift in response and tested the sample within a day, the Himachal Pradesh drug controller has been slower in its investigation of the other cough syrup consumed by the Chhindwara children, Nastro DS, made by Aquinnova Pharmaceuticals.

While samples of Nastro DS cough syrup were taken from Aquinnova’s Baddi unit, according to the unit’s incharge, the report of the tests has not been released.

Zatropha Pharma, which markets the cough syrup, in an email response to Scroll’s queries, said: “We have provided all the documents to the concerned drug authorities”. Rishabh Garg, a partner in Zatropha, told Scroll that the original manufacturer of the cough syrup is Aquinnova Pharmaceuticals, and questions should be directed to them.

Vikas Goyal, head of Aquinnova’s Baddi unit, told Scroll that they “have tested and cleared all laboratory requirements for the cough syrup”. He added, “We only purchase pharmacopeia grade glycerine. We did not find DEG contamination in our syrup.” Goyal said that the Himachal Pradesh drug controller has initiated an investigation.

Children are the most vulnerable to side effects of DEG poisoning. But as Scroll has reported, India’s drug rules do not mandate compulsory testing of DEG contamination in a cough syrup before it is cleared for sale.

“If this (testing) is made compulsory, we can detect many contaminated cough syrups before such tragedies occur,” the Maharashtra drug official said, requesting anonymity.

A doctor’s arrest

In Ridhora village, 13-month-old Prateek Pawar was amongst the first cases that caught the district administration's attention. He developed a minor cough and cold on August 20.

His father Sanjay Pawar took him to Dr Praveen Soni in Parasia who prescribed Coldrif.

For five days, Prateek was administered 2.5 ml of cough syrup four times a day. By the third day, his urination completely stopped.

For over a month now, Prateek has been in various hospitals. He is currently in Nagpur’s Lata Mangeshkar hospital for treatment of acute kidney injury. He has undergone three cycles of dialysis.

His father, Pawar, said they have spent Rs 5 lakh till now.

“My son is still in the ICU but he is recovering,” said Pawar, a farmer. “I have exhausted my savings and borrowed money from several people to keep his treatment going.”

Pawar blames Soni for prescribing an excessive dose of the syrup. Soni, a medical officer with Madhya Pradesh government hospital in Parasia, also runs a private clinic.

Of the eight children under treatment in Chhindwara and Nagpur, four consulted Soni and the others consulted a doctor identified as Thakur.

Scroll has accessed the children’s medical records, as collated by the district health department. Of the eight, six are critically ill with kidney failure.

Kapil Pawar, whose two-and-a-half-year-old son Vedansh was treated by Soni, too, alleged that the doctor had prescribed a high dose of the medicine – 3 ml of Coldrif four times a day.

Vedansh fell ill in early September. A few days after taking the cough syrup, he stopped urinating. On September 9, he was rushed to a hospital in Chhindwara and then referred to Nagpur.

Pawar alleged that the treating paediatrician in Nagpur informed him that his son “should not have been administered more than 1ml of the medicine”.

But Soni denied claims of incorrect dosage. He has been prescribing Coldrif for a “few years”, he said. “This problem has never occurred before. How a drug is manufactured is beyond my control,” he said, when he spoke to Scroll on October 3.

Two days later, Soni was suspended from the post of medical officer for practising privately and for not swiftly detecting kidney ailment in children and initiating the correct treatment. The same day, he was arrested by Chhindwara police.

Jeetendra Jat, deputy superintendent of police in Parasia, told Scroll they had waited for the health department’s investigation before initiating action.

On October 3, the Union health ministry issued an advisory to all states to avoid prescribing cough and cold medication to children aged less than 2. The same advisory also noted that cough syrup is generally not given to children below the age of 5.

In Chhindwara, paediatrician Dr Poonam Jain said she is flooded with cases of children who had the common flu, took either of the cough syrups, and fell severely ill since late August. Only a handful of patients are responding to medicines, she said.

Dr Pavan Nandulkar, another paediatrician, said children coming to him reported creatinine levels of 4-5, which is five times the normal. “Such levels mean the child will eventually suffer toxin-mediated kidney injury. The cause of death of all children who were referred to Nagpur hospitals was this,” Nandurkar said.

Absent government

Families of the children have been going from one hospital to the other for treatment, often at prohibitive costs.

Three-and-a-half-year-old Mayank fell ill in late September and required hospitalisation on September 25.

His father Nilesh Suryavanshi said he was referred from Chhindwara to Lata Mangeshkar hospital in Nagpur, where he found the treatment costs to be very high. “We went to the Nelson hospital and when our money got over, we came to the government medical college in Nagpur four days ago,” he said.

Suryavanshi has spent over Rs 8 lakhs on treatment. “My son is on a ventilator,” he said. “Crucial time was wasted in Chhindwara. Government doctors should have acted and begun treatment swiftly if so many children had already fallen ill.”

Mayank is in “critical condition”, doctors have now informed him.

Parasia MLA Sohan Balmik said he has written to Chief Minister Mohan Yadav to provide free treatment and support to patients.

Other families, too, alleged that the Madhya Pradesh health department was asleep on the job.

Pawan Pawar, whose two-year-old son Parth fell ill and stopped urinating in mid-September after consuming two doses of Nastro DS cough syrup, said he was alerted when two other families from his village had rushed to Nagpur after their children fell ill and showed similar symptoms.

Pawar stopped the cough syrup and took his son to Nagpur’s Aastha hospital. “There was no awareness raised by the health department here,” he said. “They began to take action very late. By then, several children had started falling ill.”

“Be kind to yourself” is a piece of advice that’s often given to people during difficult times or moments of stress. But for someone who is driven, a perfectionist or facing pressure, the idea of self-compassion can feel uncomfortable. To them, kindness might feel like letting themselves off the hook.

But research actually shows that consistently feeling shame and self-judgment can activate the body’s stress response just as strongly as physical danger. This increases cortisol and inflammation, both of which are linked to long-term health problems.

On the contrary, research suggests that being kind to yourself – known in psychology as “self-compassion” – can actually support motivation, accountability and resilience without the cost of burnout.

Self-compassion can be defined as the ability to view yourself with kindness and a mindful or balanced perspective on what’s happening to you – as opposed to viewing yourself with judgment, focusing on your mistakes or feeling like you’re alone in your experience.

The key components of self-compassion include mindful awareness (noticing your pain or struggle without denial or exaggeration), self-kindness (offering support rather than criticism) and shared humanity (remembering that everyone struggles sometimes and that imperfection is part of being human).

Self-compassion doesn’t mean letting yourself off the hook. It means staying connected to yourself in a way that supports real, healthy change.

But practising self-compassion is often easier said than done. If you’re someone who finds it difficult to be kind to yourself, here are three ways having more self-compassion can be beneficial for you – and how to increase self-compassion in your everyday life.

1. Reduces your body’s stress response

Stress is a natural part of life that our bodies are well-adapted to cope with. It allows us to perform daily tasks and be more engaged. However, consistent exposure to stress without relief may result in chronic stress. This can lead to both mental and physical health problems including cardiovascular disorders, decreased immunity and mental health challenges such as depression.

To reduce exposure to chronic stress, we need to be able to engage our brain’s parasympathetic system – the part of the nervous system that helps the body relax and also controls functions such as digestion and breathing. The parasympathetic system is often stimulated by relaxation and feelings of safety, security and comfort.

Self-compassion may be a powerful tool in helping create the feeling of security and comfort within ourselves that’s needed to stimulate this internal system. Research suggests self-compassionate thoughts can result in physiological changes such as improved heart rate variability – a marker of emotional regulation and resilience.

2. Helps you respond and adapt to feedback

Many people fear that too much self-compassion could mean they become self-centred or avoid responsibility. But when we practise self-compassion, we often become more available to others.

We model healthier coping strategies, respond better to feedback and recover faster from setbacks.

The reason this happens is because self-compassion teaches us to respond to ourselves with the same care we would offer others. Instead of saying: “I’m not good enough,” a self-compassionate person might say: “This was hard, what can I learn for next time?”

Better yet, as we begin to show empathy towards our own imperfections and mistakes, we are better able to extend that empathy towards others.

3. Makes you more likely to succeed

Another common fear is that self-compassion will make us lazy or unambitious. But studies show the opposite to be true.

People who practise self-compassion are more likely to take responsibility for their actions, try again after failure and stay engaged with long-term goals. They procrastinate less and take more conscientious, less impulsive decisions.

By contrast, shame and negative self-esteem may drive short-term performance, but we’re less likely to maintain this motivation over time.

How to practise self-compassion

If you’d like to give self-compassion a go, the next time you catch yourself in a loop of harsh self-talk, pause and ask: if someone I loved were in this situation, what would I say to them? Then try offering yourself the same words.

And use neutral, non-judgmental language. Instead of “I shouldn’t feel this way” or “I’ve failed again,” try to make your thinking less personal. You could tell yourself instead: “This is hard” or “I’m not the only one who feels this way.” You could even try to be more forward thinking, asking yourself: “This is my situation right now, what can I do next?” These small shifts reduce emotional reactivity and help support clearer thinking under pressure.

Finally, look at the bigger picture. It’s easy to feel alone in our struggles. But everyone, regardless of culture, background or personality, experiences doubt, regret or imperfection. Remind yourself that no one is perfect and everyone has hard days. You’re not alone.

Practices such as loving-kindness meditation can also help with developing self-compassion. During this form of meditation, the focus is on sending good wishes or kind thoughts to yourself and others.

Whether you’re navigating illness, chronic stress or the pressures of daily life, being kind to yourself isn’t indulgence – it’s a skill that protects your health, your mind and your future self.

Jennifer Donnelly is Doctoral Researcher, Meditation-based Interventions in Clinical Settings, Centre of Positive Health Sciences, RCSI University of Medicine and Health Sciences.

This article was first published on The Conversation.

Hours after undergoing a supposedly safe procedure to retrieve her eggs at a fertility clinic in Ghaziabad in Uttar Pradesh, Ruchika Gambhir suffered cardiac arrest and died on March 6.

The Delhi resident and her husband, Hemant Gambhir, had taken a chance on in vitro fertilisation or IVF treatment after trying unsuccessfully for five years to have a baby. The couple underwent a battery of tests and investigations. On March 5, they went to a private centre in Ghaziabad, where the doctors would surgically retrieve Ruchika Gambhir’s eggs and Hemant Gambhir’s sperm, which would then be fertilised in a laboratory to make embryos that would later be transferred into her uterus. But Ruchika Gambhir developed medical complications during the procedure and was shifted to a bigger hospital, where she died in the intensive care unit.

Accusing the doctors at the centre of medical negligence, Hemant Gambhir said they never once mentioned the risks associated with IVF treatment. “We were assured that it is a safe procedure,” he said. “We didn’t even take family members along because we were told by the doctor that it is a daycare procedure and we will be completely fine.” He said that had he known about the risks, he would never have opted for the treatment.

“My wife was healthy and we walked into the clinic together,” he added. “I came out with her body.”

In his complaint filed at the Indirapuram Police Station, Hemant Gambhir also alleged the fertility clinic was not equipped to handle the emergency after his wife developed complications:

“It was only when my wife was shifted to Atlanta Hospital in [the] evening, I was informed that my wife had suffered a cardiac arrest during the course of the procedure and due to non availability of the appropriate arrangements she could not be revived, which resulted in my wife slipping into a coma.”

The doctor at the centre refuted the allegations of medical negligence. “I am a qualified specialist,” she said, but refused to say anything further. Scroll.in has emailed her a list of questions and the story will be updated if she responds.

Eight months on, Hemant Gambhir said a first information report was yet to be filed. Ghaziabad Assistant Superintendent of Police Ravi Kumar said the case would be referred to the medical board, the district authority that looks into cases of medical negligence, after which a first information report would be filed.

[Update: In February 2019, a medical committee constituted by the chief medical officer of Ghaziabad district found no medical negligence on part of the centre. The Uttar Pradesh Medical Council reiterated this in August 2019, saying, “Patient management after unknown complication after anesthesia/ procedure was satisfactory.” In October 2019, the Ghaziabad district court dismissed the complaint filed by Hemant Gambhir after he failed to show up for the hearings.]

Rarely discussed risks

In India, no records are kept of fatalities during in vitro fertilisation or serious side-effects not leading to death. In 2014, media outlets reported the death of a 23-year-old egg donor in Delhi from Ovarian Hyperstimulation Syndrome. This is a condition in which the ovaries of a woman undergoing fertility treatment swell up painfully. This is a possible side-effect of a common fertility treatment in which the woman is injected with any one of a family of hormones called gonadotropins to induce her ovaries to produce multiple eggs instead of the single egg normally released in a menstrual cycle. Severe Ovarian Hyperstimulation Syndrome can lead to shortness of breath and sometimes, death.

The various procedures performed during IVF treatment come with other risks, including headache, nausea and respiratory distress, ectopic pregnancy (where the fertilised egg remains in the fallopian tube and can cause its rupture), and ovarian cancer. In vitro fertilisation can also affect the child resulting from the treatment, with premature delivery and birth defects listed as risks. Then there are the risks associated with anaesthesia.

“As most egg retrieval procedures in India are performed under general anaesthesia, all the complications linked to general anaesthesia hold true here,” said Dr Anjali Malpani, an IVF specialist in Mumbai.

Egg retrieval, commonly called egg pick-up, is conducted with the help of ultrasound imaging. “The most common complication is an injury caused to the bladder and bowel while the doctor is trying to reach the ovaries to retrieve the eggs,” said Malpani. “There is also a possibility of infection and haemorrhagic bleeding.” Malpani explained that the ovaries sit close to vital blood vessels and any injury to these vessels can lead to cardiac arrest.

Dr Anant Bhan, a researcher of bioethics and global health, pointed out that since India’s large IVF industry is mostly unregulated, the onus is on the medical community to inform couples seeking treatment about its side-effects, complications and other options. They should also be informed of the expenses and failure rates, he said.

But several women who have undergone IVF treatment spoke of a great disparity between what they were led to expect and what they experienced.

“I knew that these medical procedures come with risks but all the doctors I met downplayed or didn’t even mention them,” said a 36-year-old resident of Mumbai who did not want to be identified. She said her egg retrieval procedure left her bedridden for a week. “I couldn’t pass stool for a week and the doctor said it is okay,” she said. “I was taken to a local hospital after the pain became unbearable and underwent a procedure to clean my bowels.”

Fertility treatment is “emotionally, physically and financially distressing”, she warned.

Neelam, who also underwent IVF treatment, agreed that its side-effects are rarely discussed. The 31-year-old assistant manager at a private company took a year off work to have a baby after two miscarriages. However, her treatment did not result in pregnancy.

“I was prepared because I had read enough to know that IVF success rate is less than 50%,” she said. “What I wasn’t prepared for is the frustration associated with the daily hormone injections and the tests. There was a point during my treatment that there was no place left in my body which wasn’t pricked by a needle.”

She added, “Having a baby is completely worth the pain but I wish we knew what we were getting into.”

Now back at work, Neelam has put her plans of having a baby on hold.

‘We were so sure’

The Gambhirs, too, did not worry much about the procedures they were to undergo at the centre on March 5. “We were so sure about the procedure that we just took a day’s leave from office,” said Hemant Gambhir. “We were supposed to go to work the next day.”

Instead, Ruchika Gambhir was wheeled out of the operation theatre in an “emergency state”. Hemant Gambhir said the doctors simply told him she needed to be taken to a larger hospital.

He still does not know whether his wife developed complications before, during or after the egg retrieval procedure. “I was told her blood pressure shot up during the surgery,” he said. “I didn’t think it was serious until the doctor took me inside the operation theatre and asked me to look at the monitors attached to her body to verify that she is alive before we could take her to another hospital.”

At Atlanta Hospital, where she was shifted, the death summary says Ruchika Gambhir died of “cardiogenic shock”, an often fatal condition in which the heart suddenly fails to pump enough blood to meet the body’s needs. Her death certificate, issued by the Ghaziabad city corporation, does not indicate a cause of death.

This is the third story in a series on fertility treatments. Read the first part here and the second here, both of which focus on the risks that women who donate eggs undergo.

The Directorate General of Health Services on Friday issued an advisory to all states and Union Territories, reiterating the “judicious prescribing and dispensing” of cough syrups for children, ANI reported.

This came after deaths allegedly linked to the consumption of cough syrups in Madhya Pradesh and Rajasthan.

The department, which reports to the Union health ministry, said that most “acute cough illnesses in children are self-limiting and resolve without pharmacological intervention”, adding that cough and cold medications should not be prescribed for children under two years.

“These are generally not recommended for ages below five years and above that, any use should follow careful, clinical evaluation with close supervision and strict adherence to appropriate dosing, the shortest effective duration and avoiding multiple drug combinations,” the health authority said.

The public should be sensitised about adhering only to prescription by doctors, the advisory said.

It added that non-pharmacological measures, including “adequate hydration and rest”, should be the first-line approach for children suffering from cough and cold.

Health facilities and clinics must ensure the procurement and dispensing of products manufactured under the Good Manufacturing Practices and formulated pharmaceutical-grade excipients, it added.

Eight children, aged between one and seven, died in the past month in Madhya Pradesh and Rajasthan. The authorities have suspected cough syrup poisoning as the common cause.

In both states, health authorities had issued restrictions and advisories, and investigations were underway.

The Times of India quoted the Union health ministry as having said on Friday that the tests on the cough syrup samples taken from Madhya Pradesh revealed that it did not contain “Diethylene Glycol (DEG) or Ethylene Glycol (EG), contaminants that are known to cause serious kidney injury”.

The samples collected from Rajasthan did not have “Propylene Glycol, which can be potential source of contaminants, DEG/EG”.

However, the ministry was quoted as saying that the product “is a dextromethorphan-based formulation, which is not recommended for paediatric use”.

Deaths due to toxic cough syrups manufactured in India first made headlines in October 2022, when the World Health Organization issued a global alert for four such medicines manufactured by a Haryana-based pharmaceutical firm.

This was after the authorities in The Gambia linked 66 deaths, most of them due to acute kidney failure, to the four medicines.

The usual cause of toxicity in cough syrups has been the use of industrial-grade glycerine or propylene glycol instead of pharmaceutical-grade versions. Industrial-grade variants are cheaper but can be contaminated with diethylene glycol or ethylene glycol which can cause diarrhoea, altered mental status, acute kidney injury, and lead to death, especially in children.

In July 2024, cough syrup samples taken from over 100 pharmaceutical units across India failed tests for quality control.

Also read: India’s cough syrup testing regime has a deadly blind spot

Something unusual seems to be happening with dengue, a potentially fatal mosquito-borne viral disease found across swathes of tropical Africa, Asia and the Americas. As with most infectious diseases, the number of cases tends to rise and fall over the years as epidemics come and go, but recently changes seem to be afoot in how dengue is behaving.

Not only is the number of new infections steadily rising around the world, but outbreaks are becoming larger and less predictable. For example, 2019 saw the greatest number of dengue fever cases ever recorded – almost twice as high as the previous year. And in July 2023, there were a record number of deaths from the disease in Bangladesh.

Most people infected with dengue will suffer from flu-like symptoms, ranging from relatively mild to very unpleasant, with fever, headache and joint pain.

In more severe cases, though, blood vessels can become damaged by the virus, allowing blood to leak into the surrounding tissues. This condition, known as dengue haemorrhagic fever, can produce bruising, and bleeding from the nose and gums. It can ultimately lead to organ failure and death as the body slips into shock.

The principal agent, or vector, in the transmission of dengue, is the Asian Tiger mosquito Aedes aegypti, although its cousin Aedes albopictus is also capable of spreading the virus.

While Aedes aegypti is essentially a tropical mosquito, it is a very adaptable insect. In recent years, it has expanded its range out of the tropics into southern Europe and to several states in the US, including Florida, Hawaii, Texas and Arizona.

All mosquitos need water to breed, but another thing that has helped in its migration is its ability to use even the smallest of water containers to do so, something as small as a discarded plastic bottle cap will do.

Despite this capability, it is usually the lack of breeding sites that caps the number of mosquitoes in circulation and therefore their ability to spread the dengue virus. But in Bangladesh this year the rains arrived early and, coupled with an unusually high temperature and humidity, this led mosquito numbers to surge.

Because a large proportion of the population of Bangladesh spends a great deal of time outside and tends to have houses that are relatively simple for mosquitoes to enter, it took little time at all for dengue to take hold and then explode.

Although no one is certain about what’s driving the increase and instability of dengue, climate change may be contributing as much of the world is getting both warmer and wetter.

Fortunately for most high-income countries, even areas within the current range of Aedes Aegypti, climate change will probably not lead to any major outbreaks simply because people spend so much of their time indoors and out of the reach of mosquitos. It takes a certain amount of biting pressure within a population to sustain transmission.

Spread to new places

However, a new report by the World Health Organization’s chief scientist suggests that the disease may still be able to establish itself in parts of Europe, the US and Africa where it has previously been absent.

Something that is also likely to be seen more often is what happened recently in Bangladesh repeats itself across similar middle- and low-income countries where the opportunity for mosquitoes and people to mix is greater.

The solution is likely to be an affordable and effective vaccine. Indeed, the WHO has recently recommended the Qdenga vaccine for children living in areas where the infection is a major public health problem.

However, dengue is not the only concern as there are a variety of other mosquito-borne infections that kill around a million people every year. Diseases like chikungunya, yellow fever and Zika virus are all transmitted by Aedes aegypti.

An increasingly warmer, wetter and less reliable climate is therefore probably going to be the precursor for many more – and less predictable – mosquito-related disease outbreaks, and ultimately deaths, in the future. As with most other life-threatening communicable diseases, it is once again the poorest communities in the global tropics that will have to bear the brunt of this.

Simon Bishop Associate Professor, Faculty of Health, Anglia Ruskin University

This article was first published on The Conversation.

Would you willingly have your legs broken, the bone stretched apart millimetre by millimetre and then spend months in recovery – all to be a few centimetres taller?

This the promise of limb-lengthening surgery. A procedure once reserved for correcting severe orthopaedic problems, it has now become a cosmetic trend. While it might sound like a quick fix for those hoping to make themselves taller, the procedure is far from simple. Bones, muscles, nerves and joint all pay a heavy price – and the risks often outweigh the rewards.

Limb lengthening is not new. The procedure was pioneered in the 1950s by Soviet orthopaedic surgeon Gavriil Ilizarov, who developed a system to treat badly healed fractures and congenital limb deformities. His technique revolutionised reconstructive orthopaedics and remains the foundation of current practice today.

While the number of people undergoing cosmetic limb-lengthening surgery each year still remains relatively small, the procedure is growing in popularity. Specialist clinics in the US, Europe, India and South Korea report increasing demand – with procedures costing tens of thousands of pounds.

Reports suggest that in some private clinics, cosmetic cases of limb-lengthening surgery now outnumber medically necessary ones. This reflects a cultural shift, where people are willing to undergo a demanding, high-risk medical procedure to meet social ideals about height.

Surgeons begin by cutting through a bone – usually the femur (thigh bone) or tibia (shin bone). To ensure the existing bone stays healthy and that new bone can grow, surgeons are careful to leave intact its blood supply and periosteum (the soft issue that covers the bone).

Traditionally, the cut bone segments were then connected to a bulky external frame which was adjusted daily to pull the two ends apart. But more recently, some procedures have adopted telescopic rods placed inside of the bone itself.

These devices can be lengthened gradually using magnetic controls from outside the body – sparing patients the stigma of an external frame and reducing the risk of infection. However, they’re not suitable for all patients – especially children – and are considerably more expensive than external systems.

Regardless of whether the device sits outside or within the bone, the process is the same. After a short healing period, the device is adjusted to separate the cut ends very gradually, usually by about one millimetre per day. This slow separation encourages the body to fill the gap with new bone – a process called osteogenesis. Meanwhile, the muscles, tendons, blood vessels, skin and nerves stretch to accommodate the change.

Over weeks and months this can add up to a gain of five to eight centimetres in height from a single procedure – the limit most surgeons consider safe. Some patients undergo operations on both the femur and tibia, aiming to gain as much as 12–15 centimetres in total. However, complication rates rise sharply with each centimetre of additional growth. Complications include joint stiffness, nerve irritation, delayed bone healing, infection and chronic pain.

Intense pain

The underlying challenge of limb-lengthening surgery is the same: the body must constantly repair a bone that is being pulled apart.

When a bone breaks, a blood clot rapidly forms around the fracture. Bone cells (ostoblasts) create a callus (soft cartilage) that stabilises the break. Over weeks, osteoblasts replace this cartilage with new bone that gradually remodels to restore strength and shape.

In limb-lengthening surgeries, however, the fracture is continuously pulled apart. This means the body’s repair process is constantly interrupted and redirected, generating a column of delicate new bone where hardening is delayed.

The process is intensely painful. Patients often require strong painkillers. Physiotherapy is also essential to maintain movement. Yet, even when the surgery succeeds, people may still be left with weakness, altered gait or chronic discomfort.

There’s also the psychological burden that comes alongside the procedure. Recovery can take a year or more – much of it spent with restricted mobility. Some patients report depression or regret, particularly if the modest gain in height does not deliver the hoped-for improvement in confidence.

Muscles and tendons are also forced to lengthen beyond their natural capacity, which can lead to stiffness. Nerves are especially vulnerable. Unlike bone, they cannot regenerate across long distances. Healthy nerves can stretch by perhaps 6%-8% of their resting length – but beyond this, the fibres begin to suffer injury and become impaired.

Patients often experience tingling, numbness or burning pain during lengthening. In severe cases, nerve damage may be permanent. Joints, immobilised for months, are at risk of stiffening or developing arthritis because of changes to how force and weight are distributed.

The rise of cosmetic limb-lengthening illustrates a broader trend in aesthetic surgery – where increasingly invasive procedures are offered to people without medical need. In theory, almost anyone could gain a few centimetres of height. But in practice, it means months of broken bones, fragile new tissue, exhausting physiotherapy and the constant risk of complications.

For those with medical need, the benefits can be life-changing. But for those seeking only to add a little height, the question remains whether enduring months of pain and uncertainty is really worth it.

Michelle Spear is Professor of Anatomy, University of Bristol.

This article was first published on The Conversation.

In 2018, I underwent a heart transplant in a city far from home. The medical procedure was lifesaving, but since then I have experienced a costly and frustrating struggle to access vital diagnostics, ICU care and essential immunosuppressants.

Since 2024, I have had a senior citizen health card under Ayushman Bharat, India’s flagship health insurance scheme. But I have never been able to use it at any part of my transplant journey. In theory, I am covered. In practice, I am uninsured.

My experience mirrors that of other organ recipients. India’s organ transplant programme exists on paper, but on the ground it is a patchwork of vague policies and inaccessible services.

The National Organ and Tissue Transplant Organisation, India’s nodal agency for transplants, has no financial or executive authority to take any action. Meanwhile, the country’s transplant system is fragmented with inadequate government support.

The gap between policy and delivery leaves recipients stranded their most vulnerable while recovering from complicated medical procedures.

The illusion of coverage

Ayushman Bharat, which is touted as the world’s largest health insurance programme, aims to make tertiary care affordable for marginalised families. Heart and liver transplants were recommended for inclusion in the national scheme, but no formal announcement has followed.

Even when hospitals are empanelled under the scheme, they are under-resourced or unfamiliar with transplant care. Ayushman Bharat also does not guarantee that a patient can avail of critical components such as dedicated ICU facilities, diagnostics, immunosuppressants, biopsies or monitoring.

My Ayushman Bharat card has never provided reimbursement for a test or medicines. The hospitals where I am treated have not even applied to be included in the scheme.

Some doctors and policymakers say this crisis only affects the poor. But transplant care is unaffordable for the middle class too. I, like others, had to sell my flat to fund the transplant surgery and the long-term care it required.

Health insurers routinely reject transplant recipients. Despite appeals, the Insurance Regulatory and Development Authority of India has not issued supportive policies. This leaves recipients unprotected for life.

In 2024, I started a petition requesting the Ministry of Health and Family Welfare to provide financial support for post-transplant care. The National Organ and Tissue Transplant Organisation responded with recommendations but admitted that it did not have the authority to take action.

My experience, and that of others like me, points to a failing healthcare and organ transplant system.

A system designed for cities

Transplant-ready hospitals are concentrated in metros like Chennai, Hyderabad and Bangalore. But even cities like Pune do not have fully equipped, government-backed centres for hearts and liver transplants. State hospitals hold licences but often have performed few transplants.

According to the National Organ and Tissue Transplant Organisation report published in June, more than 175,000 people are on the kidney transplant waiting list while fewer than 14,000 surgeries were performed in the last year. For heart, lung and liver patients, the wait is longer, the options fewer. Government hospitals may have surgeons but no ICU beds, equipment but no trained nurses.

Patients from smaller cities have to travel hundreds of kilometres, at great cost and risk. In metro cities, too, the organ transplant system is fragmented. Mumbai, for example, does not have a public-sector organ retrieval and allocation network. Donated organs often go unused because there are no organ harvesting teams or ICU care.

Functioning organ transplant centres rely on a handful of committed surgeons. When these surgeons retire or move, transplant programmes collapse, making for a dangerously fragile system. In my book New Life, New Beginnings: Compelling Stories by Organ Recipients, Donors, and Doctors.

Dr KR Balakrishnan of MGM Healthcare notes, “Government hospitals lack the flexibility to recruit doctors. Transfers can leave a centre unmanned.” Yet, states like Maharashtra are rushing to convert underprepared public hospitals into organ retrieval centres.

India’s broken policy framework is best reflected by the fact that there has been investment in organ donation awareness campaigns but there is no enforcement body with authority over transplant delivery. At the same time, the National Organ and Tissue Transplant Organisation report calls for setting up centres of excellence, improved ICU capacity and public-private partnerships.

The cost of inaction

Without reliable systems, lives are lost. Patients travel far and borrow heavily for a shot at saving their lives. Donated organs go to waste. Promising centres falter due to staffing or funding gaps. Ayushman Bharat, meant to help, adds to the confusion.

One donor can save eight lives. But with few systems for retrieval, surgery and follow-up, that potential is lost.

India must match its transplant ambition with action:

• Establishing transplant hubs in every state with retrieval, surgery, ICU and follow-up capability.

• Expanding Ayushman Bharat to cover transplant from surgery to long-term care

• Publishing performance data for empanelled hospitals and delisting underprepared centres.

• Giving NOTTO executive and financial authority to support donors and recipients.

• Creating a national registry to track outcomes, infrastructure, and equity.

• Ensuring insurance access for transplant recipients across income groups.

Transplants are indeed medical procedures but also acts of faith, trust and vital public service. India has made progress in encouraging organ donation. But until that is matched by a robust, accessible and enforceable healthcare and policy infrastructure, we will continue to fail the most vulnerable patients – and the cost will be measured in lives.

Viney Kirpal is a heart transplant recipient and the author of New Life, New Beginnings: Compelling Stories by Organ Recipients, Donors, and Doctors.

World Heart Day is observed on September 29.

Also read:

India’s organ transplant system is skewed against the poor

Why women account for a majority of organ donors in India

Alzheimer’s disease is on track to become one of the defining public health challenges of our time. Every three seconds, somewhere in the world, someone is diagnosed with dementia, and it’s usually Alzheimer’s disease.

Currently, approximately 50 million people worldwide have Alzheimer’s disease. By 2050, this number will exceed 130 million.

The human health and socioeconomic consequences of this are going to be immense. But perhaps it doesn’t have to be this way.

Preventing Alzheimer’s

A 2024 report from the influential Lancet Commission suggests that up to one-third of Alzheimer’s disease cases could be prevented simply by avoiding certain risk factors. These 14 modifiable risk factors encompass: traumatic brain injury, hypertension, depression, diabetes, smoking, obesity, high cholesterol levels, low physical activity levels, too much alcohol consumption, too little education, vision loss, hearing loss, social isolation and air pollution.

While this comprehensive list is rooted soundly in science, it’s not easy for members of the general public to monitor and manage 14 separate health targets – especially when prevention efforts need to start decades before symptoms appear.

This is a problem that needs addressing. Tackling this problem requires a prevention model that is simple and memorable – something the public can easily embrace, understand and follow.

There are successful examples that can serve as a template. Stroke prevention associations, for instance, have successfully adopted the FAST (Face, Arm, Speech, Time) mnemonic to teach stroke warning signs. Alzheimer’s disease prevention needs a FAST equivalent.

SHIELD (Sleep, Head Injury prevention, Exercise, Learning and Diet) may fill that role. SHIELD brings together the most significant, overlapping dementia risk factors into five core pillars, offering a clear and effective strategy for prevention.

Sleep

Sleep is a foundational element of SHIELD. Maintaining healthy sleep habits is a key protective factor against dementia. Adequate sleep supports brain function, memory, mood and learning.

Insufficient (less than five hours per night) or poor-quality sleep (frequent awakenings), especially in midlife, increases the risk of cognitive decline and dementia. Chronic poor sleep leads to build-up in the brain of amyloid-beta protein, which is implicated in the development of Alzheimer’s disease.

Poor sleep also increases the likelihood of obesity, high blood pressure and depression, all risk factors for Alzheimer’s disease. If you’re currently sleeping four to five hours per night, consider changing this habit to avoid increasing your risk for developing dementia in later life. Sleep is a vital tool for brain protection and Alzheimer’s disease prevention.

Head injury

Head injury prevention is, rather surprisingly, often overlooked in conversations about dementia. There are strong links between traumatic brain injuries, including concussions, and higher Alzheimer’s disease risk.

Such head injuries can occur in a wide variety of settings, not just professional sports. Intimate partner violence, for example, is unfortunately common in our society and is a frequent, but neglected, cause of head trauma.

Head injury prevention should start early and continue throughout life, as damage can accumulate over time. Broader safety measures (such as improved helmet designs, stronger concussion protocols in youth and adult sports and efforts to prevent head injuries in all settings) can play a significant role in protecting long-term brain health and avoiding Alzheimer’s disease.

Exercise

Exercise is perhaps the most powerful lifestyle habit for reducing the risk of Alzheimer’s disease. Exercise directly addresses multiple major risk factors, including obesity, high blood pressure, high cholesterol and depression. It also supports the growth of brain cells, memory and emotional health.

Despite this, physical inactivity remains common, especially in high-income countries, where it may contribute to as many as one in five cases of Alzheimer’s disease. Exercise is not just “heart medicine,” but “brain medicine” too. Regular movement, even in small amounts, enables better brain aging and can help avoid Alzheimer’s disease.

Learning

Learning, both in and out of school, remains one of the strongest protective factors against dementia. Lower educational levels, such as not finishing secondary school, are linked to a significantly increased risk for dementia. Learning contributes to the brain’s “cognitive reserve,” which is the brain’s ability to function well despite damage or disease.

Individuals with Alzheimer’s disease maintained better mental function if they had continued learning throughout life. Public health messaging should promote life-long learning in all forms — from reading and language learning to engaging hobbies that keep the brain active. It’s never too early (or too late) to learn another language or to challenge your brain. Boosting your cognitive reserve boosts your brain against Alzheimer’s disease.

Diet

Diet also plays a major role in brain health and dementia prevention. No single food prevents dementia. Rather, a combination of nutrient-rich foods supports overall brain health. A healthy diet can lower dementia risk by emphasizing whole foods like fruits, vegetables, whole grains, nuts and fish, while restricting processed foods, red meat and sweets.

Adhering to dietary patterns like the Mediterranean diet has shown promising results in protecting against cognitive decline. The Mediterranean diet is a brain/heart-healthy eating style inspired by the traditional diets of people in countries bordering the Mediterranean Sea. It emphasizes plant-based foods with olive oil as the primary fat source, while limiting red meat, processed foods and added sugars.

What we eat influences brain inflammation and brain vascular health — all of which are increasingly tied to Alzheimer’s disease. A healthy diet shouldn’t feel restrictive or like a punishment for trying to improve brain health. Instead, it can be framed as a positive investment in long-term independence, clarity and energy.

By simplifying the science, the SHIELD framework offers a realistic and research-backed approach to brain health. Until a cure is discovered, prevention is the strongest tool. Concepts like SHIELD provide a starting point for achievable prevention.

Alzheimer’s disease should not be seen as inevitable. The statistic that there will be more than 130 million people with Alzheimer’s disease by 2050 must not be accepted as predestined. With the right decisions and actions, we can work towards Alzheimer’s disease prevention by protecting the minds and memories of millions.

Donald Weaver is Professor of Chemistry and Senior Scientist of the Krembil Research Institute, University Health Network, University of Toronto

This article was first published on The Conversation.

On June 20, a five-year-old girl died in Hapur in Uttar Pradesh after a private hospital allegedly refused to treat her. Her parents, who work as daily-wage labourers, claimed that this was because they were unable to immediately pay the Rs 20,000 demanded for their daughter’s treatment.

In Bengaluru in January, a 72-year-old man who suffered from gastric cancer is reported to have died by suicide after being denied the health coverage he was entitled to under the government’s Ayushman Bharat scheme.

Such incidents are part of a grim pattern of rising barriers to healthcare access as patients are being pushed to the brink and refused life-saving care because they cannot pay.

The Indian Supreme Court in 1989 recognised the right to medical care as inseparable from the right to live with dignity, which means the denial of healthcare treatment a constitutional betrayal and a profound moral failure.

Debt and devastation

When health is treated as a commodity rather than a right, even payment for tests or medicines can push a family into crippling debt. The consequences are postponed treatments, depleting savings, jewellery sold and land mortgaged.

In a country where nearly half of all healthcare spending is out-of-pocket rather than covered by government programmes or insurance, around 55 million people are driven below the poverty line every year by medical expenses alone, estimates the World Health Organization.

Unaffordable medical care can create a perpetual cycle of illness, debt and despair that traps the poorest in intergenerational poverty. It can strip families of stability and hope.

For tuberculosis patients, for instance, treatment delays of seven to nine weeks can consume more than a fifth of a family’s annual income – and this is before therapy even begins.

Households of cancer patients pay more than Rs 3 lakh in out of pocket expenses, according to one report.

Even in ostensibly free government clinics, families can face informal charges. They resort to high-interest loans and forgo essential follow-up care, perpetuating disease and impoverishment.

The anticipation of steep bills leads many to “tough it out” at home until the situation is dire. Hypertension or early-stage tuberculosis, easily managed if caught in time, is often detected only when intensive (and far costlier) interventions are required.

Lives are shortened, tertiary hospitals overflow and the costs soar for everyone. Preventable illnesses morph into life-threatening crises, exacting a toll both on the demand side (patients) and the supply side (public health infrastructure).

Preventive care (vaccines, antenatal check-ups, chronic disease screenings) is often the country’s strongest aid to staying healthy. But when these are out of reach, diseases once thought beaten return and maternal and newborn deaths stay stubbornly high.

Without routine screenings, conditions such as cervical cancer or undiagnosed diabetes progress silently to advanced, life-threatening stages.

Inequities are stark: immunisation rates among Scheduled Tribes lag by more than 20 percentage points behind forward castes. Rural children trail their urban peers by similar margins. Those priced out of formal care often turn to informal providers: pharmacists (qualified and otherwise), traditional healers, unlicensed practitioners.

Misdiagnoses, dangerous antibiotic misuse and unsterile procedures are common, fuelling drug resistance and failed treatments. In India and Pakistan, up to 80% of first-contact care happens outside the public sector. The harm goes beyond individuals as resistant infections spread unchecked, threatening communities and regions.

Lower-caste communities, sexual minorities and internal migrants face even greater barriers, including discrimination, language gaps and bureaucratic hurdles.

Even those enrolled in health schemes have to pay hidden “top up” costs for transport or diagnostics that undermine the promised protection. The result is that health indicators for marginalised groups lag national averages, widening societal fissures and eroding the chances of providing equitable care.

Illness also steals livelihoods. In India’s vast informal economy, there is no paid sick leave, no safety net. Caring for a sick family member or recovering from illness means lost wages. Over time, savings run dry, diets worsen, children are pulled from school. These sacrifices erode human capital and stunt economic growth, leading to measurable productivity losses that hold back regional or national progress.

With every incident of care being refused, substandard treatment or an inflated bill, trust in the health system is eroded.

Enforcing the right to health in India is a matter of life and death. It requires investment in infrastructure, transparency and accountability, so that no patient must choose between medical care and financial ruin. Any citizen must be able to walk into a clinic or hospital without the fear that saving their life could destroy their future.

Equally urgent is the need to expand public financing and strengthen universal health coverage mechanisms, so that healthcare is not left to the vagaries of markets or personal savings but guaranteed as a public good.

Rishiraj Bhagawati is a public health researcher based in Bengaluru.

Also read:

Harsh Mander: The plunder and loot by private healthcare in India

Have you ever woken up after a night of poor sleep, glanced in the mirror and thought, “I look tired?”

You’re not imagining it.

I am a neurologist who specialises in sleep medicine. And though “beauty sleep” may sound like a fairy tale, a growing body of research confirms that sleep directly shapes how our skin looks, how youthful it appears and even how attractive others perceive us to be.

What happens during sleep

Sleep is not just down time. Your body moves through distinct stages that serve different restorative functions. Deep, slow-wave sleep is the primary stage during which the body prioritises tissue repair, muscle recovery and collagen production.

Growth hormone is released during this sleep stage, with most daily secretion occurring in the early part of the night. This hormone drives the body’s repair and rebuilding processes, helping to heal tissues, restore muscles and boost the production of collagen, the protein that keeps skin firm and elastic.

Slow-wave sleep also creates a unique hormonal environment that benefits the skin. Cortisol, the body’s main stress hormone, falls to its lowest point during this stage. Lower cortisol protects collagen, reduces inflammation and supports the skin barrier. At the same time, higher levels of growth hormone and prolactin, a hormone that helps regulate the immune system and cell growth, enhance immune function and tissue repair, helping skin recover from daily stressors.

The skin-sleep connection

The skin is your body’s largest organ, and it works hard while you sleep. Adequate sleep promotes hydration and barrier function, helping your skin maintain moisture and resist irritation. In contrast, sleep deprivation increases water loss through the skin, leaving it drier and more vulnerable to damage and visible signs of aging.

Sleep also plays a role in acne, a common skin condition that affects people of all ages. Poor sleep can raise inflammation and stress hormones such as cortisol, both of which may worsen breakouts. Consistent, restorative sleep, on the other hand, supports your skin’s ability to regulate oil production and recover from irritation.

Collagen repair and elasticity also depend heavily on adequate rest. In one study, short-term sleep restriction, defined as just three hours of sleep per night for two nights in a row, reduced skin elasticity and made wrinkles more noticeable.

Chronic sleep deficiency, also known in sleep medicine as insufficient sleep syndrome, refers to getting fewer than seven hours of sleep per night for at least three months, accompanied by daytime fatigue or impaired functioning. This state disrupts collagen production, weakens the skin barrier and fuels low-grade inflammation that undermines healing.

Studies show that the hormonal disruptions that occur with sleep loss elevate cortisol and accelerate oxidative stress, an imbalance between cell-damaging molecules and the body’s defenses, while impairing the very processes that keep skin resilient. Over time, these changes accelerate biological aging and leave the body less resilient to daily stressors.

Face tells the story

Sleep loss does not only affect how skin functions. It also changes how the face appears to others. Controlled studies show that even after a few nights of reduced sleep, others consistently rated them as less attractive, less healthy and more fatigued. Common cues include paler skin, darker under-eye circles, red or swollen eyes, drooping eyelids and downturned mouth corners.

These signals are subtle but socially significant. Observers are less inclined to interact with or approach someone who looks sleep-deprived. Sleep also affects empathy and aesthetic perception, meaning that people who are well rested not only view others more positively but are also, in turn, viewed more positively by others. This reciprocal effect may help explain why job interviewers, dates, or even friends tend to respond more favorably to a well-rested face.

Sleep even influences how we perceive ourselves. People with poor sleep often report lower satisfaction with their own appearance.

Supporting your health

Prioritising sleep is a powerful and accessible way to support appearance and overall health. So the next time you consider trading sleep for a few extra hours of work or entertainment, remember that your skin, your health and even your social presence will benefit from those hours of rest.

Joanna Fong-Isariyawongse is Associate Professor of Neurology, University of Pittsburgh.

This article was first published on The Conversation.

The link between diabetes and dementia is becoming increasingly clear. New research shows how blood sugar problems affect brain health and vice versa. Here are ten evidence-based insights into how the two conditions are related.

1. Diabetes raises the risk of dementia

People with diabetes are about 60% more likely to develop dementia than those without, and frequent episodes of low blood sugar are linked to a 50% higher chance of cognitive decline.

2. Insulin resistance affects the brain too

Insulin resistance – the major cause of type 2 diabetes – happens when cells stop responding properly to insulin. This means that too much sugar, in the form of glucose, is left in the blood, leading to complications.

It usually affects the liver and muscles, but it also affects the brain. In Alzheimer’s, this resistance may make it harder for brain cells to use glucose for energy, contributing to cognitive decline.

3. A brain sugar shortage in dementia

The brain is only 2% of our body weight, but uses about 20% of the body’s energy. In dementia, brain cells appear to lose the ability to use glucose properly.

This mix of poor use of glucose and insulin resistance is sometimes unofficially called type 3 diabetes.

4. Alzheimer’s can raise diabetes risk

People with Alzheimer’s often have higher fasting blood glucose, even if they don’t have diabetes. This is a form of pre-diabetes. Animal studies also show that Alzheimer’s-like changes in the brain raise blood glucose levels.

Also, the highest genetic risk factor for Alzheimer’s, the APOE4 genetic variant, reduces insulin sensitivity by trapping the insulin receptor inside the cell, where it cannot be switched on properly.

5. Blood vessel damage links both conditions

Diabetes damages blood vessels, causing complications in the eyes, kidneys and heart. The brain is also at risk. High or varying blood glucose levels can injure vessels in the brain, reducing blood flow and oxygen delivery.

Diabetes can also weaken the brain’s protective barrier, letting harmful substances in. This leads to inflammation. Reduced blood flow and brain inflammation are strongly linked to dementia.

6. Memantine: a dementia drug born from diabetes research

Memantine, used to treat moderate to severe Alzheimer’s symptoms, was originally developed as a diabetes medication. It didn’t succeed in controlling blood glucose, but researchers later discovered its benefits for brain function. This story shows how diabetes research may hold clues for treating brain disorders.

7. Metformin might protect the brain

Metformin, the most widely used diabetes drug, does more than just lower blood glucose. It gets in to the brain and may lower brain inflammation.

Some studies suggest that people with diabetes who take metformin are less likely to develop dementia, and those who stop taking it may see their risk increase again.

Trials are testing its effects in people without diabetes.

8. Weight-loss injections may reduce plaque buildup

GLP-1 receptors agonist drugs, such as semaglutide (Ozempic, Wegovy), lower blood glucose and support weight loss. Records show that people with diabetes on these drugs have a lower dementia risk. Comparing GLP1 drugs to metformin, studies have found that they were even more effective than metformin at reducing dementia risk.

Two major trials, Evoke and Evoke Plus, are testing oral semaglutide in people with mild cognitive impairment or early mild Alzheimer’s.

9. Insulin therapy might help the brain

Since insulin resistance in the brain is a problem, researchers have tested insulin sprays given through the nose. This method delivers insulin straight to the brain while reducing effects on blood sugar.

Small studies suggest these sprays may help memory or reduce brain shrinkage, but delivery methods remain a challenge. Sprays vary in how much insulin reaches the brain, and long-term safety has not yet been proven.

10. SGLT2 inhibitors may lower dementia risk

New evidence suggests that compared to GLP-1 receptor agonists, SGLT2 inhibitors, (a type of diabetes drug) are superior at reducing dementia risk, including Alzheimer’s and vascular dementia, in people with type 2 diabetes. These tablets lower blood sugar by increasing sugar removal in urine. This study builds on early evidence suggesting they lower dementia risk by reducing inflammation in the brain.

This growing body of evidence suggests that managing diabetes protects more than the heart and kidneys, it also helps preserve brain function.

Questions remain whether diabetes drugs only reduce the diabetes-associated dementia risk or whether these drugs could also reduce risk in people without diabetes.

However, diabetes research has been very successful in creating at least 13 different classes of drugs, multiple combination therapies, giving rise to at least 50 different medicines. These reduce blood sugar, improve insulin sensitivity and reduce inflammation. A “side-effect” may be better preservation of brain health during ageing.

Craig Beall is Associate Professor in Experimental Diabetes, University of Exeter.

Natasha MacDonald is PhD Candidate, Biochemistry, University of Exeter.

This article was first published on The Conversation.

As a cardiologist, I frequently meet patients who have stopped taking medicines that could keep them alive. Often it’s because they’ve seen a dramatic headline or a worrying TV report about a drug they rely on. But sometimes, patients are right to pay attention: new studies really can overturn decades of medical practice.

Few drugs illustrate this tension better than beta blockers. Long prescribed after heart attacks, these medicines can be life-saving for some people, helpful for others and useless – or even harmful – for the rest.

Beta blockers have been used for more than 40 years in almost all patients with heart attacks. But this practice was based on studies done before modern treatments were available, and before we could detect very small heart attacks that do not affect the overall function of the heart.

Recently, two studies on beta blockers in patients with heart attacks were reported in the news. The Spanish-Italian study received the most attention. Media reports suggested that most heart attack patients did not benefit from beta blockers, and that in women the drug might even increase the risk of hospitalisation and death.

Reports like this can make people stop taking their medication.

At the same symposium in Madrid, the second study – which got less attention – showed almost the opposite. Patients with heart attacks did benefit from beta blockers. And if there were differences between the sexes, women might actually have had more benefit than men.

The heart of the matter

A key to understanding the different results is something called the left ventricular ejection fraction. This is the percentage of blood in the left chamber of the heart – its main pumping chamber – that is pushed out into the body with each heartbeat. Normally, ejection fraction should be at least 50%.

If we look at all the studies together, including one I led and presented last year, the picture becomes clearer. Patients with an ejection fraction of 50% or higher after a heart attack do not benefit from beta blockers. But patients with an ejection fraction below 50% do benefit. And this is true for both men and women.

The European guidelines from 2023, as well as the recently published American guidelines, still recommend beta blockers after most heart attacks. Many doctors are therefore reluctant to change a therapy tradition that has been in place for 40 years.

My colleagues and I are now planning to pool data from the recent large studies on patients with heart attacks and an ejection fraction of 50% or more. The results, expected later this year, will probably give definite answers about beta blockers in this population and change future guidelines.

But many patients clearly benefit from beta blockers, including those with heart failure and reduced ejection fraction (with or without a prior heart attack), angina pectoris (chest pain caused by reduced blood flow to the heart), or various heart rhythm disturbances.

Beta blockers can also be prescribed for other reasons, such as high blood pressure, migraine prevention, tremors, as well as off-label use for stress and anxiety. For patients, it’s not easy to know all the reasons why beta blockers are prescribed, and in some cases, they may not be suitable at all. So I’ll end with a good, if not very novel, piece of advice: always consult your doctor before making any changes to your medication.

Tomas Jernberg is Professor, Clinical Sciences, Karolinska Institutet.

This article was first published on The Conversation.

Over 60% of us will suffer from lower back pain at some point in our lives. Without question, it’s the leading cause of disability across the globe.

Your spine is comprised of 33 bones known as vertebrae, which are stacked one on top of the other. The resulting column is divided into five segments: cervical (in the neck), thoracic (at the same level as the chest), lumbar (at the level of the abdomen) and sacral (connecting with the pelvis). The fifth, the coccyx, is located at the very bottom of the spine (the tailbone) – and is very painful when injured.

The vertebrae are connected by multiple joints, including discs which allow the spine to move in multiple directions. Though we might think the spine should appear straight, it naturally curves forward and backwards so it can perform all of its important functions.

But many conditions can cause the spine to curve more than it should. This can not only lead to pain, but potentially a whole host of other health troubles too.

Dowager’s hump

The spine also supports the weight of the body, protects the spinal cord and helps the body to bend, flex and twist. The thoracic region attaches to the ribs and naturally curves backwards – this curve is known as the thoracic kyphosis.

But sometimes, the curve of the thoracic kyphosis becomes more accentuated and visible – often as a result of osteoporosis (where bones become weaker), age-related changes to the back muscles and vertebrae, or long-term poor posture.

The medical name for this condition is hyperkyphosis, though it’s sometimes referred to as “dowagers hump” as it’s around two to four times more common in women.

A stooped posture with rounded shoulders (or “hunchback” appearance) is typically a sign of hyperkyphosis. In some cases, it may become so extreme as to impact breathing since the chest can’t inflate properly. It can also affect swallowing since the neck becomes more horizontal and the gullet potentially narrowed.

And of course pain and stiffness typically arise. This is a common theme for most patients with abnormal curvature of the spine, as the vertebrae lose their ability to move, and nerves arising from the spinal cord can become compressed.

Scoliosis

Another type of deformity that can occur in the spinal column affects not only how it bends forward and backwards, but also side-to-side.

Scoliosis occurs when the vertebrae either curve sideways, rotate in relation to each other, or collapse. This produces a variety of different deformities, ranging in size and severity.

The underlying causes of scoliosis are widespread. Sometimes bones can become deformed as a result of trauma, cancer or an infection (such as tuberculosis). Scoliosis can also be present from birth, or arise from neurological disorders in early years – such as cerebral palsy.

As well as back pain, patients may also notice postural signs as scoliosis evolves. Their shoulder blades or ribcage can stick out more, and clothes may fit differently on their body.

Slipped and fused spines

Individual vertebrae in any part of the spine can sometimes also become displaced as a result of trauma, wear and tear, or certain health conditions (such as osteoporosis). This means that instead of standing in a regular stack, a vertebra slips forward, and out of line. This condition is given the long and practically unpronounceable name, spondylolisthesis.

In doing so, this displacement can trigger nerve compression. If the sciatic nerve – the largest in the human body – gets compressed, it can lead to symptoms of sciatica. These are namely pain, pins and needles, or numbness in the back of the leg or buttock.

The vertebrae in the lower back can sometimes also fuse abnormally together. A condition called ankylosing spondylitis can trigger inflammation in the spinal joints and discs, which then harden over time. Another name for the condition is bamboo spine, since the now rigid and inflexible column resembles a tough stalk of bamboo.

Managing back pain

Managing these conditions – and the pain they cause – will depend largely on the size of the deformity and what has caused it in the first place. Even a small spinal deformity can be significant.

For scoliosis for instance, braces to correct the spine as it grows may work to manage small defects in younger patients. But corrective surgery is often required to fix larger deformities and those which don’t respond to bracing.

Taking account of posture and bone health can also help prevent developing a spinal problem later in life. Using exercise to build a strong back and shoulders and avoiding slouching are solid measures, too. Managing associated conditions such osteoporosis with diet, medication and resistance training can also help.

Surgical intervention may be required in other situations – for instance, to decompress nerves that have become trapped or squashed.

Your spine is truly an architectural wonder. It’s far from a straight and rigid column – and capable of more than you’d ever expect. But this unique structure can lend itself to problems, especially when natural curves become deformities. The age-old adage “strengthen your back, strengthen your life” is a motto we should all be regularly reminded of, and to seek medical advice accordingly should back pain arise.

Dan Baumgardt is Senior Lecturer, School of Psychology and Neuroscience, University of Bristol.

This article was first published on The Conversation.

We all know how much better we feel after a good night’s sleep. Science backs this up: high-quality sleep boosts cardiovascular health, immune function, brain health and emotional wellbeing. Unsurprisingly, many people are keen to improve their sleep – and “sleep hygiene” has become a go-to strategy.

Sleep hygiene refers to the habits and environmental factors that promote good sleep, such as keeping a regular bedtime, avoiding screens before bed, and cutting back on caffeine. These are sensible tips for healthy sleepers. But for people with insomnia, some sleep hygiene practices can backfire – reinforcing sleeplessness rather than resolving it.

As a sleep therapist, I’ve seen how good intentions can sometimes make things worse. Here are five common sleep hygiene strategies that may do more harm than good for people struggling with insomnia.

1. Spending more time in bed

When sleep isn’t coming easily, it’s tempting to go to bed earlier or lie in later, hoping to “catch up”. But this strategy often backfires. The more time you spend in bed awake, the more you weaken the mental association between bed and sleep – and strengthen the link between bed and frustration.

Instead, try restricting your time in bed. Go to bed a little later and wake up at the same time each morning. This strengthens sleep pressure – your body’s natural drive to sleep – and helps restore the bed as a cue for sleep, not wakefulness.

2. Strictly avoiding screens

We’re often told to ditch screens before bed because the blue light they emit suppresses melatonin, a hormone that helps regulate sleep. But this advice may be overly simplistic.

In reality, people with insomnia may reach for their phones because they can’t sleep – not the other way around. Lying in the dark with nothing to occupy your mind can create the perfect storm for anxiety and overthinking, both of which fuel insomnia.

Rather than banning screens entirely, consider using them strategically. Choose calming, non-stimulating content, use night-mode settings, and avoid scrolling mindlessly. A quiet podcast or gentle documentary can be just the right distraction to help you relax.

3. Cutting out caffeine completely

Caffeine blocks adenosine, a neurotransmitter that makes us feel sleepy. But not everyone processes caffeine the same way – genetics play a role in how quickly we metabolise it.

Some people may find a morning coffee helps them shake off sleep inertia (the grogginess you feel upon waking) and get active, which can support a healthy sleep-wake rhythm. If you’re sensitive to caffeine, it’s wise to avoid it later in the day – but cutting it out altogether isn’t always necessary. Understanding your individual response is key.

4. Trying too hard to ‘optimise’ sleep

The global “sleep economy” – encompassing everything from wearable trackers to specialised mattresses and “sleep-promoting” sprays – is worth over £400 billion. While many of these products may be well-meaning, they can contribute to a modern condition known as orthosomnia: anxiety driven by trying to perfect your sleep.

It’s important to remember that sleep is an autonomic function, like digestion or blood pressure. While we can influence sleep through healthy habits, we can’t force it to happen. Becoming obsessed with sleep quality can paradoxically make it worse. Sometimes, the best approach is to care less about sleep – and let your body do what it’s designed to do.

5. Expecting the same amount of sleep each night

Healthy sleep isn’t a fixed number of hours – it’s dynamic and responsive to our lives. Factors like stress, physical health, age, environment, and even parenting responsibilities all affect sleep. For example, human infants need to feed every few hours, and adult sleep patterns adapt to meet that need. Flexibility in our sleep has always been a survival trait.

Expecting rigid consistency from your sleep sets up unrealistic expectations. Some nights will be better than others – and that’s normal.

In my years as a sleep therapist, I’ve noticed how sleep privilege – the ability and opportunity to sleep well – can distort conversations around sleep. Telling someone with insomnia to “just switch off” is like telling someone with an eating disorder to “just eat healthy”. It oversimplifies a complex issue.

Perhaps the most damaging belief baked into sleep hygiene culture is the idea that sleep is entirely within our control – and that poor sleepers must be doing something wrong.

If you’re struggling with sleep, there are evidence-based treatments beyond sleep hygiene. Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold standard psychological intervention. New medications are also available, such as orexin receptor antagonists (suvorexant, lemborexant and daridorexant, for example) – drugs that block the brain’s wake-promoting orexin system to help you fall and stay asleep .

Insomnia is common and treatable – and no, it’s not your fault.

Kirsty Vant is Doctoral Researcher, Department of Psychology, Royal Holloway University of London.

This article was first published on The Conversation.

Why do health stories about food and cancer grab so much attention? Because they offer an enticing promise: that a single item on your plate, or even a sudden change in what you crave, might hold the key to spotting disease early.

It’s a compelling idea, but in reality the science of appetite, taste, and cancer is far messier than the headlines suggest.

This eye-catching idea oversimplifies reality. While cancer can change appetite and taste, there’s no solid evidence that a sudden craving, such as an abrupt fixation on sweets, serves as a dependable early warning signal for undiagnosed cancer.

This is a classic case where interesting clinical anecdotes and stories have been stretched into a sweeping rule that doesn’t work as a screening tool.

The grain of truth behind these headlines comes from clinical observations. Some cancer patients do report altered taste and appetite. In older case studies, patients described dramatic changes – tea suddenly tasting awful, or favourite foods becoming repulsive – sometimes before diagnosis, sometimes after treatment began.

These accounts seem compelling, but they were never designed to prove that a particular craving reliably predicts cancer. They show that cancer can affect how we taste and eat, not that a single symptom can replace proper diagnosis.

Modern research paints a more complex picture. Studies examining “altered food behaviour” around cancer cover a wide range of changes: cravings, aversions, emotional eating and treatment-related appetite shifts.

These studies look at different cancers, stages, and time points – before, during and after treatment. The overall message is that eating behaviour can change in the context of cancer, influenced by biology (inflammation and metabolism), physiology (changes to taste and smell) and psychology (stress and mood).

What we don’t see is a specific craving pattern that reliably warns of cancer in healthy people. Appetite changes can be part of the cancer story, but they’re not a diagnostic shortcut.

It’s worth bearing in mind how common appetite changes are in everyday life. Many ordinary factors affect what tastes good and what the body wants, including medications, pregnancy, stress, quitting smoking and anaemia.

A sudden enthusiasm for a particular food might be interesting, but it rarely points to a single cause. That’s why doctors look for clusters of symptoms and lasting patterns rather than drawing conclusions from one change.

Chewing ice

There is one area where cravings connect meaningfully to health: ice chewing. Constantly chewing ice (called pagophagia) can signal iron deficiency, which has treatable causes that should be found and addressed. This is completely different from claims that tumours program sugar cravings.

Ice chewing represents a well-established link between unusual eating behaviour and a specific, testable condition. Iron deficiency itself is both common and often missed.

Iron is essential for making haemoglobin, which carries oxygen in red blood cells, and plays broader roles in energy and immune function. When levels drop, symptoms are often vague: persistent fatigue despite adequate sleep, exercise intolerance, shortness of breath and headaches, to name a few.

These overlap with many other conditions, which is why testing matters rather than guessing. Iron comes from red meat, poultry, seafood, beans, lentils, leafy greens, and fortified cereals and breads. However, a “good” diet doesn’t always guarantee adequate iron if losses are high, needs are elevated, or absorption is poor – another reason to confirm and treat the problem with proper testing.

No magic clues

Returning to the headlines, it’s easy to see why supposed tell-tale cravings capture attention. They promise a simple signal in a confusing health landscape. But medicine rarely offers magic clues.

The sensible approach is twofold. First, treat new, persistent, and unexplained changes in taste or appetite as worth noting – not panicking about. Consider the full picture: other symptoms, recent illnesses, medications, stress and overall health. If behaviour like ice chewing appears or fatigue becomes stubborn, checking for iron deficiency makes sense.

Second, for cancer risk concerns, rely on established warning signs and screening tests. Unexplained weight loss, unusual bleeding, changes in bowel habits, swallowing difficulties, new or changing lumps and age-appropriate screening catch far more cancers than chasing a single craving ever will.

The craving narrative carries another danger: it can fuel harmful behaviour, like trying to “starve” a tumour by cutting out major nutrients.

Severe restriction can cause dangerous weight loss, malnutrition and, worse, treatment tolerance, undermining recovery rather than helping. Tumours don’t outsmart sensible nutrition. What helps most is maintaining strength with a balanced diet, staying active when possible, following evidence-based screening and treatment, and using targeted tests – like iron studies – when symptoms suggest they might be helpful.

Appetite and taste are sensitive measures of health and their changes deserve attention. They’re part of the medical conversation, not a crystal ball.

If something feels wrong and stays wrong – whether that’s a new aversion to familiar foods, an odd fixation that won’t go away, or constant ice chewing – the next step isn’t to search Google for hidden meanings. Instead, talk with a doctor.

Simple tests can quickly rule out common problems, and if something more serious is happening, acting on established warning signs and screening guidelines offers the best chance of catching it early.

Justin Stebbing is Professor of Biomedical Sciences, Anglia Ruskin University.

This article was first published on The Conversation.

You may have heard high-impact activity – exercise such as running, jumping, football and basketball – is good at building bone density and strength. But what about when you’re standing still, lifting weights at the gym?

The good news is weight training is great for bone health. But some exercises are more effective than others. Here’s what the science says.

What is bone density

Bone density, also known as bone mineral density, is essentially a measure of how many minerals (such as calcium and phosphorus) are packed into your bones.

It gives you an indication of how solid your bones are, which is important because denser bones are generally less likely to break.

However, bone density is not quite the same as bone strength.

Bones also rely on a range of other compounds (such as collagen) to provide support and structure. So, even dense bones can become brittle if they are lacking these key structural components.

However, bone mineral density (measured with a bone scan) is still considered one of the best indicators of bone health because it is strongly linked to fracture risk.

While there is likely a genetic component to bone health, your daily choices can have a big impact.

What affects bone health

Research shows a few factors can influence how strong and dense your bones are:

Getting older: As we age, our bone mineral density tends to decrease. This decline is generally greater in women after menopause, but it occurs in everyone.

Nutrition: Eating calcium-rich foods – dairy in particular, but also many vegetables, nuts, legumes, eggs and meat – has been shown to have a small impact on bone density (although the extent to which this reduces fracture risk is unclear).

Exposure to sun: Sunlight helps your body make vitamin D, which helps you absorb calcium, and has been linked to better bone density.

Exercise: It is well established that people who do high-impact and high-load exercise (such as sprinting and weight training) tend to have denser and stronger bones than those who don’t.

Smoking: Older people who smoke tend to have lower bone density than those who don’t smoke.

Movement and bone density

In the same way that your muscles get stronger when you expose them to stress, your bones get stronger when they’re asked to handle more load. This is why exercise is so important for bone health – because it tells your bones to adapt and become stronger.

Many of us know that people at risk for bone loss – post-menopausal women and older adults – should be focused on exercising for bone health.

However, everyone can benefit from targeted exercise, and it’s arguably just as important to prevent declines in bone health.

In fact, whether you are male or female, the younger you start, the more likely you are to have denser bones into your older life. This is crucial for long-term bone health.

How do weights help

Yes. One of the most effective exercises for bone health is lifting weights.

When you lift weights, your muscles pull on your bones, sending signals that encourage new bone formation. There is a large body of evidence showing weight training can improve bone density in adults, including in post-menopausal women.

But not all exercises are created equal. For example, some evidence suggests large compound exercises that place more load on the skeleton – such as squats and deadlifts – are particularly effective at increasing density in the spine and hips, two areas prone to fractures.

What type of weight training

Lifting heavier weights is thought to produce better results than lifting lighter ones. This means doing sets of three to eight repetitions using heavy weights is likely to have a greater impact on your bones than doing many repetitions with lighter ones.

Similarly, it takes a long time for your bones to adapt and become denser – usually six months or more. This means for healthy bones, it’s better to integrate weight training into your weekly routine rather than do it in bursts for a few weeks at a time.

Exercises that use body weight, such as yoga and pilates, have many health benefits. However they are unlikely to have a significant impact on bone density, as they tend to put only light stress on your bones.

If you are new to weight training, you might need to start a bit lighter and get used to the movements before adding weight. And if you need help, finding an exercise professional in your local area might be a great first step.

Exercising for bone health is not complex. Just a couple of (heavy) weight training sessions per week can make a big difference.

If you’re concerned you have low bone density, speak to your doctor. They can assess whether you need to go for a scan.

Hunter Bennett is Lecturer in Exercise Science, University of South Australia.

This article was first published on The Conversation.

Cloves have long been a staple in kitchens and traditional medicine cabinets. Known for their warm, spicy flavour, they’re typically found whole or ground, and as clove oil or extract. But beyond their culinary charm, cloves are gaining scientific attention from researchers and clinicians for their potent analgesic (painkiller) properties. But could this humble spice rival ibuprofen or other commonly used painkillers?

Cloves, the aromatic flower buds of the Syzygium aromaticum tree, are native to Indonesia and widely used in global cuisines, especially in spice blends and festive dishes. Medicinally, they’re most commonly used in the form of clove oil. It contains eugenol, a compound with well-documented anaesthetic and anti-inflammatory effects.

Eugenol, the main active compound in cloves, is a naturally occurring plant chemical that works in multiple ways. It blocks certain chemicals and nerve responses that cause pain, including histamine – a chemical involved in immune responses, inflammation and allergic reactions – and noradrenaline, a neurotransmitter and hormone that can heighten pain sensitivity during stress.

Eugenol also inhibits the production of prostaglandins – substances that trigger inflammation and contribute to pain and swelling. This is the same biological pathway targeted by anti-inflammatory painkillers like ibuprofen. Because of these anti-inflammatory effects, eugenol could, in theory, be useful for conditions such as arthritis, although human evidence is limited. In an animal study, eugenol improved limb function in rats with osteoarthritis.

While research into its use for joint pain is still in early stages, most of the solid human evidence for cloves comes from dentistry.

Clove extracts are used in balms or diluted oils for muscle aches, brewed into teas for headaches, and applied as oil for toothache. Cloves have been a go-to dental remedy since at least the 13th century. Clove oil remains available in pharmacies for temporary toothache relief in adults and children over two years.

Studies suggest cloves may provide pain relief comparable to some conventional painkillers and topical anaesthetics. In dentistry, topical anaesthetics such as lidocaine or benzocaine are applied to the surface of the gums or skin to numb an area before treatment. They work by blocking pain signals from nerves near the surface – a mechanism thought to be similar to that of eugenol.

In paediatric dentistry, researchers compared clove oil, lidocaine gel and ice cones applied to injection sites in the mouth. Clove oil emerged as the most effective in reducing pain and anxiety among children, suggesting it could be a natural, cost-effective and well-accepted option to improve dental experiences. Another clinical trial in adults found clove gel to be as effective as benzocaine gel in minimising pain from dental injections, with no significant difference in pain scores.

These findings are supported by broader reviews, which show that topical clove preparations consistently outperform placebo treatments. In dental procedures, clove oil and gels not only reduce pain but also offer antiseptic and anti-inflammatory effects.

Beyond dentistry

There’s also evidence for using cloves in other types of pain relief. In one clinical trial, combining topical clove oil with lidocaine significantly reduced pain at episiotomy sites (the small surgical cuts made between the vagina and anus during childbirth to help deliver the baby) compared with lidocaine alone. These results suggest that clove oil may enhance the effectiveness of standard anaesthetics.

Cloves may also offer a range of other potential health benefits. Laboratory and animal studies indicate that eugenol and isoeugenol – a closely related plant compound with similar aroma and antimicrobial effects – have anti-inflammatory and antibacterial properties, inhibiting bacteria such as E. coli and Staphylococcus aureus.

Animal models suggest cloves may help protect the liver from damage and support its detoxification processes. Certain compounds, including nigricin (a naturally occurring clove constituent that appears to influence how cells handle sugar), have been linked to improved insulin sensitivity and glucose uptake, raising the possibility of better blood sugar control.

Eugenol has also shown cytotoxic effects (meaning it can kill or damage certain cells) against specific cancer cell lines in laboratory studies. However, these are early-stage findings, and no clinical trials in humans have yet confirmed its effectiveness or safety as a cancer treatment.

Side effects

While cloves are generally safe in culinary doses, concentrated forms such as clove oil should be used with caution.

In the mouth, clove oil may cause blistering, swelling, or lip irritation, and on the skin it can trigger burning sensations or rashes. Eugenol can be toxic in high amounts, and allergic reactions, though rare, are possible. Swallowing clove oil should be avoided, though small amounts used for toothache are generally harmless. Ingesting larger amounts of clove oil or high-dose extracts can cause serious side effects such as seizures and liver damage. High doses may also interfere with blood clotting, so anyone taking anticoagulants like warfarin should exercise caution. Animal studies have shown eugenol can lower blood sugar, so people with diabetes on insulin should monitor their levels closely.

Cloves may never replace ibuprofen across the board, but their proven effectiveness for topical and dental pain, combined with a suite of other possible health benefits, makes them a compelling natural option. For now, they remain best suited as a complementary remedy – but one with a long history, promising science and a rightful place in both the spice rack and the medicine cabinet.

Dipa Kamdar is Senior Lecturer in Pharmacy Practice, Kingston University

This article was first published on The Conversation.

Kamini Komkar, a 42-year-old home maker from Pune’s Hadapsar area, was in perfect health. So perfect that she was considered fit enough to donate a part of her liver to her husband Bapu, who was suffering from advanced liver disease.

By undergoing a surgical procedure to remove part of her liver and transplant into her husband, she probably believed she was going to save his life. As with most live liver donors, she probably expected to recover within weeks and lead a normal life.

But things did not quite turn out that way at Sahyadri Hospitals on August 15. Bapu Komkar died within hours of his surgery. Given that it is a complex major surgery on an already sick individual, liver transplant recipients have a mortality rate of 10% to 20% in the first few weeks.

But for the Komkars, something worse was in store. Around a week after her surgery Kamini Komkar went into what has been described as sudden shock and also died. This is very unusual. She was a healthy person. That is what makes this tragedy particularly shocking – and a matter of public concern.

Around the world, liver transplantation is an established procedure with a high success rate. In the West, the large majority of liver transplants are performed with organs obtained from donations after death.

Deceased donation is the most common way of obtaining multiple organs from an individual whose brain or heart has irreversibly stopped and whose family consents to donation. However, though laws are in place in the rest of the world and in India too, such donations are infrequent. As a result, surgeons devised procedures to obtain organs from the living, though this means subjecting a healthy person to a surgery.

For many decades, kidneys have been transplanted from living donors. It is safe – though there are questions about its impact on the donor in the long term.

Liver transplant deaths: Health dept seeks complete medical records of husband, wife from Sahyadri Hospitalshttps://t.co/6Srow5hE7Y

— Express Pune Resident Editor (@ExpressPune) August 26, 2025

But the liver is somewhat different.

The liver seems like a single organ but has parts that can be separately removed with their own blood vessels. If a part is removed, the liver has an enormous capacity to regenerate itself.

In 1989, Russell Strong, an Australian surgeon, decided to transplant a small part of a mother’s liver into her baby who was dying of liver failure due to a condition called biliary atresia. It was successful.

Soon, surgeons across the world started performing this procedure for children. They removed only a small portion from the liver of one of the parents, just enough to meet the child’s requirement. Though it also carries a small risk for the donor, living donor liver transplantation from a parent to a child is well accepted.

Soon, surgeons from East Asia started performing this procedure on adults. This meant removing larger portions of the donor’s liver since adults need more liver tissue. In turn this meant a higher risk for the donor. In the standard adult-to-adult living liver transplant, around 60% to 65% of the donor’s liver is removed with the assumption that the remaining 35% to 40% will sustain function and grow back.

This is a perilous tightrope walk. Though the recipient does not have a choice but to undergo the procedure, the donor does. If too little is removed the recipient suffers; if too much is removed the donor suffers. There have been donors including in India who have themselves suffered from liver failure after donation and needed emergency liver transplants.

India now performs the largest number of living donor liver transplant procedures in the world (though in proportion to its population, the numbers are limited). A large proportion of these are with live donors and for adults.

Indian surgeons have been innovative and have even described technical modifications. Their expertise has opened out an option for those dying from liver failure. But like most specialised healthcare in India, these procedures are largely performed in the private sector. Costs are high making it unaffordable for a majority. In addition, one needs a healthy and willing donor in the family.

Though hard data on outcomes is lacking because of the absence of a central organ donor registry, in general, the results are satisfactory. As the procedure is cheaper in India than in many developed countries, it has also led to a large number of foreigners coming here to get liver transplants.

Living liver transplantation has invited intense scrutiny across the world because the safety of the donor is at stake. The rate of donor death quoted in current global literature , varies from 0.2% to 0.4%. In other words, on average, three in 1000 or one in 350 healthy donors will die. For living kidney donors, this figure is one in 3000. Donor death rates have globally reduced over the years.

In most developed countries a donor death is treated as a major event and is subjected to root-cause analysis. All donor deaths are reported and audited. In the US, large experienced units have been temporarily shut down pending inquiry.

Consent for any surgery includes explaining to patients about the potential risks versus benefits of the procedure. Most accept the trade-off. Consent for living donation is unique because there is no direct benefit for the donor and a small but definite risk. Full disclosure during consenting means that the donor should be informed about all potential complications, including death.

This should involve providing the death rate for donors in the country but we do not have accurate figures for India.

Consent in Indian healthcare tends to be cursory and paternalistic. To suddenly elevate standards for living donation where coercion needs to be identified and complications need to be disclosed is challenging.

While I have witnessed family members courageously offering to be donors in spite of being informed about potential harm, I have always wondered whether this is based on autonomous decision-making. For example, in India’s social environment, it would be naive to ask a wife in front of relatives about her willingness to donate her liver to her husband and accept this affirmation as informed free consent

India does not yet have a reliable mandated registry for transplant outcomes. There is no mandatory reporting and audit of complications including death in living donors. To my knowledge only two cases of donor death have been reported in academic literature, one from Chennai and another recently from Bengaluru. But there have been several news reports from across the country about donor deaths.

While all cases of donor death do not constitute negligence, it is an event where a high-quality audit would enable transplant surgeons to develop strategies for prevention for others.

It is incongruous to talk of India’s leading global position in living liver transplant without data on results, including donor safety. India’s transplant regulators have a powerful instrument in the form of licensing and relicensing centres. But the country has failed to use it as a means to improve accountability.

For a field whose existence entirely depends on living or deceased donation – in other words, trust and public perception – this is crucial.

Meanwhile, in Pune the Komkar family has filed a police complaint about Kamini Komkar’s death. The state authority has constituted a committee to inquire into the tragedy. In an unusual move, the hospital’s licence for transplants has been temporarily suspended.

It is very difficult in India for ordinary families to take on the system. Most families who have lost a donor move on with time. When the young children of the Komkar couple sobbed in grief before the prying TV cameras, they also said that they feared for their financial future because the family had taken big loans for the transplant.

Russell Strong in his later writings expressed concern about the lack of transparency and underreporting of donor deaths and even questioned the ethical basis for the procedure. It is often stated that donor harm including death is inevitable. This should not be a smokescreen to avoid reporting, auditing, learning and making all efforts to reduce this catastrophe. It is the least we can do for our brave citizens who stake their lives for their loved ones.

The calamity that has struck the two Komkar children who lost both parents in a week is impossible for us to fathom from a distance. One wonders whether a public acknowledgement of our well-intentioned complicity as surgeons is in order. But a collective will from transplant professionals to introspect, subject ourselves to scrutiny may help prevent such tragedies from occurring again. We need to start by breaking the conspiracy of silence.

Sanjay Nagral is a gastrointestinal surgeon from Mumbai. He has been involved in liver transplantation and also writes on issues of public interest.

It can look almost too easy: athletes gliding along on a bike, runners shuffling at a pace slower than most people’s warm-up, or someone strolling so gently it barely seems like exercise at all. Yet this kind of effortless movement is at the heart of what’s becoming known as zone zero exercise.

The idea runs counter to the “push yourself” culture of gyms and fitness apps. Instead of breathless effort, zone zero exercise is all about moving slowly enough that you could chat very comfortably the whole time. For some people, it might mean a gentle stroll. For others, it could be easy yoga, a few stretches while the kettle boils, or even pottering about the garden. The point is that your heart rate stays low; lower even than what many fitness trackers label as zone 1.

In the language of endurance training, zone 1 usually means about 50-60% of your maximum heart rate. Zone zero dips beneath that. In fact, not all scientists agree on what to call it, or whether it should be counted as a separate training zone at all. But in recent years, the term has gained traction outside research circles, where it has become shorthand for very light activity, with surprising benefits.

One of those benefits is accessibility. Exercise advice often leans towards intensity: the sprint intervals, the high-intensity classes, the motivational “no pain, no gain”. For anyone older, unwell, or returning to movement after injury, this can feel impossible. Zone zero exercise offers an alternative starting point.

Quiet power of easy effort

Studies have found that even very light activity can improve several health markers including circulation, help regulate blood sugar, and support mental wellbeing. A daily walk at a gentle pace, for example, can lower the risk of cardiovascular disease.

There’s also the question of recovery. High-level athletes discovered long ago that they couldn’t train hard every day. Their bodies needed space to repair. That’s where easy sessions came in. They aren’t wasted time, but essential recovery tools.

The same applies to people juggling work, family and stress. A zone zero session can reduce tension without draining energy. Instead of collapsing on the sofa after work, a quiet half-hour walk can actually restore it.

Mental health researchers have pointed to another benefit: consistency. Many people give up on exercise plans because they set the bar too high. A routine based on zone zero activities is easier to sustain. That’s why the gains – better sleep, a brighter mood, and lower risk of chronic illness – keep adding up over months and years.

There are limits, of course. If your goal is to run a marathon or significantly increase fitness levels, gentle movement alone won’t get you there. The body needs higher-intensity challenges to grow stronger. But the “all or nothing” mindset, either training hard or not at all, risks missing the point. Zone zero can be the base on which other activity is built, or it can simply stand on its own as a health-boosting habit.

The fact that researchers are still debating its definition is interesting in itself. In sports science, some prefer to talk about “below zone 1” or “active recovery” instead of zone zero. But the popular name seems to have stuck, perhaps because it captures the spirit of effortlessness. The idea of a “zero zone” strips away pressure. You don’t need fancy equipment or the latest wearable. If you can move without strain, you’re doing it.

That simplicity may explain its appeal. Public health messages about exercise can sometimes feel overwhelming: how many minutes per week, what heart rate, how many steps. Zone zero cuts through that noise. The message is: do something, even if it’s gentle. It still counts.

And in a world where many people sit for long stretches at screens, it might be more powerful than it sounds. Evidence shows that long sedentary periods raise health risks even in people who exercise vigorously at other times. Building more light, frequent movement into the day may matter just as much as the occasional intense workout.

Zone zero exercise, then, isn’t about chasing personal bests. It’s about redefining what exercise can look like. It’s not a test of willpower but a way to keep moving, to stay connected to your body, and to build habits that last. Whether you’re an elite cyclist winding down after a race or someone looking for a manageable way back into movement, the same principle applies: sometimes, the gentlest pace is the one that gets you furthest.

Tom Brownlee is Associate Professor, Sport and Exercise Science, University of Birmingham.

This article was first published on The Conversation.

When most people think of Covid now, they picture a short illness like a cold – a few days of fever, sore throat or cough before getting better.

But for many, the story doesn’t end there. Long Covid – defined by the World Health Organization as symptoms lasting at least three months after infection – has become a lasting part of the pandemic.

Most research has focused on describing symptoms – such as fatigue, brain fog and breathlessness. But we know less about their effect on daily life, and this hasn’t been well studied in Australia. That’s where our new study, published today, comes in.

We show long Covid isn’t just uncomfortable or inconvenient. People with the condition told us it can profoundly limit their daily life and stop them from doing what they want to do, and need to do.

What is long Covid

Long Covid affects about 6% of people with Covid, with more than 200 symptoms recorded. For some, it lasts a few months. For “long haulers” it stretches into years.

The size of the problem is hard to measure, because symptoms vary from person to person. This has led to debate about what long Covid really is, what causes it, and even whether it’s real.

But mounting evidence shows long Covid is very real and serious. Studies confirm it reduces quality of life to levels seen in illnesses such as chronic fatigue syndrome, stroke, rheumatoid arthritis and Parkinson’s disease.

What people with long Covid say

We surveyed 121 adults across Australia living with long Covid. They had caught Covid between February 2020 and June 2022, with most aged 36-50. Most were never hospitalised, and managed their illness at home.

But months or years later, they were still struggling with daily activities they once took for granted.

To understand the impact, we asked them to complete two surveys widely used in health research to measure disability and quality of life – the WHO Disability Assessment Schedule (WHODAS 2.0) and the Short Form Health Survey (SF-36).

These surveys capture people’s own voices and lived experience. Unlike scans or blood tests, they show what symptoms mean for everyday life.

The results were striking.

People with long Covid reported worse disability than 98% of the general Australian population. A total of 86% of those with long COVID met the threshold for serious disability compared with 9% of Australians overall.

On average, people had trouble with daily activities on about 27 days a month and were unable to function on about 18 days.

Tasks such as eating or dressing were less affected, but more complex areas – housework and socialising – were badly impacted. People could often meet basic needs, but their ability to contribute to their homes, workplaces and communities was limited.

Quality of life was also badly affected. Energy levels and social life were the most impacted, reflecting how fatigue and brain fog affect activities, relationships and community connections. On average, overall quality of life scores were 23% lower than the general population.

What are the implications

International research shows similar patterns. One study across 13 countries found similar levels of disability. It also found women had higher disability scores than men. As long COVID disability has many facets and can change a lot over time, it doesn’t fit into traditional ways of providing health care for chronic conditions.

Another key insight from our study is the importance of self-reported outcomes. Long COVID has no diagnostic test, and people often report health professionals are sceptical about their symptoms and their impact. Yet our study showed people’s own ratings of their recovery strongly predicted their disability and quality of life.

This shows self-reports are not just “stories”. They are valid and reliable indicators of health. They also capture what medical tests cannot.

For example, fatigue is not just being tired. It can mean losing concentration while driving, giving up hobbies, or pulling away from cherished friendships.

Our study shows long Covid disrupts futures, breaks connections, and creates daily struggles that ripple out to families, workplaces and communities.

What needs to happen next

Evidence presented to the 2023 parliamentary long Covid inquiry estimates hundreds of thousands of Australians are living with long Covid.

We know disadvantaged communities are even more likely to be impacted by the cascading effects of long Covid. So ignoring the scale and severity of long Covid risks deepening inequality and worsening its impact even further.

By building services based on lived experience, we can move towards restoring not just health, but dignity and participation in daily life for people with long Covid.

We need rehabilitation and support services that go beyond basic medical care. People need support to manage fatigue, such as “pacing” and conserving energy by not overexerting themselves. Workplaces need to accommodate people with long Covid by reducing hours, redesigning job demands and offering flexible leave. People also need support to rebuild social connections.

All this requires people with long Covid to be thoughtfully assessed and treated. Listening to patients and valuing their experience is a crucial first step.

We’d like to acknowledge the following co-authors of the research mentioned in this article: Tanita Botha, Fisaha Tesfay, Sara Holton, Cathy Said, Martin Hensher, Mary Rose Angeles, Catherine Bennett, Bodil Rasmussen and Kelli Nicola-Richmond.

Danielle Hitch is Senior Lecturer in Occupational Therapy, Deakin University.

Genevieve Pepin is Professor, School of Health and Social Development, Deakin University.

Kieva Richards is Lecturer in Occupational Therapy, La Trobe University.

This article was first published on The Conversation.

Most people know they should drink more water, but our new research reveals an unexpected consequence of falling short: it could be making everyday stress significantly harder to handle.

Our study, published in the Journal of Applied Physiology, found that people who drank less than 1.5 litres daily showed dramatically higher levels of cortisol – the body’s primary stress hormone – when faced with stressful situations. The finding suggests that chronic mild dehydration may amplify stress responses in ways we’re only beginning to understand.

We tested healthy young adults by dividing them into two groups based on their usual fluid intake. One group drank less than 1.5 litres daily, while the other exceeded standard recommendations of roughly two litres for women and 2.5 litres for men. After maintaining these patterns for a week, participants faced a laboratory stress test involving public speaking and mental arithmetic.

Both groups felt equally nervous and showed similar heart rate increases. But the low-fluid group experienced a much more pronounced cortisol surge – a response that could prove problematic if repeated daily over months or years. Chronic elevation of cortisol has been linked to increased risks of heart disease, kidney problems and diabetes.

Surprisingly, the under-hydrated participants didn’t report feeling thirstier than their well-hydrated counterparts. Their bodies, however, told a different story. Darker, more concentrated urine revealed their dehydration, demonstrating that thirst isn’t always a reliable indicator of fluid needs.

The mechanism behind this stress amplification involves the body’s sophisticated water management system. When dehydration is detected, the brain releases vasopressin, a hormone that instructs the kidneys to conserve water and maintain blood volume. But vasopressin doesn’t work in isolation, it also influences the brain’s stress-response system, potentially heightening cortisol release during difficult moments.

Double burden

This creates a physiological double burden. Although vasopressin helps preserve precious water, it simultaneously makes the body more reactive to stress. For someone navigating daily pressures – work deadlines, family responsibilities, financial concerns – this heightened reactivity could accumulate into significant health harms over time.

Our findings add hydration to the growing list of lifestyle factors that influence stress resilience. Sleep, exercise, nutrition and social connections all play roles in how we handle life’s challenges. Water now emerges as a potentially underappreciated ally in stress management.

The implications extend beyond individual physiology. In societies where chronic stress is increasingly recognised as a public health crisis, hydration emerges as a surprisingly accessible intervention. Unlike many stress-management strategies that require significant time or resources, drinking adequate water is straightforward and universally available.

However, our research doesn’t suggest that water is a cure-all for stress. The study involved healthy young adults in controlled laboratory conditions, which cannot fully replicate the complex psychological and social stressors people face in everyday life. Hydration alone cannot address all aspects of real-world stress. We need long-term studies to confirm whether maintaining optimal hydration genuinely reduces stress-related health problems over years or decades.

Individual water needs vary considerably based on age, body size, activity levels and climate. Guidelines provide useful targets, but tea, coffee, milk and water-rich foods also contribute to daily fluid intake. The key is consistency rather than perfection.

A simple check involves monitoring urine colour: pale yellow typically indicates adequate hydration, while darker shades suggest increased fluid needs. This practical approach removes guesswork from an essential daily habit.

Good health stems from accumulated daily choices rather than dramatic interventions. Although proper hydration won’t eliminate life’s pressures, it might help ensure your body is better equipped to handle them. In a world where stress feels inevitable, that physiological advantage could prove more valuable than we’ve previously recognised.

Water remains essential for life in ways that extend far beyond basic survival. Our research suggests it may also be essential for managing the psychological demands of modern life, offering a simple but powerful tool for supporting both physical and mental resilience.

Daniel Kashi is Post-Doctoral Research Officer, Liverpool John Moores University.

Neil Walsh is Professor, Applied Physiology, Liverpool John Moores University.

This article was first published on The Conversation.

Could blowing a conch shell help treat sleep apnoea? As a doctor working in sleep medicine, this unexpected news story certainly grabbed my attention. My first reaction was scepticism – sleep specialists don’t typically prescribe natural objects found on beaches as medical therapy. But perhaps I was too hasty to dismiss the idea.

For those unfamiliar with them, a conch shell is the spiral home of a large sea snail that, when hollowed out, can be blown like a trumpet. This practice isn’t new – cultures worldwide have used conch shells for thousands of years in rituals, ceremonies and communication. What’s novel is the suggestion that it might help with a serious medical condition affecting millions.

We all know someone who snores, but not all snoring is harmless. If your partner notices you sometimes stop breathing during the night, that’s cause for concern. You may have obstructive sleep apnoea, a condition where throat muscles relax excessively during sleep, causing the airway to narrow or close completely. These breathing interruptions – called apnoeas – can happen dozens or even hundreds of times per night.

The consequences extend far beyond disturbing your partner’s sleep. Each pause in breathing jolts your brain out of deeper sleep stages, leaving you exhausted the next day. This isn’t merely inconvenient – drowsy drivers cause thousands of accidents annually. The repeated drops in oxygen also strain your heart, increasing risks of high blood pressure and heart disease if left untreated.

Standard treatments focus on keeping airways open during sleep. The gold standard is Cpap (continuous positive airway pressure), where a mask delivers steady airflow that acts like an internal splint. We also use oral devices that gently shift the jaw forward, surgical removal of enlarged tonsils or adenoids, and even newer techniques involving tiny electrical impulses to stimulate airway muscles.

Lifestyle changes matter, too. Weight loss reduces fatty tissue around the neck that can compress airways, while cutting alcohol and stopping smoking helps maintain firmer airway muscles – both substances make throat tissues floppier and worsen symptoms.

Muscles and sleep

So where does the conch shell fit? When you blow through any narrow opening, you’re essentially training your upper airway muscles to stay open and firm. This concept, called airway muscle training, has legitimate scientific backing. Studies show that exercises targeting the tongue, soft palate and facial muscles can improve mild to moderate sleep apnoea symptoms.

Research has even examined whether playing the didgeridoo – another wind instrument requiring sustained airway control – might benefit sleep apnoea patients. The results were promising, though limited by patient compliance. The challenge with any exercise-based treatment is maintaining daily practice long-term.

This is where the conch shell idea becomes more intriguing. For carefully selected patients with milder symptoms, it could offer an engaging, culturally rich alternative to conventional airway exercises. It’s certainly more accessible than learning the didgeridoo – and probably easier to explain to concerned neighbours.

However, let’s be clear: conch shell therapy won’t revolutionise sleep apnoea treatment. Anyone with suspected sleep apnoea needs proper medical evaluation and evidence-based treatment. Cpap therapy remains the most effective option for moderate to severe cases. But as part of a comprehensive approach – alongside weight management, lifestyle changes and conventional treatments – prescribed conch shell exercises might one day earn a place in our therapeutic toolkit.

So sleep medicine, typically obsessed with high-tech solutions, might benefit from embracing something as ancient and simple as blowing into a seashell. Of course, being sleep specialists, we’d inevitably need to give it a suitably technical name – “conchological respiratory muscle rehabilitation” has a nice ring to it, don’t you think?

Jo-Anne Johnson is Head of Undergraduate Medicine, Anglia Ruskin University.

Protein is having its moment: From grocery store shelves to Instagram feeds, high-protein foods are everywhere. Food labels shout their protein content in bold, oversized fonts, while social media overflows with recipes promising to pack more protein into your favourite dishes.

And according to the International Food Information Council’s Food and Health Survey, “high protein” topped the list of popular eating patterns in 2024. But does the hype match the science?

Yes and no.

Protein is essential to good health and boosting protein intake can support healthy aging and fitness goals, but the rush to pile on grams – often driven by marketing more than medical need – raises questions. How much do you really need? Can you overdo it? What’s the best source of protein?

This article breaks down the facts, debunks common myths and answers the most pressing questions about protein today.

Dietary protein

Protein is one of the three essential macronutrients your body needs in large amounts, alongside carbohydrates and fats. While carbs and fats are primarily used for energy, protein plays a more structural and functional role. It helps build and repair tissues, supports immune health and produces enzymes, hormones and other vital molecules.

Proteins are made of amino acids. Your body can make some amino acids, but nine must come from food. These are called essential amino acids. That’s why protein is a daily dietary requirement, not just a delicious post-workout bonus.

Unlike fat and carbohydrates, which the body can store for later use, protein doesn’t have a dedicated storage system. That means you need to replenish it regularly. In extreme situations – like prolonged fasting or severe illness – your body will break down its own muscle to release amino acids for energy and repair. It’s a last-resort mechanism that underscores just how essential protein is for survival.

How much protein do people need?

The amount of protein an individual needs to consume each day may vary based on age, physical activity levels and the presence of health conditions. However, the recommended dietary allowance (RDA) for daily protein intake is the same for almost everyone: 0.8 grams of protein per kilogram of body weight per day (g/kg/d).

For example, a woman weighing 65 kilograms should aim to consume approximately 52 grams of protein daily.

An important caveat is that the RDA is set to prevent protein deficiency, not to promote optimal health. Older adults who have a reduced ability to utilize the nutrients they consume, athletes whose bodies need more substrate for tissue growth and repair, and pregnant or breastfeeding individuals whose protein intake is shared with another being, often need more protein. Sometimes as much as 1.2 to 2 grams per kilogram of body weight. Therefore, an older person of the same body mass (65 kilograms) might need between 78 g and 130 g of protein daily, far exceeding the RDA.

Can you have too much protein?

While several expert groups agree that consuming more protein can be beneficial in certain situations – particularly for older adults – there is probably little to no advantage in consuming protein amounts exceeding two grams per kilogram per day.

The good news is that if you are generally healthy, increasing your protein intake will not shorten your lifespan, cause your kidneys to fail, give you cancer or lead to bone loss.

When should I consume my protein?

A prominent social media influencer recently claimed that post-menopausal women must consume protein within a very short window (~45 minutes) after exercise, or any benefits from exercise will quickly dissipate and they will lose all their muscle. This is absolutely not the case.

The idea of an “anabolic window” – a brief period after exercise when recovering muscles make the best use of protein – has long been debunked. Perhaps more accurately described as a garage door rather than an anabolic window, there is a generous period of at least 24 hours to consume protein after exercise.

This means your muscles remain sensitive to the muscle-building effects of protein for a long time after exercise. So, focusing your efforts on consuming enough protein each day is much more important than stressing about guzzling your protein shake in the changing room immediately following your workout.

As long as you’re eating enough protein each day, feel free to consume it on a schedule that fits your daily routine.

But if increasing the amount of protein that you eat at each meal helps you feel fuller and curb your appetite, you may be a little less likely to overeat or indulge in sweet treats.

And with the increasing off-label use of Type 2 diabetes medications such as GLP-1 agonists, which significantly reduce appetite, putting protein on your plate first might – and it’s a considerable might – help slow muscle loss that accompanies this drastic weight loss. However, this is rather speculative, and resistance exercise will probably be your best option for slowing muscle loss while on these medications.

Are all proteins created equal?

Protein is found in a wide variety of foods, from animal sources such as meat, fish, eggs and dairy to plant-based options like legumes, soy products, whole grains, nuts, seeds and even some vegetables. Protein is also widely available as a nutritional supplement, with whey, casein and collagen being among some of the most popular options.

Animal-based proteins are often touted by many online as superior, especially when it comes to supporting muscle growth, but the reality of protein quality is more nuanced.

Animal proteins often contain more of the essential amino acids and are more bioavailable, meaning they are easier for the body to absorb and use. However, a well-planned plant-based diet can also supply all the essential amino acids the body needs – it just takes a bit more variety and intention.

If that wasn’t enough, and you find yourself trying to wrap your head around food labelling, you’re not the only one. When it comes to high-protein products seen all over the grocery store, meat, dairy, shakes and bars are no longer the only options. Now, consumers are bombarded with high-protein popcorn, chips and even candy. Most of these, like diets promoted by influencers, are unnecessary “health halo” gimmicks.

My advice would be to follow a varied, whole-food, protein-forward diet – much like the dietary guidelines. And whatever your preferred protein source – animal- or plant-based – fill about a quarter of your plate or bowl at breakfast, lunch and dinner.

This approach will greatly support your overall health, especially when combined with a diverse diet rich in fruits, vegetables and whole grains, along with regular physical activity.

The bottom line is that protein is an essential nutrient, and consuming enough of it daily is crucial for maintaining good health. But meeting your body’s protein needs doesn’t need to be complicated.

James McKendry is Assistant Professor in Nutrition and Healthy Aging, University of British Columbia.

This article was first published on The Conversation.

When you order a coffee, do you ask for it to be “extra hot”?

Whether you enjoy tea, coffee or something else, hot drinks are a comforting and often highly personal ritual. The exact temperature to brew tea or serve coffee for the best flavour is hotly debated.

But there may be something else you’re not considering: your health.

Yes, hot drinks can be too hot – and are even linked to cancer. So, let’s take a look at the evidence.

What’s the link?

There is no evidence for a link between hot drinks and throat cancer and the evidence for a link between hot drinks and stomach cancer is unclear. But there is a link between hot drinks and cancers of the “food pipe” or oesophagus.

In 2016, the International Agency for Research on Cancer classified drinking very hot beverages, meaning above 65 degrees celsius, as “probably carcinogenic to humans” – this is the same risk category as emissions from indoor wood smoke or eating a lot of red meat.

The agency’s report found it was the temperature, not the drinks, that were responsible.

This is based mainly on evidence from South America, where studies found a link between drinking a lot of maté – a traditional herbal drink usually drunk at around 70 degrees celsius – and a higher risk of oesophageal cancer.

Similar studies in the Middle East, Africa and Asia have also supported the link between drinking very hot beverages and developing oesophageal cancer.

However, until recently we didn’t have substantial research exploring this link in Europe and other Western populations.

This year, a large study of almost half a million adults in the United Kingdom confirmed drinking higher amounts of very hot drinks (tea and coffee) was associated with oesophageal cancer.

The study found that someone who drank eight or more cups a day of very hot tea or coffee was almost six times more likely to develop oesophageal cancer, compared to someone who didn’t drink hot drinks.

How do hot drinks cause cancer

Drinking a lot of very hot drinks can damage cells in the oesophagus lining, and it’s believed over time this can lead to cancer developing. Researchers first proposed this link almost 90 years ago.

What we know about how hot drinks can damage the oesophagus mainly comes from animal studies.

Very hot water may accelerate cancer growth. One animal study from 2016 studied mice that were prone to developing cancer. Mice given very hot water (70°C) were more likely to develop precancerous growths in the oesophagus, and sooner, compared to mice given water at lower temperatures.

Another theory is that heat damage to the oesophagus lining weakens its normal barrier, increasing the risk of further damage from gastric acid reflux (from the stomach). Over time, this chronic damage can increase the chance of oesophageal cancer developing.

Does how much you drink matter?

The risk of cancer may depend on how much hot liquid you drink in one sitting and how quickly. It seems drinking a lot in one go is more likely to damage the oesophagus by causing a heat injury.

In one study, researchers measured the temperature inside the oesophagus of people drinking hot coffee at different temperatures.

They found the size of the sip the person took had more impact than how hot the drink was. A very big sip (20 millilitres) of 65°C coffee increased the temperature inside the oesophagus by up to 12°C. Over time, large sips can lead to sustained heat injury that can damage cells.

The occasional small sip of coffee at 65 degrees celsius isn’t likely to result in any long-term problems. But over years, drinking large amounts of very hot drinks could very well increase the risk of oesophageal cancer.

What’s safe temperature?

The brewing temperatures for drinks such as coffee are very high – often close to the boiling point of water.

For example, takeaway hot drinks may be sometimes be served at very high temperatures (around 90 degrees celsius) to allow for cooling when people drink them later at the office or home.

One study from the United States calculated the ideal temperature for coffee, factoring in the risk of heat injury to the oesophagus while preserving flavour and taste. The researchers came up with an optimum temperature of 57.8 degrees celsius.

How to have hot beverages safely

Slow down, take your time and enjoy.

Allowing time for a very hot drink to cool is important and research has shown a hot drink’s temperature can drop by 10-15 degrees celsius in five minutes.

Other things that may help cool a hot drink:

• stirring and blowing

• opening the lid on a takeaway drink. Coffee with the lid off can cool twice as fast as with the lid on

• mixing in some cool water or milk.

Finally, small sips are a good idea to test the temperature, given we know having a large amount has a significant impact on the temperature inside the oesophagus and potential damage to its lining.

Vincent Ho is Associate Professor and Clinical Academic Gastroenterologist, Western Sydney University.

This article was first published on The Conversation.

Instant noodles are cheap, quick and comforting – often a go-to snack or meal for students, busy workers, families and anyone trying to stretch their grocery budget.

In Australia, the instant noodle market continues to grow, as food costs rise and the popularity of Asian cuisines soars.

But what happens if they become an everyday meal? Can you survive, and thrive, on a daily diet of instant noodles?

Let’s explore what’s in an average pack, what that means for our health, and how to make noodles part of a more balanced meal.

Affordable, versatile and culturally important

Instant noodles are incredibly accessible. A single serving is very cheap, can take just a few minutes to prepare and fill you up. They’re easy to store, have a long shelf life, and are available in almost every supermarket or corner shop.

Noodles also carry cultural significance.

For many international students and migrants, they’re a familiar taste in an unfamiliar place. A packet of Maggi mi goreng, a bowl of Shin Ramyun, or a serving of Indomie can instantly transport someone back to a childhood kitchen, a bustling night market, or a late-night supper with friends.

These dishes aren’t just quick meals – they hold memory, identity, and belonging. In a new environment, they offer both a full belly and a sense of home.

But what’s actually in a pack?

While instant noodles offer comfort and familiarity, their nutritional profile has room for improvement.

A standard packet of instant noodles is made from wheat flour noodles and a packet of flavour enhancers. Some fancier versions also include dried vegetables or crispy fried garlic.

On average, though, most packets are very high in salt: a typical serving can contain 600–1,500mg of sodium, which is close to or even above your recommended daily intake (the World Health Organization recommends less than 2,000mg sodium/day).

Over time, high sodium intake can strain the heart and kidneys.

Because they’re usually made from refined wheat (not wholegrains), instant noodles typically do not contain much fibre. Dietary fibre is important to help keep your digestion regular and support a healthy gut.

Instant noodles are also low in protein. You will feel full right after eating instant noodles because of the refined carbohydrates, but without added eggs, tofu or meat as a source of protein, that fullness will be short-lived. You will be hungry again soon after.

They are also low in nutrients such as vitamins and minerals. These matter because they help your body function properly and stay healthy.

Health risks

Occasional instant noodles won’t harm you. But if they become your main source of nutrition, research suggests some potential longer-term concerns.

A study of South Korean adults found that frequent instant noodle consumption (more than twice a week) was associated with a higher risk of metabolic syndrome, especially among women. Metabolic syndrome is a group of conditions that together raise your risk of heart disease, diabetes and other health issues.

While this study doesn’t prove that instant noodles directly cause health concerns, it suggests that what we eat regularly can affect our health over time.

High sodium intake is linked to increased risk of high blood pressure, heart disease and stroke. Noodles have been linked to higher rates of metabolic syndrome, likely because of the sodium content. Most Australians already exceed recommended sodium limits, with processed foods as the main contributor.

Low fibre diets are also associated with poor gut health, constipation, and higher risk of type 2 diabetes and bowel cancer.

A lack of variety in meals can mean missing out on important nutrients found in vegetables, legumes, fruits and wholegrains.

These nutrients help protect your health in the long term.

How to make them healthier

If noodles are on high rotation in your kitchen, there’s no need to toss them out completely.

Instead, you can upgrade your bowl with a few easy additions, by:

• adding vegetables (toss in a handful of frozen peas, spinach, broccoli, carrots or whatever’s on hand to bump up your fibre, vitamins and texture)

• including protein (add a boiled or fried egg, tofu cubes, edamame beans, shredded chicken or tinned beans to help you stay full longer and support muscle and immune health)

• cutting back on the flavour sachet (these are often the main source of salt, so try using half or less of the sachet or mixing in low-sodium stock, garlic, ginger, herbs or chilli instead)

• trying wholegrain or air-dried noodles (some brands now offer higher-fibre options made with buckwheat, brown rice or millet, so check the ingredients on the back of the packet to see the main source of grain).

Ditch the noodle?

Not at all.

Like most foods, instant noodles can fit into a healthy diet, just not as the main event every day.

Think of your body like a car. Instant noodles are like fuel which can give you enough to get you moving, but not enough to keep the engine running smoothly over time.

Noodles definitely have a place in busy lives and diverse kitchens.

With a few pantry staples and simple tweaks, you can keep the comfort and convenience, while also adding a whole lot more nourishment.

Lauren Ball is Professor of Community Health and Wellbeing, The University of Queensland.

Emily Burch is Accredited Practising Dietitian and Lecturer, Southern Cross University.

Pui Ting Wong (Pearl) is PhD Candidate, Culinary Education and Adolescents' Wellbeing, The University of Queensland.

This article was first published on The Conversation.

We’re constantly being reminded by news articles and social media posts that we should be getting more sleep. You probably don’t need to hear it again – not sleeping enough is bad for your brain, heart and overall health, not to mention your skin and sex drive.

But what about sleeping “too much”? Recent reports that sleeping more than nine hours could be worse for your health than sleeping too little may have you throwing up your hands in despair.

It can be hard not to feel confused and worried. But how much sleep do we need? And what can sleeping a lot really tell us about our health? Let’s unpack the evidence.

Sleep and health

Along with nutrition and physical activity, sleep is an essential pillar of health.

During sleep, physiological processes occur that allow our bodies to function effectively when we are awake. These include processes involved in muscle recovery, memory consolidation and emotional regulation.

The Sleep Health Foundation – Australia’s leading not-for-profit organisation that provides evidence-based information on sleep health – recommends adults get seven to nine hours of sleep per night.

Some people are naturally short sleepers and can function well with less than seven hours.

However, for most of us, sleeping less than seven hours will have negative effects. These may be short term; for example, the day after a poor night’s sleep you might have less energy, worse mood, feel more stressed and find it harder to concentrate at work.

In the long term, not getting enough good quality sleep is a major risk factor for health problems. It’s linked to a higher risk of developing cardiovascular disease – such as heart attacks and stroke – metabolic disorders, including type 2 diabetes, poor mental health, such as depression and anxiety, cancer and death.

So, it’s clear that not getting enough sleep is bad for us. But what about too much sleep?

Too much sleep

In a recent study, researchers reviewed the results of 79 other studies that followed people for at least one year and measured how sleep duration impacts the risk of poor health or dying to see if there was an overall trend.

They found people who slept for short durations – less than seven hours a night – had a 14% higher risk of dying in the study period, compared to those who slept between seven and eight hours. This is not surprising given the established health risks of poor sleep.

However, the researchers also found those who slept a lot – which they defined as more than nine hours a night – had a greater risk of dying: 34% higher than people who slept seven to eight hours.

This supports similar research from 2018, which combined results from 74 previous studies that followed the sleep and health of participants across time, ranging from one to 30 years. It found sleeping more than nine hours was associated with a 14% increased risk of dying in the study period.

Research has also shown sleeping too long (meaning more than required for your age) is linked to health problems such as depression, chronic pain, weight gain and metabolic disorders.

This may sound alarming. But it’s crucial to remember these studies have only found a link between sleeping too long and poor health – this doesn’t mean sleeping too long is the cause of health problems or death.

What’s the link?

Multiple factors may influence the relationship between sleeping a lot and having poor health.

It’s common for people with chronic health problems to consistently sleep for long periods. Their bodies may need additional rest to support recovery, or they may spend more time in bed due to symptoms or medication side effects.

People with chronic health problems may also not be getting high quality sleep, and may stay in bed for longer to try and get some extra sleep.

Additionally, we know risk factors for poor health, such as smoking and being overweight, are also associated with poor sleep.

This means people may be sleeping more because of existing health problems or lifestyle behaviours, not that sleeping more is causing the poor health.

Put simply, sleeping may be a symptom of poor health, not the cause.

What’s the ideal amount

The reasons some people sleep a little and others sleep a lot depend on individual differences – and we don’t yet fully understand these.

Our sleep needs can be related to age. Teenagers often want to sleep more and may physically need to, with sleep recommendations for teens being slightly higher than adults at eight to ten hours. Teens may also go to bed and wake up later.

Older adults may want to spend more time in bed. However, unless they have a sleep disorder, the amount they need to sleep will be the same as when they were younger.

But most adults will require seven to nine hours, so this is the healthy window to aim for.

It’s not just about how much sleep you get. Good quality sleep and a consistent bed time and wake time are just as important – if not more so – for your overall health.

The bottom line

Given many Australian adults are not receiving the recommended amount of sleep, we should focus on how to make sure we get enough sleep, rather than worrying we are getting too much.

To give yourself the best chance of a good night’s sleep, get sunlight and stay active during the day, and try to keep a regular sleep and wake time. In the hour before bed, avoid screens, do something relaxing, and make sure your sleep space is quiet, dark, and comfortable.

If you notice you are regularly sleeping much longer than usual, it could be your body’s way of telling you something else is going on. If you’re struggling with sleep or are concerned, speak with your GP. You can also explore the resources on the Sleep Health Foundation website.

Charlotte Gupta is Senior Postdoctoral Research Fellow, Appleton Institute, HealthWise Research Group, CQUniversity Australia.

Gabrielle Rigney is Senior Lecturer in Psychology, Appleton Institute, CQUniversity Australia.

This article was first published on The Conversation.

With summer in full swing, many people will be tempted by supposedly miraculous dieting tricks to lose those excess kilos that prevent them from enjoying the perfect physique. Among them are so-called “mono diets”: restrictive regimes that consist of exclusively eating one type of food for a period of time, with the aim of quickly losing weight and “detoxing”.

Popular examples include pineapple, apple, watermelon, peach or artichoke, as well as grain-based options like rice and protein-based ones such as tuna or milk. Their appeal lies in the promise of simplicity and fast results.

Fleeting weight loss

Diets built on a drastic reduction of calorie intake can lead to swift weight loss. However, consuming such a small amount of calories means reduced blood sugar levels. In order to maintain energy levels, our bodies have mechanisms that compensate for a drop in nutrient intake.

Initially, the body uses hepatic glycogen, the main source of the glucose reserve that maintains blood glucose levels, especially between meals or when fasting. However, once this store is depleted, the body begins to convert muscle mass to obtain amino acids which, through other metabolic routes, can produce glucose. This process, sustained over time, can lead to a significant loss of muscle mass and other metabolic disturbances.

Much of any sudden weight loss is therefore the result of a loss of water and muscle mass rather than body fat, meaning these results tend to be temporary. When a person returns to their usual diet after a strict regime, it is common for them to quickly regain any lost weight – this is known as the “rebound effect”.

In short, mono diets may seem like a quick fix, but they do not promote sustained weight loss, nor are they conducive to healthy eating habits.

Are there any benefits

Beyond the initial weight loss, there is virtually no scientific evidence to suggest that mono diets have any real or lasting benefits. Some people report a feeling of “lightness” or better digestion, but these effects may be due more to the elimination of certain processed foods than to the diet itself.

The “detox” element of mono diets can also have a placebo effect. The belief that they are somehow cleansing their body can make a person feel better, even in the absence of any proven physiological changes.

Are they dangerous

Mono diets can be very dangerous, especially if they are prolonged. The main risk is the deficiency of essential nutrients, as by eating only one type of food, we miss out on the proteins, healthy fats, vitamins and minerals that the body needs to function properly. In addition, they can lead to digestive problems, metabolic disorders, musculoskeletal problems, hormonal disturbances and electrolyte imbalances, especially in people with pre-existing health conditions.

Another significant danger is the creation of an unhealthy relationship with food, one marked by restriction and guilt. In extreme cases, this can lead to eating disorders such as orthorexia or anorexia nervosa.

Additionally, radically limiting nutrients can affect the balance of neurotransmitters in the brain, contributing to irritability and fatigue which, in turn, negatively impact emotional well-being.

Why are they so popular?

Despite their risks, mono diets continue to be successful, especially on social media. Their appeal lies in their simplicity and the promise of quick results with minimal effort. In addition, many of these diets are promoted by celebrities or influencers, giving them a false sense of credibility. Misinformation, aesthetic pressure and a broader lack of nutritional education are also contributing factors.

The key takeaway is that single-food diets may be effective for quick and temporary weight loss, but they are not effective in the long term, and are dangerous if followed for long periods of time. They provide no real health benefits, and can lead to nutritional deficiencies and major health problems.

For these reasons, they are not recommended, and should not be promoted as appropriate forms of weight control or health improvement. The best way to reach and maintain a healthy weight is still a balanced, varied diet, accompanied by regular physical activity and healthy lifestyle habits.

Ana Montero Bravo is Profesora Titular. Grupo USP-CEU de Excelencia “Nutrición para la vida (Nutrition for life)”, ref: E02/0720, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Universidad CEU San Pablo.

This article was first published on The Conversation.

There’s something oddly luxurious about a lie-in. The sun filters through the curtains, the alarm clock is blissfully silent, and your body stays at rest. Yet lie-ins are often treated as indulgences, sometimes framed as laziness or a slippery slope to soft living.

When the holidays arrive and alarm clocks are switched off, or are set later, something else emerges: your body reclaims sleep. Not just more of it, but deeper, richer and more restorative sleep. Anatomically and neurologically, a lie-in might be exactly what your body needs to recover and recalibrate.

Throughout the working year, it’s common to accumulate a chronic sleep debt – a shortfall in the sleep the body biologically needs, night after night. And the body keeps score.

On holiday, freed from early starts and late-night emails, our internal systems seize the opportunity to rebalance. It’s not uncommon to sleep an hour or two longer per night in the first few days away. That’s not laziness; it’s recovery.

Importantly, holiday sleep doesn’t just extend in duration. It shifts in structure. With fewer disturbances and less external pressure, sleep cycles become more regular, and we often experience more slow-wave sleep – the deepest phase, linked to physical healing and immune support.

The body uses this window not only to repair tissue but also to regulate metabolism, dial down inflammation and restore energy reserves.

Our sleep-wake cycle is governed by circadian rhythms, which are controlled by the brain’s master clock – the suprachiasmatic nucleus in the hypothalamus. These rhythms respond to light, temperature and routine. And when we’re overworked or overstimulated, they can drift out of sync with our environment.

A lie-in allows your circadian system to recalibrate, aligning internal time with actual daylight. This re-training leads to more coherent sleep cycles and better daytime alertness.

Holiday lie-ins also owe something to the drop in stress hormones. Cortisol, released by the adrenal glands, follows a diurnal pattern, peaking in the early morning to get us going.

Chronic stress – from work demands, commuting or constant notifications – can raise cortisol levels and disrupt this rhythm. When you take time off, cortisol production normalises. Waking up without a jolt of adrenaline allows the sleep architecture (the pattern of sleep stages) to stabilise, leading to fewer interruptions and more restful nights.

One of the more striking features of holiday sleep is a surge in vivid dreaming – sometimes unsettlingly so. This is because of a phenomenon called REM rebound. When we’re sleep-deprived, the brain suppresses REM (rapid eye movement) sleep to prioritise deep, restorative phases.

Once the pressure lifts – say, during a lazy week in the sun – the brain makes up for lost REM, leading to longer and more intense dream episodes. Far from frivolous, REM sleep is crucial for memory consolidation, mood regulation and cognitive flexibility.

Sleep also affects your body’s structure. When you lie down, your spine gets a break from the constant pressure of gravity. During the day, as you stand and move around, the intervertebral discs – soft, cushion-like pads between the vertebrae – slowly lose fluid and become slightly flatter. A lie-in gives these discs more time to rehydrate and return to their normal shape. That’s why you’re a little taller in the morning – and even more so after a long sleep.

Meanwhile, microtears in muscles, strained ligaments and overworked joints benefit from prolonged periods of cellular repair, especially during deep sleep stages.

Should we all be sleeping in every weekend? Not necessarily. While occasional lie-ins can help with recovery from acute sleep deprivation, habitual oversleeping –especially beyond nine hours a night – can be a red flag. It’s associated in some studies with higher rates of depression, heart disease and early death. Although long sleep might be a symptom, not a cause.

Larks and owls

That said, the occasional lie-in remains anatomically restorative, especially when aligned with your body’s natural chronotype – a biological predisposition that determines when you feel most alert and when you feel naturally inclined to sleep.

Some people are naturally “larks”, who rise early and function best in the morning. Others are “owls”, who tend to feel sleepy late and wake later, with their peak cognitive and physical performance occurring in the afternoon or evening. Many fall somewhere in between.

Chronotype is governed by the same internal circadian system that regulates sleep-wake cycles, and it appears to be strongly influenced by genetics, age and light exposure. Adolescents typically have later chronotypes, while older adults often revert to earlier ones.

Crucially, chronotype doesn’t just affect sleep. It also plays a role in hormone release, body temperature, digestive timing and mental alertness throughout the day.

Conflict arises when social expectations, such as early work or school start times, force people, especially night owls, to adopt sleep-wake schedules that are out of sync with their biology. This mismatch, known as social jetlag, can lead to persistent tiredness, mood changes and even long-term health risks.

So if you find yourself sleeping in until 9 or 10am on the third day of your holiday, don’t berate yourself. Your body is taking the opportunity to repair, replenish and rebalance. The anatomical systems involved – from your brainstem to your adrenal glands, your intervertebral discs to your dream-rich REM phases – are doing what they’re designed to do when finally given the time.

Michelle Spear is Professor of Anatomy, University of Bristol.

This article was first published on The Conversation.

Seventy-five-year-old Anasuya Patel and her husband VP Patel, 77, can barely walk without support.

But on Wednesday morning, the couple joined an angry crowd as it marched towards the iconic kabutarkhana in Mumbai’s Dadar and tore off the tarpaulin sheet in which it was covered.

The kabutarkhana, or pigeon-feeding spot, had been covered with the sheet and wooden scaffolding on Sunday on the orders of the Bombay High Court.

Hundreds of pigeons immediately flocked to the spot to peck at the grains hurled by the crowd.

The court had directed the Brihanmumbai Municipal Corporation to seal 51 pigeon-feeding spots in the city on the grounds that their droppings and feathers posed a public health hazard.

But Patel was aghast. “If your children are dying of hunger, can you eat?” she asked.

The couple had taken a taxi from their home in Mumbai’s Matunga to defy the court order.

Two floors above Patel’s flat in Jamnadas Mansion, however, Bhogilal Manilal Parmar is tired of shooing away pigeons.

Outside his home is the decades-old Matunga kabutarkhana. From his window, he can see pigeons swarm over almost every inch of the tree outside.

Parmar has breathing problems, as do his three daughters. One of them recently contracted pneumonia.

A doctor had told him that their respiratory problems were due to the pigeon droppings all around their home, Parmar said.

“We moved into this building six years ago,” Parmar said. “Our breathing problems began after that.”

He has been planning to move out of the flat, but the court order has given him pause. “We are hopeful that the kabutarkhana will remain shut and we won’t have to move,” he told Scroll.

Parmar said he has tried to reason with his neighbours. “But they think I am cruel,” he said.

As with Patel and Parmar, the ban on feeding pigeons in public has sharply divided the residents of Mumbai neighbourhoods.

The Jain community has taken the lead in mobilising protestors to defy court orders and push for the reopening of all kabutarkhanas.

With the civic polls approaching, Maharashtra Chief Minister Devendra Fadnavis has tried to placate the community by directing the municipality to permit controlled feeding.

The health risk

As Scroll has reported, the pigeon population in India has increased enormously, as the bird has adapted extremely well to urban, concrete environments.

The 2023 State of India’s Birds report found that between 2000 and 2023, the population of pigeons in India increased by more than 150%.

With easy access to grain and ample space in buildings to lay eggs, their population has multiplied rapidly, posing a health hazard.

The Bombay High Court cited a report by the pulmonology department of KEM Hospital, which warned that exposure to pigeons could lead to “acute interstitial pneumonitis”, a debilitating condition.

The report said that pigeon droppings and feathers have pathogens that trigger asthma, affect lung function and lead to lung diseases like hypersensitivity pneumonitis.

Alpa Mehta found that out the hard way.

The 54-year-old lived on the second floor of Anasuya Patel’s building in Matunga till about five years ago. Like many others, she too fed pigeons regularly.

“Around that time, my mother was diagnosed with hyper-fibrosis of the lungs,” Jayna Mehta, her daughter said. “The pulmonologist advised us to move out immediately.”

Jayna recalls speaking to the building residents, several of them Jains, about the health risks posed by pigeons. “They thought we were making it up,” Alpa Mehta said.

Only 47% of her mother’s lungs are in a working state, Jayna Mehta said. There is an oxygen cylinder always at home and she will be dependent on steroids for the rest of her life.

Jayna Mehta has little sympathy for those inciting others to defy court orders.

“We are Jains too,” she said. “But we are shocked that our community would go and tear open a kabutarkhana. Only those who suffer can fully understand the risk.”

‘Act of service’

Her former neighbours remain unconvinced.

Jayshree Shah, who lives on the first floor of Jamnadas Mansion, refuses to believe that pigeons can cause any health risk.

She said none of the residents who have complained about the birds could show her any proof.

“My grandmother taught me to feed pigeons when I was a child,” she said. “We have been doing so for generations. For Jains, feeding pigeons is an act of service.”

When the municipal corporation shut the feeding spots, Shah began a campaign on WhatsApp, urging people to come out and protest.

“It hurts us to see the birds die of hunger,” she said.

Several pigeon lovers told Scroll they continue to feed the birds secretly.

“We check if there is a civic official around. If he is not, we throw some grains near that tree,” said shopkeeper Dhanwant Mehta, pointing to an area close to the Matunga kabutarkhana.

The city municipal corporation has fined nearly 150 people for flouting the ban.

‘Not animal haters’

Sometimes, the conflict between the pro- and anti- bird feeding camps has tipped over into violence.

On August 3, Premal Patel, a senior executive in a multinational company, registered a first information report against some members of his apartment complex on Mira Road.

He alleged that they had assaulted him with iron rods when he objected to them feeding the birds.

In the last nine months, the number of people feeding pigeons in the complex has grown.

“So, more and more pigeons now fly into our society,” Premal Patel said.

Their presence made him worried about his 70-year-old father’s health. “I am worried this will affect his lungs. He already has breathing problems.”

On August 3, his father clicked photographs of a local resident who was feeding pigeons in violation of the court order. That led to a heated argument and the alleged assault.

“We are not animal haters,” Premal said. “But there is a thin line between loving animals and encouraging an uncontrolled population that can harm humans.”

Lakshmi (name changed), a school headmistress, was well-known for her warmth, boundless energy and legendary parties. A few years after retirement, she began to wane with mild signs of cognitive decline, which quickly deteriorated into dementia after the loss of her husband.

Struggling with loneliness, the once vibrant woman was reduced to a hollow shell, losing her identity and sense of self. She could no longer remember words or names, and became occasionally aggressive. Unable to handle her behaviour changes, her relatives admitted her into an eldercare and dementia care facility, where she spent her last days in the midst of strangers.

Around 8.8 million Indians over the age of 60 – that is 7.4% of India’s elderly – currently live with dementia. This number is projected to rise as India ages – one in every five Indians will be a senior citizen by 2050, when the number of elderly Indians is expected to reach 340 million. It’s not just a burgeoning health crisis but also a societal challenge with immense implications for families, healthcare systems and the nation’s future productivity.

The World Health Organization defines dementia as “a term for several diseases that affect memory, thinking and the ability to perform daily activities”. It can be caused by conditions which over time destroy nerve cells and damage the brain.

The symptoms of dementia begin with forgetting things or events from the immediate or recent past. These episodes gradually increase in frequency and may be accompanied with mood or behaviour changes, all of which affect everyday functioning.

“Changes in behaviour can be challenging and can include aggression, agitation, hallucinations, delusions, and suspiciousness,” explained Soumya Hegde, a geriatric psychiatrist based in Bengaluru. “For example, they may have hidden their keys in a drawer or under the bed to keep it safe, and forget, so they accuse someone else of taking it.”

Why prevalence is rising

Based on the Longitudinal Aging Study in India conducted between 2018 and 2020, researchers from institutions in India and the United States found that dementia prevalence among women was almost double that of men, and higher in rural areas compared to the cities and towns.

The study also found considerable variation across the country, with lowest prevalence in Delhi at 4.5% and highest in Jammu and Kashmir at 11.0%.

Using population projections and data from the Longitudinal Aging Study in India, researchers estimate that India’s dementia prevalence among the elderly will double from 8.8 million in 2016 to 16.9 million in 2036.

“There has been a noticeable increase in dementia cases in India over the past five to 10 years,” Nilanjana Maulik, Secretary General of Alzheimer’s and Related Disorders Society of India Kolkata, said. “This can be attributed to several factors such as aging population, sedentary lifestyles, poor diets, social isolation, reduced family support, and mental health issues among older adults and increased prevalence of lifestyle diseases such as diabetes, hypertension and obesity – key risk factors for dementia.”

In 2017, the World Health Organization put out a Global Action Plan (2017 to 2025) on the Public Health response to dementia, and urged countries to come out with their own action plans. The WHO initiative outlines seven action areas: awareness and friendliness; risk reduction; diagnosis, treatment, care and support; information systems; research and innovation; support for carers; and dementia as a public health priority.

Aligning with the WHO’s action plan to promote research and innovation, the Indian Institute of Science’s Centre for Brain Research is conducting long-term studies on brain ageing, focused on capacity-building and risk reduction efforts. The research is specifically tailored to the Indian context.

This is important as most existing research in this area is from Western populations and there is a dearth of longitudinal population-based data from low- and middle-income countries, researchers say. The vast differences in lifestyle factors, diet, literacy, environmental stressors, and genetics render the findings from high-income settings ungeneralisable to low- and middle-income countries populations.

The research could help generate context-specific evidence that could inform global frameworks for brain health that are more diverse, equitable, and inclusive of low- and middle-income countries.

For example, the researchers explained that exploring how factors such as undernutrition, cardiovascular risks, multilingualism, and intergenerational living (which are far more prevalent in India than in many Western countries) impact cognitive processes can significantly strengthen the understanding of dementia risk across different populations.

Additionally, biomarker profiling and genomic characterisation from underrepresented populations would help build globally relevant risk prediction models, diagnostic tools, prevention approaches, and precision medicine.

The team is running two parallel urban and rural community-based long-term studies that aim to evaluate risk factors as well as protective factors of dementia and other related disorders among cognitively healthy individuals over the age of 45.

The Tata Longitudinal Study of Aging includes participants from urban Bengaluru and the Srinivaspura Aging, Neuro Senescence and COGnition study cohort includes individuals from the villages of Srinivaspura Taluk in Karnataka’s Kolar district.

The findings are still in the preliminary stage, but there is an indication of a high prevalence of non-communicable diseases such as hypertension, impaired blood sugars, dyslipidaemia, and obesity in both the urban and rural cohorts. Proportions of these NCDs were around 46% and 55% in rural and urban participants, respectively.

“This implies that roughly one in two older adults had metabolic syndrome, urban significantly more than rural,” the researchers wrote in a 2022 article in eClinicalMedicine, a journal part of The Lancet Discovery Science.

“The high prevalence of undiagnosed co-morbidities among rural adults is concerning, calling for urgent public health measures in this marginalised and health-disparate population.”

In a March 2025 article in the journal Acta Diabetologica, the team revealed that insulin resistance is associated with poorer cognitive performance related to auditory attention. Then, in an April 2025 article in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, the researchers showed that those with hearing loss are more likely to experience cognitive impairment compared to those without hearing loss.

These early findings are in line with the modifiable risk factors outlined by the 2024 Lancet Commission on Dementia, which include hypertension, traumatic brain injury, obesity, depression, social isolation, physical inactivity, diabetes, low literacy, hearing loss, among others.

Managing comorbidities like diabetes and vascular conditions is crucial, as they increase dementia risk, said Asha Dsouza, senior project manager and dementia care lead at Nightingales Medical Trust in Bengaluru. “Additionally, hearing impairment can exacerbate behavioural issues due to communication difficulties, while addressing hearing loss can improve cognitive function and quality of life.”

Awareness of the disease is key to developing interventions and managing the disease. Dsouza added that awareness about dementia is growing in cities like Bengaluru, leading to more families seeking diagnosis and care.

Why seeking help isn’t easy

Despite this growing awareness, there are multiple challenges when it comes to diagnosis. Misconceptions about normal aging versus dementia lead to delayed diagnosis, said Dsouza. “People with dementia often exhibit distinct memory patterns, such as vividly recalling childhood memories but struggling with recent events, often without insight into their memory loss.”

“In the beginning, most people are able to manage their daily functioning independently and the frequency of forgetting events/ names or conversations is sporadic,” said Hegde. "If a diagnosis of dementia is delayed, symptoms can become more severe.”

Early detection and diagnosis is important as interventions can delay rapid deterioration. Some underlying medical issues such as a metabolic deficiency, thyroid abnormalities, tumours, autoimmune conditions, or even depression can mimic dementia.

Hegde explained, “These need to be ruled out and appropriate treatment initiated. We don’t have a cure for dementia yet, but it is possible to manage the symptoms better, understand strategies to slow down the progression and help the person with dementia have a better quality of life.”

Caring for a family member with dementia can be challenging because of the behavioural challenges and loss of memory. Both patients and their families need support to manage the disease.

Centres like Nightingales and Alzheimer’s and Related Disorders Society of India provide services such as patient and caregiver counselling, training for family and professional caregivers and conduct memory screening and awareness programmes in local communities.

Apart from memory loss, 81-year-old Anand Mehta (name changed) had hallucinations, wandered out of his home occasionally, had trouble sleeping and would not let his wife sleep. “He refused to acknowledge his difficulties, and blamed others," his wife said. "It was very difficult to deal with him.”

Harrowed by his behaviour, she sought help from a geriatric psychiatrist. Through counselling and therapy, she learned practical strategies to dementia-proof their home. This included placing bells on the main door to alert her if he wandered out, and creating flashcards with words and names he struggled to recall. These interventions improved their ability to manage Mehta’s condition, bringing some much-needed relief to his wife.

However, Maulik of the Alzheimer’s and Related Disorders Society of India said, specialised clinics are scarce, especially in rural and semi-urban areas. Private neurological consultations and scans can be expensive. “Further, there is a strong social stigma attached to memory loss or mental illness, often leading to delayed help-seeking, isolation of the person, or even neglect.

The gap between demand and supply is vast and growing. A national network of dementia care services – anchored in the public health system and supported by public-private partnerships – is urgently required.”

Health systems need to improve

India has fewer than 50 full-fledged dementia care centres across the country, and they are unevenly distributed, with most located in major cities, run by private hospitals, or nonprofits, Maulik explained.

“The Kerala state government under the Vayomithram project runs mobile clinics including dementia screening and community support. ICCONS, a government‑linked neuroscience institute, provides cognitive disorder care, including dementia.”

She added that full-scale dementia care in India’s public health system remains limited, especially outside major cities. “There is no dedicated national policy for dementia and government health spending is low (~1% of GDP, with only 1%-2% of that on mental health), though there’s a pledge to increase this to 2.5% of GDP by 2025.

But there are encouraging signs – integration into Ayushman Bharat, National Program for Health Care for Elderly, and National Mental Health Program is being advocated, but implementation is still in early stages.”

IndiaSpend reached out to the Secretary, Ministry for Health and Family Welfare on July 15 regarding the current state of, and plans to enhance dementia care in government hospitals and centres. We will update this story when we receive a response.

“Current solutions, though few, are built for urban areas. There is a dire need for solutions for rural areas – because non-communicable diseases are not diagnosed or managed well, it is possible that dementia prevalence is more,” said Ramani Sundaram, executive director of Dementia India Alliance, a non-profit supporting dementia patients and their families. “But it is likely underreported due to poor awareness, limited diagnostic infrastructure and appropriate screening tools. If people in semi-urban and rural areas are to be reached, the government has to get involved.”

To address this gap in Karnataka to start with, Dementia India Alliance and National Institute for Mental Health And Neuro Sciences promoted advocacy with the Government of Karnataka and in 2023, the state government declared dementia as a public health priority.

“In continuation with this, a draft action plan for the state has been submitted by experts from NIMHANS, Dementia India Alliance and the Department of Health and Family Welfare, Government of Karnataka,” Prathima Murthy, director and professor of psychiatry at National Institute for Mental Health And Neuro Sciences said. “The implementation of the provisions in the action plan requires multi-sectoral intervention with the role of government, health professionals and non-governmental organisations.”

There are several other initiatives planned through National Institute for Mental Health And Neuro Sciences, Dementia India Alliance, Government of Karnataka, the Karnataka Brain Health Initiative and other stakeholders towards the implementation of the action plan, which is still an ongoing process, she explained.

“Some of these initiatives include training primary and community health centre staff and ASHA workers for initial screening and establishing pathways including memory clinics to reach as many people as possible,” Sundaram elaborated.

“The memory clinics work with patients and their families, help adhere to treatment plans, do meticulous follow-ups, provide family support and train caregivers to dementia proof their homes.” Aligning with the WHO action plan, the focus is also on creating awareness, promoting research, enhanced diagnosis, and capacity development.

The science shaping dementia care

The Centre for Brain Research is also working to address these focus areas. As the team continues to gather data on risk factors and protective factors, the findings could potentially shape age-specific cognitive screening protocols that could be incorporated into the state’s primary healthcare systems.

The researchers say substantial data on potential modifiable risk factors such as hypertension, diabetes, low-quality sleep, and lack of education could play a pivotal role in informing/designing targeted strategies such as state-level health promotion campaigns and lifestyle interventions for risk reduction.

Based on learnings thus far from its cohort studies, the Centre for Brain Research is planning to conduct a lifestyle-based non-pharmacological intervention study for dementia risk reduction (inspired by the World-Wide FINGERS trial).

The Centre for Brain Research’s collaboration with UK Dementia Research Institute on blood-based biomarkers that is just taking off, could pave the way for minimally invasive, scalable, and cost-effective methods for early diagnosis of dementia and other related neurodegenerative conditions. In this domain, efforts will also focus on developing scalable tests that move from conventional venous blood draws to simpler, at-home “finger-prick” methods.

Through national and international collaborations, the scientists aim to build AI infrastructure that may make cognitive testing and follow-up feasible in low-resource settings. They plan to team up with existing health programmes across the country. By combining their data, they hope to create a national source of information that can guide public health strategies, policy decisions, and scalable interventions for dementia prevention and healthy brain aging.

The researchers from the Centre for Brain Research say that in the long run, they aspire to extend the cohort studies to other regions of India, representing different linguistic, socio-cultural, and genetic groups in order to enhance the generalisability of the findings. The work of the Centre for Brain Research has implications not only for improved brain health outcomes in Karnataka and across India, but also for equity-centric global dementia prevention strategies.

Dementia is a life-altering disease. D’Souza of Nightingales said, “Public awareness, timely screening, and comprehensive care are essential for early detection, effective management, and creating a comprehensive care ecosystem for individuals with dementia and their families.”

Deepa Padmanaban is a Bangalore-based journalist who reports on environment and energy.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.

Your fitness tracker might be lying to you. That 10,000-step target flashing on your wrist? It didn’t come from decades of careful research. It came from a Japanese walking club and a marketing campaign in the 1960s.

A major new study has found that 7,000 steps a day dramatically cuts your risk of death and disease. And more steps bring even greater benefits.

People hitting 7,000 daily steps had a 47% lower risk of dying prematurely than those managing just 2,000 steps, plus extra protection against heart disease, cancer and dementia.

The findings come from the biggest review of step counts and health ever done. Researchers gathered data from 57 separate studies tracking more than 160,000 people for up to two decades, then combined all the results to spot patterns that individual studies might miss. This approach, called a systematic review, gives scientists much more confidence in their conclusions than any single study could.

So where did that magic 10,000 number come from? A pedometer company called Yamasa wanted to cash in on 1964 Tokyo Olympics fever. It launched a device called Manpo-kei – literally “10,000 steps meter”. The Japanese character for 10,000 resembles a walking person, while 10,000 itself is a memorable round number. It was a clever marketing choice that stuck.

At that time, there was no robust evidence for whether a target of 10,000 steps made sense. Early research suggested that jumping from a typical 3,000 to 5,000 daily steps to 10,000 would burn roughly 300 to 400 extra calories a day. So the target wasn’t completely random – just accidentally reasonable.

This latest research paper looked across a broad spectrum – not just whether people died, but heart disease, cancer, diabetes, dementia, depression and even falls. The results tell a fascinating story. Even tiny increases matter. Jump from 2,000 to 4,000 steps daily and your death risk drops by 36%. That’s a substantial improvement.

But here’s where it gets interesting. The biggest health benefits happen between zero and 7,000 steps. Beyond that, benefits keep coming, but they level off considerably. Studies have found meaningful benefits starting at just 2,517 steps per day. For some people, that could be as little as a 20-minute stroll around the block.

Age changes everything, too. If you’re over 60, you hit maximum benefits at 6,000 to 8,000 daily steps. Under 60? You need 8,000 to 10,000 steps for the same protection. Your 70-year-old neighbour gets 77% lower heart disease risk at just 4,500 steps daily.

The real secret of why fitness targets often fail? People give up on them.

Research comparing different step goals found a clear pattern. Eighty-five per cent of people stuck with 10,000 daily steps. Bump it to 12,500 steps and only 77% kept going. Push for 15,000 steps and you lose nearly a third of people.

One major study followed middle-aged adults for 11 years. Those hitting 7,000 to 9,999 steps daily had 50-70% lower death risk. But getting beyond 10,000 steps? No extra benefit. All that extra effort for nothing. Other researchers watching people over a full year saw the same thing. Step programmes worked brilliantly at first, then people slowly drifted back to old habits as targets felt unrealistic.

Most steps happen without realising it

Here’s something that might surprise you. Most of your daily steps don’t come from structured walks or gym sessions. Eighty per cent happen during everyday activities – tidying up, walking to the car, general movement around the house.

People naturally build steps through five main routes: work (walking between meetings), commuting (those train station treks), household chores, evening strolls and tiny incidental movements. People using public transport clock up 19 minutes of walking daily just getting around.

Research has also found something else interesting. Frequent short bursts of activity work as well as longer walks. Your body doesn’t care if you get steps from one epic hike or dozens of trips up the stairs. This matters because it means you don’t need to become a completely different person. You just need to move a bit more within your existing routine.

So, what does this mean for you? Even 2,500 daily steps brings real health benefits. Push up to 4,000 and you’re in serious protection territory. Hit 7,000 and you’ve captured most of the available benefits.

For older people, those with health conditions, or anyone starting from a sedentary baseline, 7,000 steps is brilliant. It’s achievable and delivers massive health returns. But if you’re healthy and can manage more, keep going. The benefits climb all the way up to 12,000 steps daily, cutting death risk by up to 55%.

The 10,000-step target isn’t wrong exactly. It’s just not the magic threshold everyone thinks it is.

What started as a Japanese company’s clever marketing trick has accidentally become one of our most useful health tools. Decades of research have refined that original guess into something much more sophisticated: personalised targets based on your age, health and what you can actually stick to.

The real revelation? You don’t need to hit some arbitrary target to transform your health. You just need to move more than you do now. Every single step counts.

Jack McNamara is Senior Lecturer in Clinical Exercise Physiology, University of East London.

This article was first published on The Conversation.

How much does your weight really say about your health? Probably less than you think. You could eat your five-a-day, hit the gym regularly, have textbook blood pressure and cholesterol levels – and still be dismissed as “unhealthy” based on the number on the scale. Meanwhile, someone with a so-called “healthy” weight might be skipping meals, running on stress and caffeine, and rarely moving their body.

We’ve been taught to equate thinness with wellness and excess weight with illness. But the science tells a more nuanced story – one where weight is just a single data point in a far more complex picture. So if weight alone doesn’t reflect how healthy we really are, what does?

Body weight is one of the most measured aspects of health. Society places huge emphasis on it, and criticism of a person’s weight is often framed as a health concern. So how much meaningful health information does weight actually offer?

Simply put, body weight measures exactly that – the total weight of a body. Changes in weight over time can give an indication of a person’s calorie intake. If they are gaining weight, they are eating more calories than they burn. If they are losing weight, they are burning more than they eat.

It is perhaps more useful to consider the health information weight doesn’t give us. Important health indicators, such as cholesterol, blood sugar, blood pressure and heart rate are not visible on the scales.

Neither does weight reflect the quality of someone’s diet. A person could be eating plenty of fruit, vegetables and whole foods, getting the vitamins and minerals needed for good energy, bone strength and immune function. Or they might not. They might be eating mostly healthy fats, like those found in olive oil, nuts and fish, which are linked to better heart health. Or they may get their fat from processed foods, high in saturated and trans fats, which increase the risk of heart disease. They may be getting plenty of fibre to support digestion, regulate their blood sugar and maintain healthy cholesterol, or they may be getting very little. Weight alone reveals none of these important dietary details.

Weight also doesn’t accurately reflect how much body fat someone carries, or more importantly, where that fat is located. Visceral fat (which surrounds the internal organs) is linked to a higher risk of heart disease, type 2 diabetes and some types of cancer, whereas subcutaneous fat, found just beneath the skin, poses fewer health risks.

Weight doesn’t give details about how much exercise someone does, which improves health even if it doesn’t lead to weight loss. Nor does weight reflect other major influences on health, like sleep quality or stress.

All of these factors are harder to measure than body weight, and far less visible at first glance, but they provide a much more meaningful picture of someone’s health.

This is not to say that there is no association between weight and these factors, but the link is not clear cut. Details such as someone’s diet quality or their activity patterns cannot be found by simply looking at their weight.

At a population level, there is a clear association between higher body weight and increased risk of disease. For instance, studies show that people classified as overweight or obese using body mass index (BMI), which is a measure of weight relative to height, tend to have higher rates of cardiovascular disease, type 2 diabetes and certain types of cancer.

Some people who are classified as overweight or obese have healthy blood pressure, cholesterol and blood sugar levels. This is often referred to as “metabolically healthy obesity”. On the other hand, someone with a “healthy” body weight might have high visceral fat, poor diet quality, or a sedentary lifestyle – increasing their health risks, despite appearing thin. Terms like “Tofi” (thin outside, fat inside) or “skinny-fat” have emerged to describe this.

These examples highlight how health cannot be judged accurately by weight alone. Someone eating a fibre-rich diet, high in vegetables, whole grains and healthy fats – all of which are linked to better health outcomes, might still fall into the “overweight” category, and be perceived as unhealthy simply because they eat more calories than they burn.

Conversely, a person eating a diet low in nutrients but not exceeding their calorie requirements may be considered a “healthy” weight. Which of these people would be viewed as healthy by society, and which by a doctor?

Why we think weight matters

So, why is so much emphasis put on a person’s weight? In truth, it probably shouldn’t be. However, it is a cheap and easy thing to measure, unlike blood tests, dietary assessments or body scans, which require more time, money and expertise. It’s not to say that more detailed tests are never carried out, but cost is usually a consideration.

Weight is also very visible. It is one of the few aspects of health that’s apparent to others at a glance. This makes it easy for society to pass judgement. But what is visible isn’t always what matters most. Societal ideas about what a “healthy” body looks like are deeply ingrained and not necessarily evidence based.

While losing weight as a result of healthy lifestyle modifications improves health, these modifications, such as increasing exercise and improving diet, have been shown to benefit health even if weight is not lost.

It has also been shown that the societal stigma surrounding obesity is not helpful in achieving weight loss, and can actually undermine it.

Therefore, if health really is the main concern, attention should shift away from weight as the primary focus and towards factors such as diet quality, physical activity, sleep and stress. Improvements in these areas can offer health benefits to people of all sizes.

Rachel Woods is Senior Lecturer in Physiology, University of Lincoln.

This article was first published on The Conversation.

Mumbai-based registered dietician and diabetes educator Shilpa Joshi faces a new conundrum. For more than two decades, she has been helping people living with diabetes navigate their diet and lifestyles as they manage the disease. However, in recent times, Joshi’s patients are approaching her with challenges that are beyond the dietician’s purview.

“It is raining in Mumbai and Pune now. In May, we experienced heavy rains and floods, and in March, people were suffering from heat exhaustion. With so many changes, it is difficult for patients to adhere to the diet and lifestyle protocols we recommend. Unseasonal rains have increased the price of most vegetables, and between the rains and the heat, physical activities, like walking, have become challenging. Not everyone can afford to go to gyms,” shares Joshi.

The day-to-day challenges outlined by Joshi provide a brief window into the life of a person living with diabetes in India under the shadow of climate change. According to a 2024 study published in The Lancet, India is home to 212 million people suffering from the disease, the highest in the world.

Further, there has also been a marked increase in the incidence of diabetes. Between 1990 and 2021, the prevalence of diabetes in India has gone up from 162.74 people to 264.53 people per 100,000 population. In the same period, mortality from the disease has also increased from 23.09 to 31.12 per 100,000 population.

Globally, several studies have examined the links between climate change and diabetes, however data from the Indian subcontinent is lacking. A 2017 US-based study showed that diabetes incidence increased by 0.314 per 1000 people for every 1 degrees celsius rise in temperature.

A 2019 study from Brazil showed that a 5 degrees celsius rise in daily mean temperatures led to a 6% increase in diabetes-related hospital admissions, primarily among the elderly. Similarly, a recent Kuwait-based study also found that hot days (>33 degrees celsius) contributed to an excess of 282 diabetic admissions annually.

Climate change diabetes

Among the most common non-communicable diseases in the world, diabetes or diabetes mellitus, refers to a group of metabolic disorders characterised by high blood glucose levels or hyperglycaemia.

The disease is broadly classified into type 1 and type 2 diabetes, denoting inadequate insulin production (type 1) or a combination of inadequate production and poor response to the produced insulin (type 2). Other categories also include prediabetes, where individuals are at a high risk of developing the disease, and gestational diabetes, marked by the presence of the disease during pregnancy.

Existing research indicates that climate change can have varying impacts on people living with the disease. In a review article, Ratter-Rieck et al show that extreme heat can increase the incidence of the disease.

The article explains that it also affects the patient’s response to heat stress due to impaired blood flow in the skin and abnormal sweating. Some studies mentioned in the review article point to increased hospital admissions, both in extreme heat and cold conditions, and additional impacts due to comorbidities as a result of kidney and cardiovascular issues.

Apart from temperature-related impacts, studies show that extreme weather events can also cause long-term disruptions in the patient’s health and impair glycaemic control, while increasing the risks for related complications.

Researchers now also warn that climate change can increase the incidence of infections globally. Fuelled by changing temperatures, rainfall patterns, as well as changes in animal migration patterns and coastal water temperatures, experts caution that physicians must be prepared for an altered landscape where infections will be on the rise along with the emergence of new ones.

This is particularly important for people living with diabetes, as the disease makes them more susceptible to infections. Diabetes is a risk factor for infectious diseases such as encephalitis, chikungunya, West Nile virus and dengue, and therefore, the impacts of climate change on disease risks of people living with diabetes warrants a separate focus.

Lack of data

While existing research shows that climate change can further complicate the pathophysiology of diabetes and its management in patients, significant gaps exist in our understanding of these interconnections, explains a review article by researchers from the US, UK, India and South Africa.

Based on data from 73 peer-reviewed human studies, the article shows that the majority of the observations exists from the North American and Caribbean regions. The researchers did not find relevant studies from India in their review and noted that most of the studies focused on high-income countries.

A 2023 study examining the links between air pollution and diabetes in two Indian cities, Chennai and Delhi, shows that both short and medium-term exposure to airborne particulate matter less than 2.5 micrometres in diameter, increases fasting plasma glucose levels and glycated haemoglobin (a measure of long-term blood sugar control). The study also shows that long-term exposure to air pollution increases the risk of developing the disease.

Commenting on the lack of observations from India, Siddhartha Mandal, lead author of the study and senior research scientist at Ashoka University, explains that epidemiological studies of this nature are sparse in the country not just for diabetes, but for other conditions as well.

With air pollution, for example, Mandal explains that lack of monitoring data hindered assessing exposure at the ambient level, and recent developments in satellite-based models have aided in reducing some of this gap.

“Climate change by itself encompasses air pollution, and it will have other systemic issues as well, such as changes in food and agricultural patterns. A one-degree change in temperature can set in motion several factors that may ultimately lead to the prevalence of diabetes. To study the combined effects of all these influences is a massive challenge. It is crucial to have quality health data to understand the impacts of these exposures and its outcomes,” explains Mandal.

While there is some increase in awareness on the impacts of air pollution and climate change on human health, it will take a while for the existing evidence to be collated for policy-level interventions in India, explains Mandal. “But, the efforts are ongoing,” he says.

An evolving landscape

In April 2025, the International Diabetes Federation, launched a working group to develop treatment recommendations and diagnostic criteria for a newly recognised category of diabetes called type 5 or Malnutrition Modulated Diabetes Mellitus.

With chronic undernutrition during the early stages of life being a leading cause for this category, the International Diabetes Federation states that the disease is prevalent among teens and young adults in low and middle-income countries.

Dr Nihal Thomas, senior professor of endocrinology at Christian Medical College, Vellore, and co-chair of the working group, explains that type 5 diabetes was first reported in 1955 in Jamaica and was later classified in 1985 by the World Health Organisation.

However, lack of physiological evidence and misdiagnosis as type 1 or 2 led to the classification being removed in 1999.

He adds that the renewed interest in type 5 diabetes is especially crucial for India. In a study of low birth rates among 44 low and middle-income countries, India had the third highest prevalence of low birth-weight births.

The Global Hunger Index 2024 also states that 13.7% of India’s population is undernourished, and 35.5% of children in the country under the age of five are stunted as a result of chronic undernutrition.

“If there is low birth weight followed by undernutrition during the developmental years, it is a double hit, increasing one’s risk for type 5 diabetes,” explains Dr Thomas. He adds that while other metabolic processes also contribute to the disorder, the role of dietary factors is of significance here and the impacts of climate change in this regard needs further investigation.

Several studies have highlighted the fact that climate change not only reduces agricultural productivity; it also diminishes the nutritional value of crops, thereby contributing to food insecurity and undernutrition.

Dr Thomas adds that looking at the links between climate change, undernutrition and the prevalence of diabetes will require more representative data at scale, which is challenging to obtain.

Furthermore, he also emphasises the need to understand these influences in urban and rural settings as they will lead to differences in the way the disease develops and progresses.

“While it is important to look at the links between diabetes and climate change, it is not that straightforward. If you list all the risk factors for type 2 diabetes, for example, you will find that every factor will be a confounder when you study the others. Diet assessments will also need to consider physical activity, and conducting accurate physical activity evaluations are very difficult. These studies need to be well-planned,” he adds.

Adding to the discussion, Charles E Leonard, associate professor of epidemiology at the Perelman School of Medicine in Philadelphia, emphasises the need for granular data so personalised diabetes management can factor in the individual’s environment.

“Focus on extreme temperatures has largely been limited to curbing excess physical activity and issues with storing insulin. So far, there has been very little specific focus on how unusually high or low ambient temperatures, for example, could impact diabetes treatment decisions,” he explains.

Apart from data generation, Leonard also emphasises the need for healthcare providers to build awareness among their patients.

“Healthcare providers may wish to educate their patients on potential risks of environmental extremes – and how such events (eg, a heatwave) in the setting of their chronic disease could place them at a disproportionate risk for harm. Furthermore, they may also consider designing personalised preparedness plans such that patients know the appropriate actions to take to manage their diabetes during extreme weather events,” he adds.

This article was first published on Mongabay.

We’re constantly told to “eat healthy” – but what does that actually mean? Even doctors sometimes struggle to offer clear, practical advice on which specific foods support health, why they work and what real benefits people can expect.

A growing body of research is starting to offer some answers. Along with colleagues, I have researched whether a group of plant compounds called flavan-3-ols could help lower blood pressure and improve blood vessel function. The results suggest these everyday compounds may have real potential for protecting heart health.

Flavan-3-ols – sometimes called flavanols or catechins – are natural plant compounds that belong to the flavonoid family. They’re part of what gives plants their colour and helps protect them from sunlight and pests.

For us, they show up in some of our most familiar foods: cocoa, green and black tea, grapes, apples and even some berries. That slightly tart or bitter note you taste in dark chocolate or strong tea? That’s flavan-3-ols at work.

Scientists have long been interested in their health effects. In 2022, the Cosmos trial (Cocoa Supplement and Multivitamin Outcomes Study), which followed over 21,000 people, found that cocoa flavanols, but not multivitamin supplements, reduced deaths from cardiovascular disease by 27%. Our study set out to dig even deeper, focusing specifically on their effects on blood pressure and endothelial function (how well blood vessels dilate and respond to blood flow).

We analysed data from 145 randomised controlled trials involving more than 5,200 participants. These studies tested a range of flavan-3-ol-rich foods and supplements, including cocoa, tea, grapes, apples and isolated compounds like epicatechin, and measured their effects on two key cardiovascular markers: blood pressure and flow-mediated dilation (FMD): a measure of how well the inner lining of blood vessels functions.

The studies ranged from short-term (a single dose) to longer-term interventions lasting weeks or months. On average, participants consumed about 586 mg of flavan-3-ols daily; roughly the amount found in two to three cups of tea, one to two servings of dark chocolate, two tablespoons of cocoa powder, or a couple of apples.

Regular consumption of flavan-3-ols led to an average drop in office blood pressure of 2.8 mmHg systolic (the top number) and 2.0 mmHg diastolic (the bottom number).

But for people who started with elevated blood pressure or diagnosed hypertension, the benefits were even greater with reductions of up to 6–7 mmHg systolic and 4 mmHg diastolic. That’s comparable to the effects of some prescription blood pressure medications and could significantly lower the risk of heart attacks and strokes.

We also found that flavan-3-ols improved endothelial function, with an average 1.7% increase in FMD after sustained intake. This benefit appeared even in participants whose blood pressure was already normal, suggesting these compounds may help protect blood vessels through multiple pathways.

Side effects were uncommon and typically mild, usually limited to minor digestive issues, suggesting that adding flavan-3-ol-rich foods to your diet is generally safe.

Supporting cardiovascular health

While the benefits were most pronounced in those with high blood pressure, even people with normal readings saw improvements in vascular function. This suggests flavan-3-ols may help prevent cardiovascular problems before they begin.

High blood pressure is one of the major drivers of heart disease worldwide, even at levels that don’t qualify as full-blown hypertension (140/90 mmHg or higher). Recent guidelines from the European Society of Cardiology now recognise that even “elevated” blood pressure (120–139 systolic and 70–89 diastolic) carries increased risk.

Lifestyle changes, particularly diet and exercise, are recommended by doctors as first-line strategies. But patients and even healthcare providers often lack clear, specific guidance on which foods truly make a difference. Our findings help fill this gap by showing that boosting flavan-3-ol intake through everyday foods may offer a simple, evidence-based way to support cardiovascular health.

What about supplements

Some studies tested supplements or isolated flavan-3-ol compounds, but these generally showed smaller effects than whole foods like tea or cocoa. This may be because other beneficial compounds in whole foods work together, enhancing absorption and effectiveness.

At present, it appears both safer and more effective to focus on getting flavan-3-ols from foods rather than high-dose supplements, especially for people taking medications, since interactions are not fully understood.

The studies we reviewed suggest that 500–600 mg of flavan-3-ols daily may be enough to see benefits. You could reach this by combining two to three cups of green or black tea, one to two servings (about 56g) of dark chocolate or two to three tablespoons of cocoa powder, two to three apples, plus other flavan-3-ol-rich fruits like grapes, pears and berries.

Small daily swaps, then, like trading a sugary snack for an apple and a piece of dark chocolate or adding an extra cup of tea, could gradually improve your heart health over time. Because flavan-3-ol content can vary between foods, monitoring your blood pressure at home may help you see if it’s making a difference for you.

More research is needed, particularly in people with diabetes, where the results were less consistent. We also need to better understand how flavan-3-ols interact with medications and whether even greater benefits can be achieved when combined with other healthy habits.

But the evidence is now strong enough to recommend flavan-3-ol-rich foods as part of a heart-healthy diet. As clinicians seek practical, affordable lifestyle strategies for patients, these findings bring us closer to the idea of using food as medicine.

Of course, flavan-3-ols aren’t a magic fix. They won’t replace medication for everyone. But combined with other healthy habits, they may offer a meaningful – and delicious – boost to cardiovascular health. And unlike many health fads, this isn’t about exotic superfoods or expensive powders. It’s about foods many of us already enjoy, used a little more intentionally.

Christian Heiss is Professor of Cardiovascular Medicine, Head of Department of Clinical and Experimental Medicine, University of Surrey.

This article was first published on The Conversation.

This article was originally published in Rest of World, which covers technology’s impact outside the West.

Mahbubur Rahman is used to the rhythms and interruptions of running a telemedicine center on the northern fringe of the Sunderbans, the world’s largest mangrove forest.

At the government-funded hospital in Dacope, Bangladesh, the internet sometimes cuts out for days. Or the power goes out, like it did one recent morning in May, with more than a dozen patients waiting.

Rahman, a 36-year-old administrator, technician, and all-around troubleshooter at Dacope’s telehealth clinic told them to hold on.

No one complained. Rahman is widely respected, and they knew he didn’t have to be there. He hasn’t been paid since January. Bangladesh’s health sector has been beset by crisis since a new government came to power last August. It was further worsened when the US Agency for International Development, which gave around $88 million yearly to Bangladesh’s health programmes between 2021 and 2023, halted funding in January.

The health ministry has so far not funded the telehealth programme, which treated more than 8,000 patients a month during its peak years after the Covid-19 pandemic. Rahman has struggled to keep the Dacope clinic running.

“I find a deep sense of joy in serving. Even though I’m not able to provide the same quality of care as before, I can’t bear the thought of the centre closing completely,” he told Rest of World.

“But we have no food on our plates. We can’t show this hardship to anyone,” he said.

Telemedicine, which includes virtual consultations and other remote health care technologies, surged in popularity worldwide during Covid-19 as millions went online to visit doctors. It was the future of health care, experts said, especially in poorer regions, but it is often hampered by poor infrastructure, lack of funding, and digital illiteracy.

In Bangladesh, too, the modestly named “telemedicine service” got a boost during the pandemic, Israt Jahan Kakon, who heads the telemedicine programme at the Directorate General of Health Services, told Rest of World. By 2024, there were 234 such centers across the country, and they treated more than 100,000 patients last year. It was Bangladesh’s longest-running telehealth programme.

The centres, located within subdistrict hospitals, had a computer and LED screen for video conferencing, a backup battery, a 2 Mbps internet connection, and an assortment of smart devices for remote monitoring, including a stethoscope, an ECG machine, and a spirometer.

But with the funding crisis, only about 35 centres have survived, kept on life support by unpaid staff who occasionally open the clinics, leading to uncertainty about the future of this programme in Bangladesh. Rural residents who used the centres earlier told Rest of World they are no longer receiving sufficient care.

“Without strong policy backing or well-thought-out planning, telemedicine has yet to reach its full potential in Bangladesh. It’s an idea with promise, but it needs much more support to become truly effective and accessible,” MH Choudhury Lelin, a doctor and public health expert who was not involved in the programme, said.

Bangladesh’s government spent just 0.7% of its gross domestic product on health care last year, among the lowest in the world but similar to other lower-income nations, such as Pakistan and Nigeria.

Virtual care makes sense for the nation, where 68% of the population lived outside cities in 2022. Millions of working-class people find traveling to the capital Dhaka or other cities too expensive, especially for chronic conditions that require regular checkups.

Bangladesh also suffers from a severe shortage of doctors, with only five available to treat every 10,000 people – much lower than the global average of 17. The scarcity is even worse in rural areas.

“Hospitals are often far from rural villages. Normally, patients are referred to [city] hospitals when a specialist is needed, but through this telemedicine system, they could access specialist care without leaving their [area],” Kakon said.

The Dacope clinic is set in the busy town on a low-lying riverine island in the Ganges delta. The water here is so saline that many residents develop skin infections due to constant salt exposure.

But Dacope does not have a dermatologist. In fact, the town has only one specialist – an orthopedist – and 10 vacancies, according to Sudip Kumar Bala, Dacope’s health officer.

The telehealth center, launched in 2011, provided some relief. Local doctors would refer patients to the clinic, where a medical officer would connect them to a dermatologist in a distant city. The doctors would decide on a course of treatment together, either prescribing medicines or referring to a hospital. Skin disorders are easier than other conditions to diagnose using only photos, without other diagnostic tests.

Rahman, then 21 and a second-year university student of philosophy, was hired to run it. Fifteen years on, he is well-known and respected by villagers, army officials and administrators alike. He liaises between patients and physicians, gently asking people to put up with the constant delays caused by recurring tech failures. He also does basic nursing tasks such as measuring blood pressure, taking photographs of affected areas, and organising the material for the physician.

One morning, while waiting for the power to be restored, physician Selim Reza praised the center. “For just 10 taka [8 cents], patients can speak directly to a senior doctor while sitting in their local health center,” he told Rest of World. “For many, it feels like a dream.”

As Rahman switched on the battery backup, the LED screen blinked to display a dermatologist in the nearby city of Barishal. Reza presented the case of Sagar Chandra Mondal, a middle-aged farmer and tutor who had a persistent, generalised itch.

The dermatologist suggested medicines, which Reza prescribed.

Mondal said the treatment was a “blessing.”

“Getting specialist care without having to travel far is very important for us. We are working-class people,” he told Rest of World.

Then, the battery drained and the power went out.

Reza said the internet, too, is slow and unreliable, sometimes making it difficult to diagnose. “Sometimes, it is really hard to understand the voice and see the photo due to slow internet speed,” he told Rest of World.

Rahman unlocked a cupboard in a corner and pulled out the internet-connected diagnostic medical devices, including a stethoscope and a microscope the clinic received a decade ago. But the government never provided the software to run them, so they are kept in storage, he said.

The clinic, like most of rural Bangladesh, has a 2 Mbps internet connection provided by Bangladesh Telecommunications Company Limited, the nation’s largest telecom provider, which maintains a 38,000-kilometre fiber-optic network. But the cables are vulnerable to the delta’s ferocious storms, leading to regular power and internet outages. And there is only one repair technician for the entire district, where 2.6 million people live.

“We don’t have enough manpower,” MD Jubaer Ahmed, an assistant manager at the telecom company, told Rest of World.

The internet is among the biggest barriers to telemedicine in Bangladesh, BM Mainul Hossain, director of the Institute of Information Technology at the University of Dhaka, told Rest of World.

“Because of internet speed issues, telemedicine services are inconvenient for many, so they are a little reluctant [to use it],” he said. “Since patients are seen from a distance, it is important that the internet not be inconvenient for both the patient and the doctor. Otherwise, there is a risk of misdiagnosis.”

Satellite internet provided by Starlink has recently launched in Bangladesh, but it costs at least twice the price of the cable connection.

Despite its bare bones setup, the center treated as many as 300 patients every month at its peak, Rahman said, confirming, “So many patients depend on it, and they would truly suffer without it.”

Shah Ali Akbar Ashrafi, director of management information systems in the health department, said the ministry has not committed to restoring the telehealth service.

“We have written several letters, but no decision has been made at the relevant levels of the government yet. As a result, we still do not know its future,” Ashrafi told Rest of World.

A three-hour drive by road from Dacope leads to a telehealth clinic at Bagerhat, which has fared poorly compared to its neighbor. Cobwebs hung from the ceiling, and a layer of dust covered the furniture and equipment. The internet has been cut.

Pranto Mondal, 25, the administrator who ran the center, told Rest of World he stopped getting paid last August and quit in February.

“I kept going for nearly six months, hoping things would get better. But, honestly, how long can someone keep pushing through like this?” he said.

Jesmin Papri is a Labor x Tech reporter based in Dhaka, Bangladesh.

This article was originally published in Rest of World, which covers technology’s impact outside the West.

For years, people living with obesity have been given the same basic advice: eat less, move more. But while this mantra may sound simple, it’s not only ineffective for many, it can be deeply misleading and damaging.

Obesity is not just about willpower. It’s a complex, chronic, relapsing condition and affects around 26.5% of adults in England, and 22.1% of children aged ten–11 in England.

A new report estimates the rapidly growing number of people that are overweight or obese costs the UK £126 billion a year. This includes £71.4 billion in reduced quality of life and early mortality, £12.6 billion in NHS treatment costs, £12.1 billion from unemployment and £10.5 billion in informal care.

Food campaigners and health experts have called for urgent government action, including expanding the sugar tax to more products, restricting junk food advertising and mandating reformulation of ultra processed foods. As Henry Dimbleby, author of a government-commissioned independent report called the National Food Strategy, warned: “We’ve created a food system that’s poisoning our population and bankrupting the state.”

Without significant policy change, these costs are projected to rise to £150 billion a year by 2035. Despite this, much of the UK’s approach continues to frame obesity as a lifestyle issue that can be tackled by emphasising personal responsibility. But this framing ignores the bigger picture.

We now understand that obesity is multifactorial. Genetics, childhood experiences, cultural norms, economic disadvantage, psychological health, mental illness and even the kind of job you have all play a role. These aren’t things you can simply change with a Fitbit and salad.

This broader perspective isn’t new. In 2007, the UK government’s Foresight report mapped out the complex web of factors behind rising obesity rates, describing how modern environments actively promote weight gain.

This “obesogenic environment” refers to the world we live in. Its one where high-calorie, low-nutrient foods are cheap and everywhere, and where physical activity has been engineered out of everyday life, from car-centric cities to screen-dominated leisure time.

These environments don’t affect everyone equally. People in more deprived areas are significantly more exposed to conditions that drive obesity, such as food deserts (areas with limited access to affordable, nutritious food), poor public transport and limited green space. In this context, weight gain becomes a normal biological response to an abnormal environment.

Why ‘eat less, move more’ falls short

Despite growing awareness of these systemic issues, most UK obesity strategies still centre on individual behaviour change, often through weight management programmes that encourage people to cut calories and exercise more. While behaviour change has a place, focusing on it exclusively creates a dangerous narrative: that people who struggle with their weight are simply lazy or lack willpower.

This narrative fuels weight stigma, which can be incredibly harmful. Yet data shows a clear link between higher rates of obesity and deprivation, especially among children.

It’s clear many people still don’t understand the role of structural and socioeconomic factors in shaping obesity risk. And this misunderstanding leads to judgement, shame and stigma, especially for children and families who are already vulnerable.

Good obesity care

Instead of outdated advice and blame, we need a holistic, stigma-free and science-informed approach to obesity care, one that reflects current Nice guidelines and the Obesity Health Alliance’s recommendations. There are several things that need to be done.

First, we should recognise obesity as a chronic disease. Obesity is not a failure of willpower. It’s a relapsing, long-term medical condition. Like diabetes or depression, it requires structured, ongoing support, not short-term fixes or crash diets.

Second, we need to tackle weight stigma head-on. Weight-based discrimination is widespread in schools, workplaces and even healthcare settings. We need training for professionals to reduce bias, promote inclusive care and adopt person-centred, non-stigmatising language. Discriminatory practices must be challenged and eliminated.

Third, deliver personalised, multidimensional support. Treatment plans should be tailored to each person’s life, including their cultural background, psychological history and social context. This includes shared decision-making, regular follow-up and integrated mental health support.

And fourth, focus on changing the environment, not just people. We must shift the focus to the systems and structures that make healthy choices so hard. That means investing in affordable, nutritious food; improving access to physical activity; and tackling inequality at its roots.

Systemic shift

Obesity isn’t just about what people eat or how often they exercise. It’s shaped by biology, experience and the environment we build around people. Framing it as a personal failure not only ignores decades of evidence – it actively harms the very people who need support.

If we want to reduce stigma, improve health outcomes – and avoid a £150bn crisis – then the “eat less, move more” era must come to an end. What we need instead is a bold, compassionate, evidence-based systems approach – one that sees the whole person and the world they live in.

Lucie Nield is Senior Lecturer in Nutrition and Dietetics, University of Sheffield.

Catherine Homer is Associate Professor of Obesity and Public Health, School of Sport and Physical Activity , Sheffield Hallam University.

This article was first published on The Conversation.

You’re standing at your front door, facing a five kilometre commute to work. But you don’t have your car and there’s no bus route. You can walk for an hour – or jump on your bicycle and arrive in 15 minutes, barely breaking a sweat. You choose the latter.

Many people would make the same choice. It’s estimated that there are more than a billion bikes in the world. Cycling represents one of the most energy-efficient forms of transport ever invented, allowing humans to travel faster and farther while using less energy than walking or running.

But why exactly does pedalling feel so much easier than pounding the pavement? The answer lies in the elegant biomechanics of how our bodies interact with this two-wheeled machine.

A wonderfully simple machine

At its heart, a bicycle is wonderfully simple: two wheels (hence “bi-cycle”), pedals that transfer power through a chain to the rear wheel, and gears that let us fine-tune our effort. But this simplicity masks an engineering that perfectly complements human physiology.

When we walk or run, we essentially fall forward in a controlled manner, catching ourselves with each step. Our legs must swing through large arcs, lifting our heavy limbs against gravity with every stride. This swinging motion alone consumes a lot of energy. Imagine: how tiring would it be to even swing your arms continuously for an hour?

On a bicycle, your legs move through a much smaller, circular motion. Instead of swinging your entire leg weight with each step, you’re simply rotating your thighs and calves through a compact pedalling cycle. The energy savings are immediately noticeable.

But the real efficiency gains come from how bicycles transfer human power to forward motion. When you walk or run, each footstep involves a mini-collision with the ground. You can hear it as the slap of your shoe against the road, and you can feel it as vibrations running through your body. This is energy being lost, literally dissipated as sound and heat after being sent through your muscles and joints.

Walking and running also involve another source of inefficiency: with each step, you actually brake yourself slightly before propelling forward. As your foot lands ahead of your body, it creates a backwards force that momentarily slows you down. Your muscles then have to work extra hard to overcome this self-imposed braking and accelerate you forward again.

Kissing the road

Bicycles use one of the world’s great inventions to solve these problems – wheels.

Instead of a collision, you get rolling contact – each part of the tyre gently “kisses” the road surface before lifting off. No energy is lost to impact. And because the wheel rotates smoothly so the force acts perfectly vertically on the ground, there’s no stop-start braking action. The force from your pedalling translates directly into forward motion.

But bicycles also help our muscles to work at their best. Human muscles have a fundamental limitation: the faster they contract, the weaker they become and the more energy they consume.

This is the famous force-velocity relationship of muscles. And it’s why sprinting feels so much harder than jogging or walking – your muscles are working near their speed limit, becoming less efficient with every stride.

Bicycle gears solve this problem for us. As you go faster, you can shift to a higher gear so your muscles don’t have to work faster while the bike accelerates. Your muscles can stay in their sweet spot for both force production and energy cost. It’s like having a personal assistant that continuously adjusts your workload to keep you in the peak performance zone.

Walking sometimes wins out

But bicycles aren’t always superior.

On very steep hills of more than about 15% gradient (so you rise 1.5 metres every 10 metres of distance), your legs struggle to generate enough force through the circular pedalling motion to lift you and the bike up the hill. We can produce more force by pushing our legs straight out, so walking (or climbing) becomes more effective.

Even if roads were built, we wouldn’t pedal up Mount Everest.

This isn’t the case for downhills. While cycling downhill becomes progressively easier (eventually requiring no energy at all), walking down steep slopes actually becomes harder.

Once the gradient exceeds about 10% (it drops by one metre for every ten metres of distance), each downhill step creates jarring impacts that waste energy and stress your joints. Walking and running downhill isn’t always as easy as we’d expect.

Not just a transportation device

The numbers speak for themselves. Cycling can be at least four times more energy-efficient than walking and eight times more efficient than running. This efficiency comes from minimising three major energy drains: limb movement, ground impact and muscle speed limitations.

So next time you effortlessly cruise past pedestrians on your morning bike commute, take a moment to appreciate the biomechanical work of art beneath you. Your bicycle isn’t just a transport device, but a perfectly evolved machine that works in partnership with your physiology, turning your raw muscle power into efficient motion.

Anthony Blazevich is Professor of Biomechanics, Edith Cowan University.

This article was first published on The Conversation.

The Union health ministry has urged all government departments, autonomous bodies and ministries to display details about how much oil, sugar and fats are present in snacks in their cafeterias and meeting rooms to tackle obesity.

In a letter on June 21, Union Health Secretary Punya Salila Srivastava said that “we are proposing display of Sugar and Oil Boards initiative to promote healthier dietary habits in various settings”.

Srivastava said that the boards would serve as “visual behavioural nudges in schools, offices, public institutions, etc., displaying key information about hidden fats and sugars in everyday foods”.

Additionally, the Press Information Bureau clarified on Tuesday that the Union government had not issued any directives to display health warnings on deep-fried snacks like samosas and jalebis.

This came after several media reports on Monday claimed that the health ministry had ordered cigarette-style health warnings on Indian snacks.

The general advisory is not specifically for any particular food products, said the Press Information Bureau.

“It does not target India’s rich street food culture,” it added.

In the advisory to departments, ministries and autonomous bodies, the Centre ordered to print health messages on all official stationery, including letterheads, envelopes, notepads, folders and publications to reinforce daily reminders on fighting obesity.

The letter asked them to provide healthier options, including fruits and vegetables, in their offices, while limiting the availability of sugary drinks and high-fat snacks.

It further called for the promotion of physical activities such as the use of stairs, short exercise breaks and facilitating walking routes.

Srivastava referred to a study published in The Lancet in March, which predicted that nearly 45 crore Indians could be overweight or obese by 2050. This would mean that India is likely to have the second-highest number of overweight and obese people in the world, after China.

Obesity significantly increases the risk of non-communicable diseases such as diabetes, heart disease, kidney and liver problems, and certain cancers. It also affects mental health, mobility and quality of life.

The campaign undertaken by the ministry will first be rolled out at the All India Institute of Medical Sciences in Nagpur, The Hindu reported. An unidentified ministry official told the newspaper that the campaign was expected to expand to other cities later this year.

Cancer is traditionally known as a disease affecting mostly older people.

But some worrying trends show cancer rates in younger people aged under 50 are on the rise.

This week’s ABC 4 Corners suggest chemicals, including plastics, may play a role in rising rates of these early-onset cancers.

So what does the evidence say is causing this increase? And what can we do about it?

Cancer and older people

Each cell in your body contains a copy of your DNA – the instructions needed to keep that cell functioning properly.

However, DNA can be damaged or “mutated” in such a way that a cell will no longer do the job it’s supposed to.

Some mutations will allow a cell to make too many copies of itself and grow out of control. Others can protect it from dying. And others still allow it to move around and travel to other organs where it doesn’t belong.

Accumulating too many of these DNA mutations can lead to cancer.

Every time a new cell is made in our body, a copy of our DNA is made too. Sometimes, due to random chance, mistakes occur which introduce genetic mutations.

Think of it like making a photocopy of a photocopy, and so on. Each copy will be slightly different than the original.

Most DNA mutations are harmless.

But your cells are making billions of new copies of themselves each day. So the older you get, the more DNA copies you will have made during your lifetime, and the more likely you are to have dangerous mistakes in those copies.

As we get older, our bodies aren’t as good at recognising and removing cells with dangerous mutations. That’s why cancer is much more common in older people.

Cancer in young people

One of the reasons increased cancer rates in younger people is so worrying is it means there are likely environmental factors involved we don’t yet know about.

Environmental factors are anything outside of our bodies: things such as chemicals, viruses and bacteria, the amount we exercise, and the foods we eat.

Many of these environmental factors can increase the likelihood of DNA copying mistakes, or even directly damage our DNA, increasing our risk of cancer.

One well-known example is ultraviolet (UV) radiation from the sun, which can lead to skin cancer. Another is smoking, which can lead to lung cancer.

Fortunately, public awareness campaigns about the dangers of sun exposure, and reduced rates of people smoking cigarettes, have led to falling numbers of skin and lung cancer cases in Australians under 50 over the past 30 years.

But other types of cancer – including cancers of the liver, pancreas, prostate, breast and kidney – are increasing in young people in Australia. The trend is global, particularly among richer, western countries.

What role do chemicals play?

Researchers are working to understand the causes of these increases. Currently, chemicals are in the spotlight as an environmental factor of particular interest.

We’re exposed to more chemicals in the modern day than many of our ancestors were – things such as air pollution, food additives, plastics and many more.

Alcohol and cigarette smoke aside, most chemicals that are definitively linked to cancer are not ones most people would regularly encounter, as they’re restricted to spaces such as industry.

One of the main chemicals of concern are plastics, which are ubiquitous: almost everyone encounters them, every day.

Experts agree plastics represent an overall massive general risk to human health and the environment.

But there are so many thousands and thousands of plastics, it’s hard to point fingers at specific ones causing specific problems, including cancers.

Studies using animals can give strong evidence one way or another. But in humans who are exposed to thousands of different environmental factors every day, it’s difficult to definitively state “risk factor X contributes to cancer Y”.

So, it’s not possible to point to a single “smoking gun” in the case of the increasing early-onset cancer rates.

Let’s use colorectal cancer (also called bowel cancer) as an example to illustrate the issue.

Bowel cancer in young people

In older people, bowel cancer rates are actually falling. This is thought to be in part due to improved testing and screening helping to catch and destroy dangerous cells before they actually become cancer.

But early-onset bowel cancer rates are rising.

Some people speculate this may be due to increased exposure to plastics, as the digestive system is exposed to these through the food we eat. This includes things such as nano- or micro-plastics, or chemicals leaching out of the plastics into foods, such as PFAS (per- and poly-fluoroalkyl substances).

But there are other potential culprits, such as diet and lifestyle, with obesity and alcohol intake correlating with increased cancer rates.

Bacteria may also play a role: the types of bacteria found in your microbiome are thought to contribute to bowel cancer risk. Even exposure to certain bacterial toxins has been linked to bowel cancer risk.

Reducing risk

While there is no definitive evidence linking chemicals to increased cancer risk in young people, this is an area of intense ongoing research. Reducing your use of and exposure to plastics and chemicals where possible is still probably a healthy thing to do.

On top of that, you can reduce your overall cancer risk through regular exercise and maintaining a healthy, balanced diet.

If you have any concerns, and particularly if you have a family history of cancer, consult your doctor.

Sarah Diepstraten is Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research).

John (Eddie) La Marca is Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)

This article was first published on The Conversation.

There’s long been evidence that what we eat can affect our risk of dementia, Alzheimer’s disease and cognitive decline as we age. But can any one diet actually keep the brain strong and lower dementia risk? Evidence suggests the so-called “Mind diet” might.

The Mind diet (which stands for the Mediterranean-Dash intervention for neurocognitive delay) combines the well-established Mediterranean diet with the “Dash” diet (dietary approaches to stop hypertension). However, it also includes some specific dietary modifications based on their benefits to cognitive health.

Both the Mediterranean diet and Dash diet are based on traditional eating patterns from countries which border the Mediterranean sea.

Both emphasise eating plenty of plant-based foods (such as fruits, vegetables, nuts and seeds), low-fat dairy products (such as milk and yoghurts) and lean proteins including fish and chicken. Both diets include very little red and processed meats. The Dash diet, however, places greater emphasis on consuming low-sodium foods, less added sugar and fewer saturated and trans-fats to reduce blood pressure.

Both diets are well-researched and shown to be effective in preventing lifestyle-related diseases – including cardiovascular disease and hypertension. They’re also shown to help protect the brain’s neurons from damage and benefit cognitive health.

The Mind diet follows many of the core tenets of both diets but places greater emphasis on consuming more foods that contain nutrients which promote brain health and prevent cognitive decline, including:

• flavonoids and polyphenols found in fruit, vegetables, tea and dark chocolate

• folate found in leafy greens and legumes

• N-3 polyunsaturated fatty acids found in oily fish, nuts and seeds.

Numerous studies have been conducted on the Mind diet, and the evidence for this dietary approach’s brain health benefit is pretty convincing.

For instance, one study asked 906 older adults about their usual diet – giving them a “Mind score” based on the number of foods and nutrients they regularly consumed that are linked with lower dementia risk. The researchers found a link between people who had a higher Mind diet score and slower cognitive decline when followed up almost five years later.

Another study of 581 participants found that people who had closely followed either the Mind diet or the Mediterranean diet for at least a decade had fewer signs of amyloid plaques in their brain when examined post-mortem. Amyloid plaques are a key hallmark of Alzheimer’s disease. Higher intake of leafy greens appeared to the most important dietary component.

A systematic review of 13 studies on the Mind diet has also found a positive association between adherence to the Mind diet and cognitive performance and function in older people. One paper included in the review even demonstrated a 53% reduction in Alzheimer’s disease risk in those that adhered to the diet.

It’s important to note that most of this research is based on observational studies and food frequency questionnaires, which have their limitations in research due to reliability and participant bias. Only one randomised control trial was included in the review. It found that women who were randomly assigned to follow the Mind diet over a control diet for a short period of time showed a slight improvement in memory and attention.

Research in this field is ongoing, so hopefully we’ll soon have a better understanding of the diet’s benefits – and know exactly why it’s so beneficial.

Mind your diet

UK public health guidance recommends people follow a balanced diet to maintain good overall health. But the Mind diet offers a more targeted approach for those hoping to look after their cognitive health.

While public health guidance encourages people to eat at least five portions of fruit and vegetables daily, the Mind diet would recommend choosing leafy green vegetables (such as spinach and kale) and berries for their cognitive benefits.

Similarly, while UK guidance says to choose unsaturated fats over saturated ones, the Mind diet explicitly recommends that these fats come from olive oil. This is due to the potential neuroprotective effects of the fats found in olive oil.

If you want to protect your cognitive function as you age, here are some other small, simple swaps you can make each day to more closely follow the Mind diet:

• upgrade your meals by sprinkling nuts and seeds on cereals, salads or yoghurts to increase fibre and healthy fats

• eat the rainbow of fruit and vegetables, aiming to fill half your plate with these foods

• canned and frozen foods are just as nutrient-rich as fresh fruits and vegetables

• bake or airfry vegetables and meats instead of frying to reduce fat intake

• opt for poly-unsaturated fats and oils in salads and dressings – such as olive oil

• bulk out meat or meat alternatives with pulses, legumes chickpeas or beans. These can easily be added into dishes such as spaghetti bolognese, chilli, shepherd’s pie or curry

• use tinned salmon, mackerel or sardines in salads or as protein sources for meal planning.

These small changes can have a meaningful impact on your overall health – including your brain’s health. With growing evidence linking diet to cognitive function, even little changes to your eating habits may help protect your mind as you age.

Aisling Pigott is Lecturer, Dietetics, Cardiff Metropolitan University.

Sophie Davies is Lecturer in Nutrition & Dietetics, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University.

This article was first published on The Conversation.

The death toll from extreme heat events always makes the headlines. But what happens when you’re on the brink of joining that number, and are brought back from the edge?

Devi Prasad Ahirwar, a 55 year-old former security guard, collapsed from a heat stroke in Delhi last year during one of the country’s worst and most prolonged episodes of extreme heat.

Unconscious, with a dangerously high fever, he spent six days on a ventilator before miraculously gaining consciousness. He’d survived despite the odds, experts said.

A year later, however, the heat stroke isn’t entirely behind him. Survival gave Devi Prasad a second chance at life, but it’s a life marred by strange new afflictions his family is learning to live with.

The severity of his heat stroke has resulted in rare neurological side-effects – he can no longer speak clearly, write, or get up from the floor without feeling dizzy. To walk, he now uses the help of a stick when in the past, he could walk for kilometres on end without tiring.

He now spends his days mostly silent and resting, or walking up and down the courtyard outside his village home. “He was a healthy man before he collapsed,” said Binodi Ahirwar, his wife. “It’s been a year of taking him to doctors, doing scans. When will he get better?”

The long-term neurological and physiological impacts of heat stroke are not well-studied among survivors in India, even though research points to the existence of debilitating residual effects. Though rare, Devi Prasad’s case isn’t the only one, Mongabay India found.

An incomplete recovery

When the body’s internal temperature breaches 40 degrees celsius, it can cause cellular breakdown and multi-organ failure if left untreated. In such cases, the central nervous system is especially susceptible to damage.

“A heat stroke can cause direct injury to the brain because at high internal temperatures, the electrical activity of nerve cells is affected,” explained Atri Chatterjee, assistant professor of neurology at Vardhaman Mahavir Medical College and Safdarjung Hospital. “Unlike most other neurological disorders, a heat stroke can affect the entire brain at once, though certain parts of the brain, like the cerebellum, are more sensitive to heat.”

In the months following his heat stroke, Devi Prasad gradually regained his strength and was able to walk, take himself to the bathroom, and eat. But he never regained his speech, and his gait is unsteady. In conversation, he can comprehend, but not contribute. When he opens his mouth to say something, the words are distorted, and his family struggles to interpret.

No longer fit to resume guard duties, he returned to his village in Tikamgarh, a drought-prone district in Madhya Pradesh where outmigration is rampant. From the cramped quarters of his room in New Delhi, Devi Prasad and his wife now live in the cramped quarters of their village, with a single tree for shade. “It can become hot here too, especially when the electricity goes,” said Roshani, Devi Prasad’s daughter, who is a street vendor selling samosas.

Three weeks ago, as she fried samosas over hot oil under a relentless sun, she began to feel dizzy. “My husband and I were terrified after seeing what happened with my father,” she said, adding, “I sat myself in front of the cooler immediately. I didn’t want to risk landing up in the same situation.”

To seek a solution to his father’s problem, Devi Prasad’s eldest son, Sanjay, a construction worker, has ferried his father from doctor to doctor across three cities – Delhi, Bhopal, and Gwalior – collecting a growing pile of papers and prescriptions, all paid for by dwindling savings. But none of them carry a cure. The recommended treatment – speech and physiotherapy – is difficult to come by in Tikamgarh.

An MRI scan revealed chronic small-vessel ischemic changes in his brain, a condition that can result in restricted blood flow to the brain and, depending on the severity, cause problems with cognition, speech, and movement. In the absence of a clear case history, however, directly attributing this condition to a heat stroke is challenging.

“The doctors have asked us to do the MRI scan again to check his brain, but it costs so much money. We haven’t been able to do it,” said Binodi.

Outside his immediate family, Devi Prasad’s story doesn’t serve as much of a cautionary tale, said Neha Ahirwar, a neighbour who recently completed her training as a nurse. “People don’t really understand the severity of heat stroke here. No one thinks it will happen to them.” And even if they do, they have no option but to work.

Central nervous system

Symptoms such as slurred speech and poor coordination in the aftermath of a heat stroke are consistent with damage to the cerebellum, several doctors told Mongabay India.

Located at the base of the brain, the cerebellum controls balance, posture, and coordination, and hosts a large number of Purkinje cells. These unique neurons play a fundamental role in motor movement, but are easily damaged when exposed to high temperatures.

“Damage to the cerebellum due to heat stroke can lead to the appearance of people being very unsteady, and could lead to permanent disorders of coordination, walking, and other activities. But this depends on the individual, and the consequences will depend on which other parts of the brain might have been affected,” said Sanjay Sisodiya, Professor at the UCL Queen Square Institute of Neurology who has researched the links between climate change and neurological disorders.

A little-known research paper published by doctors in Ram Manohar Lohia Hospital, a public hospital in Delhi, recorded similar cases of persistent neurological deficits in heat stroke patients leaving the ICU. Like Devi Prasad, these were patients trapped in the grips of last year’s heat wave, when temperatures stayed above 41 degrees celsius.

Take the case of a 38-year-old man with no known comorbidities, who was admitted into the ICU with an internal temperature of 108 degrees. After two days of treatment, his condition improved, “however, he continued to have residual neurological abnormalities, such as agitated behavior and hallucinations, and was not able to vocalize, though he was able to follow simple verbal commands”, says the paper.

One month after being discharged, the patient’s behavioural changes and hallucinations had resolved, but “the deficit in spoken speech was persistent”.

The paper details two other cases in which patients were left with a combination of residual effects – one 50-year-old labourer was left after treatment with decreased verbal output and impaired comprehension, and another 67-year-old man with schizophrenia who suffered a “deficit in motor response, comprehension of spoken words, and verbal output”, one month after discharge.

Who is likely to make a full recovery and who isn’t is difficult to say, but deserves closer study, said Chatterjee. “We might typically expect to see such long-term effects in children and older populations. But we don’t have the data to really understand which populations are likely to have residual neurological impacts from heat stroke,” said Chatterjee, adding “I haven’t come across a study that tries to systematically capture the long-term impact of heat stroke on the nervous system, or any other system, on a population level.”

Mortality from heat stroke can be as high as 64%, and those suffering from long-term impacts are likely to make up a small proportion of survivors. The concern, however, is that if left unaddressed, these disabilities could become more systemic as heat waves worsen, damaging the health of those affected by rising temperatures and leaving them with conditions that are otherwise preventable.

An older investigation from 2012, when parts of Chennai in Tamil Nadu were gripped by a heat wave, found that 4 out of 17 patients admitted in the ICU were discharged with neurological deficits. Most patients in the study had comorbidities like hypertension and diabetes, with an average age of 53.

“We do not have long term follow up data of our patients, but 24% had neurological deficits at hospital discharge, while other organ functions recovered,” said MS Kalaiselvan, a critical care specialist who authored the study. “Literature review shows neurological deficit up to 33% among survivors. We should make efforts to stop these things early, identify vulnerable populations and provide adequate education.”

Emergency cooling

The biggest life saving factor involved with heat stroke is emergency cooling. “Emergency cooling can prevent patients with heat related illness from ever having to visit the ICU in the first place,” said Ajay Chauhan, a faculty of the medicine department at RML hospital, who helped set up Delhi’s first heart ward.

Emergency cooling entails rapidly bringing the body’s temperature down within 30 minutes of a serious heat related event. Guidelines issued before last year’s heat wave recommend using any materials available – cold water or ice – to cool the entire body. Ice immersion is the most efficient method, but using ice packs and cold water can work too. “Delay in cooling is directly associated with adverse outcomes including high mortality,” say the guidelines.

But a survey on the levels of heat preparedness among healthcare facilities paints a bleak picture. Of 5,690 healthcare facilities assessed across India – including primary, community, and tertiary centres – only a third had emergency cooling management practices in place, the survey, conducted by the National Programme on Climate Change and Human Health between April and June 2024, found.

Only 6% of healthcare facilities were found to have an “optimal” level of preparedness for active cooling. And 51% were found to have inadequate preparedness “for their level,” the survey said.

The onus of carrying out emergency cooling and heat stroke prevention can’t lie with health facilities alone, especially when heat stroke can occur at places of work, said Vidhya Venugopal, Professor of Occupational and Environmental Health at Sri Ramachandra Institute of Higher Education and Research.

Without a law guaranteeing rights or insurance to fall back on, migrant labourers are among the groups most likely to suffer on account of extreme heat – both economically and physiologically. Out of 75 heat stroke patients admitted in RML’s emergency heat ward, an overwhelming majority were men who worked as street vendors, labourers, and in other occupations in the unorganised sector.

“It needs to be mandatory for employers, even contractors and subcontractors, to educate their workers about the dangers of heat stroke, how to identify signs, and carry out first aid. This type of awareness is completely lacking on the ground,” said Venugopal, who is also the Country Director of the National Institute for Health and Care Research’s Centre on Environmental Change and NCDs. “Even if someone presents with a high fever and dehydration, they might be given paracetamol and sent home. The real solution lies in reducing exposure, by managing workload and heat.”

Heat Action Plans, which are the foremost blueprints that state governments and districts use to mitigate the impacts of extreme heat, generally perform poorly when it comes to identifying and targeting vulnerable populations. For prevention measures to be more meaningful, policy must catch up.

“What we don’t know is which individuals might have individual vulnerability factors, and what the mechanisms are that link the changes in the environment to changing patterns of disease, prevalence, incidence, severity and so on,” said Sisodiya of UCL, adding, “That’s where we need more research. Unless we understand those mechanisms, all we can offer is generic support.”

Living with the heat

The heat wave that sent Devi Prasad and hundreds like him to the hospital was made approximately 1.5 degrees celsius hotter due to global warming, a rapid analysis found. The Ministry of Health suspects India saw 48,156 cases of heat stroke last year, nearly 40% of which were admitted in healthcare facilities, indicating serious illness.

Heatwaves are projected to become more frequent as climate change accelerates, depending on the extent of global warming. Heat waves in India are already longer by three days compared to 30 years ago.

But both the number of heat wave cases and the death count – suspected to be 269 and confirmed to be 161 – are widely accepted to be gross undercounts. Without an accurate number, determining the scale of the problem becomes a challenge, experts have argued.

A decadal analysis of all-cause mortality data by researchers from India, Sweden, and the US project the number of deaths due to heat stroke in India to be 1,116 annually.

In their observation, when extreme temperatures above the 97th annual percentile stay high for two days consecutively, it is associated with a 14.7% increase in daily mortality.

After a year in recovery, such hostilities in the climate are no longer a hindrance to Devi Prasad’s plans. In the absence of a cure, with no arable land to speak of, and in need of money, Devi Prasad is determined to rejoin the workforce. “The contractors who gave him the job simply ran away when he collapsed last year. We’re going to try and demand that he be given his job back,” said Binodi.

Devi Prasad pointed to his village home and shook his head, gesturing his desire to leave. He will not stay, not without work.

This article was first published on Mongabay.