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.

Have you had a tonsillectomy (your tonsils taken out), appendectomy (your appendix removed) or lumpectomy (removal of a lump from your breast)? The suffix “ectomy” denotes surgical removal of the named body part, so these terms give us a clear idea of what the procedure entails.

So why is the removal of the uterus called a hysterectomy and not a uterectomy?

The name hysterectomy is rooted in a mental health condition – “hysteria” – that was once believed to affect women. But we now know this condition doesn’t exist.

Continuing to call this significant operation a hysterectomy both perpetuates misogyny and hampers people’s understanding of what it is.

‘Hysteria’

Hysteria was a psychiatric condition first formally defined in the 5th century BCE. It had many symptoms, including excessive emotion, irritability, anxiety, breathlessness and fainting.

But hysteria was only diagnosed in women. Male physicians at the time claimed these symptoms were caused by a “wandering womb”. They believed the womb (uterus) moved around the body looking for sperm and disrupted other organs.

Because the uterus was blamed for hysteria, the treatment was to remove it. This procedure was called a hysterectomy. Sadly, many women had their healthy uterus unnecessarily removed and most died.

The word “hysteria” did originally came from the ancient Greek word for uterus, “hystera”. But the modern Greek word for uterus is “mitra”, which is where words such as “endometrium” come from.

Hysteria was only removed as an official medical diagnosis in 1980. It was finally recognised it does not exist and is sexist.

“Hysterectomy” should also be removed from medical terminology because it continues to link the uterus to hysteria.

Common but confusing

About one in three Australian women will have their uterus removed. A hysterectomy is one of the most common surgeries worldwide. It’s used to treat conditions including:

• abnormal uterine bleeding (heavy bleeding)

• uterine fibroids (benign tumours)

• uterine prolapse (when the uterus protrudes down into the vagina)

• adenomyosis (when the inner layer of the uterus grows into the muscle layer)

• cancer.

However, in a survey colleagues and I did of almost 500 Australian adults, which is yet to be published in a peer-reviewed journal, one in five people thought hysterectomy meant removal of the ovaries, not the uterus.

It’s true some hysterectomies for cancer do also remove the ovaries. A hysterectomy or partial hysterectomy is the removal of only the uterus, a total hysterectomy removes the uterus and cervix, while a radical hysterectomy usually removes the uterus, cervix, uterine tubes and ovaries.

There are important differences between these hysterectomies, so they should be named to clearly indicate the nature of the surgery.

Research has shown ambiguous terminology such as “hysterectomy” is associated with low patient understanding of the procedure and the female anatomy involved.

Uterectomy should be used for removal of the uterus, in combination with the medical terms for removal of the cervix, uterine tubes and ovaries as needed. For example, a uterectomy plus cervicectomy would refer to the removal of the uterus and the cervix.

This could help patients understand what is (and isn’t) being removed from their bodies and increase clarity for the wider public.

Male names

There are many eponyms (something named after a person) in anatomy and medicine, such as the Achilles tendon and Parkinson’s disease. They are almost exclusively the names of white men.

Eponyms for female anatomy and procedures include the Fallopian tubes, Pouch of Douglas, and Pap smear.

The anatomical term for Fallopian tubes is uterine tubes. “Uterine” indicates these are attached to the uterus, which reinforces their important role in fertility.

The Pouch of Douglas is the space between the rectum and uterus. Using the anatomical name (rectouterine pouch) is important, because this a common site for endometriosis and can explain any associated bowel symptoms.

Pap smear gives no indication of its location or function. The new cervical screening test is named exactly that, which clarifies it samples cells of the cervix. This helps people understand this tests for risk of cervical cancer.

Language matters

Language in medicine impacts patient care and health. It needs to be accurate and clear, not include words associated with bias or discrimination, and not disempower a person.

For these reasons, the International Federation of Associations of Anatomists recommends removing eponyms from scientific and medical communication.

Meanwhile, experts have rightly argued it’s time to rename the hysterectomy to uterectomy.

A hysterectomy is an emotional procedure with not only physical but also psychological effects. Not directly referring to the uterus perpetuates the historical disregard of female reproductive anatomy and functions. Removing the link to hysteria and renaming hysterectomy to uterectomy would be a simple but symbolic change.

Educators, medical doctors and science communicators will play an important role in using the term uterectomy instead of hysterectomy. Ultimately, the World Health Organization should make official changes in the International Classification of Health Interventions.

In line with increasing awareness and discussions around female reproductive health and medical misogyny, now is the time to improve terminology. We must ensure the names of body parts and medical procedures reflect the relevant anatomy.

Theresa Larkin is Associate Professor of Medical Sciences, University of Wollongong.

This article was first published on The Conversation.

So you’ve never been to a gym and are keen to start, but something’s holding you back. Perhaps you don’t know what to actually do in there or feel like you’ll just look stupid in front of everyone. Maybe you’re worried about injuring yourself.

It’s OK. Everyone starts somewhere. I did, too.

Resistance exercise (such as weight lifting) is really good for your health. Benefits include a reduced risk of osteoporosis-related fractures, reduced risk factors for chronic diseases such as diabetes, better sleep, improved mental health and, of course, stronger and bigger muscles.

So, how do people get started in the gym? Here’s what you need to know, and what the research says.

Worried about injury?

Don’t be. It’s probably less risky than lots of other forms of exercise you might already do or did in the past.

Team sports such as rugby and soccer, and strength-based sports such as powerlifting, weightlifting, and cross fit all have similar injury rates. They’re all in the vicinity of three to four injuries per 1,000 hours of participation.

Going to the gym has almost half this rate of injuries, at about 1.8 per 1,000 hours.

Let’s put that into context.

If you go to the gym three times per week for a one-hour session – and you do that every week of the year – you achieve approximately 156 hours of resistance training exercise a year.

So if the injury rate is about 1.8 injuries per 1,000 hours, that means that you could exercise for years in the gym without even a little niggle!

Some groups, such as young men under 40, may be at a greater risk of injury in the gym. So if that’s you, you may want to be a little more conscious about how fast you progress, and the types of exercises you do in the gym.

Compare these injury risk stats to the known risks of sedentary lifestyles, and the worry should go out the door.

In short, it’s a lot more dangerous to be sedentary than it is to go to the gym.

Ok, how do I get started?

It’s fine to begin with what you feel most comfortable with. You don’t have to go straight to a ridiculously complex or challenging program.

However, that doesn’t mean you don’t need to put in the effort!

Most gyms can start you off by designing a workout program for you (you might have to pay for a personal training session). If you have a medical condition, find an accredited exercise physiologist. They’re trained to help you exercise safely.

It’s OK to start with gym machines, which are designed to make it easier to keep your movements consistent.

But keep your mind open about trying the free weights section (where the dumbbells, barbells and mirrors are). Benefits from this type of training may vary from what you get via machines.

That’s because a lot of the moves you do with free weights are what’s called compound exercises, meaning they work a lot of muscles and joints together at the same time. They’re really good for you. Examples of compound exercises include:

• squats

• lunges

• deadlifts

• bench presses

• hip thrusts

• kettle bell swings.

How much should I do in the gym?

Standard government physical activity recommendations state you should do muscle strengthening twice per week.

If you are new to the gym, you can make progress with a minimalist approach. For example, you may choose to only lift once or twice per week, compared with many seasoned gym-goers who might lift four or five times per week.

Recent research shows even those people already consistently lifting in a gym can maintain or slowly improve by doing just two sessions per week, in which each exercise is only performed for one set and the whole session lasts just 30 minutes or so.

So if you can stick to one hour per week (made up of two challenging half-hour sessions) then you will still be making progress.

How do I make my habit stick?

Sticking to the habit after the novelty has worn off is where many come unstuck.

Some research suggests it takes six weeks to form a gym habit, and that the more frequent the attendance in those first six weeks, the more likely the habit will stick.

At the one-year mark, the biggest predictor of regular attendance (defined as twice per week) was enjoyment. This was followed closely by the concept of self-efficacy (believing in yourself and your ability to stick to it), and social support.

This is really important.

Find what you like about the gym. Train the way that you enjoy. Find a friend to join the gym with. That will help you create the habit.

From there, you can progress the types and intensity of gym exercises you do.

I feel like a duck out of water

Every gym-goer felt this at first. I did too.

The confusion about which bit of the machine to sit on, pull, or push, is a tad overwhelming.

The sense of security in sticking to the familiar, shying away from the free weight area.

Remember: everyone is there to improve themselves and is on their own journey.

Most people won’t even notice that you are there, and most experienced gym-goers will be delighted to help if you’re unsure.

If that’s not your experience at your local gym, perhaps look for a new and more welcoming environment. Not all gyms and gym cultures are created equal.

Mandy Hagstrom is Senior Lecturer, Exercise Physiology. School of Health Sciences, UNSW Sydney.

This article was first published on The Conversation.

The liver is one of the hardest working organs in the human body. It detoxifies harmful substances, helps with digestion, stores nutrients, and regulates metabolism.

Despite its remarkable resilience – and even its ability to regenerate – the liver is not indestructible. In fact, many everyday habits, often overlooked, can slowly cause damage that may eventually lead to serious conditions such as cirrhosis (permanent scarring of the liver) or liver failure.

One of the challenges with liver disease is that it can be a silent threat. In its early stages, it may cause only vague symptoms like constant fatigue or nausea.

As damage progresses, more obvious signs may emerge. One of the most recognisable is jaundice, where the skin and the whites of the eyes turn yellow. While most people associate liver disease with heavy drinking, alcohol isn’t the only culprit. Here are five common habits that could be quietly harming your liver.

1. Drinking too much alcohol

Alcohol is perhaps the most well-known cause of liver damage. When you drink, your liver works to break down the alcohol and clear it from your system. But too much alcohol overwhelms this process, causing toxic by products to build up and damage liver cells.

Alcohol-related liver disease progresses in stages. At first, fat begins to accumulate in the liver (fatty liver), often without any noticeable symptoms and reversible if drinking stops. Continued drinking can lead to alcoholic hepatitis, where inflammation and scar tissue begin to form as the liver attempts to heal itself.

Over time, this scarring can develop into cirrhosis, where extensive hardening of the liver seriously affects its ability to function. While cirrhosis is difficult to reverse, stopping drinking can help prevent further damage.

Even moderate drinking, if sustained over many years, can take its toll, particularly when combined with other risk factors like obesity or medication use. Experts recommend sticking to no more than 14 units of alcohol per week, and including alcohol-free days to give your liver time to recover.

2. Poor diet and unhealthy eating habits

You don’t need to drink alcohol to develop liver problems. Fat can build up in the liver due to an unhealthy diet, leading to a condition now called metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD).

Excess fat in the liver can impair its function and, over time, cause inflammation, scarring, and eventually cirrhosis. People who are overweight – particularly those who carry excess weight around their abdomen – are more likely to develop MASLD. Other risk factors include high blood pressure, diabetes and high cholesterol.

Diet plays a huge role. Foods high in saturated fat, such as red meat, fried foods and processed snacks, can raise cholesterol levels and contribute to liver fat accumulation. Sugary foods and drinks are also a major risk factor. In 2018, a review found that people who consumed more sugar sweetened drinks had a 40% higher risk of developing fatty liver disease.

Ultra-processed foods such as fast food, ready meals and snacks packed with added sugar and unhealthy fats also contribute to liver strain. A large study found that people who ate more processed foods were significantly more likely to develop liver problems.

On the flip side, eating a balanced, wholefood diet can help prevent – and even reverse – fatty liver disease. Research suggests that diets rich in vegetables, fruit, whole grains, legumes, and fish may reduce liver fat and improve related risk factors such as high blood sugar and cholesterol.

Staying hydrated is also important. Aim for around eight glasses of water a day to support your liver’s natural detoxification processes.

3. Overusing painkillers

Many people turn to over-the-counter painkillers such as paracetamol for headaches, muscle pain, or fever. While generally safe when used as directed, taking too much – even slightly exceeding the recommended dose – can be extremely dangerous for your liver.

The liver breaks down paracetamol, but in the process, produces a toxic by-product called NAPQI. Normally, the body neutralises NAPQI using a protective substance called glutathione. However, in an overdose, glutathione stores become depleted, allowing NAPQI to accumulate and attack liver cells. This can result in acute liver failure, which can be fatal.

Even small overdoses, or combining paracetamol with alcohol, can increase the risk of serious harm. Always stick to the recommended dose and speak to a doctor if you find yourself needing pain relief regularly.

4. Lack of exercise

A sedentary lifestyle is another major risk factor for liver disease. Physical inactivity contributes to weight gain, insulin resistance, and metabolic dysfunction – all of which can promote fat accumulation in the liver.

The good news is that exercise can benefit your liver even if you don’t lose much weight. One study found that just eight weeks of resistance training reduced liver fat by 13% and improved blood sugar control. Aerobic exercise is also highly effective: regular brisk walking for 30 minutes, five times a week, has been shown to reduce liver fat and improve insulin sensitivity.

5. Smoking

Most people associate smoking with lung cancer or heart disease, but many don’t realise the serious damage it can do to the liver.

Cigarette smoke contains thousands of toxic chemicals that increase the liver’s workload as it tries to filter and break them down. Over time, this can lead to oxidative stress, where unstable molecules (free radicals) damage liver cells, restrict blood flow, and contribute to scarring (cirrhosis).

Smoking also significantly raises the risk of liver cancer. Harmful chemicals in tobacco smoke, including nitrosamines, vinyl chloride, tar, and 4-aminobiphenyl, are all known carcinogens. According to Cancer Research UK, smoking accounts for around 20% of liver cancer cases in the UK.

Love your liver

The liver is a remarkably robust organ – but it isn’t invincible. You can protect it by drinking alcohol in moderation, quitting smoking, taking medications responsibly, eating a balanced diet, staying active and keeping hydrated.

If you notice any symptoms that may suggest liver trouble, such as ongoing fatigue, nausea, or jaundice, don’t delay speaking to your doctor. The earlier liver problems are detected, the better the chance of successful treatment.

Dipa Kamdar is Senior Lecturer in Pharmacy Practice, Kingston University.

This article was first published on The Conversation.

Paul Farmer in Pathologies of Power speaks evocatively of the crossroads at which humankind today finds itself. Healthcare, he observes, can be considered either a “commodity to be sold” or “a basic social right”. It cannot be both at the same time. Which of these pathways we will choose, he declares, is the highly consequential choice that people of goodwill must make “in these dangerous times”. He terms this as “the great drama” of our times.

As this “great drama” plays out in the world today, what choice are policymakers making?

The majority are opting for a significant, even paramount, role for for-profit private health providers in universal healthcare and the statutory right to health care. Their assumption is that the private sector will bring in efficiency, choice, high-quality healthcare and by bridging the resource gaps in public health systems, it will enhance the access of excluded groups. The result of these policy choices is a retreat of the state from direct healthcare provisioning, the crumbling of even the aspiration of a welfare state and the largescale transfer of scarce public funds to the private medical sector.

In this essay, I interrogate the legitimacy of these assumptions. The question I ask is whether there is not inherent in this choice of largescale public health provisioning by large corporate hospitals the potential for grave conflicts of interest? Is there not an intrinsic clash between, on one side, profit-seeking and, on the other, equitable quality healthcare that is based on need and not the capacity to pay?

A challenge literally of life and death for policymakers is to find ways to best bridge the massive chasms between health needs and health access, especially of the poor.

Thinktank Oxfam, in its briefing paper Sick Development, explains that a “poorly evidenced, but largely unchallenged, narrative has emerged that says extending healthcare to those most denied it can be done by funding for-profit, fee-charging healthcare providers and encouraging more private finance, including private equity firms, to do the same”.

The stark and unconscionable reality of our world remains one in which half the world’s population are still excluded from access to even the most essential healthcare. Sixty people every second suffer catastrophic and impoverishing costs paying for healthcare out-of-pocket.

These approaches of placing the life and health of impoverished people in the hands of profit-driven large corporations would be “deeply unpopular in European nations but are being exported to the Global South, with little democratic oversight and with significant taxpayer-backed budgets”, says the briefing paper.

What advocates of private health provisioning wilfully ignore is extensive evidence that for-profit private hospitals frequently block, bankrupt or even detain patients who cannot pay. Commercial and market-based approaches in healthcare can entrench and exacerbate the gap between rich and poor, and between women and men.

They also skew resources away from already under-funded government services while further excluding those who are excluded because they cannot pay or are socially oppressed. For-profit health providers lack incentives to prevent ill-health. Instead, the system hatches perverse incentives to misdiagnose or over-treat.

Policymakers and scholars do admit to the potential for conflicts of interests between profit and care. But the solution that we repeatedly encounter – as we did in our last chapter – is for robust and reliable regulatory systems for holding private health care providers accountable to high professional, ethical and equity standards. The argument is that if a coherent and legally enforceable robust ecosystem of state regulation, legal mandates, legal accountability, transparency and accountability is in place, these – with the active participation of patients and communities – can ensure that private health care providers are kept aligned with right to health goals.

This may sound convincing on paper. However, the reality is that accountability mechanisms on the ground are frequently found to be ineffective due to many reasons, such as weak implementation, fragmentation, and power asymmetries.

Even where formal mechanisms for transparency and accountability are in place, they often fail in practice due to institutional weakness, regulatory capture, legal ambiguity, and the concentration of power among private healthcare actors. State regulators may be underfunded or politically constrained. Courts may defer to legislative silence or interpret contracts narrowly. Local governments often lack autonomy and resources. Patients and families face barriers such as legal illiteracy, fear of reprisal, and inaccessible complaint systems. This is even more the case in low- and middle- income countries where the juggernaut of private corporate healthcare provisioning is most triumphal.

In a salutary way, Oxfam draws attention to the impacts of enormous inequality in power, status and information between provider and patient inherent in healthcare provision. What makes for-profit healthcare different from public healthcare is the perverse incentive for profit-seekers to exploit this inequality for commercial gain. “All of Oxfam’s interviews with patients and their relatives for this research laid bare the brutal reality that exploitation and extortion of patients and carers by for- profit healthcare providers are frighteningly easy, due to the universal willingness of human beings to make infinite sacrifices to save the life of a loved one”.

Besides this rare sense of empowerment of impoverished patients to hold doctors to account, effective regulation of the private health sector requires both resources and robust state capacity. Studies establish that these are scant in low- and even middle-income countries, therefore it is unsurprising that regulation in these countries is often found to be wanting. But the only reasons for weak regulation of the private health sector may not just be that they lack in budgets and capacity.

The even more fundamental constraints may be that there is little political will to hold powerful big business in check. And this may apply not just to low- and middle-income countries, but equally to rich countries. The reality of governments worldwide is of the formidable and ever-growing power of big business in policy making – of what Oxfam describes aptly as “elite capture” of the contemporary neo-liberal state; and, indeed, growing cronyism.

Such elite capture of policy making is pervasive and increasingly normalised. When Donald Trump was sworn in as President of the United States in January 2025, prominent among those in attendance were the world’s three wealthiest people – Tesla CEO and the world’s richest person Elon Musk (worth $433.9 billion), Amazon founder Jeff Bezos (worth $239.4 billion) and Meta’s Mark Zuckerberg ($211.8 billion). Their combined wealth was greater than the entire wealth of half the American population. The early months of Trump’s presidency – at the time I write this – is tarnished by the massive influence that Musk is visibly exercising on public decision-making in the world’s most powerful executive office.

The estimated value of the healthcare industry, including pharmaceutical and medical equipment companies, insurance and corporate hospital chains is a staggering $7 trillion. Health entrepreneurs are entering in growing numbers and power in billionaire lists of the richest people in many countries.

The president of leading health corporations in Brazil – Proparco and Rede D’or – is Brazil’s 10th richest billionaire. Ranjan Pai, controller of British International Investment-backed Manipal Group, saw his real-terms wealth grow by US$1.48bn in just one year alone. The cumulative impact of decades of neo-liberal policies is the effective transfer of power from public institutions to private enterprises.

Public health analyst Amit Sengupta regards that the state’s active role in facilitating the dominance of the private sector in healthcare not just a techno-managerial choice, but the wilful and wanton abdication by the state of its primary duties, by transferring responsibility for universal health care to the for-profit private health sector. Sengupta identifies what he calls “regulatory capture”, in which designated “experts” are drawn in by the state to assist and advise the state on the regulation of the very industries from which the “experts” are drawn.

Against the sobering reality of this landscape of the political economy of much of our world, I am troubled by the assumption that is still widely purveyed by policymakers globally, that states have the power, the capacity and the will to regulate the private health sector, to ensure that they promote the public good rather than private profits. I wonder how effective can we expect regulations and remedies in law to be to actually prevent the conflict between the duty of equitable health provisioning and the corporate pursuit of profit?

Oxfam, in its briefing paper, documents how in Kenya and India patients are imprisoned by private hospitals for not paying their bills. The statutorily mandated right to emergency care is denied. Treatment is impossibly expensive. Patients entitled to free care are instead pushed deep into poverty, being forced to pay high fees to access health services.

During the Covid-19 pandemic, some hospitals acted appallingly, profiteering even more than in normal times from people’s suffering and their fear of this new disease. Oxfam concludes that global and domestic taxpayers’ money is being ploughed into back expensive, for-profit private hospitals that block, bankrupt or even detain patients who cannot pay.

The report tells macabre stories of how a leading private hospital chain in Nairobi, Kenya, did not even release the corpses of patients who died for up to two years if the families could not pay the bills.

A newborn baby was held for three months for the same reason, and her mother would come each day to the hospital to breast-feed her. A schoolboy was held hostage for 11 months until his parents paid the bills.

In Nigeria, a normal child delivery costs as much as nine months’ income for the poorest 50% of Nigerians. A caesarean birth was even more expensive, costing as much as 24 years’ income for the poorest 10%. The bill for one patient who died from the Covid-19 virus in a private hospital in Nigeria cost an incredible US$116,000.

The bottom line is this: Consider a most powerless, excluded woman or girl child – suffering savage discrimination because of her race, caste, religion, sexuality or her undocumented status – who seeks life-saving healthcare from a highly privatised healthcare system dominated by giant and politically powerful corporate hospitals. Can she realistically rely on state regulation of giant private health providers to ensure stoutly her right to high quality health care so her life is saved?

For clues to this question, I will in this essay focus my microscope on the experience of one of the most privatised health care systems in the world, India. Some observers rate this to be the most privatised healthcare systems in the world, surpassing even the United States.

Why is it instructive to look closely at the functioning of India’s private and corporatised health system? The hospital industry accounts for 80% of India’s total healthcare market. India has one of the highest out-of-pocket spending levels on health in the world. Out-of-pocket spending as a proportion of total health spending is a leading cause of impoverishment in India. Thirty-seven per cent of Indians experience catastrophic health expenditures in private hospitals.

The abdication of the state in provisioning healthcare is spectacular. The Economist in 2017 observed that India’s extreme reliance on private healthcare is not ideological as much as the outcome of the reality that “government has done such a lousy job” of providing healthcare.

Over many years, India’s budgetary investment in public health has hovered from 0.8% to 1.1% of the country’s gross domestic product, among the lowest in the world. India stands fifth from the bottom in its public spending on health globally. And too little of even this paltry resource has gone into strengthening public health delivery and particularly into building primary healthcare. China invests three times this abysmal level.

In India’s mixed healthcare system, out-of-pocket spending and the market provision of services predominate. Only a little over a quarter of total health expenditure in India is borne by the state; the rest is out-of-pocket private spending and capital investments by the private sector. As much as 87% of private health spending is by individuals who lack insurance cover. Official data reveals that anything between 55 to 68 million people are pushed into poverty because of private health spending.

Private health care accounts for 80% of all health transactions in India. Eighty out of 100 trained doctors in India work in the private health sector (and this is after a significant number have migrated to countries of the Global North, earning high salaries that spiral further up the benchmark of aspirations of doctors who continue to live and work in India). India ranks 155th out of 167 countries on hospital bed availability. Seventy-two per cent of hospitals and 60% of hospital beds are in the private sector. Eighty per cent of all out-patient health services and 60% of in-patient health services are supplied by the private sector.

A quarter of a total of one million private health enterprises in India are middle to large medical establishments. In 2016, investments in private hospitals and diagnostic centres crossed 4000 million US dollars, including significant foreign capital transfers. Of 425 medical colleges in India, more than half are private medical colleges, accounting for 48% of all MBBS seats, with dizzyingly steep fees. They make large investments in land, buildings and equipment which they recover through sky-high fees. Naturally, the education they offer does little to prepare students for public service.

A common defence of private sector investments in health, often with international aid and financial institutions significantly contributing the capital for these, is that these fill gaps in public health systems resulting from low available public funds.

The Oxfam briefing paper First, Do No Harm, nails the disingenuity, indeed the complete falsehood of these claims. It looks at where large corporate hospitals funded by World Bank’s private sector arm, the International Finance Corporation are located. It finds that these private corporate hospitals have done nothing to bridge the access gaps suffered by impoverished rural populations.

For most private hospitals are concentrated in highly populated urban areas, and that too in the more economically developed states, because this is where more income and therefore profit can be generated. Seventy-eight per cent of the International Finance Corporation direct investee chain hospitals are in Million Plus population cities. Sixty per cent of hospitals are in Tier 1 cities, 35% are in Tier 2 cities and only 4% are in smaller habitations.

Of the 144 hospitals listed on the corporate websites of these chains, only one is in a rural area. Only 14% of the hospitals are in the 10 states ranked lowest in terms of the overall performance of the health system based on the Annual Health Index 2021; and not a single hospital operates in four of these 10 states.

Insurance helps create the mirage that unaffordable healthcare is actually affordable, although studies reveal that not more than 25% Indians can actually afford private insurance. And the net outcome of the state bearing the costs of private insurance of impoverished households is the transfer of scarce public resources to the private sector which arguably could have been better spent on strengthening primary healthcare in the public sector.

The near-complete absence of mechanisms to prevent the conflict of interest in public health policy decision-making (including privatisation and purchase of medical equipment) creates fertile ground for kickbacks and profiteering by health administrators and government doctors. This conflict of interest often veers decision-makers away from choosing optimal, rational and low-cost options.

To map, in some granular detail, how the private health sector actually operates in an environment of low regulation like in India, I will draw partly on inside accounts by seasoned health practitioners, teachers and scholars.

Seventy-eight such ethical doctors came together – many of them working in corporate hospitals choosing to be whistle-blowers – to reflect on the rot that has set into the vocation of health care. Their voices come together in a book titled Dissenting Diagnoses: Voices of Conscience from the Medical Profession, that should be compulsory reading for everyone seeking policy pathways to equitable and ethical healthcare.

A similar sombre account emerges from Healers or Predators? Healthcare Corruption in India. In this book, policy makers, practitioners and public health scholars examine the deep-rooted crisis of the consistent denial of basic healthcare to the overwhelming majority of Indian citizens.

I also draw from reports by Oxfam, a leading global voice for equity in health provisioning, particularly two that closely examine the functioning of private corporate hospitals established by global development aid and international funding institutions, in its briefing papers Sick Development and First, Do No Harm.

The picture that emerges from these searching and brave accounts by health insiders is sordid, terrifying and utterly unconscionable. We see how since the 1990s, in the “whirlwind” of privatisation, public health is consistently starved of funds and investments, and a relatively well-intentioned service-oriented vocation with the public health sector in the commanding heights is transformed first into a market-led commodity, and then into a corporate-led profiteering industry.

Pharmaceutical companies, medical equipment manufacturers, insurance companies, private medical colleges, international vaccine manufacturers, corporate hospitals and diagnostic centres, all join hands to convert health care into a high-premium commodity that becomes intractably inaccessible to the working and destitute poor.

It is not as though corruption was not rampant within public systems and does not continue to be so. But, as Kaveri Gill argues, in the public health sector, redress and reform are conceivably feasible if there is political will. Private sector corruption, on the other hand, appears beyond redress and redemption because corporate power is formidable, the spoils tremendous, corrupt practices pervasive and regulatory mechanisms feeble.

Senior health practitioner Mani also affirms that corruption also characterised public healthcare when it dominated the Indian health scene in the first decades after freedom. There were surgeons who would not operate on patients unless they first met then in their private chambers and paid them a hefty fee. Doctors employed touts in bus stands and railway stations to waylay patients and lure them to their door, for a commission. But he said these were in the past exceptions, condemned by the majority of the medical community.

However today such practices have become the norm. “We advertise ourselves”, he laments. “We employ touts to bring patients to us, we pay commissions to the doctors who send patients to us, we perform unnecessary and expensive tests and accept and even demand cutbacks from the diagnostic laboratories, we prescribe the most expensive of drugs and are rewarded for this by the pharmaceutical industry, and we even abet our patients’ efforts to defraud insurance companies. What will we not stoop to?”

Dr George Mathai, a physician from Alibag similarly grieves that “the very objectives and motivations for joining the medical profession have changed. Nowadays the only reason for joining the medical profession is to make as much money as one can, with as little work as one can get away with”. The personal conduct and ethical practice of doctors have hit new lows, as they prioritise profits over the welfare of patients. The social logic of “patients first” has given way almost fully to “profits first”.

Spurred and bribed by the pharmaceutical industry and owners of corporate hospitals, doctors prescribe unnecessary tests, expensive medicines and redundant, even harmful procedures, all at soaring costs with inflated bills. The result is that patients have to bear unnecessary, sometimes catastrophic expenditures because private hospitals have invidious links with drug manufacturers, pharmacies and middlemen of many kinds, including even autorickshaw drivers.

A senior and highly respected physician Dr Vijay Ajgaonkar bewails the many ethical distortions of the private health sector. Terminally ill 70- and 80-year-olds are kept in ICU and put on ventilators, even when there is no chance of their recovery, only to inflate hospital bills. In the process, they ruin the family and stretch the suffering of the patient. They don’t let him die in peace surrounded by his family members. In the ICU, there are tubes in his nose and mouth: he cannot speak even if he wants to. Even dead patients are sometimes retained on ventilators to further inflate hospital bills. Hospital agents converge like hawks at road accident sites to grab as many patients as they can. Doctors boast later about the numbers of “lambs” they have caught.

Ajgaonkar speaks bitterly of the bribes distributed by pharmaceutical companies, that include holidays abroad, expensive liquor, clothes, even expensive jewellery. The result, for instance, is that insulin that sold for Rs 30 rupees is now priced at Rs 150. Ethically the cost of research had long been recovered so the costs should instead have been reduced. Instead, the price is raised five times!

Many other doctors also report that medicines with no greater benefits than cheaper versions are widely prescribed to benefit the pharmaceutical companies. The companies make small changes in the formula of medicines that carry no additional benefit, then raise the price greatly while withdrawing the cheaper medicine from the market and encouraging doctors to prescribe the expensive version. There is no reason for ethical doctors to not prescribe only generic medicines which would cost them much less. Instead, doctors prescribe expensive antibiotics when cheaper ones would be no less effective.

The plunder of patients does not end here. Hospitals further mark up the costs of medicines in their bills to sometimes five or 10 times the maximum retail price. Even more egregiously, sometimes patients are administered much higher doses of medicines than are required, even risking the health of the patient. Likewise, patients are charged two to five times the price of coronary stents, and experts estimate that nearly a third of all stenting procedures in India are inappropriate.

“Doctors have now become servants of the pharmaceutical companies”, a physician observes dryly. Medical representatives take young doctors under their wings, benefit them materially and “retrain” them to adapt their practices in ways that maximise the company’s profits. They also draw doctors into bogus medical trials.

“One of the tricks played by the corporate hospitals is that they rarely give you a full prescription listing all the medicines”, a patient reported to Oxfam. “The nurse just gives you a slip. That way it is difficult to know the prices they are charging.” Oxfam finds that this problem is widespread in India. Its report refers to recent studies that found that profit margins for medicines, consumables and diagnostics ranged from 100%-1,737% in four of the largest private hospitals in Delhi, and that these items made up almost half the cost of patient bills.

It is noteworthy that the scandalously inflated costs of the doctor-pharmaceutical company nexus are borne entirely by the patient. The patient pays for the medicine, but has no control over the choice of the medicine. It is this monopoly over decision-making that a doctor possesses that is exploited by pharmaceutical companies to maximise their profits at the expense of the powerless patient.

The massive growth of multi-speciality corporate hospitals has metamorphosised health care into a highly lucrative industry. Hospitals have been reinvented from havens of healing and care to oases of luxury and privilege.

Gadre and Shukla observe that with its massive growth with liberalisation and expansion of the IT industry, an Indian city like Pune should have at least 50 public hospitals. It has only one. On the other hand, new, shining, multi-speciality private corporate hospitals are rising everywhere. They compare these aptly with shopping malls, which they resemble not just architecturally but in their business model. Just as malls have edged out small retailers that sold groceries and consumables, corporate hospitals have edged out the single-doctor practices and small nursing homes of the past.

“Hospital malls” have aggressively shifted the medical sector to the exclusive mercy of markets. Many of these private corporate hospitals claim to be charitable hospitals, which entitles them to concessional or free land and significant tax breaks. But in practice they rarely admit free patients, or if they are admitted, they are not respectfully treated.

Oxfam, too, records instances of refusal by private hospitals to extend free healthcare to patients living in poverty – although this was the conditions under which free or subsidised land was allotted to these hospitals. Poor patients also report to Oxfam instances of disrespectful behaviour by the staff of private corporate hospitals. “They don’t behave well to us when they know we are from the slum. When they learn that we are from the slum the hospital staff make us leave… We don’t take people there now… It is not for us. It is not for the poor families. It is for the rich people.”

Oxfam’s research also shows many cases of private hospitals unlawfully denying people emergency care, even though in India patients have a right to emergency care from all hospitals. For instance, a child was badly wounded and left unconscious by a traffic accident, but the private hospital denied treatment unless the family paid $1,200.

Unethical practices begin right from the stage of writing the prescriptions. The initial diagnosis that the doctor makes is wantonly graver than warranted by the patient’s condition, only to justify unnecessary diagnostics, drugs and procedures. Often there are no findings listed in the prescription, only the tests and medicines.

In corporate hospitals, patients are typically seen by multiple doctors and each bill the patient separately. There are no regulations or oversight about qualifications, or standard treatment protocols. Patients are also admitted to hospitals when all they need is OPD care. All a child with diarrhoea may need is the administration of ORH in their homes. Instead, they are admitted to hospital and given saline drips and a hefty bill at the end of this.

Oxfam also encountered shocking instances of medical malpractice and exploitation. For instance, a patient testified that the hospital staff said he had an 80% blockage to his heart and needed emergency surgery if his life was to be saved. He was sceptical, took a discharge, and consulted with a government doctor who repeated the tests and showed the diagnosis to be entirely false.

In another such instance, a man got admitted into a private hospital to have a problematic gallstone removed. The hospital ran several tests on him, including an ECG and echocardiogram to check the health of his heart. After the surgery the same tests were done, and doctors said he had an 80% blockage in his heart and that they would need to operate to save him. They even began treatment for this without his consent. It took the intervention of an influential local figure to secure his release. He then consulted a government doctor, who repeated the tests and then said to him: “Whoever is telling you that your heart is blocked is not telling you the truth.”

Oxfam also found grave cases of medical negligence confirmed by regulators even in the high-end World Bank financed corporate hospitals.

In one a patient is dropped on the floor leading to multiple fractures and death. Another dies because the patient is left unattended in an ambulance. In yet another death results because cotton wool is left in a patient’s brain after brain surgery. For one patient, the wrong leg is operated on, and for another a child is left permanently disabled. One baby is declared dead by doctors only to be discovered to be breathing as the last rites are performed. This on top of the widespread problems of overcharging, price rigging, and financial conflict of interest.

In corporate hospitals, investigations are not based on what the patient’s illness is, or whether the patient actually needs particular investigations. Doctors employed in large corporate hospitals are given targets of prescribing diagnostic tests even when these are not necessary.

Healthy pregnant women – to cite just one example – are pointlessly prescribed repeated hemograms, liver function tests and kidney function tests. Patients with confirmed diagnoses of depression are pointlessly prescribed expensive MRI and CT Scan tests. A gastroenterologist performs a series of endoscopies when only one is sufficient. Patients, influenced by marketing of corporate hospitals and diagnostic centres, themselves opt for “master check-ups”, most of which are unnecessary.

Ajgaonkar speaks of large public hospitals in Mumbai that have outsourced their radiology and lab departments to the private sector, only to benefit the private corporations. Pathologists also share that many pathological labs resort to what are informally called “sink tests”, in which the samples are just poured into the sink and a normal report sent. This can be dangerous for patients whose real maladies are missed.

Even more shocking than a superfluous test is when procedures and surgeries are prescribed that are not needed. A doctor confided that he was contemplating giving up his lucrative position in a corporate hospital. This was because of the pressure from the hospital management to deliver a target of 40% “conversions” of OPD visits to hospital surgery. His ratio was 15%. But he was caught in a dilemma. After studying so hard, he needed a job. And the only jobs he could find were in corporate hospitals. How long would he heed the voice of his conscience?

Another senior cardiologist also spoke of the pulls of his conscience that led him to leave his well-paid position in a corporate hospital where he was pressured by the management to recommend and perform unnecessary procedures like angioplasties. Another surgeon testified that often “totally unnecessary surgeries are done in corporate hospitals. For instance, a small gall bladder stone is causing no discomfort to the patient. But the patient is scared into surgery.

There are even shocking “pretend surgeries” in which small cuts and sutures are made with no actual surgery, but hefty bills presented. Gynaecologists report peers who are impatient with monitoring 14 to sixteen hours of labour and instead opt for a caesarean operation with a high bill.

A doctor explains it pithily, that first the hospital pays you a handsome salary, but then expects you to earn back that salary, even with – for instance – unnecessary kidney biopsies. Appendicitis and cataract operations and hysterectomies are performed when there is no need for these.

A surgeon speaks of his helpless regret when he sees how the bills for surgeries were inflated. The costs of surgery are routinely fixed in corporate hospitals at rates far higher than justified, but the patient has little choice, especially if beds and this surgery are unavailable in public hospitals. There is no regulation of what a doctor or hospital can charge.

For small procedures and surgeries, it is not uncommon to raise bills many times higher than what is warranted. The doctor cites the case of a very minor inguinal hernia procedure for which the patient was charged Rs 1.5 lakh.

Oxfam finds in low- and middle-income countries that the average starting cost of an uncomplicated vaginal birth delivery at a large private hospital amounts to over one year’s total income for an average earner in the bottom 40%. The cost of a caesarean birth amounts to over two years’ total income for the same person.

For an average earner in the bottom 10%, the starting cost for an uncomplicated vaginal birth at the private hospital rises to over nine years’ total income, and over 16 years for a caesarean birth. In First, Do No Harm Oxfam estimates that the cost of a two-day stay in a hospital in Delhi for a C-section is the equivalent of three to four months of Delhi’s average wage in Delhi-based IFC-funded Apollo, Max, and Fortis hospitals.

A doctor recounts the case of a man who died of a heart attack in a corporate hospital. They drew up an extortionate bill of Rs 16 lakh. His relatives could not afford it, so the hospital management resorted to the same strategy as the Nairobi hospital that I spoke of earlier. They hid the corpse. The police finally were called in to claim the body for the family. In another case, for a terminal and incurable case of cancer, the hospital prescribed an expensive and worthless regime that would impoverish the family long after the death of the patient.

Predatory over-charging reached even higher peaks during the pandemic. A large survey of over 2,500 Covid-19 patients in the state of Maharashtra found that private hospitals ignored government price cap with impunity. Seventy-five per cent of patients treated at private hospitals were overcharged by an average of Rs 1,56,000 (US$1,890). The research also revealed that average amounts of overcharging were far greater in larger corporate hospitals.

Public relations officers of corporate hospitals swarm doctors, offering them bulky “cuts” or commissions to refer patients to their hospitals. The practice of giving or receiving “cuts” or commissions for referrals to other specialists or diagnostic centres has also become routine.

Corporate hospitals institutionalise this by paying a portion of the money spent by a patient to the doctor who referred her to the hospital. Many hospitals pay 10%-15% of the total bill paid by the patient to the referring doctor. Diagnostic centres pay from 20%-50% to the referring doctor. Doctors frequently do not even record a patient’s history in any details. Instead, they just prescribe a set of investigations, for which they receive a cut or kickback. This is sometimes even more problematic in small nursing homes. Large corporate hospitals at least have rate-charts. In small hospitals, charges are often discretionary and therefore even more predatory.

Doctors and pathologists who refuse to participate in this morally grey zone of medical practice often find themselves with no work. Those who work in corporate hospitals report that their frustration that if they are scrupulous, their integrity does not benefit the patient who is still billed at levels that include the commissions.

Even other personnel connected in some way with corporate hospitals and nursing homes are also drawn into the embrace of “cuts”, even ambulance drivers and auto-rickshaw drivers. Late at night when relatives of a patient hail an autorickshaw to transport their patient to a particular hospital of choice, the driver refuses, insisting he would take them only to another hospital, one that has promised him a commission.

Doctors in smaller hospitals sometimes admit patients who they know they don’t have the competence to treat. They run up a high bill with the patient as her condition declines, then they refer them to corporate hospitals and harvest another “cut” from them.

Mani also describes many ways that doctors abet patients in unlawful ways. They certify fake illnesses to enable them to get leave or avoid a court appearance. Influential people soon after their arrest find doctors who certify that they suffer from grave ailments so they should be shifted from their prison ward to a much more salubrious hospital room.

Some unscrupulous doctors are also happy to abet for a high fee insurance fraud. The doctor records for the patient a diagnosis for a grave ailment from which the patient does not suffer, and bills expenses for expensive treatment that she or he did not receive. The reimbursement by the insurance company is shared between the patient and the doctor.

Independent research and testimonies of ethical insiders of the Indian health system strongly indicate that the mammoth expansion and domination of expensive private hospitals with feeble, even broken regulatory oversight or safeguards is, as summarised by Oxfam, “driving up healthcare inequality, diverting public funding and locking out opportunities for building truly universal and equitable health systems”.

This is because profit maximisation objectives in healthcare bring inherent risks to public health and patient rights. These have produced worse health outcomes and given less financial protection than similar investments in government-funded healthcare would have yielded. Worse still, evidence from countries like India shows that “by encouraging large-scale inclusion of for-profit hospitals, poor and marginalised people, particularly women, are being exposed to even greater risk of catastrophic and impoverishing healthcare bills”.

The wide claim of higher efficiency of private health provisioning is busted entirely by this disgraceful record of over-pricing, predatory marketing, and inappropriate medication, procedures and surgeries.

When maximising profits overtakes the healing and well-being of the patient, in the many ways we saw in this chapter, the private health sector no longer is the site of ethical treatment and care of patients. Instead, it mutates into a business for wealth accumulation by any means, many of these unethical and even unlawful.

One doctor observed wryly that corporate hospitals “maintain everything five-star style, but forget about the patient”. Another said that corporate hospitals want the doctor they employ only to earn them money. If the doctor wants to practice ethically, they have no place for him or her. And yet another – “there is no humanism to be found in corporate hospitals”.

I would evaluate the true worth of a health system by the respectful care it ensures to that most dispossessed and excluded woman or girl child who I started this essay with. There can be little doubt about one thing. And this is that the large shiny corporate “hospital malls” of our time have completely failed her.

I am grateful for research support from Rishiraj Bhagawati.

Harsh Mander is a peace and justice worker, writer, teacher who leads the Karwan e Mohabbat, a people’s campaign to fight hate with radical love and solidarity. He teaches part-time at the South Asia Institute, Heidelberg University, and has authored many books, including Partitions of the Heart, Fatal Accidents of Birth and Looking Away.

You stayed up too late scrolling through your phone, answering emails or watching just one more episode. The next morning, you feel groggy and irritable. That sugary pastry or greasy breakfast sandwich suddenly looks more appealing than your usual yogurt and berries. By the afternoon, chips or candy from the break room call your name. This isn’t just about willpower. Your brain, short on rest, is nudging you toward quick, high-calorie fixes.

There is a reason why this cycle repeats itself so predictably. Research shows that insufficient sleep disrupts hunger signals, weakens self-control, impairs glucose metabolism and increases your risk of weight gain. These changes can occur rapidly, even after a single night of poor sleep, and can become more harmful over time if left unaddressed.

I am a neurologist specialising in sleep science and its impact on health.

Sleep deprivation affects millions. According to the Centers for Disease Control and Prevention, more than one-third of US adults regularly get less than seven hours of sleep per night. Nearly three-quarters of adolescents fall short of the recommended eight-10 hours sleep during the school week.

While anyone can suffer from sleep loss, essential workers and first responders, including nurses, firefighters and emergency personnel, are especially vulnerable due to night shifts and rotating schedules.

These patterns disrupt the body’s internal clock and are linked to increased cravings, poor eating habits and elevated risks for obesity and metabolic disease. Fortunately, even a few nights of consistent, high-quality sleep can help rebalance key systems and start to reverse some of these effects.

Hunger hormones

Your body regulates hunger through a hormonal feedback loop involving two key hormones.

Ghrelin, produced primarily in the stomach, signals that you are hungry, while leptin, which is produced in the fat cells, tells your brain that you are full. Even one night of restricted sleep increases the release of ghrelin and decreases leptin, which leads to greater hunger and reduced satisfaction after eating. This shift is driven by changes in how the body regulates hunger and stress. Your brain becomes less responsive to fullness signals, while at the same time ramping up stress hormones that can increase cravings and appetite.

These changes are not subtle. In controlled lab studies, healthy adults reported increased hunger and stronger cravings for calorie-dense foods after sleeping only four to five hours. The effect worsens with ongoing sleep deficits, which can lead to a chronically elevated appetite.

Brain’s reward mode

Sleep loss changes how your brain evaluates food.

Imaging studies show that after just one night of sleep deprivation, the prefrontal cortex, which is responsible for decision-making and impulse control, has reduced activity. At the same time, reward-related areas such as the amygdala and the nucleus accumbens, a part of the brain that drives motivation and reward-seeking, become more reactive to tempting food cues.

In simple terms, your brain becomes more tempted by junk food and less capable of resisting it. Participants in sleep deprivation studies not only rated high-calorie foods as more desirable but were also more likely to choose them, regardless of how hungry they actually felt.

Slow metabolism

Sleep is also critical for blood sugar control.

When you’re well rested, your body efficiently uses insulin to move sugar out of your bloodstream and into your cells for energy. But even one night of partial sleep can reduce insulin sensitivity by up to 25%, leaving more sugar circulating in your blood.

If your body can’t process sugar effectively, it’s more likely to convert it into fat. This contributes to weight gain, especially around the abdomen. Over time, poor sleep is associated with higher risk for Type 2 diabetes and metabolic syndrome, a group of health issues such as high blood pressure, belly fat and high blood sugar that raise the risk for heart disease and diabetes.

On top of this, sleep loss raises cortisol, your body’s main stress hormone. Elevated cortisol encourages fat storage, especially in the abdominal region, and can further disrupt appetite regulation.

Metabolic reset

In a culture that glorifies hustle and late nights, sleep is often treated as optional. But your body doesn’t see it that way. Sleep is not downtime. It is active, essential repair. It is when your brain recalibrates hunger and reward signals, your hormones reset and your metabolism stabilises.

Just one or two nights of quality sleep can begin to undo the damage from prior sleep loss and restore your body’s natural balance.

So the next time you find yourself reaching for junk food after a short night, recognise that your biology is not failing you. It is reacting to stress and fatigue. The most effective way to restore balance isn’t a crash diet or caffeine. It’s sleep.

Sleep is not a luxury. It is your most powerful tool for appetite control, energy regulation and long-term health.

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

This article was first published on The Conversation.

The Maharashtra government has ambitious plans for Palghar district. Seven large projects such as a bullet train that will pass through to Gujarat and the Vadhavan Port are aimed at transforming Palghar into another Mumbai to decongest the crowded metropolis to the south.

But the reality of this Adivasi-dominated district is starkly different from India’s commercial capital. Palghar, like other Adivasi-dominated districts in the wealthy state of Maharashtra, suffers from malnutrition, a dearth of livelihoods, depletion of forests and, crucially, maternal and infant deaths.

In April, Chief Minister Devendra Fadnavis announced an upgrade in health services in Maharashtra that would ensure healthcare access for communities within 5 km of where they live.

But the same month, health activists presented ground-level research on public healthcare and access in the district at the ninth Maharashtra Mahika Arogya Hakk Parishad in Palgarh’s Chahade village.

They highlighted major gaps in Palghar’s medical infrastructure to reiterate that extending equal healthcare access, especially for poor and marginalised residents, will be a formidable challenge for the state government.

Participants at the meeting highlighted the challenges of inadequate basic facilities and insufficient technicians and doctors in rural areas. They also emphasised the toll this takes on the lives of women and workers in the informal sector.

So underdeveloped is the health infrastructure in Palgarh that residents are compelled to visit private hospitals or travel north to Gujarat, with which it shares a boundary. For many, the nearest public hospital is in Silvassa, in the Union Territory of Dadra and Nagar Haveli. But this facility is often hard-pressed to accept patients from Maharashtra.

Fadnavis’s health plan comes at a time when the use of public health facilities in Maharashtra is lower than the national average.

Women pay the price

According to the 2011 census, Palghar district had a population of nearly 30 lakh, of which 37.39% is Adivasi. In 2014, Palghar – which sprawls out over 5,344 square km – was carved out from Thane district to improve its administration.

Despite this, the district’s health services are still underdeveloped. This is especially evident from the toll on pregnant women. In 2024, there were 14 maternal deaths in the district, a health official said. They were investigated by the statutory Maternal Deaths Review Committee to identify shortcomings in the medical system.

The health official said that Palghar has nine rural hospitals and three subdistrict hospitals but no tertiary hospital – which is equipped for specialist medical treatment and care. The district lacks an obstetrics ICU, which is crucial for emergencies.

The system is understaffed. There are no technicians or specialist doctors, said the official. There is also no government radiologist in the district. It has only two permanent gynaecologists and seven on call on a need basis. This absence of staff is especially acute in the four remote talukas of Mokhada, Wada, Jawhar, Vikramgad, said the health official.

Only in November, a pregnant woman from Sarni village died in an ambulance without oxygen. She had come to the rural hospital in Kasa but was sent on to Silvassa.

Women at the Maharashtra Mahika Arogya Hakk Parishad said the government promotes hospital deliveries but healthcare staff are indifferent and lacking in empathy.

Women experiencing distressful pregnancies were shunted from one healthcare facility to another while some died since they were not attended to on time, said advocate Meena Dhodade from the Bhoomi Sena.

Dhodade and her team investigated 12 of the 14 maternal deaths in Palghar taluka – an administrative unit of the district – between April 2023 to December 2024. They found that a young woman in her ninth month was turned away from the Manor government hospital since there were no proper facilities there. She was redirected to Silvassa but she died there after she was not attended to on time.

Another woman who could not access medical treatment at Safale died en route to the Palghar rural hospital. A private hospital, too, recorded the death of a pregnant woman.

In another instance, a woman who travelled to Valsad in neighbouring Gujarat for her delivery did not make it on time. Some women died after giving birth and in another case, a woman died of excessive bleeding after her delivery.

Dhodade said official records underestimated maternal deaths in Palghar taluka during the same period.She and her team investigated 12 incidents and found that two deaths were not registered. The women were between 20 to 24 years. Some suffered from anaemia.

According to the fifth round of the National Family Health Survey, 2019-’21, 54% of women in Maharashtra are anaemic. Anaemia is particularly high among rural women, young women between the ages of 15-19 and women from the Scheduled Tribes.

Madhu Dhodi, an activist of an organisation called the Kashtakari Sanghatna, said that of 28 women interviewed for her study in three villages, 22 who went to government hospitals were sent to other health facilities without any explanation. Women also said that there were often no doctors and that their babies had been delivered by nurses.

There have been other healthcare violations as well.

A young participant at the parishad said that two years after she underwent a caesarean procedure, she found a wire dangling from her body. She pulled it out, thinking it was a leftover thread from her surgery. She told a health worker, who took her to a nearby doctor. It turned out to be the remnants of copper T, a contraceptive, which had been inserted inside her without her knowledge.

Reliance on midwives

Some women said that after the delivery, they could not contact their families and felt isolated. Dhodi said the hospitals and primary health centres were also filthy, with no clean linen or even warm water. She pointed out that at times, there was no surgical thread available for post-surgery stitching.

Women at the parishad also said they preferred midwives as they felt safer with them. The Warli Adivasi community has relied on “soyeen”, or midwives, for generations.

Adivasi Ekta Parishad activist Kirti Vartha profiled 10 “soyeen” and found that some of them had delivered three generations of children. With the customary midwife practices vanishing, she said the government must provide training and support to health workers, especially in the absence of qualified doctors in the area.

She also said midwives should accompany pregnant women to hospitals or health centres. At times even the medical staff has relied on the knowledge and experience of the soyeens, she said.

Dr Nilangi Sardeshpande, project coordinator for Society for Health Alternatives or SAHAJ said the Centre had issued guidelines for midwife services in India and that one of the training centres is in Telangana.

Maharashtra’s maternal mortality rate is 33, far below the national average of 97. But in places like in Palghar, there are likely to be huge variations in ground-level data. The state has achieved the UN Sustainable Development Goal of bringing down maternal mortality rates but to reduce it further, the focus must be on marginalised communities.

On June 6, the Palghar district administration announced its healthcare preparations for the monsoon, focusing on maternal and child health. The plans include establishing contact with expecting or breastfeeding mothers in 82 villages and 137 hamlets with no road connectivity.

Exposed to the weather

Another challenge faced by women in Palgarh is the extreme weather, Since many women have jobs in the informal or unorganised sector, they often work outdoors, bearing the brunt of extreme weather – like heatwaves in summer.

Pradnya Gawad of the Rashtra Seva Dal studied women who sold vegetables on the street and fisherwomen. Many of them walked to the market, often carrying 15 kg of produce. There were no facilities for shade, water and toilets in the vicinity.

The women said they suffered from body aches, high blood pressure and that they couldn’t seek medical advice due to their work timings. It was worse during menstruation with no clean toilets or shady spots to rest.

The lives of brick kiln workers who migrate annually within the district were equally dire, illustrating the challenge of extending health services to marginalised residents.

Snehalata Gamre of the nonprofit Aarohan said that according to the study she carried out, the workers live in makeshift shanties with no water or power, and no access to food rations. They are paid a pittance of Rs 800 to Rs 1,000 per week per family, despite working for nearly 15 hours a day. Many complained of body ache, burning eyes and urinary tract infections. Gamre suggested establishing mobile dispensaries and providing food rations.

Meena Menon is a freelance journalist and a postdoctoral visiting fellow at the Leeds Arts and Humanities Research Institute, University of Leeds, UK.

In September 2024, a 38-year-old woman consulted Narendra Kotwal, director of endocrinology at Paras Health, Panchkula. She reported persistent fatigue, difficulty falling asleep, irregular menstrual cycles, mood disturbances such as irritability and low mood and had gained 5 kg over six months. The woman works nights at a call centre and lives close to a brightly lit digital billboard.

Kotwal, a retired lieutenant general in the Indian Army and president of the Endocrine Society of India, noted that the patient was overweight and exhibited features suggestive of insulin resistance – skin tags, a high waist-to-hip ratio and a large neck circumference – indicating a pre-diabetic state. That is not odd: A 2023 study showed that 136 million Indians are pre-diabetic, as we reported in August that year.

The patient also had pronounced dark circles under her eyes. Laboratory investigations revealed subclinical hypothyroidism and elevated evening cortisol levels, which disrupt the body's natural stress response and sleep cycle.

Kotwal attributed her condition primarily to light pollution or photo pollution – chronic exposure to artificial light at night during biologically-intended sleep hours.

Streetlights, illuminated billboards, neon signage, industrial and office lighting during night shifts, household lighting, and external security lights are the common sources of light pollution.

Kotwal’s prescription started with a series of light hygiene measures: installing blackout curtains, wearing an eye mask during sleep and using blue-light blocking glasses after sunset. Blue light is emitted by electronic gadgets such as smartphones and tablets. She was also advised to avoid screens for at least two hours before sleeping.

To restore the patient’s circadian (24-hourly) rhythm through chronotherapy, Kotwal recommended scheduled bright light exposure in the early evening to increase alertness during her desired wake phase, followed by a gradual dimming of ambient light to cue sleep readiness.

Stress management, including mindfulness and deep-breathing exercises, were also advised. Regular monitoring and control of the thyroid-stimulating hormone and of blood glucose levels formed an essential component of her long-term care.

Diligent adherence to this integrative regimen helped the patient experience significant recovery. However, Kotwal noted that in certain individuals, especially those with persistent sleep disruption and heightened stress, melatonin supplementation or sleeping pills may be required. Left unaddressed, such circadian misalignment may put individuals at the risk of – or exacerbate – metabolic disorders like type-2 diabetes.

Anoop Misra, chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, says clinical practice is increasingly showing up patients of hormonal imbalances and metabolic dysfunction such as diabetes, where light pollution and the ensuing stress and sleep disturbances are suspected contributors.

This is, perhaps, an outcome of 80% of the world living under light-polluted skies, according to a world atlas of artificial sky luminance generated in 2016.

Misra stressed the need to establish a direct cause-and-effect relationship between light pollution and metabolic disorders through controlled studies, which India has few of. However, a review of health studies conducted overseas shows that light pollution has a severe detrimental impact on human health, causing mental health issues, cancer and Alzheimer’s.

Effects of artificial light

Being exposed to artificial light at night reduces the production of melatonin, popularly called “the hormone of darkness” since it is produced at night. Insufficient melatonin, in turn, disrupts the body’s circadian rhythm, the biological clock regulating the sleep-wake cycle. The fallout of this isn’t just the obvious sleep disturbances – exacerbated metabolic, hormonal and immunological imbalances are some of the other outcomes.

A study published in Sleep and Vigilance in January 2021 described the role of melatonin in the development and growth of cancer, immune activity, anti-oxidation and free radical scavenging (neutralising free radicals that can potentially harm healthy cells and tissues).

Co-author Manisha Naithani, professor of biochemistry at the All India Institute of Medical Sciences, Rishikesh, explained that the damage starts in the part of the brain called the suprachiasmatic nucleus, when it receives light signals from photosensitive cells in the retina. The suprachiasmatic nucleus is a part of the brain, located in the front part of the hypothalamus, the central control of the endocrinological system. It works as the brain’s central clock, regulating the daily rhythm of the body.

Naithani’s study cites epidemiological evidence supporting the cancer link. “A Spanish study showed greater breast cancer risk and prostate cancer risk in people exposed to higher artificial light levels at night,” she said. “An Israeli study found a 73% increase in breast cancer incidence in areas with high night-time light.”

“Female shift workers such as nurses and police personnel have a higher breast cancer risk (see here and here),” she said.

Naithani pointed out that insufficient sleep is associated with hormone-sensitive cancers, meaning cancers that develop as an outcome of hormonal disturbances, such as breast, colorectal and endometrial cancers.

Some other side effects of exposure to artificial light at night are weight gain, gut inflammation, mood disorders and low resistance to environmental and emotional stressors.

A review study published in August 2024 established a clear link between light pollution and sleep disturbances leading to mood alterations, a finding in line with psychiatrists’ clinical experience.

“Poor sleep or insomnia is closely tied to depression and anxiety,” said Kersi Chavda, consultant psychiatrist, PD Hinduja Hospital & Medical Research Centre, Mumbai. “People living in brightly lit urban areas often report feeling more stressed, anxious, or down. Night-time light exposure also makes seasonal depression worse for some, since the natural contrast between night and day gets blurred. Some victims find it harder to concentrate and think clearly during the day.”

Both Naithani and Chavda cited the blue light from a cell phone, and LEDs, as a key contributor to light pollution. “Blue-enriched light affects the suprachiasmatic nucleus the most, causing chronic stress and potentially triggering inflammation and lowering immunity,” said Naithani.

“Children, shift workers and those already dealing with mental health challenges are most vulnerable,” added Chavda.

Higher outdoor night-time light has also been linked with a higher prevalence of Alzheimer’s disease. In fact, it was found to be a bigger risk factor for Alzheimer’s than factors such as alcohol abuse, chronic kidney disease, depression, heart failure and obesity, according to a study published in Frontiers of Neuroscience last year.

The challenge, Naithani said, is that the “potential detrimental effects of artificial light are not known to all, the hidden perils of light are yet to be brought in full public knowledge so that night-time light can be dealt with effectively.”

Low awareness

An online survey published in the Journal of Urban Management in September 2022 found very low awareness of light pollution among Indians aged 16 to 65 years – the age group that is most likely to have a nightlife and be exposed to various kinds of light pollution that the study described, such as light trespass, skyglow, over-illumination, light clutter and glare.

Recognise the many kinds of light pollution

Light trespass: refers to light spilling over the area it is meant to illuminate. For instance, when undesired street light enters someone’s window.

Skyglow: is the orange-pink glow that envelopes the night skies of many cities. Natural factors as well as artificial lighting emit skyglow and are further scattered through dust particles, gas and suspended water droplets.

Over-illumination: is the practice of using more light than what is needed for a specific activity or place. For instance, keeping lights on when no one is present.

Light clutter: is caused by excessively bright lights that can cause confusion. For instance, some streets have too much lighting and overly bright advertisement screens.

Glare: is the effect of bright light on eyes, such as when car headlights flash in the face of a pedestrian. Glare can impact eyes and vision in varying degrees, from being merely distracting to discomforting to disabling and in the worst possible case, blinding.

When respondents were asked how often they had heard of light pollution, 57% replied they hadn’t heard of it at all. When they were asked to explain light pollution, some of them said it referred to “violation of UV and other harmful rays in the sunlight”, “pollution which is not very harmful” and “maybe something related to the environment”.

The authors concluded that the lack of awareness extended the threat associated with light pollution.

Public lighting is widely perceived to contribute to safety but research does not prove this link. A study conducted in the UK showed that darkness does not increase the risk of certain types of crime. “Outdoor lighting may lower safety by making victims and potential theft articles more easily visible,” said Tanya Bedi, assistant professor, Department of Architecture, School of Planning and Architecture, Bhopal.

Poor enforcement

Artificial light at night has been shown to increase with the growth of a country’s gross domestic product. But this association is deeper. It’s not the GDP volume as such that increases night-time brightness but the physical expansion of cities through real estate, highways, and urban sprawl, explained Bedi.

Essentially, “as a nation develops, infrastructure indicators such as road and streetlight density contribute to brightness levels”, she said.

Studies in India comparing light pollution over time show how much more bright the night sky has become.

A study by Bedi and others at the School of Planning and Architecture, Bhopal, identified Bengaluru, Kolkata, Hyderabad, Delhi and Mumbai as India’s most polluted cities from the perspective of light. Their research also found streets with illumination four times the Indian Standards recommendation.

A key reason for the excessive increase in night-time luminosity is the outburst of development with no strict regulations.

“Urban local bodies like municipal corporations, development authorities, and gram panchayats are responsible for public lighting,” said Bedi. “But compliance with the Indian Standards and the focus on curbing light pollution is usually hindered by a lack of awareness and specific regulations.”

Bedi’s study found the rampant use of low-mounted and densely packed luminaires, non-cut-off fixtures (fixtures that cannot direct the light downwards rather than upwards), and lamps of more wattage than required. Both administrative and local level measures are needed to reduce light pollution, she says.

Mumbai resident Nilesh Desai complained to the collector of Mumbai City about flood lights installed in the Wilson Gymkhana and the Police Gymkhana in Mumbai in 2017. Desai, who lives in the area, was disturbed by the excess lighting at night.

The collector took prompt action, ordering the lights to be switched off at 10 pm, and set up in a way that no resident is disturbed. He also instructed all gymkhanas to get prior permission to install lights.

Since then, Desai has also complained to the Brihanmumbai Municipal Corporation about lighting on construction sites that work round the clock, and digital hoardings, both of which are meant to be switched off at 11 pm.

The challenge is: “after the pandemic no enforcement is happening,” said Desai. “Night matches in the Police Gymkhana start at 11 pm, it is a pity that awareness about light pollution is very low. I have written to the police commissioner to switch off the Police Gymkhana lights after 10 pm but no action has been taken so far.”

Around the time Desai complained about light pollution from the gymkhanas near Marine Lines, Sumaira Abdulali, founder of Awaaz Foundation, a not-for-profit working on environmental issues, also studied light pollution in Mumbai.

“We found that coloured LED lights put up at Juhu beach for a ‘beautification’ project was contributing to light pollution,” Abdulali told IndiaSpend. “When we inquired, we were told that they were for safety but the light was focused and coloured so it could never serve to increase safety.”

“A review of street lighting on Mumbai’s main roads showed that it is quite effective in lighting up roads and isn’t intrusive,” added Abdulali. “However, what is intrusive and is getting worse over the years is lighting during festivals, and in recent years, digital hoardings, some building façades and construction sites, and advertisements of new properties. All these lights are intrusive, especially for drivers, in areas of natural beauty such as sea-fronts, and in residential areas, unless you use black-out curtains. Most people don’t use these, and why should they?”

Abdulali wrote to the civic body and objected to the civic body’s proposed hoarding policy, opposing brightly lit and moving digital hoardings as a safety hazard for drivers and a health hazard in residential areas. She was even called for a hearing in late 2024, but nothing has come of it as yet, she said.

IndiaSpend has reached out to the offices of the commissioners of the Brihanmumbai Municipal Corporation, the Municipal Corporation of Delhi and the Municipal Corporation of Greater Bengaluru. We will update this story when we receive a response.

Better lighting decisions

A salient characteristic of light pollution is that it is localised and hence controllable. Unlike air pollution, it doesn’t spread on a windy day.

“Government authorities should promote better lighting design,” said Bedi. “State governments should adopt reference standards to control existing and proposed external lighting usage so that the concerned authority – municipal corporations in urban areas and gram panchayats in rural areas – can take necessary action towards responsible parties to resolve light nuisances and enforce dimming schedules for non-essential lighting during off-peak hours. Also practical issues like how tender specifications are framed, and limited technical capacity for monitoring lighting design must be addressed.”

Practical strategies to mitigate light pollution include mandating the use of full cut-off luminaires and environment-friendly backlight-uplight-glare rated lighting fixtures to minimise glare and skyglow, said Bedi. “Further, energy efficiency concerns have pushed the widespread adoption of LEDs, but warm-toned LEDs can help reduce circadian rhythm disruptions in both humans and wildlife.”

Zoning can also play a key role in reducing light pollution. Creating lighting environmental zones, particularly in ecologically sensitive or biodiversity-rich areas, would allow for more adaptive and localised control, said Bedi. “Ward-level prioritisation maps would support a phased implementation approach, targeting the most ecologically vulnerable or light-polluted areas first.”

A lot can be done. But the experience of those who have complained shows that so far, light pollution isn’t being taken seriously enough.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.

Fitness enthusiasts have debated the question for decades: is it better to do cardio before or after lifting weights? Until recently, the answer has largely been down to preference – with some enjoying a jog to warm up before hitting the weights, while others believe lifting first is better for burning fat.

But a new study may have finally answered this long disputed question.

According to the study, the order of your workout does significantly affect how much fat you lose. Participants who performed weight training before cardio lost significantly more fat and became more physically active throughout the day compared to those who did cardio first.

The researchers recruited 45 young men aged 18-30 years who were classified as obese. The researchers split participants into three groups for 12 weeks. One group was a control group. This meant they stuck to their usual lifestyle habits and didn’t make any changes to their exercise regime.

The other two groups exercised for 60 minutes three times weekly. Participants were also given sports watches to objectively track daily movement. This helped the researchers avoid reliance on self-reporting, which can often be inaccurate.

Both exercise groups followed identical training programmes, differing only in exercise sequence. Strength training involved actual weights, with participants performing exercises such as the bench press, deadlift, bicep curl and squat. The cardio sessions involved 30 minutes of stationary cycling.

Participants in both groups experienced improvements in their cardiovascular fitness, muscle strength and body composition – specifically, they lost fat mass while gaining lean muscle mass. Interestingly, cardiovascular fitness improvements were similar regardless of sequence – echoing recent findings that exercise order has limited impact on cardiovascular adaptations.

But the real differences emerged when it came to fat loss and muscle performance. Participants who lifted weights first experienced significantly greater reductions in overall body fat and visceral fat – the type of fat most strongly linked to cardiovascular disease risk.

They also increased their daily step count by approximately 3,500 steps compared to just 1,600 steps for the cardio-first group. Additionally, the weights-first approach enhanced muscular endurance and explosive strength.

Why exercise sequence matters

The reason behind these findings is tied to how your body uses energy.

Resistance training depletes muscle glycogen stores – the sugar that’s stored in the muscles which acts as your body’s quick-access fuel. Imagine glycogen as petrol in your car’s fuel tank. When you lift weights first, you effectively drain this fuel tank, forcing your body to switch energy sources.

With glycogen stores already low, when you transition to cardio, your body must rely more heavily on fat reserves for energy. It’s akin to a hybrid car switching to battery power once the petrol runs low. This metabolic shift helps explain the greater fat loss seen in the weights-first group.

This recent study’s findings align with broader research. A comprehensive systematic review published in 2022 found resistance training alone can significantly reduce body fat and visceral fat, the type linked to chronic diseases. Muscles are metabolically active tissues, continuously burning calories even at rest, which amplifies these effects.

Conversely, performing cardio first might compromise your strength training effectiveness. Cardio uses up glycogen stores, leaving muscles partially depleted before you even lift a weight. It also induces fatigue and may reduce your muscles’ ability to produce explosive power and strength.

A recent systematic review on concurrent training (the practice of combining both resistance and aerobic exercise within the same program) supports this – highlighting that explosive strength gains might diminish if aerobic and strength training occur in the same session, especially if cardio is performed first.

These findings align with other research on concurrent training. A systematic review and meta-analysis examining exercise sequence effects found that resistance-first protocols produced significantly superior strength improvements compared to endurance-first training.

The American Heart Association’s 2023 statement on resistance training confirmed resistance exercise significantly improves lean body mass and reduces fat, especially when combined with other exercise types. However, resistance training alone was found less effective in improving cardiovascular health. This underscores the importance of including cardio in your exercise routine.

However, it is worth noting the study’s limitations. As it only involved obese young men, this means we don’t know how the results will apply to women, older adults or those with different body compositions. A 2024 review suggests adaptations may differ by sex, indicating the need for further research involving diverse populations.

The 12-week duration also may not capture long-term changes. Results also specifically only apply to concurrent training – performing both exercises in the same session.

Moreover, the study did not account for nutritional intake, sleep patterns or stress levels, all of which can significantly influence body composition outcomes. Future research should incorporate these factors to offer even more comprehensive guidance.

Workout sequence

Whether you prefer to do cardio before or after lifting weights, the message is clear: both will improve overall health. The only difference is that weight training before cardio provides advantages for fat loss, abdominal fat reduction and increased daily physical activity.

Interestingly, resistance training boosts confidence and energy levels, naturally encouraging more movement throughout the day, further aiding fat loss.

If cardiovascular fitness is your primary goal, the sequence matters less, as both ways equally boost aerobic fitness. However, if fat loss and optimising daily activity are your main objectives, evidence strongly supports placing resistance training first.

Jack McNamara is Senior Lecturer in Clinical Exercise Physiology, University of East London.

This article was first published on The Conversation.

At a tense meeting in Nigeria’s capital Abuja, health workers poured over drug registers and testing records to gauge whether US aid cuts would unravel years of painstaking work against tuberculosis in one of Africa’s hardest hit countries.

For several days in May, they brainstormed ways to limit the fallout from a halt to US funding for the TB Local Network (TB LON), which delivers screening, diagnosis and treatment.

“To tackle the spread of TB, you must identify cases and that is in a coma because of the aid cuts,” said Ibrahim Umoru, coordinator of the African TB Coalition civil society network, who was at the Abuja meeting.

“This means more cases will be missed and disaster is looming.”

This desperate struggle to save endangered programmes is being replicated from the Philippines to South Africa as experts warn that US aid cuts risk reviving a deadly infectious disease that kills around one million people every year.

President Donald Trump’s gutting of the US Agency for International Development has put TB testing and tracing on hold in Pakistan and Nigeria, stalled vital research in South Africa and left TB survivors lacking support in India.

The World Health Organization says “the drastic and abrupt cuts in global health funding” threaten to reverse the gains made by global efforts to fight the disease – namely 79 million lives saved since 2000 – with rising drug resistance and conflicts exacerbating the risks.

In Nigeria, TB Local Network is in the firing line.

The project was set up in 2020, during Trump’s first term, and received $45 million worth of funding from USAID. The US development agency said at the time it was committed to a “TB free Nigeria”.

Five years later and with the same president back in charge but now with a more radical “America first” agenda, USAID support for TB LON's community testing work was terminated in February, according to a TB LON official. The official did not want to be named because he was not authorised to speak on behalf of the project.

‘Hard work in jeopardy’

TB kills 268 Nigerians every day and cases have historically been under-reported increasing the risk of transmission. If one case is missed, that person can transmit TB to 15 people over a year, according to the World Health Organization.

Context spoke to half a dozen health workers who collect TB test samples for TB LON but had stopped doing so in January due to the US aid freeze.

Between 2020-2024, TB LON screened around 20 million people in southwestern states in Nigeria, and more than 100,000 patients were treated as a result.

“All that hard work is in jeopardy if we don’t act quickly,” Umoru said, adding that non-profits working with TB LON had laid off more than 1,000 contract workers who used to do TB screening.

Nigeria’s health ministry did not respond to request for comment on the effect of the USAID cuts on TB programmes.

In March, First Lady Oluremi Tinubu declared TB a national emergency and donated 1 billion naira ($630,680) to efforts to eradicate the disease by 2030.

In South Africa, medical charity Médecins Sans Frontières said TB and HIV programmes had been disrupted across the country, making patient tracking and testing more difficult, according to a statement sent to Context/the Thomson Reuters Foundation.

South Africa had an TB incidence rate of 427 per 100,000 people in 2023, government data showed, down 57% from 2015. TB-related deaths in South Africa dropped 16% over that period, the data showed.

Minister of Health Aaron Motsoaledi said in May that the government would launch an End TB campaign to screen and test five million people, and was also seeking new donor funding.

“Under no circumstances will we allow this massive work performed over a period of more than a decade and half to collapse and go up in smoke,” he said at the time, referring to efforts to tackle TB and HIV.

Blow to critical research

South Africa is also a hub for research into both TB and HIV and the health experts say funding cuts risk derailing this vital work.

The Treatment Action Group, a community-based research and policy think tank, says around 39 clinical research sites and at least 20 TB trials and 24 HIV trials are at risk.

“Every major TB treatment and vaccine advance in the past two decades has relied on research carried out in South Africa,” said Treatment Action Group TB project co-director Lindsay McKenna in a March statement.

People struggling with poor nutrition and those living with HIV – the latter affects eight million people in South Africa – were also more at risk of contracting TB as aid cuts made them more vulnerable by derailing nutrition programmes, community outreach and testing, said Cathy Hewison, head of MSF’s TB working group.

“It’s the number one killer of people with HIV,” she said.

In the Philippines, US cuts have disrupted TB testing in four USAID-funded projects, and affected the supply of drugs, Stop TB Partnership, a UN-funded agency said.

“The country has a nationwide problem with recurrent drug shortages, which is leading to a direct impact on efforts to eliminate TB,” said Ghazali Babiker, head of mission for MSF Philippines.

In Pakistan, which sees 510,000 TB infections each year, MSF said US cuts had disrupted TB screening in communities and other services in the hard-hit southeastern province of Sindh.

“We are worried that the US funding cuts that have impacted the community-based services will have a disproportionate effect on children, leading to more children with TB and more avoidable deaths,” said Ei Hnin Hnin Phyu, medical coordinator with MSF in Pakistan.

“We cannot afford to let funding decisions cost children’s lives.”

This article first appeared on Context, powered by the Thomson Reuters Foundation.

In January 2020, an official at a primary health centre in Jharkhand told Khageshwar Kumar about a drug-resistant tuberculosis patient who had stopped taking medicines for the last two months.

Kumar stepped in.

For 18 months, he visited the patient in Parasnath block in Giridih district three times a week, counselling him in sessions that lasted three hours or more.

“He had become suicidal. Even his family had given up on his treatment,” Kumar said. “For hours I would talk to him. I was able to help him because I was a TB patient myself. I can relate to how patients feel.”

Kumar is a TB Champion or TB Vijeta, a term coined for patients cured of the bacterial infection, who are then drafted to the National Tuberculosis Elimination Programme. Their role – to counsel other patients and raise community awareness.

In this case, Kumar’s efforts paid off. He convinced the patient to resume his medicines and helped him through their painful side-effects. The patient went on to finish his treatment in 2022 and is now employed with a private firm.

Khageshwar Kumar was diagnosed with tuberculosis in 2007 and cured the same year.

The 29-year-old began working as a TB Champion in Giridih in 2019 for an honorarium of Rs 6,000 per month. “The amount was small, but I had no other job and I was passionate about TB,” he said.

Since 2023, however, that money has stopped. Several TB Champions have dropped out of the programme in Jharkhand, though some like Kumar do limited volunteer service in spare time.

“For how long can we work for free?” Kumar asked.

A support group

The TB Champion programme was initiated in India in 2016 as a major component under the National Tuberculosis Elimination Programme, which aimed to eradicate tuberculosis by 2025.

The deadline, missed by India, has now been pushed to 2030.

But across India, the programme is under stress, with multiple states complaining of delay in financial reimbursement or a complete freeze in funds.

Each state allocates a different amount as fee for the former tuberculosis patients. In some states, NGOs partner with the government and pay the amount.

In May, Nishant Kumar, joint director of the central tuberculosis division was asked why the programme was struggling at a conference. “TB Champions (programme) has not stopped,” Kumar said. “It is transitioning.”

But several counsellors Scroll spoke to said irregular payments are a problem.

In Haryana, Sagar Verma, who is the TB Champions Network President, said he received Rs 8,000 per month until 2024 through an NGO called World Vision that had partnered with the government. “It stopped due to funds shortage,” he said.

Verma now works at a district hospital in Haryana. “There are over 100 counsellors like me who are jobless in the state. We have approached state authorities multiple times to release funds for this programme,” Verma said. The last time, the counsellors engaged with tuberculosis patients in Haryana was March 2024.

In Odisha, counsellor Kailash Mishra has not received April’s honorarium till date. “The state government said that March funds have not reached them from the Centre.”

Mishra visits four patients every day and does regular district level reporting of cases apart from conducting community meetings to raise awareness. For this, he receives Rs 3,500 a month from the Odisha government. “The payment is frequently delayed,” he said.

“Many of us travel 200 km to district headquarters for meetings. Sometimes we also collect sputum to test for TB bacteria,” Mishra said. Although the National Tuberculosis Elimination Programme permits states to reimburse counsellors for such services, Mishra said no reimbursement is given to them.

Eldred Tellis, founder of Sankalp Rehabilitation Trust, said the issue has become acute in the last few months. “Whenever we approach state officials, they cite fund shortage,” he said. “The central ministry refuses to acknowledge this problem. This has not only cut the source of livelihood for TB Champions, it has also affected patient care.”

Other health activists agreed that the absence of the counsellors would hurt patients. “TB Champions fill a crucial gap in the programme by providing mental health support to patients,” said health activist Ganesh Acharya. “In their absence a major component will be lost.”

‘A vital part’

In 2016, Reach, a non-profit that partnered with the government on tuberculosis control, trained its first cohort of 25 TB Champions and went on to train 3,000 such counsellors.

Ramya Ananthkrishnan, director at Reach, said the aim was to provide a support group for TB patients. “They play a vital part. Some look at advocacy, some get deeply involved in the programme to handle treatment and diagnosis,” she said.

Across India, the National Tuberculosis Elimination Programme has trained over 30,000 champions till 2023.

In Mumbai, a hotbed of drug-resistant tuberculosis, the Brihanmumbai Municipal Corporation relied heavily on the TB Champions to carry out door-to-door visits and engage with the community.

Till last year, Maharashtra paid the highest compensation to the counsellors, at Rs 10,000 a month. Moreover, the counsellors were employed by the civic body on a contractual basis.

But in June 2024, the civic body discontinued the programme. About 25 people employed to counsel patients were rendered jobless.

“Few were retained and assured of payment. But since the last eight months, they have not been paid,” said activist Meera Yadav.

Yadav said that the funds meant for the programme were discontinued by the state’s TB division due to overall budget cuts.

A state government official requesting anonymity said funds under the National Health Mission have been "delayed consistently”.

“We use NHM funds for various diseases, including tuberculosis,” the official said. “This year, the funds were supposed to be disbursed by March. We have not received them till now.”

The delay and underutilisation of funds is apparent in the 2023-24 budget and expenditures made by the National Tuberculosis Elimination Programme.

Out of a budget of Rs 1,888 crore, the programme had spent only Rs 840 crore till March 15, 2024. For 2022-23, the programme spent Rs 910 crore out of the approved budget of Rs 1,666 crore.

Some officials employed with NGOs, who work with the government on tuberculosis, told Scroll that the abrupt end of funds from the United States Agency for International Development this January has also forced them to curtail spending on TB Champions.

Shazad Ahmed, who is a TB Champion in Balrampur, Uttar Pradesh, stopped receiving a monthly honorarium of Rs 8,000 from 2024. He was being paid by Reach.

He still continues to work though in the hope the government will resume payments. “I am working to help other patients. I will continue to work for free as long as possible.”

More and more people over the age of 50 are taking up physical exercise. Medical associations resoundingly agree that this is a good thing. Physical exercise is not only key to disease prevention, it is also a recommended part of treatment for many illnesses.

However, starting to move at this stage of life requires some care. This is especially true for those who have not previously been physically active, or for people who are overweight or obese.

It has been proven that starting to exercise with routines that are too demanding can lead to significant muscular and skeletal injuries, especially if combined with an inadequate diet. This risk is even greater after the age of 50, as the loss of muscle and bone mass is more pronounced due to natural ageing processes.

Before starting any new exercise programme, it is a good idea to carry out a complete analysis, especially to assess the need for micronutrient supplements.

Protein is key

In addition to micronutrients, the body also needs carbohydrates, fats and proteins – known collectivey as macronutrients. Proteins provide the body with the essential amino acids needed to maintain and develop muscle mass, and to prevent sarcopenia: age-related muscle injury, osteoporosis, and loss of muscle mass and strength (formerly referred to as frailty).

Protein requirements vary according to an individual’s clinical situation. In people over 50 years of age who are moderately physically active, protein requirements range from 1 to 1.5 grams per kilogram of body weight per day.

However, it is not advisable to increase protein intake without a corresponding increase in physical exercise. Too much protein can actually have harmful effects, especially on bone health, as it has been observed to increase calcium excretion in the urine (calciuria) due to decreased tubular calcium reabsorption.

Animal and vegetable protein

Protein sources should combine those of vegetable origin – soy, beans, seeds, peanuts, lentils, and so on – with those of animal origin, such as eggs, dairy products, chicken and fish.

While the ideal is to have balance of both, it has been shown that following a vegetarian diet is compatible with high-performance sports, so long as there is suitable medical and nutritional monitoring.

In addition to what you eat, it also matters when you do it. Spreading protein intake throughout the day is more beneficial than concentrating it in a single meal. You should also eat protein 30 minutes before or after exercise, as its absorption and availability in the body will be better.

Essential micronutrients

Some micronutrients – by which we mean vitamins and minerals – play a key role in physical exercise at this age. These include magnesium, calcium and vitamin D.

Magnesium aids muscle recovery and bone formation, and can be found in foods such as wheat bran, cheese, pumpkin seeds and flax seeds.

Calcium is essential for maintaining adequate bone mineralisation and preventing loss of bone mineral density (osteopenia) associated with calcium deficiencies in the blood.

Dairy products are known to be beneficial for bone health, both for their bioavailable calcium, and the vitamin D content in their whole milk. Certain plant-based foods, such as tahini (sesame paste), almonds, flaxseed, soya and hazelnuts, are also decent sources of calcium, but their phytate and oxalate content can hinder its absorption.

Lastly, oily fish (tuna, sardines, salmon, and so on) and egg yolks are considered complementary sources of vitamin D in dietary plans focused on people over 50 years of age who do physical exercise.

It is also vitally important to maintain proper hydration before, during and after exercise. Both dehydration and overhydration can affect performance, and increase the risk of muscle injury.

Exercise

So far we have seen how nutrition influences athletic performance and ultimately the risk of injury. But there is another part of the puzzle: the exercise you do.

There is actually no clear consensus on this, and there is ongoing debate about which type of exercise is the most appropriate according to age, gender or body composition. The question is whether it is better to prioritise strength exercises, alternate with cardio sessions, or do both on different days.

Despite the different theories on the subject, one thing is clear: regular exercise, adapted to the abilities of each individual and with good medical and nutritional monitoring, reduces the risk of multiple diseases and improves quality of life.

Patricia Yárnoz Esquíroz is Profesor Clínico Asociado, Universidad de Navarra.

This article was first published on The Conversation.

Predicting your risk of a range of health outcomes – from type 2 diabetes to depression and even your longevity – is as simple as testing how tight your grip is.

Grip strength refers to the power generated by the muscles of the hand and forearm to perform actions such as grabbing, squeezing an object or even shaking hands. This action involves a complex interplay between the various muscle groups located in the forearm, as well as the muscles within the hand itself.

Grip strength is a very cheap, easy and non-invasive measure of muscle strength. This test has been used since the mid-1950s as a measure of overall health. Since then, the simple test has been firmly established as a reliable marker of various aspects of health – with some researchers even suggesting grip strength can be used to determine a person’s risk of everything from type 2 diabetes to depression.

The standard method for measuring grip strength involves using a handheld dynanometer – an instrument which can measure a person’s power. This test is usually done while a person is sitting down. With their forearm bent at a 90-degree angle and wrist held in a neutral position, the person then squeezes the dynamometer as hard as they can – usually three separate times for one minute each.

The average of the highest readings from each hand, or sometimes just the dominant hand, is then recorded as the person’s grip strength. This can be measured in both kilograms or pounds. A grip strength value of under 29kg for men and 18kg for women is typically considered low. You can pick up a handgrip dynamometer for under £5 should you wish to test at home.

Not only is grip strength a trusted indicator of overall health, it’s also strongly correlated with overall muscle strength and lean body mass across a person’s lifespan.

Moreover, the stronger a person’s grip is, the more independent they will be in their daily life as they get older. This means they’ll be able to perform normal daily activities without assistance, such as rising from a chair and moving around the house.

A substantial body of evidence also shows low grip strength is not only linked with greater susceptibility of a wide range of chronic diseases – including cancer and cardiovascular disease – but greater risk of early death due to these chronic disease, as well.

Researchers have also observed links between low grip strength and greater risk of depression, anxiety and diabetes, to name a few.

There’s also a significant association between grip strength and a person’s lifespan. In this study, people who died before the age of 79 were 2.5 times less likely than those who lived to be 100 to be in the top 33% for grip strength when they were middle aged.

However, in a 12-year prospective study published in 2022, the authors reported that baseline hand grip strength was the same in participants that died between the beginning and end of the study as in those who survived. But walking speed, speed of standing up from a chair and leg press strength were all worse in the people that died than in t that survived. This tells us is that there are better predictors of longevity than grip strength – such as total body muscle mass and leg strength.

So why is it that such a simple measure can tell us about the risk of so many diseases, and ultimately death? The answer is that grip strength is a proxy measure of total muscle strength and size. This means that grip strength alone is not a cause of early mortality or disease, but is correlated with a cause of early mortality or disease (such as low muscle mass or muscle strength of the legs).

Muscle mass is crucial for overall health. It plays an integral role in our metabolism. For example, muscle helps regulate blood sugar by removing glucose from circulation. This may explain why muscle mass protects against developing diabetes.

Muscle also releases chemicals called myokines, which act upon other tissues and organs in the body – such as fat, our bones, the gut, liver and even our skin and brain. These myokines generally appear to have a protective effect on all of these tissues. This suggests muscle provides more than just the power we need to move our bodies.

Improving grip strength

Unless you’re a rock climber or otherwise need a strong grip, there’s not much point working specifically on improving your grip strength. Although grip strength is linked with longevity and disease, this is because grip strength is an estimate of total body strength.

As such, if you want to improve your health and strength, you should focus on training your leg strength. Leg strength is particularly important for health and fitness as it permits movement and helps you continue doing tasks independently in your daily life. Research also shows a correlation between leg strength and a person’s risk of chronic disease and their longevity.

You can also add in other movements such as deadlifts, press-ups and pull-ups to build strength in your core, back and arms.

Grip strength values serve as a very cheap and easy measure of a person’s overall health. It’s a cost-effective tool for measuring health but there are better ways to improve health with exercise.

Lawrence Hayes is Lecturer in Physiology, Lancaster University.

This article was first published on The Conversation.

The probability of any American having dementia in their lifetime may be far greater than previously thought.

For instance, a 2025 study that tracked a large sample of American adults across more than three decades found that their average likelihood of developing dementia between ages 55 to 95 was 42%, and that figure was even higher among women, Black adults and those with genetic risk.

Now, a great deal of attention is being paid to how to stave off cognitive decline in the aging American population. But what is often missing from this conversation is the role that chronic stress can play in how well people age from a cognitive standpoint, as well as everybody’s risk for dementia.

We are professors at Penn State in the Center for Healthy Aging, with expertise in health psychology and neuropsychology. We study the pathways by which chronic psychological stress influences the risk of dementia and how it influences the ability to stay healthy as people age.

Recent research shows that Americans who are currently middle-aged or older report experiencing more frequent stressful events than previous generations. A key driver behind this increase appears to be rising economic and job insecurity, especially in the wake of the 2007-2009 Great Recession and ongoing shifts in the labor market.

Many people stay in the workforce longer due to financial necessity, as Americans are living longer and face greater challenges covering basic expenses in later life.

Therefore, it may be more important than ever to understand the pathways by which stress influences cognitive aging.

Social isolation and stress

Although everyone experiences some stress in daily life, some people experience stress that is more intense, persistent or prolonged. It is this relatively chronic stress that is most consistently linked with poorer health.

In a recent review paper, our team summarised how chronic stress is a hidden but powerful factor underlying cognitive aging, or the speed at which your cognitive performance slows down with age.

It is hard to overstate the impact of stress on your cognitive health as you age. This is in part because your psychological, behavioral and biological responses to everyday stressful events are closely intertwined, and each can amplify and interact with the other.

For instance, living alone can be stressful – particularly for older adults – and being isolated makes it more difficult to live a healthy lifestyle, as well as to detect and get help for signs of cognitive decline.

Moreover, stressful experiences – and your reactions to them – can make it harder to sleep well and to engage in other healthy behaviors, like getting enough exercise and maintaining a healthy diet. In turn, insufficient sleep and a lack of physical activity can make it harder to cope with stressful experiences.

Prevention efforts

A robust body of research highlights the importance of at least 14 different factors that relate to your risk of Alzheimer’s disease, a common and devastating form of dementia and other forms of dementia. Although some of these factors may be outside of your control, such as diabetes or depression, many of these factors involve things that people do, such as physical activity, healthy eating and social engagement.

What is less well-recognised is that chronic stress is intimately interwoven with all of these factors that relate to dementia risk. Our work and research by others that we reviewed in our recent paper demonstrate that chronic stress can affect brain function and physiology, influence mood and make it harder to maintain healthy habits. Yet, dementia prevention efforts rarely address stress.

Avoiding stressful events and difficult life circumstances is typically not an option.

Where and how you live and work plays a major role in how much stress you experience. For example, people with lower incomes, less education or those living in disadvantaged neighborhoods often face more frequent stress and have fewer forms of support – such as nearby clinics, access to healthy food, reliable transportation or safe places to exercise or socialise – to help them manage the challenges of aging. As shown in recent work on brain health in rural and underserved communities, these conditions can shape whether people have the chance to stay healthy as they age.

Over time, the effects of stress tend to build up, wearing down the body’s systems and shaping long-term emotional and social habits.

Lifestyle changes

The good news is that there are multiple things that can be done to slow or prevent dementia, and our review suggests that these can be enhanced if the role of stress is better understood.

Whether you are a young, midlife or an older adult, it is not too early or too late to address the implications of stress on brain health and aging. Here are a few ways you can take direct actions to help manage your level of stress:

• Follow lifestyle behaviors that can improve healthy aging. These include: following a healthy diet, engaging in physical activity and getting enough sleep. Even small changes in these domains can make a big difference.

• Prioritise your mental health and well-being to the extent you can. Things as simple as talking about your worries, asking for support from friends and family and going outside regularly can be immensely valuable.

• If your doctor says that you or someone you care about should follow a new health care regimen, or suggests there are signs of cognitive impairment, ask them what support or advice they have for managing related stress.

• If you or a loved one feel socially isolated, consider how small shifts could make a difference. For instance, research suggests that adding just one extra interaction a day – even if it’s a text message or a brief phone call – can be helpful, and that even interactions with people you don’t know well, such as at a coffee shop or doctor’s office, can have meaningful benefits.

Lifelong learning

A 2025 study identified stress as one of 17 overlapping factors that affect the odds of developing any brain disease, including stroke, late-life depression and dementia. This work suggests that addressing stress and overlapping issues such as loneliness may have additional health benefits as well.

However, not all individuals or families are able to make big changes on their own. Research suggests that community-level and workplace interventions can reduce the risk of dementia. For example, safe and walkable neighborhoods and opportunities for social connection and lifelong learning – such as through community classes and events – have the potential to reduce stress and promote brain health.

Importantly, researchers have estimated that even a modest delay in disease onset of Alzheimer’s would save hundreds of thousands of dollars for every American affected. Thus, providing incentives to companies who offer stress management resources could ultimately save money as well as help people age more healthfully.

In addition, stress related to the stigma around mental health and aging can discourage people from seeking support that would benefit them. Even just thinking about your risk of dementia can be stressful in itself. Things can be done about this, too. For instance, normalising the use of hearing aids and integrating reports of perceived memory and mental health issues into routine primary care and workplace wellness programs could encourage people to engage with preventive services earlier.

Although research on potential biomedical treatments is ongoing and important, there is currently no cure for Alzheimer’s disease. However, if interventions aimed at reducing stress were prioritised in guidelines for dementia prevention, the benefits could be far-reaching, resulting in both delayed disease onset and improved quality of life for millions of people.

Jennifer E Graham-Engeland is Professor of Biobehavioral Health, Penn State.

Martin J Sliwinski is Professor of Human Development and Family Studies, Penn State.

This article was first published on The Conversation.

Humans and our ancestors have been running for millions of years. Back then, it helped us capture – or avoid becoming – prey. Now, we do it to keep fit, boost mental health, unwind in nature, or play our favourite sport.

But while many of us were taught how to ride a bike, throw and catch a ball, or kick a footy, it seems very few people are ever taught how to run. You might’ve wondered: am I running wrong?

Well, the truth is there’s no one right way to run. Your ideal technique depends on factors such as leg and foot length, muscle mass, and even how springy your tendons are.

It also depends on whether you’re out for your Sunday run or running full pelt in a sprint.

That said, thinking a little more about how to run can make it feel easier and faster, and reduce injury risk.

Here are five basics to keep in mind.

1. Feet: how you land matters

Some of us land on our heels, others on the balls of our feet. If you grew up running barefoot, you’ll more often land towards the forefoot.

Debate rages on which is best. The truth is heel-first striking stresses the knees a bit more while forefoot landing places more impact on the calves and Achilles tendon.

So, if you’re injury prone in one of those areas, it might be worth adjusting your style.

But for healthy runners, there’s no strong evidence one technique is better for injury.

If you’re considering a change, do it slowly over several months, ideally with expert help.

As you run faster, you’ll bounce more in each step. You’ll naturally land more on your forefoot, especially when sprinting.

2. Legs: softer landings and smoother strides

Three things are worth focusing on:

• minimise the twisting of the legs under your body as you land, to reduce strain on knees and ankles

• keep your pelvis level during landings (dropping or rotating it increases injury risk)

• don’t bounce too high; a smooth, low trajectory uses less energy and keeps impacts manageable.

These principles are perfectly demonstrated by Ethiopian former long-distance runner Haile Gebrselassie:

Just keep relaxed, and allow the knees and ankles to flex normally.

If you find your landing style causes stress or pain, consider running with slightly shorter strides.

Then there’s the “leg recovery phase” – when your leg swings forward after push-off. During jogging, we pull the leg forward briefly with our hip muscles, but otherwise it’s a pretty passive task.

In sprinting, however, the faster leg recovery powered by your hip can contribute about 25% of your forward propulsion in each step. So make sure you flex at the hip while you push back into the ground, so your legs act like scissors as they swing.

Also, the faster you run, the more your knee should flex, and the more the foot should rise under you. This helps the leg swing forwards faster.

In other words: pick your feet up more as you pick up the pace.

3. Arms: built-in shock absorbers

During jogging, your arms help with balance, absorbing bumps or stumbles, especially on uneven ground, as seen here:

They swing mostly passively and act as shock absorbers during jogging; they can’t do their job when they’re stiff. Relaxation is key.

To keep energy cost low, try bending your elbows to keep their mass closer to your shoulder and keep your shoulders relaxed.

When sprinting, your arms become more active. They help stabilise your whole body in the short time your feet are on the ground.

Top sprint coaches often insist the “drive arm” (the arm swinging backwards) contributes to forward propulsion, thanks to physics.

But the limited studies to date suggest the effect on propulsion is moderate; future studies might shed more light.

That said, the fastest sprinters, like Usain Bolt, are renowned for their aggressive backwards arm drive:

See how his drive arm whips backwards with rapid extension of the shoulder and elbow? Meanwhile, the recovery arm – swinging forwards – is more flexed and moves much slower.

4. Torso: lean just a little

When we run, the torso naturally rotates left and right. That’s fine, although when we run faster there should be less rotation. A more aggressive arm swing helps balance out these rotations.

Our pelvis then rotates in the opposite direction to the torso. The twisting helps us balance, but also contributes a little to forward force.

But as we run faster, these rotations should become smaller as we use our arms to balance better. As your speed increases, swing your arms a bit harder and your body, legs and other arm will follow.

Finally, it’s generally accepted that we keep our torso upright when we run relaxed, with only a very slight forward lean.

But if we want to speed up, leaning forward is a great way to accelerate quickly without doing too much tiring muscle work.

And for those with knee troubles, leaning forward a bit might help reduce impact on the knees.

5. Head: a balancing act

You might be tempted to tilt your head down when you run, to watch your feet or in an effort to accelerate forwards.

But during upright (non-sprinting) running, try to keep it in normal position. Rest your head quietly on the top of your shoulders, just as as evolution intended.

During sprinting, try looking about 20 metres in front of you (a slight chin tuck is fine). When jogging, try looking ahead toward the horizon.

Not sure what your own technique looks like? Try asking a friend to take a quick video of you running. Compare it to an experienced runner running at the same speed.

You might be surprised what you notice.

Anthony Blazevich is Professor of Biomechanics, Edith Cowan University.

This article was first published on The Conversation.

It’s a question that’s long been the cause of debate: is it better to shower in the morning or at night?

Morning shower enthusiasts will say this is the obvious winner, as it helps you wake up and start the day fresh. Night shower loyalists, on the other hand, will argue it’s better to “wash the day away” and relax before bed.

But what does the research actually say? As a microbiologist, I can tell you there actually is a clear answer to this question.

First off, it’s important to stress that showering is an integral part of any good hygiene routine – regardless of when you prefer to have one.

Showering helps us remove dirt and oil from our skin, which can help prevent skin rashes and infections.

Showering also removes sweat, which can quell body odour.

Although many of us think that body odour is caused by sweat, it’s actually produced by bacteria that live on the surface of our skin. Fresh sweat is, in fact, odourless. But skin-dwelling bacteria – specifically staphylococci – use sweat as a direct nutrient source. When they break down the sweat, it releases a sulphur-containing compound called thioalcohols which is behind that pungent BO stench many of us are familiar with.

Day or night

During the day, your body and hair inevitably collect pollutants and allergens (such as dust and pollen) alongside their usual accumulation of sweat and sebaceous oil. While some of these particles will be retained by your clothes, others will inevitably be transferred to your sheets and pillow cases.

The sweat and oil from you skin will also support the growth of the bacteria that comprise your skin microbiome. These bacteria may then also be transferred from your body onto your sheets.

Showering at night may remove some of the allergens, sweat and oil picked up during the day so less ends up on your bedsheets.

However, even if you’ve freshly showered before bed, you will still sweat during the night – whatever the temperature is. Your skin microbes will then eat the nutrients in that sweat. This means that by the morning, you’ll have both deposited microbes onto your bed sheets and you’ll probably also wake up with some BO.

What particularly negates the cleaning benefits of a night shower is if your bedding is not regularly laundered. The odour causing microbes present in your bed sheets may be transferred while you sleep onto your clean body.

Showering at night also does not stop your skin cells being shed. This means they can potentially become the food source of house dust mites, whose waste can be allergenic. If you don’t regularly wash your sheets, this could lead to a build-up of dead skin cell deposits which will feed more dust mites. The droppings from these dust mites can trigger allergies and exacerbate asthma.

Morning showers, on the other hand, can help remove dead skin cells as well as any sweat or bacteria you’ve picked up from your bed sheets during the night. This is especially important to do if your sheets weren’t freshly washed when you went to bed.

A morning shower suggests your body will be cleaner of night-acquired skin microbes when putting on fresh clothes. You’ll also start the day with less sweat for odour-producing bacteria to feed on – which will probably help you smell fresher for longer during the day compared to someone who showered at night. As a microbiologist, I am a day shower advocate.

Of course, everyone has their own shower preference. Whatever time you choose, remember that the effectiveness of your shower is influenced by many aspects of your personal hygiene regime – such as how frequently you wash your bed sheets.

So regardless of whether your prefer a morning or evening shower, it’s important to clean your bed linen regularly. You should launder your sheets and pillow cases at least weekly to remove all the sweat, bacteria, dead skin cells and sebaceous oils that have built up on your sheets.

Washing will also remove any fungal spores that might be growing on the bed linen – alongside the nutrient sources these odour producing microbes use to grow.

Primrose Freestone is Senior Lecturer in Clinical Microbiology, University of Leicester.

This article was first published on The Conversation.

As we enter the colder months in Australia, Covid-19 is making headlines again, this time due to the emergence of a new variant: NB.1.8.1.

Last week, the World Health Organization designated NB.1.8.1 as a “variant under monitoring”, owing to its growing global spread and some notable characteristics which could set it apart from earlier variants.

So what do you need to know about this new variant?

The current Covid situation

More than five years since Covid was initially declared a pandemic, we’re still experiencing regular waves of infections.

It’s more difficult to track the occurrence of the virus nowadays, as fewer people are testing and reporting infections. But available data suggests in late May 2025, case numbers in Australia were ticking upwards.

Genomic sequencing has confirmed NB.1.8.1 is among the circulating strains in Australia, and generally increasing. Of cases sequenced up to May 6 across Australia, NB.1.8.1 ranged from less than 10% in South Australia to more than 40% in Victoria.

Wastewater surveillance in Western Australia has determined NB.1.8.1 is now the dominant variant in wastewater samples collected in Perth.

Internationally NB.1.8.1 is also growing. By late April 2025, it comprised roughly 10.7% of all submitted sequences – up from just 2.5% four weeks prior. While the absolute number of cases sequenced was still modest, this consistent upward trend has prompted closer monitoring by international public health agencies.

NB.1.8.1 has been spreading particularly in Asia – it was the dominant variant in Hong Kong and China at the end of April.

Where does this variant come from

According to the WHO, NB.1.8.1 was first detected from samples collected in January 2025.

It’s a sublineage of the Omicron variant, descending from the recombinant XDV lineage. “Recombinant” is where a new variant arises from the genetic mixing of two or more existing variants.

The image shows more specifically how NB.1.8.1 came about.

What does research say

Like its predecessors, NB.1.8.1 carries a suite of mutations in the spike protein. This is the protein on the surface of the virus that allows it to infect us – specifically via the ACE2 receptors, a “doorway” to our cells.

The mutations include T22N, F59S, G184S, A435S, V445H, and T478I. It’s early days for this variant, so we don’t have much data on what these changes mean yet. But a recent preprint (a study that has not yet been peer reviewed) offers some clues about why NB.1.8.1 may be gathering traction.

Using lab-based models, researchers found NB.1.8.1 had the strongest binding affinity to the human ACE2 receptor of several variants tested – suggesting it may infect cells more efficiently than earlier strains.

The study also looked at how well antibodies from vaccinated or previously infected people could neutralise or “block” the variant. Results showed the neutralising response of antibodies was around 1.5 times lower to NB.1.8.1 compared to another recent variant, LP.8.1.1.

This means it’s possible a person infected with NB.1.8.1 may be more likely to pass the virus on to someone else, compared to earlier variants.

What are the symptoms

The evidence so far suggests NB.1.8.1 may spread more easily and may partially sidestep immunity from prior infections or vaccination. These factors could explain its rise in sequencing data.

But importantly, the WHO has not yet observed any evidence it causes more severe disease compared to other variants.

Reports suggest symptoms of NB.1.8.1 should align closely with other Omicron subvariants.

Common symptoms include sore throat, fatigue, fever, mild cough, muscle aches and nasal congestion. Gastrointestinal symptoms may also occur in some cases.

What about the vaccine?

There’s potential for this variant to play a significant role in Australia’s winter respiratory season. Public health responses remain focused on close monitoring, continued genomic sequencing, and promoting the uptake of updated Covid boosters.

Even if neutralising antibody levels are modestly reduced against NB.1.8.1, the WHO has noted current Covid vaccines should still protect against severe disease with this variant.

The most recent booster available in Australia and many other countries targets JN.1, from which NB.1.8.1 is descended. So it makes sense it should still offer good protection.

Ahead of winter and with a new variant on the scene, now may be a good time to consider another Covid booster if you’re eligible. For some people, particularly those who are medically vulnerable, Covid can still be a serious disease.

Lara Herrero is Associate Professor and Research Leader in Virology and Infectious Disease, Griffith University.

This article was first published on The Conversation.

In today’s digital world, people routinely turn to the internet for health or medical information. In addition to actively searching online, they often come across health-related information on social media or receive it through emails or messages from family or friends.

It can be tempting to share such messages with loved ones – often with the best of intentions.

As a global health communication scholar studying the effects of media on health and development, I explore artistic and creative ways to make health information more engaging and accessible, empowering people to make informed decisions.

Although there is a fire hose of health-related content online, not all of it is factual. In fact, much of it is inaccurate or misleading, raising a serious health communication problem: Fake health information – whether shared unknowingly and innocently, or deliberately to mislead or cause harm – can be far more captivating than accurate information.

This makes it difficult for people to know which sources to trust and which content is worthy of sharing.

Allure of fake health information

Fake health information can take many forms. For example, it may be misleading content that distorts facts to frame an issue or individual in a certain context. Or it may be based on false connections, where headlines, visuals or captions don’t align with the content. Despite this variation, such content often shares a few common characteristics that make it seem believable and more shareable than facts.

For one thing, fake health information often appears to be true because it mixes a grain of truth with misleading claims.

For example, early in the Covid-19 pandemic, false rumors suggested that drinking ethanol or bleach could protect people from the virus. While ethanol or bleach can indeed kill viruses on surfaces such as countertops, it is extremely dangerous when it comes into contact with skin or gets inside the body.

Another marker of fake health information is that it presents ideas that are simply too good to be true. There is something appealingly counterintuitive in certain types of fake health information that can make people feel they have access to valuable or exclusive knowledge that others may not know. For example, a claim such as “chocolate helps you lose weight” can be especially appealing because it offers a sense of permission to indulge and taps into a simple, feel-good solution to a complex problem. Such information often spreads faster because it sounds both surprising and hopeful, validating what some people want to believe.

Sensationalism also drives the spread of fake health information. For instance, when critics falsely claimed that Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the chief medical adviser to the president at the time, was responsible for the Covid-19 pandemic, it generated a lot of public attention.

In a study on vaccine hesitancy published in 2020, my colleagues and I found that controversial headlines in news reports that go viral before national vaccination campaigns can discourage parents from getting their children vaccinated. These headlines seem to reveal sensational and secret information that can falsely boost the message’s credibility.

The pull to share

The internet has created fertile ground for spreading fake health information. Professional-looking websites and social media posts with misleading headlines can lure people into clicking or quickly sharing, which drives more and more readers to the falsehood. People tend to share information they believe is relevant to them or their social circles.

In 2019, an article with the false headline “Ginger is 10,000x more effective at killing cancer than chemo” was shared more than 800,000 times on Facebook. The article contained several factors that make people feel an urgency to react and share without checking the facts: compelling visuals, emotional stories, misleading graphs, quotes from experts with omitted context and outdated content that is recirculated.

Visual cues like the logos of reputable organisations or photos of people wearing white medical coats add credibility to these posts. This kind of content is highly shareable, often reaching far more people than scientifically accurate studies that may lack eye-catching headlines or visuals, easy-to-understand words or dramatic storylines.

But sharing content without verifying it first has real-world consequences. For example, studies have found that Covid-19-related fake information reduces people’s trust in the government and in health care systems, making people less likely to use or seek out health services.

Unfounded claims about vaccine side effects have led to reduced vaccination rates globally, fueling the return of dangerous diseases, including measles.

Social media misinformation, such as false claims about cinnamon being a treatment for cancer, has caused hospitalisations and even deaths. The spread of health misinformation has reduced cooperation with important prevention and treatment recommendations, prompting a growing need for medical professionals to receive proper training and develop skills to effectively debunk fake health information.

How to combat it

In today’s era of information overload in which anyone can create and share content, being able to distinguish between credible and misleading health information before sharing is more important than ever. Researchers and public health organisations have outlined several strategies to help people make better-informed decisions.

Whether health care consumers come across health information on social media, in an email or through a messaging app, here are three reliable ways to verify its accuracy and credibility before sharing:

• Use a search engine to cross-check health claims. Never rely on a single source. Instead, enter the health claim into a reputable search engine like Google and see what trusted sources have to say. Prioritise information from established organisations like the World Health Organization, Centers for Disease Control and Prevention, United Nations Children’s Fund or peer-reviewed journals like The Lancet or Journal of the American Medical Association. If multiple reputable sources agree, the information is more likely to be reliable. Reliable fact-checking websites such as FactCheck.org and Snopes can also help root out fake information.

• Evaluate the source’s credibility. A quick way to assess a website’s trustworthiness is to check its “About Us” page. This section usually explains who is behind the content, their mission and their credentials. Also, search the name of the author. Do they have recognised expertise or affiliations with credible institutions? Reliable websites often have domains ending in .gov or .edu, indicating government or educational institutions. Finally, check the publication date. Information on the internet keeps circulating for years and may not be the most accurate or relevant in the present context.

• If you’re still unsure, don’t share. If you’re still uncertain about the accuracy of a claim, it’s better to keep it to yourself. Forwarding unverified information can unintentionally contribute to the spread of misinformation and potentially cause harm, especially when it comes to health.

Questioning dubious claims and sharing only verified information not only protects against unsafe behaviors and panic, but it also helps curb the spread of fake health information. At a time when misinformation can spread faster than a virus, taking a moment to pause and fact-check can make a big difference.

Angshuman K Kashyap is PhD candidate in Health Communication, University of Maryland.

This article was first published on The Conversation.

This year marks the 25th year of the ban on smoking in public places, a landmark judgement of the Kerala High Court. Subsequently, the Cigarettes and Other Tobacco Products Act, 2003, was passed, which prohibited smoking in public places and introduced penalties for violations.

Despite decades of policy action, however, India is the world’s second-largest consumer and producer of tobacco, and consequently faces a formidable public health and economic challenge.

The Global Adult Tobacco Survey 2016-’17 says that nearly 267 million Indian adults – about 29% of the adult population – use tobacco in some form. More recent estimates suggest there are around 253 million tobacco users in India as of 2022. The lack of updated national surveys since 2022 limits precise tracking of current trends, highlighting the need for frequent surveys to inform evidence-based policymaking.

While the ban under act has led to reduced passive smoking, enforcement remains inconsistent across states, according to the Report on Tobacco Control in India 2022, by the Ministry of Health and Family Welfare.

Nicotine is among the most addictive substances in the world, with some researchers deeming it to be more addictive than cocaine and heroin. “The tobacco industry takes advantage of this by targeting young people through advertisements and behavioural strategies, aiming to create lifelong customers,” says Ravi Mehrotra, Program Lead at the India Cancer Research Consortium, affiliated with the Indian Council of Medical Research. “A significant portion of tobacco users, including smokers, begin using tobacco products before age 18.”

One-third of all daily smokers aged 20-34 had started smoking tobacco on a daily basis before attaining the age of 18, the Global Adult Tobacco Survey found.

Every state has different enforcement policies, as a result of which India has no uniform evaluation metrics for the outcomes. In states with weaker enforcement, limited funding and inadequate training for enforcement officers hinder compliance with the act.

“Today, the cessation facilities available in India are very few, and there has been little to no scientific study or random clinical trials to see how many people have benefited and what the actual quit rate is due to these facilities,” says Mehrotra, who serves on the board of directors of the India Cancer Genome Atlas and is the founder of the Centre of Health Innovation & Policy foundation.

In India, smoking causes 930,000 deaths each year while smokeless tobacco leads to 350,000 deaths – together adding up to about 3,500 deaths every day, estimates suggest. In addition, over 200,000 people die from causes attributable to second-hand smoke exposure. The economic cost is staggering: tobacco use cost India nearly Rs 1.7 trillion in 2017-’18, taking into account the healthcare expenses and lost productivity.

Geographical variations

The National Family Health Surveys suggest a decline in tobacco consumption. In 2019-’21, 38% men aged 15 to 49 years reported using some form of tobacco, down from 57% in 2005-’06. Among women, this number fell from 11% to 9%. North East Indian states report the highest prevalence of tobacco use.

Driving factors

Several factors contribute to the widespread use of smoking tobacco in India. From a behavioural science perspective, a 2023 paper groups the reasons for tobacco use initiation into six categories based on the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

Psychological capabilities play a role, as many individuals lack knowledge about the harmful health effects of tobacco, struggle with self-control, or face mental challenges. Many people start using tobacco believing it will relieve stress, anxiety, or improve mood. Individuals with mental health disorders are particularly vulnerable.

Pratima Murthy, director, National Institute of Mental Health and Neurosciences, Bengaluru, and an expert in addiction psychiatry and tobacco cessation, points out the mental health links to smoking.

“Research shows that the risk of smoking is doubled among people with depression, and those with depression are more likely to develop dependent patterns of tobacco use and experience more severe withdrawal symptoms.”

Integrating tobacco cessation into mental health services at primary health centres could address higher relapse rates among individuals with depression or anxiety.

Physical opportunities, including the widespread presence of tobacco advertising, easy access to tobacco products, and seeing celebrities smoke on screen, create an environment that encourages smoking initiation. Social opportunities, like peer pressure, parental tobacco use, cultural traditions that normalise tobacco, and notions of masculinity, further reinforce the habit.

For example, in Uttar Pradesh and elsewhere, the cultural practice of chewing paan with tobacco, often offered at social gatherings, normalises smokeless tobacco use, particularly among women.

One notable driver of physical opportunities is the widespread sale of single cigarettes. Nearly 75% of all cigarettes are sold as single sticks, estimates show, making them more affordable and accessible, especially to minors and low-income users. “This practice undermines the impact of health warnings and taxation, as single sticks do not display the mandated graphic warnings and evade higher taxes applied to full packs,” explains Mehrotra.

Automatic motivation, such as using tobacco to manage emotions, seeking temporary pleasure, or engaging in risk-taking, and reflective motivation, which includes beliefs about perceived benefits, underestimating risks, and coping with stress – also drive people to start smoking or to persist with the habit.

India has implemented strict tobacco control measures, including large pictorial health warnings covering 85% of tobacco packaging.

However, as Mehrotra points out, “They have been shown to have some effectiveness, but the impact can diminish over time. Many young people become desensitised to the current warning labels.”

Regularly updating and strengthening warning labels and combining them with other anti-tobacco campaigns is therefore essential. The Ministry of Health and Family Welfare announced new packaging and labelling rules in December 2024, introducing stronger warnings and a national quitline number, effective from June 2025.

According to the World Health Organization, the most effective way to discourage tobacco smoking has been to increase the taxes on it and other smoking products. “The single best way of increasing the effectiveness of tobacco control is increasing the taxes.

In countries like Australia, where the cigarette tax is as high as 69%, there has been a significant decline in smoking in the past decade,” said Mehrotra. While India’s cigarette taxes, reaching 53% of retail price, are high, they fall short of WHO’s 75% benchmark, limiting their impact on reducing affordability.

Quit smoking efforts

The government has made several efforts for individuals seeking to quit smoking. The National Tobacco Control Programme focuses on establishing Tobacco Cessation Centres in district hospitals, offering free behavioural counselling, medication, and nicotine replacement therapy. This also reflects in the data: About 32% of people who use tobacco reported trying to quit in the 12 months prior to the 2019-’21 health survey.

With only 600 centres nationwide, however, India has roughly one cessation centre per two million people, with rural areas particularly underserved.

The National Tobacco Quit Line provides community-based counselling through a toll-free number, and the m-cessation initiative uses text messaging to support quitting. Specialised institutes like NIMHANS in Bengaluru and Tata Memorial Centre in Mumbai offer tobacco cessation services. AI-powered apps like QuitNow, tailored for Indian users, could complement m-cessation by offering personalised quitting plans.

Community-based programmes

There is an urgent need to strengthen community-based programmes and implement effective screening initiatives, especially in rural and underserved areas. Mehrotra urges the community leaders and social workers to focus on their level with the help of technology.

“Leveraging the widespread availability and affordability of mobile devices and internet connectivity, community health workers can use smartphones and tablets to conduct screenings, maintain records, and ensure that no one is left out of follow-up care.”

Mehrotra stresses the need for early screening and cancer detection to minimise the burden on healthcare and personal expenses. “Early screening is essential because many individuals, especially women from lower-income groups who are busy with daily work, may not recognise the importance of getting checked for early signs of disease. By making screening accessible, affordable, and trusted, health systems can detect health issues in asymptomatic individuals and improve outcomes across communities.”

Rakesh Gupta, president, Strategic Institute for Public Health Education and Research, and a tobacco control advocate, tells IndiaSpend how the model was established by the National Tobacco Control Program in Punjab, a state that has seen a significant decline in tobacco consumption.

“We had a state-level coordination committee, which included most of the stakeholder ministries, like the health department, the education department, and the home department under which they have the police. All the stakeholders are part of the state-level coordination committee, and meetings were held every three months.” There are enforcement squads at the state level, district level and block level with similar bodies to ensure cooperation on the ground.

These enforcement squads are responsible for raiding premises which violate the tobacco laws frequently. “The NTCP [National Tobacco Control Programme] in the state earned enough through challans (fines) in these squares to regulate its tobacco enforcement. This framework is being replicated in states like Rajasthan, Bihar, Uttar Pradesh and Karnataka, though ensuring these are enforced properly is a challenge. It depends on the state programme officer, state nodal officer, and the political will in the state.”

India needs to find a collective will to eradicate smoking from its public places, through community-led interventions that prevent the initiation altogether, and take inspiration from model states to establish policies tailored to their regions.

IndiaSpend reached out to the health ministry for comments. We will update this story when we receive a response.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.

You might’ve noticed some physiotherapists advertise they offer treatments for headaches and wondered: would that work?

In fact, there’s a solid body of research showing that physiotherapy treatments can be really helpful for certain types of headache.

Sometimes, however, medical management is also necessary and it’s worth seeing a doctor. Here’s what you need to know.

Cervicogenic headache

Cervicogenic headache is where pain is referred from the top of the neck (an area known as the upper cervical spine).

Pain is usually one-sided. It generally starts just beneath the skull at the top of the neck, spreading into the back of the head and sometimes into the back of the eye.

Neck pain and headache are often triggered by activities that put strain on the neck, such as holding one posture or position for a long time, or doing repetitive neck movements (such as looking up and down repeatedly).

Unlike in migraine, people experiencing cervicogenic headache don’t usually get nausea or sensitivity to light and sound.

Because this is a musculoskeletal condition of the upper neck, physiotherapy treatments that improve neck function – such as manual therapy, exercise and education – can provide short- and long-term benefits.

Can physio help

Migraine is a neurological disorder whereby the brain has difficulty processing sensory input.

This can cause episodic attacks of moderate to severe headache, as well as:

• sensitivity to light and noise

• nausea and

• intolerance to physical exertion.

There are many triggers. Everyone’s are different and identifying yours is crucial to self-management of migraine. Medication can also help, so seeing a GP is the first step if you suspect you have migraine.

About 70%-80% of people with migraine also have neck pain, commonly just before or at the onset of a migraine attack. This can make people think their neck pain is triggering the migraine.

While this may be true in some people, our research has shown many people with migraine have nothing wrong with their neck despite having neck pain.

In those cases, neck pain is part of migraine and can be a warning (but not a cause or trigger) of an imminent migraine attack. It can signal patients need to take steps to prevent the attack.

On the other hand, if the person has musculoskeletal neck disorder, physiotherapy neck treatments may help improve their migraine. Musculoskeletal neck disorder is what physiotherapists call typical neck pain caused by, for instance, a sports injury or sleeping in a weird way.

You may have heard of the Watson manual therapy technique being used to treat migraine. It involves applying manual pressure to the upper cervical spine and neck area.

There are currently no peer-reviewed studies looking at how effective this technique is for migraine.

However, recent studies investigating a combination of manual therapy, neck exercises and education tailored to the individual’s circumstances show some small effects in improving the number of migraine attacks and the disabling effects of headache.

Manual therapy and neck exercises can also give short-term pain relief.

However, in some cases the neck can become very sensitive and easily aggravated in migraine. That means inappropriate assessment or treatment could end up triggering a migraine.

Physiotherapy can help with migraine but you first need a comprehensive and skilled physical assessment of the neck by an experienced physiotherapist. It’s crucial to identify if a musculoskeletal neck disorder is present and, if so, which type of neck treatment is needed.

It is also important people with migraine understand how their migraine is triggered, what lifestyle factors contribute to it and when to take the appropriate medications to help manage their migraines.

A trained physiotherapist can provide some of this information and help patients make sense of their condition and recommend the patient see their GP for medication, when appropriate.

Tension headaches

Tension type headache is the most common type of headache, characterised by a feeling of “tightness” or “band-like” pain around the head.

Nausea and sensitivity to light and noise are not usually present with this type of headache.

Like migraine, tension type headache is often associated with neck pain and also has different aggravating factors, not all of which are due to the neck.

Again, a detailed assessment by a trained physiotherapist is needed to identify if the neck is involved and what type of neck treatment is best.

There is some evidence a combination of manual therapy and exercise can reduce tension type headache.

Physiotherapists can also provide education and advice on aggravating factors and self management.

Seeking help

There are many types and causes of headache. If you suffer frequent headaches or have a new or unusual headache, ask a doctor to investigate.

There is good evidence physiotherapy treatment will improve cervicogenic headache and emerging evidence it might help migraine and tension type headache (alongside usual medical care).

If you are wondering if you have cervicogenic headache or if you have bothersome neck pain associated with headache, ask your doctor to refer you to a skilled physiotherapist trained in headache treatment. A careful assessment can determine if physiotherapy treatment will help.

Zhiqi Liang is Lecturer in Physiotherapy, The University of Queensland.

Julia Treleaven is Associate Professor in Physiotherapy, The University of Queensland.

Lucy Thomas is Teaching and research academic in Physiotherapy, The University of Queensland

This article was first published on The Conversation.

Knowing the calorie content of foods does not help people understand which foods are healthier, according to a study I recently co-authored in the Journal of Retailing. When study participants considered calorie information, they rated unhealthy food as less unhealthy and healthy food as less healthy. They were also less sure in their judgments.

In other words, calorie labeling didn’t help participants judge foods more accurately. It made them second-guess themselves.

Across nine experiments with over 2,000 participants, my colleague and I tested how people use calorie information to evaluate food. For example, participants viewed food items that are generally deemed healthier, such as a salad, or ones that tend to be less healthy, such as a cheeseburger, and were asked to rate how healthy each item was. When people did not consider calorie information, participants correctly saw a big gap between the healthy and unhealthy foods. But when they considered calorie information, those judgments became more moderate.

In another experiment in the study, we found that asking people to estimate the calorie content of food items reduced self-reported confidence in their ability to judge how healthy those foods were − and that drop in confidence is what led them to rate these food items more moderately. We observed this effect for calories but not for other nutrition metrics such as fat or carbohydrates, which consumers tend to view as less familiar.

This pattern repeated across our experiments. Instead of helping people sharpen their evaluations, calorie information seemed to create what researchers call metacognitive uncertainty, or a feeling of “I thought I understood this, but now I’m not so sure”. When people aren’t confident in their understanding, they tend to avoid extreme judgments.

Because people see calorie information so often, they believe they know how to use it effectively. But these findings suggest that the very familiarity of calorie counts can backfire, creating a false sense of understanding that leads to more confusion, not less. My co-author and I call this the illusion of calorie fluency. When people are asked to judge how healthy a food item is based on calorie data, that confidence quickly unravels and their healthiness judgments become less accurate.

Why it matters

These findings have important implications for public health and for the businesses that are investing in calorie transparency. Public health policies assume that providing calorie information will drive more informed choices. But our research suggests that visibility isn’t enough – and that calorie information alone may not help. In some cases, it might even lead people to make less healthy choices.

This does not mean that calorie information should be removed. Rather, it needs to be supported with more context and clarity. One possible approach is pairing calorie numbers with decision aids such as a traffic light indicator or an overall nutrition score, which both exist in some European countries. Alternatively, calorie information about an item could be accompanied by clear reference points explaining how much of a person’s recommended daily calories it contains – though this may be challenging because of how widely daily calorie needs vary.

Our study highlights a broader issue in health communication: Just because information is available doesn’t mean it’s useful. Realising that calorie information can seem easier to understand than it actually is can help consumers make more informed, confident decisions about what they eat.

What still isn’t known

In our studies, we found that calorie information is especially prone to creating an illusion of understanding. But key questions remain.

For example, researchers don’t yet know how this illusion interacts with the growing use of health and wellness apps, personalised nutrition tools or AI-based food recommendations. Future research could look at whether these tools actually help people feel more sure of their choices – or just make them feel confident without truly understanding the information.

Deidre Popovich is Associate Professor of Marketing, Texas Tech University.

This article was first published on The Conversation.