What to know about endometriosis

Endometriosis is an incurable but manageable gynecological condition.

It occurs when endometrial implants, comprised of tissue normally found within the uterus, are present in other areas of the body.

As the tissue continues to thicken, break down, respond to menstrual cycle hormones, and bleed during the menstrual cycle, endometriosis forms deep inside the body.

Scar tissue and adhesions form, and this can cause organ fusion and anatomical changes.

Endometriosis is thought to affect around 11 percent of women in the United States aged between 15 and 44 years.

Fast facts on endometriosis

Here are some key points about endometriosis. More information is in the main article.

  • Endometriosis affects between 6 and 10 percent of women of reproductive age worldwide.
  • The condition appears to be present in a developing fetus, but estrogen levels during puberty are thought to trigger the symptoms.
  • Symptoms are generally present during the reproductive years.
  • Most women go undiagnosed, and in the U.S. it can take around 10 years to receive a diagnosis.
  • Allergies, asthma, chemical sensitivities, autoimmune diseases, chronic fatigue syndrome, fibromyalgia, breast cancer, and ovarian cancer are linked to women and families with endometriosis.

What is endometriosis?

Endometrial tissue consists of gland, blood cells, and connective tissue. It normally grows in the uterus, to prepare the lining of the womb for ovulation.

Endometrial implants are buildups of endometrial tissue that grow in locations outside the uterus.

When they grow outside the uterus, this is called endometriosis.

They can develop anywhere in the body, but they usually occur in the pelvic area.

They may affect:

  • the ovaries
  • the fallopian tubes
  • the peritoneum
  • the lymph nodes

Normally, this tissue is expelled during menstruation, but displaced tissue cannot do this.

This leads to physical symptoms, such as pain. As the lesions grow larger, they can affect bodily functions. For example, the fallopian tubes may be blocked.

The pain and other symptoms can affect different areas of life, including the ability to work, medical care costs, and difficulty maintaining relationships.

Symptoms

Other medical conditions such as pelvic inflammatory disease (PID), ovarian cysts, and irritable bowel syndrome (IBS) can mimic the symptoms of endometriosis.

Symptoms of endometriosis include:

  • Severe menstrual cramps, unrelieved with NSAIDS
  • Long-term lower-back and pelvic pain
  • Periods lasting longer than 7 days
  • Heavy menstrual bleeding where the pad or tampon needs changing every 1 to 2 hours
  • Bowel and urinary problems including pain, diarrhea, constipation, and bloating
  • Bloody stool or urine
  • Nausea and vomiting
  • Fatigue
  • Pain during intercourse
  • Spotting or bleeding between periods

Pain is the most common indication of endometriosis, but the severity of the pain does not always correlate with the extent of the disease.

Pain often resolves following menopause, when the body stops producing estrogen production. However, if hormone therapy is used during menopause, symptoms may persist.

Pregnancy may provide temporary relief from symptoms.

Complications

Complications include:

  • infertility, which can affect 50 percent of those with the condition.
  • increased risk of developing ovarian cancer or endometriosis-associated adenocarcinoma
  • ovarian cysts
  • inflammation
  • scar tissue and adhesion development
  • intestinal and bladder complications

It is important to see a health care provider about symptoms, to avoid future complications.

Treatment

Surgery is possible, but it is normally considered only if other treatments are not effective.

Other options include:

Pain medications: Either over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or prescription drugs for the treatment of painful menses.

Hormones: Treatment may be with hormonal therapies such as hormonal birth control, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, Medroxyprogesterone (Depo-Provera) or Danazol. Placement of an intrauterine device (IUD) may also be recommended.

Surgery: Initial surgery will seek to remove the areas of endometriosis, but a hysterectomy with removal of both ovaries may be necessary.

Fertility treatment: Pregnancy may be recommended via in-vitro fertilization (IVF).

Managing symptoms at home

Complementary and alternative treatments may include acupuncture, chiropractic, and herbal medicine, but there is little evidence to show that these are effective.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

Exercise, such as walking, may reduce pain and slow the progress of the condition by reducing estrogen levels.

It is important to monitor symptoms, because of the long-term complications of endometriosis. Intolerable pain or unexpected bleeding should be reported to a doctor.

Although there is currently no cure for endometriosis, most women are able to relieve the pain of symptoms and will still be able to have children.

Diagnosis

Diagnosis can be challenging because there is no single test for evaluation.

The only way to truly confirm the condition is by undergoing a surgical laparoscopy.

A surgical laparoscopy is a minimally invasive procedure in which a thin, lighted tube with a miniature camera attached, called a laparoscope, is inserted through a small incision in the pelvic area.

A diagnosis can be categorized as follows:

  • Stage 1: Lesions are minimal and isolated
  • Stage 2: Lesions are mild. There may be several and adhesions are possible.
  • Stage 3: Lesions are moderate, deep or superficial with clear adhesions
  • Stage 4: Lesions are multiple and severe, both superficial and deep, with prominent adhesions.

It can take many years to receive a diagnosis.

Other possible diagnostic strategies include a pelvic exam, radiologic imaging with ultrasound or magnetic resonance imaging (MRI), and the use of certain medications including birth control or gonadotropin releasing hormone (GnRH) agonists.

Diet

Dietary steps have been suggested for managing the pain and effects of endometriosis.

A 2004 study suggests that a brown seaweed called bladderwrack may have an estrogen-reducing effect in women. This can reduce the growth rate of endometriosis.

One author presented a case study using a diet low in short-chain-fermentable carbohydrates to reduce the symptoms of endometriosis. This diet has been shown to work on IBS and since it is often found with endometriosis, then perhaps the diet would be effective for those with only endometriosis.

More research is needed, but there is little harm in trying this approach.

Dietary choices have also been linked to the development of endometriosis. A study carried out in 2011 suggested that fruit intake increased the risk of endometriosis and a higher total fat intake decreased the risk.

Dairy products were also shown to reduce the risk of endometriosis, although these results were not statistically significant.

Eating yogurt, sauerkraut, and pickles or finding a good source of probiotics may help reduce gastrointestinal symptoms and cause increased digestive activity.

Avoiding caffeine may help to reduce pain, as caffeine can worsen symptoms.

All about dementia, Medical Myths

Today, an estimated 5.8 million people aged 65 years or older in the United States have dementia. Due to the fact that the average lifespan of people in the U.S. has increased over recent decades, some experts project that by 2050, the number of older adults with dementia could reach 13.8 million.

1. Dementia is inevitable with age

This statement is not true. Dementia is not a normal part of aging.

According to a report that the Alzheimer’s Association published, Alzheimer’s disease, which is the most common form of dementia, affects 3% of people aged 65–74 years in the U.S. As a result of the risk increasing as we age, 17% of people aged 75–84 years and 32% of people aged 85 years and older have a dementia diagnosis.

2. Dementia and Alzheimer’s disease are the same thing

This is not quite correct. Alzheimer’s is a type of dementia, accounting for 60–80% of all dementia cases. Other types of dementia include frontotemporal dementia (FTD), vascular dementia, mixed dementia, and Lewy body dementia.

The National Institute on Aging define dementia as “the loss of cognitive functioning — thinking, remembering, and reasoning — and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.”

Although dementias share certain characteristics, each type has a distinct underlying pathology.

Alzheimer’s disease is associated with a buildup of so-called plaques and tangles in the brain. These structures interfere with brain cells, eventually killing them. In contrast, brain cell death in vascular dementia occurs due to a lack of oxygen, which can result from a stroke, for instance.

FTD, as another example, occurs when abnormal protein structures form in the frontal and temporal lobes of the brain, causing the brain cells in these regions to die.

3. A family member has dementia, so I will get it

A common myth is that dementia is purely genetic. In other words, if a person’s family member has a dementia diagnosis, they are guaranteed to develop dementia later in life. This is not true.

Although there is a genetic component to some forms of dementia, the majority of cases do not have a strong genetic link.

As we learned above, rather than genetic factors, the most significant risk factor for dementia is age. However, if a parent or grandparent developed Alzheimer’s when they were younger than 65 years, the chance of it passing on genetically is higher.

Early-onset Alzheimer’s is relatively uncommon, though. It occurs in about 5.5% of all Alzheimer’s cases.

As the majority of dementia cases are Alzheimer’s disease, this means that most dementia cases are not hereditary. FTD, which is much less common, has a stronger genetic link, but if a parent or grandparent develops the condition, it does not mean that children or grandchildren are guaranteed to develop it.

Today, FTD affects an estimated 15–22 in every 100,000 people. Of these individuals, 10–15% have a strong family history of the condition.

4. Dementia only affects older adults

Age is a risk factor for dementia, but dementia can affect younger adults in rare cases. Some scientists estimate that, in people aged 30–64 years, 38–260 people in 100,000 — equivalent to 0.038–0.26% — develop early-onset dementia.

In the 55–64 age bracket, this increases to close to 420 people in 100,000, or 0.4%.

5. Using aluminum pans causes Alzheimer’s

In the 1960s, scientists injected rabbits with high levels of aluminum. They found that the animals developed neurological lesions similar to those that form in the brains of people with Alzheimer’s.

Additionally, some studies have identified aluminum within the plaques associated with Alzheimer’s. However, aluminum also appears in the healthy brain, and researchers have not established a causal link between this element and the disease.

Following on from these studies, myths still circulate that drinking from aluminum cans or cooking with aluminum pots increases the risk of Alzheimer’s.

However, since those early experiments, scientists have not found a clear association between Alzheimer’s and using aluminum pots and pans.

Although researchers will, eventually, establish the precise relationship between aluminum and Alzheimer’s, consuming aluminum through the diet is unlikely to play a major role.

As the Alzheimer’s Society explain: “Aluminum in food and drink is in a form that is not easily absorbed into the body. Hence, the amount taken up is less than 1% of the amount present in food and drink. Most of the aluminum taken into the body is cleaned out by the kidneys.”

However, they also write that some research has found “a potential role for high dose aluminum in drinking water in progressing Alzheimer’s disease for people who already have the disease.”

6. Dementia signals the end of a meaningful life

Thankfully, this is not the case. Many people with a dementia diagnosis lead active, meaningful lives. Some people fear that if a doctor diagnoses them with dementia, they will no longer be able to go for a walk alone and will have to stop driving their vehicle immediately.

It is true that these adjustments may come in time as the condition progresses, but in mild cases of dementia, no changes may be necessary. As dementia worsens, changes to the way an individual leads their life are likely, but that does not mean that the person cannot lead a fulfilling life.

“Too many people are in the dark about dementia — many feel that a dementia diagnosis means someone is immediately incapable of living a normal life, while myths and misunderstandings continue to contribute to the stigma and isolation that many people will feel,” explains Jeremy Hughes, former Chief Executive of the Alzheimer’s Society.

7. Memory loss always signifies dementia

Although memory loss can be an early symptom of dementia, it does not necessarily signify the start of this condition. Human memory can be unpredictable, and we all forget things occasionally. However, if memory loss is interfering with everyday life, it is best to speak with a doctor.

Although memory issues tend to be an early sign of Alzheimer’s disease, that is not the case for other forms of dementia. For instance, early signs and symptoms of FTD can include changes in mood and personality, language difficulties, and obsessive behavior.

8. Dementia is always preventable

This, unfortunately, is untrue. Importantly, though, certain factors can either reduce the risk of certain types of dementia developing or delay their onset.

For instance, the Lancet Commission’s 2020 report on dementia prevention, intervention, and care lists 12 factors that increase the risk of dementia:

  • less education
  • hypertension
  • hearing impairment
  • smoking
  • obesity
  • depression
  • physical inactivity
  • diabetes
  • low levels of social contact
  • alcohol consumption
  • traumatic brain injury
  • air pollution

Some of these factors are more difficult to modify than others, but working on changing any of them might help reduce the risk of developing dementia. The authors of the report explain:

9. Vitamins and supplements can prevent dementia

Linked to the section above, this is also false. To date, there is no strong evidence that any vitamin or mineral supplements can reduce the risk of dementia. In 2018, the Cochrane Library conducted a review with the aim of answering this question.

Their analysis included data from more than 83,000 participants across the 28 included studies. Although the authors report “some general limitations of the evidence,” they conclude:

10. All people with dementia become aggressive

In some cases, people with dementia might find it increasingly hard to make sense of the world around them. This confusion can be frustrating, and some individuals might respond to the emotions in an angry manner. However, this is not the case for everyone.

In a study involving 215 people with dementia, 41% of the participants developed aggression during the 2-year study. When they looked at factors that increased the risk of developing aggression, the researchers identified two of the primary factors as physical pain and a low quality relationship between the person and their caregiver.

11. Dementia is never fatal

Unfortunately, dementia can be fatal. According to a recent study, which appears in JAMA Neurology, dementia may be a more common cause of death than experts have traditionally thought it to be. The authors “found that approximately 13.6% of deaths were attributable to dementia over the period 2000–2009.”

Dementia worries people, especially as they age, and this is justifiable in many ways. However, it is important to counter misinformation that might enhance concerns and stigma.

For now, researchers are working tirelessly to develop better ways to treat and prevent dementia. In the future, hopefully, science will reduce the impact of dementia and, therefore, the fear associated with the condition.

Water: Do we really need 8 glasses a day?

We often hear that we should drink eight 8-ounce glasses of water a day. However, there is some controversy about this figure and what it really means.

Water is an essential nutrient. It is necessary to sustain all forms of life, and humans can only live a few days without it. It is also a healthful drink.

Health authorities and others often encourage people to consume 2 or more liters of water a day, but is this only plain water or does water from other sources count?

Some sources have described these recommendations as a “myth,” and professionals have questioned the guidelines.

Some point to a lack of scientific evidence to support the claims, while others note that promoters of the concept have included a major mineral water producer.

How much plain water do we really need?

Fast facts on water intake

Here are some key points about daily water consumption.

  • Foods and fluids, including water, are the main source of water in our bodies.
  • The advice to drink eight 8-ounce glasses of water a day is not based on evidence.
  • The amount of water we need depends on individual needs and circumstances, including activity and climate.
  • The healthy body naturally maintains a well-tuned balance of fluid, and the thirst mechanism tells us when we need more.

Recommended daily water intake

In 1945, the U.S. Food and Nutrition Board advised people to consume 2.5 liters (84.5 fluid ounces (fl oz) of water a day, including fluid from prepared foods.

Today, the Centers for Disease Control and Prevention (CDC) say, “There is no recommendation for how much plain water adults and youth should drink daily.” However, there are recommendations about total fluid intake from all sources.

In 2004, the Institute of Medicine set the amount at around 2.7 liters, or 91 fluid ounces (fl oz) of total water a day for women and an average of around 3.7 liters (125 fl oz) daily for men.

This refers to the total daily fluid intake from all sources, defined as “the amount of water consumed from foods, plain drinking water, and other beverages.”

The U.S. Dietary Guidelines 2015-2020 do not recommend a specific daily water or fluid intake, but they do recommend choosing plain rather than flavored water and juices with added sugar.

There is currently no set upper level for water intake, although excessive quantities have been known to have adverse effects.

In the United Kingdom, the National Health Service (NHS) recommend consuming 6 to 8 glasses a day, or 1.9 liters (almost 34 fl0.oz), including water that is in food. They note this amount is suitable for a temperate climate. In hotter climates, they say, more will be needed.

Recommended intake by age

There is no fixed amount of fluid recommended by age, but some patterns emerge among healthy individuals doing a moderate amount of activity in a temperate climate.

The following shows average water intake for infants and adults:

Age groupAverage daily fluid intake
InfantsFrom 525 ml for a 3.5-kilo newborn to 1,200 ml for an 8-kilo infant per day, as breast or bottled milk
Adults aged 19 to 30 yearsAverage of 3.7 liters a day for men and 2.7 liters for women, depending on climate, activity, pregnancy status, and health

Infants

The amount of formula or breast milk an infant takes in averages 780 milliliters (ml), or just over 26 fl oz, of breast milk or formula milk each day until the age of around 6 months. Before the age of 6 months, plain water is not recommended.

This ranges from around 525 ml (just under 18 fl oz) a day for 3.5-kilo newborn to 1,200 ml per day (45 fl oz) for an 8-kilo infant at 6 months, or around 150 ml (5 fl oz) per kilo of weight per day.

This is proportionally far more than an adult needs. After infants start consuming solid foods, they need less fluid from breast milk and formula.

Children aged over 12 months

Children should be encouraged to drink water:

  • as part of the daily routine, for example, after brushing teeth and before, during and after playtime at school
  • when the weather is warm
  • as an alternative to sweetened drinks and juices

Juice consumption should be limited to one glass a day.

Parents are advised to keep a pitcher handy to encourage healthful water-drinking habits, and schools should have water fountains or equivalent facilities.

Children who are sick with a fever

For children who are at risk of dehyration, for example, with a fever, the CDC recommend the following:

AgeAmount of fluid needed
Up to 12 months3 cups
1 to 3 years4 cups
4 to 8 years5 cups
6 to 13 years8 cups
14 years and over11 to 13 cups for males and 8 to 9 cups for females

If a child is sick with a fever, it is important to seek medical help. A doctor may also advise oral an rehydration solution to ensure an adequate electrolyte balance.

Adults aged 19 to 30 years

The CDC cites figures showing that in 2005-2010 in the U.S., young people were drinking an average of 0.45 liters or 15 fl oz of water on a given day, while adults drank an average of 1.2 liters, or 39 fl oz.

The adequate intakes recommended for total water from all sources each day for most adults between 19 and 30 years of age are:

  • 3.7 liters (or about 130 fl oz) for men
  • 2.7 liters (about 95 fl oz) for women

One source suggests a man’s requirements might range from 2.5 liters (84.5 fl oz) if sedentary to up to 6 liters (203 fl oz) if active and living in a warm climate.

For women, the requirements will probably be 0.5 to 1 liter (17 to 34 fl oz) lower than those for men because of typically smaller body mass.

However, during pregnancy, women are likely to need an extra 0.3 liters (10 fl oz), and an additional 0.7 to 1.1 liters (23 to 37 fl oz) while breast-feeding.

Older adults

Older adults may be at risk of both dehydration and overhydration, as a result of health conditions, medications, loss of muscle mass, reduction in kidney function, and other factors.

Older adults who are well hydrated have been found to have:

  • fewer falls
  • less constipation
  • in men, a lower risk of bladder cancer

Dehydration has been linked to a higher frequency of:

  • urinary tract infections
  • confusion
  • kidney failure
  • slower wound healing

Needs for fluid intake will depend on the individual.

Few studies have looked at fluid input and output in older people, but at least one has concluded that it is not significantly different from that of younger people.

Those caring for older people are encouraged to provide fluids regularly and assist with ambulation, especially if a reduction in mobility makes it harder to visit the bathroom.

Where do the figures come from?

While water is known to be crucial for life and for preventing dehydration, recommendations for intake are based mainly on survey results showing the average amounts that people consume.

Conclusions are based on the assumption that these amounts must be about right for optimal hydration.

There is little evidence showing that specific quantities have a particular effect on health.

It is impossible to define an optimal intake, because these vary greatly according to:

  • activity
  • environmental conditions
  • individual factors
  • body mass
  • sex and age
  • health status, for example, poor kidney function
  • medications, such as diuretics
  • whether or not a person is pregnant or breast-feeding

Recommendations that a person should drink eight glasses of water a day also fail to take into account the fact that much of our fluid intake comes from food and other drinks.

Sources of water

Water in the body comes not only from drinking water.

Estimations vary, but according to one source:

  • around 20 to 30 percent comes from food
  • some 60 to 70 percent comes from drinking water and other fluids
  • a small percentage, about 10 percent is “metabolic water,” produced by cells during normal cell function

The more active the body is, the more metabolic water is produced.

Some surveys suggest that around 20 percent of water intake comes from foodstuffs and the rest is from fluids. This depends on diet. A higher intake of fresh fruit and vegetables will mean a higher intake of water from foods.

Metabolic water accounts for around 250 to 350 ml (8.4 to 11.8 fl oz) a day.

Water content of foods

Here are some examples of the water content of different foods and fluids:

Water content as a percentage (%)Food or drink
100%Water
90-99%Fat-free milk, tea, coffee, juicy fruits such as strawberries and cantaloupes, vegetables such as lettuce, celery, and spinach
80-89%Fruit juice, yogurt, fruits such as apples, pears and oranges, vegetables such as carrots, and cooked broccoli
70-79%Bananas, avocados, baked potatoes, cottage and ricotta cheeses
60-69%Pasta, beans, and peas, fish such as salmon, chicken breasts, and ice cream
30-39%Bread, bagels, and cheddar cheese
1-9%Nuts, chocolate cookies, crackers, cereals
0%Oils and sugars

Tap or bottled water?

Bottled or tap water are equally effective at hydrating the body. In terms of hydration, studies in the UK have not found any significant difference between drinking the two.

Mineral waters contain different amounts of minerals, depending on where they come from, but this, too is not significant, as most minerals come from other dietary sources.

What about coffee?

Caffeinated drinks are thought to be dehydrating as opposed to hydrating because of a belief that they have a diuretic effect on our water balance.

A number of studies to test how caffeinated fluids affect hydration have shown that tea and coffee are in fact good sources of water and do not lead to dehydration.

One study of 18 healthy male adults found that no significant difference in impact on hydration, measured in body weight, urine and blood tests after a variety of caffeinated, non-caffeinated, caloric, and non-caloric drinks.

“Advising people to disregard caffeinated beverages as part of the daily fluid intake is not substantiated,” say the researchers.

Another concludes that there is “no evidence of dehydration with moderate daily coffee intake.”

Benefits of drinking water

Water is necessary for the body. It:

  • regulates temperature
  • lubricates the joints and bones
  • protects the spinal cord and other sensitive tissues
  • removes waste from the body

Short-term benefits

A healthy fluid intake, including water, prevents dehydration.

The short-term symptoms of significant dehydration include:

  • unclear thinking
  • mood change
  • overheating
  • feeling thirsty and having a dry mouth
  • fatigue
  • dizziness
  • headache
  • dry mouth, eyes, and lips
  • urinating less than usual

Overheating can lead to organ damage, coma, and death.

The CDC urge people to make sure they drink enough water before, during, and after physical work, especially if this involves activity in a hot climate. This can help maintain alertness and effectiveness.

In a hot environment, you may need one 8-ounce cup every 15-20 minutes, but not more than 48 ounces in one hour, as this can lead to hyponatremia, a low level of sodium.

Plain water provides hydration without adding calories or jeopardizing dental health. Sports drinks can be useful in moderation, but too many will add unnecessary sugar to the body.

Long-term benefits

Studies suggest that long-term benefits of drinking water might include a lower risk of:

  • colorectal cancer and cancers of the urinary system
  • heart disease
  • urinary tract infections
  • kidney stones
  • constipation
  • high blood pressure
  • stroke

However, these possible long-term benefits also depend on a wide variety of other factors.

In addition, study participants with the lower risk of these conditions still drank fewer than eight 8-ounce glasses of water a day.

Weight loss

Drinking water may also help with weight loss, if a person “preloads” with water before a meal. This may help them feel fuller faster during meals. If they choose water over sweetened juice or soda, they consume fewer calories.

In a study where 318 people with obesity or overweight switched from sugary drinks to plain water, an average loss of 2 to 2.5 percent in weight was noted. But this could be easily explained by a decrease in total calories rather than water itself.

Other possible benefits

Other supposed benefits of drinking more water include prevention of:

  • migraine
  • nosebleeds
  • depression
  • high blood pressure
  • asthma
  • dry cough
  • dry skin
  • acne

However, there is little or no scientific evidence to confirm these claims.

In children, a higher water consumption has been linked to better diets, behavior and overall health.

When is more water needed?

Extra water may be needed when a person:

  • is in a hot climate
  • is doing physical activity
  • has diarrhea or vomiting
  • has a fever

These can lead to additional loss of water.

What about a water detox?

There have also been claims that water can “detox” the body.

These claims are not based on scientific facts.

The liver, kidneys, and human body normally break down toxic substances into less harmful ones or expel them from the body through urine. Water does not have a unique role in these processes.

Too much water can lead to hyponatremia, also known as low sodium. Low sodium levels can be life-threatening causing confusion, seizures, coma and death.

Hydration during exercise

During exercise, factors affecting the amount of fluid lost and the need for extra intake include:

  • the type and intensity of the activity
  • environmental factors, such as climate
  • the size and muscle mass of the athlete

Guidance from the American College of Sports Medicine (ACSM), published in 2007, recommends making an individual estimation of the fluid replacement needed by people taking part in exercise, to avoid dehydration.

Larger athletes may require higher fluid intake, for example, compared with smaller, leaner athletes, due to a larger body surface and higher body weight.

The ACSM advises drinking water during activity to prevent:

  • dehydration that leads to a fall in body weight of more than 2 percent
  • changes in the electrolyte balance

These changes, they say, can lead to reduced performance.

However, a study published in the British Journal of Sports Medicine concludes that a loss of up to 3 percent of water has “no effect” on real-world sports performance.

The conclusions were supported by findings from a cycling time-trial over 25 kilometers in hot conditions of 91.4° Fahrenheit and 40 percent relative humidity.

Results showed no difference in performance, physiological, and perceptual variables between participants who received hydration and those who did not.

The reason for this, say the authors, is “the body’s rapid defense of its plasma and blood volume following dehydration.”

In other words, the body can regulate water balance with high sensitivity.

Authors of a study focusing on runners in the 2002 Boston Marathon, published in the New England Journal of Medicine (NEJM), concluded:

“Because runners vary considerably in size and in rates of perspiration, general recommendations regarding specific volumes of fluids and frequencies of intake are probably unsafe and have been superseded by recommendations favoring thirst or individual perspiration rates as a primary guide.”

A review of 15 studies found that exercise-induced dehydration did not reduce performance. The authors encouraged athletes to “drink according to their thirst.”

Water and dehydration in the human body

Dehydration can be measured in terms of blood and urine osmolality.

Osmolality is an estimation of the osmolar concentration of plasma. It reflects the concentration of particles in a solution.

As regards dehydration:

  • high osmolality indicates a greater need for hydration
  • low osmolality suggests there are too few particles, specifically sodium and electrolytes, a sign of overhydration

How much water is in the human body?

The main chemical making up the human body is water. It accounts for between 55 percent and 75 percent of the body’s composition, and it varies between individuals.

  • in the average young man, between 50 and 70 percent of the body weight is water
  • in infants, 75 percent of body weight is water
  • in older people, it is 55 percent

Differences of age, sex, and aerobic fitness affect an individual’s ratio of lean to fat body mass and therefore how much water they contain.

Calculating human water needs

The amount of water we need to take in to maintain a healthy balance is decided by how much water we use and lose that must be replaced.

Over the course of 24 hours, healthy resting adults regulate their water balance to within around 0.2 percent of body weight.

In older children and adults, if a person’s body weight falls by 3 percent due to fluid loss, this is considered dehydration. Moderate dehydration is when weight falls by 6 percent, and severe dehydration is when it falls by 9 percent.

It is difficult to measure the amount of water used or lost by the body. Measures taken across groups of people in studies have shown wide variation.

However, if people show symptoms of dehydration, such as confusion or decreased urine output, they need medical attention.

What about dark urine?

There is a popular concept that darker urine means a person is dehydrated, while pale urine shows they are adequately hydrated.

However, it is difficult to assess the significance of urine color precisely. It depends on the time of day, medications, and other health problems.

Tea- or cola-colored urine, particularly after exercise, can indicate serious muscle injury and severe dehydration and requires urgent medical attention.

However, in normal circumstances, urine that is well within the limits of normal osmolality in laboratory tests can appear moderately yellow. This does not indicate that a person is dehydrated.

In addition, other factors such as diet, medications and health conditions can cause individuals to differ in their urine color.

How does the body regulate water?

Without water, there is no life. For this reason, all living organisms have adapted to avoid dehydration.

Humans can only survive for a few days without water. Infants and older people who lose water through illness and do not replace it can experience life-threatening complications.

Most of the time, however, our bodies’ sensitive natural mechanisms maintain appropriate fluid levels, or homeostasis, as long as we continue to consume food and water.

The two main ways the body does this are:

Thirst: This which tells us when we need to take in more fluid.

Urine output: The kidneys regulate any excess or lack of the water we consume by either emptying it into the urinary bladder or holding onto it in the blood plasma.

The body expels 0.5 to 1 liter (around 17 to 34 fl oz) per day in the form of urine.

The kidneys also:

  • regulate the balance of electrolytes, such as sodium and potassium, in the body fluids
  • receive hormonal signals to conserve or release water into the urine if the brain detects changes in the concentration of the solutes in the blood

The brain also responds to these changes in solutes, known as plasma osmolality. This is one factor that triggers the thirst for water.

Other ways in which water is lost or expelled from the body are:

Breathing: About 250-350 ml (8.5 to 11.8 fl oz) per day exit from the lungs during. exhalation

Feces: Around 100-200 ml (3.4 to 6.8 fl oz) per day passes out of the body in feces.

Sweating: Sedentary loss ranges from around 1,300-3,450 ml (44 to 117 fl oz) a day, but a physically active person can lose 1,550-6,730 ml (52 to 227.5 fl oz) a day

What about ‘8 by 8’?

It is often said that we needed to drink at least eight glasses of water a day, although there is little scientific evidence to support this.

Prof. Heinz Valtin, of Dartmouth Medical School in Hanover, NH, is one expert who has questioned this advice. He suggests it may be not only unnecessary but maybe even harmful.

In an article published in the American Journal of Physiology in 2002, he concludes:

“Not only is there no scientific evidence that we need to drink that much, but the [8 by 8] recommendation could be harmful, both in precipitating potentially dangerous hyponatremia and exposure to pollutants, and also in making many people feel guilty for not drinking enough.”

Prof. Heinz Valtin

The right types of fluid

Recommendations are now more likely to note that water can come from other beverages and from food. However, these should be chosen carefully.

Beverages that are high in fat or sugar or contain alcohol do not benefit health, and plain water is recommended in preference to these.

More than one alcoholic beverage per day in women and more than two alcoholic beverages per day in men on a regular basis can lead to liver inflammation and injury, an increased cancer risk, as well as negatively affecting every system of the body.

Fatty or sweetened drinks increase calories and lack nutritional value.

Processed foods, such as burgers and chips, high fat, and high sugar diets will contain less water than fresh fruits and vegetables.

Nearly all foods contain water, but fresh and healthful ingredients contain the most compared to processed foods, sugars, and fats.

The CDC note with concern that young people who consume high quantities of junk food are also drinking less water and eating less fresh fruit and vegetables. This can lead to further health problems. They are also often drinking highly sweetened beverages rather than water.

A study published by the CDC in 2013 showed that:

  • Seven percent of adults said they did not drink any water
  • Thirty-six percent said they drank 1 to 3 cups a day
  • Thirty-five percent reported drinking 4 to 7 cups
  • Twenty-two percent said they drank 8 cups or more

Those who drank the least water were also less likely to pursue other healthful behaviors, such as consuming fresh fruits and vegetables.

Too much water?

Some have raised concerns that consuming too much water could be dangerous.

Not only the amount of fluid in the body but the balance of minerals that is important for maintaining health and life.

Too much water in the body could lead to hyponatremia, or water intoxication, when sodium levels in the blood plasma become too low.

Symptoms include:

  • lung congestion
  • brain swelling
  • headache
  • fatigue and lethargy
  • confusion
  • vomiting
  • seizures
  • coma
  • death

Hyponatremia may be a risk for people who use the recreational drug Ecstasy. This is likely due to a variety of reasons including a change in hormone levels, brain chemistry, body function, kidney function, along with increased sweating and thirst.

People who drink too much water while exercising could also be at risk. In the Boston runners survey, for example, almost 2,000 of the participants were thought likely to have some degree of hyponatremia due to excessive fluid consumption, and 90 may have finished with critical hyponatremia.

Another risk factor is having certain diseases or using some medications. Diabetes, for example, can lead to excessive thirst. Conditions in which the kidneys cannot excrete enough water, too, can result in this type of problem.

However, just as the body can adapt to higher or lower levels of water and can remind us, through thirst, when we need to drink more, scientists believe an internal mechanism also stops most people from drinking too much water.

Takeaway

There are few scientific measures of how much water we need.

Most studies have focused on how much people consume and assumed that this figure matches or exceeds our needs. It does not determine whether a person is efficiently hydrated or not.

The amount of water a person uses and loses varies according to conditions and activities. Heat, activity, and illness, such as diarrhea and vomiting, can lead to dehydration.

Most healthy people in a temperate climate consume sufficient fluid to remain healthy while carrying out their daily activities, and around one fifth to a quarter of this comes from food. Where there is a lack, the body will usually regulate these needs.

Meanwhile, those who work outside or exercise in a hot climate will not be able to get all their water needs from food. They will need additional water.

Perhaps, as Prof. Farrell of Monash University says, “If we just do what our body tells us, we will probably get it right.”

Q:

Should people aim to consume a particular quantity of water each day?

A:

The most recent research supports the theory that thirst is the best guide for determining fluid intake. For the average individual, even in routine physical activity, allow thirst to determine when and how much you drink. 

Those with certain medical conditions, such as kidney disease or heart failure, may need to follow their doctor’s advice regarding daily fluid intake in order to avoid the complications of low sodium levels in their blood.

Judith Marcin, MD

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Immune aging and how to combat it

With age, the human immune system becomes less effective at tackling infections and less responsive to vaccinations. At the same time, the aging immune system is associated with chronic inflammation, which increases the risk of almost all conditions linked to old age.

The good news is that exercising and adopting the right diet may help a person maintain healthy immunity into older age.

Chimpanzees and gorillas, our closest primate relatives, live for only 10–15 years in the wild once they have reached maturity. After the human evolutionary lineage split from theirs, our ancestors’ life expectancy doubled over the next 5 million years.

Scientists believe that it remained relatively stable into the 18th century. In the 250 years between then and now, however, life expectancy more than doubled again due to improvements in sanitation and healthcare.

We live in a time of high average life expectancies. However, our long evolutionary history has adapted us for different lifestyles (and even life expectancies), and these have changed drastically.

As a result, immunity not only weakens in older age; it also becomes imbalanced. This affects the two branches of the immune system — “innate” immunity and “adaptive” immunity — in a double whammy of “immunosenescence.”

“Innate” immunity, which is our first line of defense against infections, fails to resolve after the initial threat has passed, causing chronic, systemic inflammation.

“Adaptive” immunity, which is responsible for remembering and attacking particular pathogens, steadily loses its ability to defend against viruses, bacteria, and fungi.

Chronic, low-grade inflammation is associated with almost all conditions linked to older age, including type 2 diabetes, cardiovascular disease, cancer, and dementia. It also plays a leading role in certain autoimmune conditions that are more common in older adults, such as rheumatoid arthritis.

Meanwhile, the loss of adaptive immunity that comes with older age not only makes people more susceptible to infections; it can also reactivate dormant pathogens that were previously suppressed.

In addition, the weaker adaptive immunity of older adults means that their bodies respond less strongly to vaccinations, such as the annual flu shot.

Aging and innate immunity

Researchers have dubbed the persistent, low-level inflammation that is implicated in almost all conditions associated with older age as “inflammaging.”

“While inflammation is part of the normal repair response for healing, and essential in keeping us safe from bacterial and viral infections and noxious environmental agents, not all inflammation is good. When inflammation becomes prolonged and persists, it can become damaging and destructive.”

After an initial infection or injury, younger people’s immune systems switch to an anti-inflammatory response. This does not appear to happen as effectively in older adults. This is due to the accumulation of aged, or “senescent,” immune cells.

Senescent cells have shorter telomeres, which are the protective caps at the tips of chromosomes. Just as the plastic caps on the ends of shoelaces prevent them from fraying, telomeres prevent vital genetic material from becoming lost when the chromosome is copied during cell replication.

Telomeres get a little shorter every time a cell divides, until, eventually, division has to stop completely. If the cell survives, it becomes steadily more dysfunctional.

Senescent immune cells produce more immune signaling molecules called cytokines, which promote inflammation. Specifically, they churn out more interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha).

Scientists have linked high levels of IL-6 and TNF-alpha to disability and mortality in older adults. They have a particularly strong association with type 2 diabetes, cardiovascular disease, neurodegenerative disease, and cancer.

As the number of pro-inflammatory cells increases, there is an increase in the number of immune cells called M1 macrophages (more pro-inflammatory) and a decrease in the number of M2 macrophages (more immunoregulatory).

These changes in the frequency of M1 and M2 cells seem to be associated with an increased risk of developing plaques comprising fat and debris, which block the arteries in atherosclerosis.

Aging and adaptive immunity

Through adaptive immunity, the immune system learns to recognize and neutralize particular pathogens.

A type of immune cell known as a T cell plays a crucial role in adaptive immunity. In the course of an infection, “naïve” T cells learn to recognize the specific pathogen involved. They then differentiate into cells that are specialized to mount future immune responses against the same pathogen.

The total number of T cells remains constant throughout our lifetime, but the pool of naïve, undifferentiated cells steadily shrinks over the years, as more and more cells commit to tackling specific infections.

As a result, the bodies of older adults become less able to mount effective immune responses to new infections. For the same reason, vaccinations provoke weaker responses from the aging immune system and, therefore, provide less protection.

Ironically, a lifetime of influenza vaccinations may, in itself, diminish the efficacy of the annual vaccine later in life. Indeed, research suggests that repeated influenza immunizations could lead to reduced antibody responses.

Many older adults harbor a latent infection of human cytomegalovirus. This viral infection is very common and persistent, and it usually produces few (if any) symptoms. However, in older adults, this infection may steadily deplete their immune resources, making them more prone to other viral infections and reducing the effect of influenza immunizations.

In addition to this slow decline in immunity with age, senescent T cells also produce more pro-inflammatory cytokines, such as IL-6. These, in turn, stoke the chronic, systemic inflammation of inflammaging.

Holding back the years

Although nothing can prevent aging, there are certain lifestyle changes a person can make to stay healthy into older age.

The sections below will look at these factors in more detail.

Getting regular physical activity

Exercise has a profound effect on the immune system, according to a recent overview of research in the journal Nature Reviews Immunology.

Inevitably, people become less physically active as they age, but there is evidence to suggest that getting as much exercise as possible can slow or even reverse some of the effects of immunosenescence.

Skeletal muscle produces a range of proteins called myokines that reduce inflammation and preserve immune function. Therefore, it makes sense that maintaining muscle mass through exercise protects against infection and conditions such as type 2 diabetes and cardiovascular disease, which are closely linked to chronic inflammation.

One study found that aerobic fitness among 102 healthy males, aged 18–61 years, was inversely proportional to the number of senescent T cells in their blood after adjusting for age. In other words, increased physical fitness was associated with less immunosenescence.

The fittest males not only had fewer senescent T cells but a greater number of naïve T cells.

Another study compared the immune responses of 61 healthy males, aged 65–85 years, to a flu vaccination. Around one-third of the males were intensively active (though participation in running or sports), one-third were moderately active, and one-third were mostly inactive.

After adjusting for their age, the researchers found that the intensively and moderately active males produced more antibodies in response to vaccination than the least active males.

Remarkably, the more active males had higher serum concentrations of antibodies to some flu strains even before they underwent vaccination.

A range of other studies have identified similar benefits, not only from long-term physical activity but also from single bouts of exercise before vaccination.

“Taken together, these studies suggest that the emergence of certain features of immunosenescence and the extent of immune remodeling is likely to be heavily influenced by insufficient physical activity as humans age.”

It is important to note that the majority of the research into the relationship between exercise and immunity in older adults has involved “cross-sectional” studies. This type of study investigates relationships between variables at a single point in time.

To confirm the benefits of physical fitness, the authors of the review above call for more “interventional” studies, which would follow participants over time.

Adopting the Mediterranean diet

For now, there is no direct evidence to suggest that making dietary changes can slow the rate of immunosenescence in older adults. However, there is plenty of indirect evidence.

In particular, research suggests that diet helps determine older adults’ risk of developing sarcopenia. This condition causes a loss of muscle mass, strength, and functionality.

There appears to be a two-way relationship between skeletal muscle and the immune system. Muscles produce anti-inflammatory myokines, but recent evidence suggests that chronic inflammation also accelerates the muscle loss in sarcopenia.

Taking dietary supplements that reduce the risk of sarcopenia — such as vitamin D and polyunsaturated fatty acids — may help, due to their anti-inflammatory properties.

A growing body of evidence also suggests that people who eat a Mediterranean diet are less likely to become “frail” in older age, such as by losing muscle strength, walking slowly, and tiring easily.

The Mediterranean diet comprises:

  • large amounts of fruit, leafy vegetables, and olive oil
  • moderate amounts of fish, poultry, and dairy
  • low amounts of red meat and added sugar

Previous studies have linked this diet to a lower risk of obesity, cardiovascular disease, type 2 diabetes, and cancer.

A 2018 review of observational studies, which Medical News reported on, found that people who adhered the most closely to the Mediterranean diet were less than half as likely to become frail over a 4-year period, compared with those who followed it the least closely.

Among other possible explanations, this may be a result of the diet’s anti-inflammatory properties. The authors write:

“Frail individuals have higher levels of inflammatory markers, and inflammation is considered to be closely associated with frailty. A Mediterranean diet is associated with low levels of inflammatory markers and may reduce frailty risk through this mechanism.”

Maintaining a moderate weight

Although muscle plays a role in reducing inflammation in older adults, fat, or “adipose,” tissue may have the opposite effect.

Normal aging often leads to weight gain, due to an accumulation of adipose tissue beneath the skin and around the organs. According to a roundup of research on the aging immune system, adipose tissue may make a significant contribution to inflammaging.

Up to 30% of the pro-inflammatory cytokine IL-6 in the bloodstream may originate from adipose tissue. Therefore, having obesity or overweight in older age may significantly contribute to chronic inflammation.

In addition, animal and human studies suggest that the immune system of people with obesity may produce fewer antibodies in response to the flu vaccination.

Exercising and eating a healthful diet appear to counter the effects of immune aging. In part, this might be due to the way that these two lifestyle factors prevent excessive weight gain.

Studies have suggested that older adults who exercise regularly and have a moderate weight have fewer senescent T cells and lower levels of pro-inflammatory cytokines in their blood.

However, whether or not diet, exercise, and weight loss can reverse immunosenescence remains an open question for future research.

What causes blackouts?

A blackout is a loss of consciousness or complete or partial memory loss. Possible causes of blackouts include epilepsy and drinking a large volume of alcohol.

If a person notices someone falling unconscious, they should put them in a seated position or help them lie down so that they do not hurt themselves.

What is a blackout?

Some people define blackouts as a temporary loss of consciousness that typically lasts for a few minutes.

However, a 2016 review observes that overconsuming alcohol may lead to alcohol-induced blackouts, which can, in some cases, be due to memory loss rather than a loss of consciousness.

Other possible causes of blackouts include syncope, epilepsy, and stress.

Alcohol blackouts

Two different kinds of blackouts can result from drinking alcohol: en bloc and fragmentary.

When a person consumes a very large volume of alcohol, an en bloc blackout may occur. If this happens, they will not remember anything that they did while they were drinking.

Fragmentary blackouts tend to affect only patches of memory, so a person may be able to piece together a memory on prompting.

Symptoms

If someone has drunk too much alcohol, they may have the following symptoms of alcohol intoxication:

  • becoming confused
  • difficulty staying awake, or not being able to wake up
  • clammy skin and low body temperature
  • slow heart rate
  • vomiting and seizures

Treatment

If a person is showing symptoms of severe alcohol intoxication, it is important to call the emergency services for treatment.

According to the National Institute on Alcohol Abuse and Alcoholism, a very high blood-alcohol concentration may result in a person struggling to remain conscious. In the most severe cases of alcohol intoxication, they may even fall into a coma. Due to this, it is really important to get someone emergency help if their condition is deteriorating.

In cases where someone who has drunk too much needs first aid, people should:

  • lie the person down on their side with their knees up so that they will not choke on their vomit
  • check that they are breathing every 15 minutes
  • monitor their condition and call 911 immediately if it worsens

Syncope blackouts

The American Heart Association (AHA) describe a syncope blackout as a short temporary loss of consciousness that happens when not enough blood reaches the brain.

People may also refer to this type of blackout as fainting. Low blood pressure typically causes syncope blackouts because the heart cannot pump enough oxygen-rich blood to the brain.

There are two main types of syncope blackouts: neurally mediated and cardiac.

A neurally mediated syncope is usually benign and requires no further treatment. It could occur when a person’s blood pressure drops after they experience pain or dehydration or get up too quickly. This type of syncope tends to occur more in children and young adults.

A cardiac syncope is more serious as it could signal an underlying problem with the heart. Tachycardia, bradycardia, or other types of hypotension could cause a cardiac syncope. If a person does not get treatment, they are at risk of complications or even sudden cardiac death.

Treatment

A doctor may prescribe fludrocortisone to reduce blackouts in people who experience neurally mediated syncope.

If anyone feels as though they are about to faint, they should sit or lie down so that they do not injure themselves if they fall unconscious.

Diagnosis

If a person is experiencing syncope blackouts, a doctor may request an electrocardiogram (EKG) to see whether there are any underlying problems with the heart.

They may also order a tilt test. During this test, a person lies down on a board that moves to change their position while healthcare professionals measure their blood pressure and heart rate.

Epilepsy blackouts

A disturbance of neuronal activity in the brain can cause an epileptic episode. During these episodes, people may experience a seizure. Their muscles may contract, and they could lose consciousness.

However, just because a person has epilepsy, it does not necessarily mean that they will blackout when they have a seizure. The disorder is a spectrum, and it covers many other symptoms.

Symptoms

Many different symptoms could accompany epileptic blackouts, depending on the type of seizure that a person is experiencing.

According to the University of California, San Francisco, one particular type of epileptic seizure that causes blackouts is a tonic-clonic seizure — also known as a grand-mal seizure. During this epileptic episode, people lose consciousness, and the body goes stiff (tonic phase). The muscles then contract, which may result in the jaw clamping shut (clonic phase).

Treatment

The National Institute of Neurological Disorders and Stroke estimate that 70% of people with epilepsy can control their symptoms by taking medication or undergoing surgery.

Since the Food and Drug Administration (FDA) approved them in 2019, doctors have been able to prescribe cenobamate tablets for adults who experience blackouts during seizures. If medication proves ineffective, doctors may recommend surgery.

Some children may be unable to take medication due to the side effects. In these cases, they may benefit from special diets.

Diagnosis

If a doctor suspects that a person has epilepsy, they may request an MRI or CT scan. These imaging techniques help the doctor examine brain activity and rule out other neurological conditions.

Learn more about epilepsy here.

Can stress cause blackouts?

If a person experiences blackouts as a result of stress, this is known as a psychogenic blackout. While these blackouts are similar to syncope and epileptic blackouts, the causes are different.

Experts believe that when people are experiencing a threatening feeling, thought, or memory, it can overwhelm them so much that it induces a seizure.

Some symptoms of psychogenic blackouts include:

  • fainting and falling
  • jerking movements of the arms and legs
  • losing control of the bladder and bowel
  • going “blank” and feeling out of touch with the surroundings
  • not being able to remember the blackout

Treatment

According to the Epilepsy Society, people who experience psychogenic blackouts may benefit from cognitive behavioral therapy (CBT). CBT helps people identify stressful triggers and put techniques in place to cope when they feel overwhelmed.

Diagnosis

If a person believes that they are experiencing psychogenic blackouts, a doctor may refer them to a neurologist, who may be able to diagnose psychogenic blackouts by ruling out other causes.

Can medication cause blackouts?

According to one 2015 study, vasodilatory medications and diuretics could result in syncope blackouts.

Another 2015 study suggests that overconsuming sedatives could cause memory loss. In one case study, the excessive use of alprazolam (Xanax) led a 50-year-old woman to experience memory loss blackouts. However, more research is necessary to support these findings.

When to see a doctor

A person should speak to a doctor if they believe that they are experiencing symptoms of syncope, epileptic blackouts, or blackouts that are the result of medication. In cases of severe alcohol intoxication, a person may need emergency assistance.

With treatment, most people will be able to continue their daily activities. If a person’s blackouts are related to an underlying medical condition, they should stop once the person receives treatment to manage the condition.

Summary

Excessive alcohol use, stress, medication, and epilepsy can all cause blackouts. While blackouts are a frightening experience, treatment can allow people to lead a normal life without the fear of falling unconscious or losing their memory.

What is the impact of eating too much sugar?

In the short-term, eating too much sugar may contribute to acne, weight gain, and tiredness. In the long-term, too much sugar increases the risk of chronic diseases, such as type 2 diabetes and heart disease.

According to the Centers for Disease Control and Prevention (CDC), people in the United States consume too much added sugar. Added sugars are sugars that manufacturers add to food to sweeten them.

In this article, we look at how much added sugar a person should consume, the symptoms and impact of eating too much sugar, and how someone can reduce their sugar intake.

How much sugar is too much? 

According to the Dietary Guidelines for Americans 2010-2015, on average, Americans consume 17 teaspoons (tsp) of added sugar each day. This adds up to 270 calories.

However, the guidelines advise that people limit added sugars to less than 10% of their daily calorie intake. For a daily intake of 2,000 calories, added sugar should account for fewer than 200 calories.

However, in 2015, the World Health Organization (WHO) advised that people eat half this amount, with no more than 5% of their daily calories coming from added sugar. For a diet of 2,000 calories per day, this would amount to 100 calories, or 6 tsp, at the most.

Symptoms of eating too much sugar

Some people experience the following symptoms after consuming sugar:

  • Low energy levels: A 2019 study found that 1 hour after sugar consumption, participants felt tired and less alert than a control group.
  • Low mood: A 2017 prospective study found that higher sugar intake increased rates of depression and mood disorder in males.
  • Bloating: According to Johns Hopkins Medicine, certain types of sugar may cause bloating and gas in people who have digestive conditions, such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO).

Risks of eating too much sugar 

Consuming too much sugar can also contribute to long-term health problems.

Tooth decay

Sugar feeds bacteria that live in the mouth. When bacteria digest the sugar, they create acid as a waste product. This acid can erode tooth enamel, leading to holes or cavities in the teeth.

People who frequently eat sugary foods, particularly in between mealtimes as snacks or in sweetened drinks, are more likely to develop tooth decay, according to Action on Sugar, part of the Wolfson Institute in Preventive Medicine in the United Kingdom.

Acne

A 2018 study of university students in China showed that those who drank sweetened drinks seven times per week or more were more likely to develop moderate or severe acne.

Additionally, a 2019 study suggests that lowering sugar consumption may decrease insulin-like growth factors, androgens, and sebum, all of which may contribute to acne.

Weight gain and obesity

Sugar can affect the hormones in the body that control a person’s weight. The hormone leptin tells the brain a person has had enough to eat. However, according to a 2008 animal study, a diet high in sugar may cause leptin resistance.

This may mean, that over time, a high sugar diet prevents the brain from knowing when a person has eaten enough. However, researchers have yet to test this in humans.

Diabetes and insulin resistance

A 2013 article in PLOS ONE, indicated that high sugar levels in the diet might cause type 2 diabetes over time.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) add that other risk factors, such as obesity and insulin resistance, can also lead to type 2 diabetes.

Cardiovascular disease

A large prospective study in 2014 found that people who got 17–21% of their daily calories from added sugar had a 38% higher risk of dying from cardiovascular disease (CVD) than those who consumed 8% added sugars. For those who consumed 21% or more of their energy from added sugars, their risk for CVD doubled.

High blood pressure

In a 2011 study, researchers found a link between sugar-sweetened beverages and high blood pressure, or hypertension. A review in Pharmacological Research states that hypertension is a risk factor for CVD. This may mean that sugar exacerbates both conditions.

Cancer

Excess sugar consumption can cause inflammation, oxidative stress, and obesity. These factors influence a person’s risk of developing cancer.

A review of studies in the Annual Review of Nutrition found a 23–200% increased cancer risk with sugary drink consumption. Another study found a 59% increased risk of some cancers in people who consumed sugary drinks and carried weight around their abdomen.

Aging skin

Excess sugar in the diet leads to the formation of advanced glycation end products (AGEs), which play a role in diabetes. However, they also affect collagen formation in the skin.

According to Skin Therapy Letter, there is some evidence to suggest that a high number of AGEs may lead to faster visible aging. However, scientists need to study this in humans more thoroughly to understand the impact of sugar in the aging process.

How to eat less sugar

A person can reduce the amount of added sugar they eat by:

  1. checking food labels for sweeteners
  2. reducing foods with added sugar
  3. avoiding processed foods in general

Checking food labels

Added sugar and sweeteners come in many forms. Ingredients to look out for on a food label include:

  • brown sugar
  • fructose
  • glucose
  • sucrose
  • maltose
  • honey
  • corn sweetener
  • corn syrup
  • high fructose corn syrup
  • raw sugar
  • molasses
  • malt syrup
  • evaporated cane juice
  • agave nectar
  • maple syrup
  • invert sugar
  • fruit juice concentrates
  • trehalose
  • turbinado sugar

Some of these ingredients are natural sources of sugar and are not harmful in small amounts. However, when manufacturers add them to food products, a person might easily consume too much sugar without realizing it.

Reducing foods that contain added sugar

Some food products contain large amounts of added sugars. Reducing or removing these foods is an efficient way to reduce the amount of sugar a person eats.

The Dietary Guidelines for Americans 2010–2015 state that soda and other soft drinks account for around half a person’s added sugar intake in the U.S. The average can of soda or fruit punch provides 10 tsp of sugar.

Another common source of sugar is breakfast cereal. According to EWG, many popular cereals contain over 60% sugar by weight, with some store brands containing over 80% sugar. This is especially true of cereals marketed towards children.

Swapping these foods for unsweetened alternatives will help a person lower their sugar intake, for example:

  • swapping soda for water, milk, or herbal teas
  • swapping sugary cereals for low sugar cereal, oatmeal, or eggs

Avoiding processed foods

Manufacturers often add sugars to foods to make them more appealing. Often, this means people do not realize how much sugar a food contains.

By avoiding processed foods, a person can get a better sense of what their food contains. Cooking whole foods at home also means someone can control what ingredients they put into their meals.

When to see a doctor

People should see their doctor if they experience the symptoms of high blood sugar. According to the NIDDK, symptoms include:

  • increased thirst and urination
  • increased hunger
  • fatigue
  • blurred vision
  • numbness or tingling in the hands or feet
  • unexplained weight loss
  • sores that do not heal

These symptoms may indicate a person has diabetes. A doctor can test for diabetes by taking a urine sample.

People should also speak to a doctor if they experience other symptoms after eating sugar, such as bloating.

Summary

Consuming too much added sugar has many adverse impacts on health, including tiredness and weight gain, and more severe conditions, such as heart disease. Added sugars are present in many processed foods and drinks.

People can reduce their sugar intake by knowing what to look for on food labels, avoiding or reducing common sources of sugar, such as soda and cereals, and prioritizing unprocessed whole foods.

If a person is concerned about weight gain, symptoms that may indicate diabetes, or other symptoms they experience after eating sugar, they should speak to a doctor.

What to know about bipolar disorder

A person with bipolar disorder will experience changes in mood, energy, and activity levels that can make day-to-day living difficult.

Bipolar disorder can cause severe disruption to a person’s life, but the impact varies between individuals. With appropriate treatment and support, many people with this condition live a full and productive life.

According to the National Alliance on Mental Illness (NAMI), bipolar disorder affects over 10 million people in the United States or around 2.8% of the population.

On average, a person will receive a diagnosis around the age of 25 years, but symptoms can appear during the teenage years or later in life. It affects males and females equally.

What is bipolar disorder?

The National Institute of Mental Health describe the main symptoms of bipolar disorder as alternating episodes of high and low mood. Changes in energy levels, sleep patterns, ability to focus, and other features can dramatically impact a person’s behavior, work, relationships, and other aspects of life.

Most people experience mood changes at some time, but those related to bipolar disorder are more intense than regular mood changes, and other symptoms can occur. Some people experience psychosis, which can include delusions, hallucinations, and paranoia.

Between episodes, the person’s mood may be stable for months or years, especially if they are following a treatment plan.

Treatment enables many people with bipolar disorder to work, study, and live a full and productive life. However, when treatment helps a person feel better, they may stop taking their medication. Then, the symptoms can return.

Some aspects of bipolar disorder can make a person feel good. During an elevated mood, they may find they are more sociable, talkative, and creative.

However, an elevated mood is unlikely to persist. Even if it does, it may be hard to sustain attention or follow through with plans. This can make it difficult to follow a project through to the end.

Symptoms

According to the International Bipolar Association, symptoms vary between individuals. For some people, an episode can last for several months or years. Others may experience “highs” and “lows” at the same time or in quick succession.

In “rapid cycling” bipolar disorder, the person will have four or more episodes within a year.

Mania or hypomania

Hypomania and mania are elevated moods. Mania is more intense than hypomania.

Symptoms can include:

  • impaired judgment
  • feeing wired
  • sleeping little but not feeling tired
  • a sense of distraction or boredom
  • missing work or school
  • underperforming at work or school
  • feeling able to do anything
  • being sociable and forthcoming, sometimes aggressively so
  • engaging in risky behavior
  • increased libido
  • feeling exhilarated or euphoric
  • having high levels of self-confidence, self-esteem, and self-importance
  • talking a lot and rapidly
  • jumping from one topic to another in conversation
  • having “racing” thoughts that come and go quickly, and bizarre ideas that the person may act upon
  • denying or not realizing that anything is wrong

Some people with bipolar disorder may spend a lot of money, use recreational drugs, consume alcohol, and participate in dangerous and inappropriate activities.

Depressive symptoms

During an episode of bipolar depression, a person may experience:

  • a feeling of gloom, despair, and hopelessness
  • extreme sadness
  • insomnia and sleeping problems
  • anxiety about minor issues
  • pain or physical problems that do not respond to treatment
  • a sense of guilt, which may be misplaced
  • eating more or eating less
  • weight loss or weight gain
  • extreme tiredness, fatigue, and listlessness
  • an inability to enjoy activities or interests that usually give pleasure
  • difficulty focusing and remembering
  • irritability
  • sensitivity to noises, smells, and other things that others may not notice
  • an inability to face going to work or school, possibly leading to underperformance

In severe cases, the individual may think about ending their life, and they may act on those thoughts.

Psychosis

If a “high” or “low” episode is very intense, the person may experience psychosis. They may have trouble differentiating between fantasy and reality.

According to the International Bipolar Foundation, psychosis symptoms during a high include hallucinations, which involve hearing or seeing things that are not there and delusions, which are false but strongly felt beliefs. A person who experiences delusions may believe they are famous, have high-ranking social connections, or have special powers.

During a depressive or “low” episode, they may believe they have committed a crime or are ruined and penniless.

It is possible to manage all these symptoms with appropriate treatment.

Types of bipolar disorder

A person may receive a diagnosis of one of three broad types of bipolar disorder. According to NAMI, symptoms occur on a spectrum, and the distinction between the types is not always clear-cut.

Bipolar I disorder

For a diagnosis of bipolar I disorder:

  • The individual must have experienced at least one manic episode.
  • The person may have had a previous major depressive episode.
  • The doctor must rule out other disorders, such as schizophrenia and delusional disorder.

Bipolar II disorder

Bipolar II disorder involves periods of hypomania, but depression is often the dominant state.

For a diagnosis of bipolar II disorder, a person must have had:

  • one or more episodes of depression
  • at least one hypomanic episode
  • no other diagnosis to explain the mood shifts

A person with hypomania may feel good and function well, but their mood will not be stable, and there is a risk that depression will follow.

People sometimes think of bipolar II disorder as a milder version. For many, however, it is simply different. As NAMI indicate, people with bipolar II disorder may experience more frequent episodes of depression than people with bipolar I disorder.

Cyclothymia

The National Health Service (NHS) in the United Kingdom note that cyclothymia has similar features to bipolar disorder, but the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classifies it separately. It involves hypomania and depression, but the changes are less intense.

Nevertheless, cyclothymia can impact a person’s daily life, and a doctor can provide treatment.

Diagnosis

A medical professional will diagnose bipolar disorder using criteria set out in the DSM-5.

The National Institue of Mental Health (NIMH) explain that in order to receive a diagnosis of bipolar I disorder, a person must have had symptoms for at least 7 days, or less if symptoms were severe enough to need hospitalization. They may also have had a depressive episode lasting at least 2 weeks.

To receive a diagnosis of bipolar II, a person will have experienced at least one cycle of hypomania and depression.

A doctor may carry out a physical examination and some diagnostic tests, including blood and urine tests, to help rule out other causes.

It can be challenging for a doctor to diagnose bipolar disorder, as people are more likely to seek help with a low mood than a high mood. As a result, it can be hard for them to distinguish it from depression.

If the person has psychosis, a doctor may misdiagnose their condition as schizophrenia.

Other complications that may occur with bipolar disorder are:

  • use of drugs or alcohol to cope with symptoms
  • post-traumatic stress disorder (PTSD)
  • anxiety disorder
  • attention-deficit hyperactivity disorder (ADHD)

NIMH urge healthcare providers to look for signs of mania in the person’s history, to prevent misdiagnosis. Some antidepressants can trigger mania in susceptible people.

A person who receives a diagnosis of bipolar disorder has a lifelong diagnosis. They may enjoy long periods of stability, but they will always live with the condition.

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What are the symptoms of type 2 diabetes?

Type 2 diabetes is the most common form of diabetes. It happens when blood sugar levels rise due to problems with the use or production of insulin.

It can appear at any age, but it is more likely to occur after the age of 45 years.

It affects over 30 million Americans, according to the United States Centers for Disease Control and Prevention (CDC), and it accounts for 90–95 percent of diabetes cases.

What is type 2 diabetes?

People with type 2 diabetes do not make or use insulin correctly.

Insulin is a hormone that regulates the movement of blood glucose, or sugar, into cells, which use it as energy.

When sugar cannot enter cells, this means:

  • too much glucose collects in the blood
  • the body’s cells cannot use it for energy

A doctor may diagnose diabetes if a person’s blood sugar levels are 126 milligrams per deciliter (mg/dl) or above after fasting for 8 hours.

Symptoms

The symptoms of high blood sugar in type 2 diabetes tend to appear gradually. Not everyone with type 2 diabetes will notice symptoms in the early stages.

If a person does experience symptoms, they may notice the following:

  • Frequent urination and increased thirst: When excess glucose builds up in the bloodstream, the body will extract fluid from tissues. This can lead to excessive thirst and the need to drink and urinate more.
  • Increased hunger: In type 2 diabetes, the cells are not able to access glucose for energy. The muscles and organs will be low on energy, and the person may feel more hungry than usual.
  • Weight loss: When there is too little insulin, the body may start burning fat and muscle for energy. This causes weight loss.
  • Fatigue: When cells lack glucose, the body becomes tired. Fatigue can interfere with daily life when a person has type 2 diabetes.
  • Blurred vision: High blood glucose can cause fluid to be pulled from the lenses of the eyes, resulting in swelling, leading to temporarily blurred vision.
  • Infections and sores: It takes longer to recover from infections and sores because blood circulation is poor and there may be other nutritional deficits.

If people notice these symptoms, they should see a doctor. Diabetes can lead to a number of serious complications. The sooner a person starts to manage their glucose levels, the better chance they have of preventing complications.

Symptoms in children and teens

Type 2 diabetes is more likely to appear after the age of 45 years, but it can affect children and teens who:

  • have excess weight
  • do not do much physical activity
  • have high blood pressure
  • have a family history of type 2 diabetes
  • have an African American, Asian American, Hispanic American, or American Indian background

The following symptoms may occur:

  • weight loss, despite increased appetite and hunger
  • extreme thirst and dry mouth
  • frequent urination and urinary tract infections
  • fatigue
  • blurred vision
  • slow healing of cuts or wounds
  • numbness or tingling in hands and feet
  • itchy skin

If caregivers notice these symptoms, they should take the child to see a doctor. These are also symptoms of type 1 diabetes. Type 1 is less common but more likely to affect children and teenagers than adults. However, type 2 diabetes is becoming more common in young people than it was in the past.

Symptoms in older adults

At least 25.2 percent of people aged 65 and above have type 2 diabetes in the United States. They may have some or all the classic symptoms of type 2 diabetes.

They may also experience one or more of the following:

  • flu-like fatigue, which includes feeling lethargic and chronically weak
  • urinary tract infections
  • numbness and tingling in the hands, arms, legs, and feet due to circulation and nerve damage
  • dental problems, including infections of the mouth and red, inflamed gums

Early signs

Most people do not experience symptoms in the early stages, and they may not have symptoms for many years.

A possible early sign of type 2 diabetes is darkened skin on certain areas of the body, including:

  • the neck
  • the elbows
  • the knees
  • the knuckles

This is known as acanthosis nigricans.

Other early symptoms include:

  • frequent bladder, kidney, or skin infections
  • cuts that take longer to heal
  • fatigue
  • extreme hunger
  • increased thirst
  • urinary frequency
  • blurred vision

A person may have mild or subtle symptoms for many years, but these can become in time. Further health problems can develop.

Prediabetes and diabetes prevention

A person with blood sugar levels of 100–125 mg/dl will receive a diagnosis of prediabetes. This means that their blood sugar levels are high, but they do not have diabetes. Taking action at this stage can prevent diabetes from developing.

According to a 2016 report published in The Journal of the American Board of Family Medicine, 33.6 percent of people aged 45 years and older had prediabetes in 2012.

The CDC estimate that around 84 million American adults have prediabetes, but most do not know they have it.

Complications

Diabetes may cause a number of health complications if people do not manage it properly. Many of these are chronic, or long-term, but they can become life-threatening. Others need immediate medical attention as soon as they appear.

Emergency complications

Complications can arise quickly if blood sugar rises or falls too far.

Hypoglycemia

If blood glucose dips below 70 mg/dl, this is hypoglycemia, or low blood sugar.

This can happen if a person who uses insulin takes more than they need for a particular time.

A home blood glucose test can check for hypoglycemia.

It is vital to know the early signs of hypoglycemia, as it can progress quickly, resulting in seizures and a coma. In the early stages, however, it is easy to treat.

Symptoms of hypoglycemia include:

  • confusion
  • dizziness
  • feeling faint
  • heart palpitations
  • rapid heartbeat
  • mood changes
  • loss of consciousness
  • sweating
  • clamminess

If symptoms are mild, a person can often resolve low blood sugar levels by consuming:

  • a few pieces of hard candy
  • a cup of orange juice
  • a teaspoon of honey
  • a glucose tablet

The person should then wait 15 minutes, test their blood sugar, and if it is still low, they should take another glucose tablet or sweet.

When levels return to above 70 mg/dl, the person should eat a meal, to stabilize their glucose levels.

If they remain low for 1 hour or longer, or if symptoms worsen, someone should take the person to the emergency room.

Anyone who has frequent or severe hypoglycemic episodes should speak to their doctor, as they may need to adjust their treatment plan.

Hyperglycemia and diabetic ketoacidosis (DKA)

If blood sugar levels rise too far, hyperglycemia can result. If a person notices increased thirst and urination, they should check their blood sugar levels.

It the level is above the target level that their doctor recomends, they take appropriate action.

Without treatment, high a person with hyperglycemia can develop diabetic ketoacidosis (DKA), which happens when high levels of ketones collect in the blood, making it too acidic. For this reason, the person should also test their ketone levels.

Ketoacidosis can lead to:

  • difficulty breathing
  • a fruity smell on the breath
  • a dry mouth
  • nausea and vomiting
  • coma

It can be life-threatening. A person with these signs and symptoms should seek immediate medical attention.

People who regularly experience high blood sugar should speak to their doctor about adjusting their treatment plan.

People should check with their doctor how often they need to test.

Long-term complications

Keeping blood glucose within target levels can prevent complications that can become life-threatening and disabling over time.

Some possible complications of diabetes are:

  • heart and blood vessel diseases
  • high blood pressure
  • nerve damage (neuropathy)
  • foot damage
  • eye damage and blindness
  • kidney disease
  • hearing problems
  • skin problems

Effective management of blood glucose levels can reduce the risk of complications.

Diagnosis and treatment

A doctor can diagnose type 2 diabetes with blood tests that measure blood glucose levels. Many people discover they have high blood sugar during a routine screening test, but anyone who experiences symptoms should see a doctor.

Treatment aims to keep blood glucose levels stable at a healthy level and prevent complications. The main ways to do this are through lifestyle measures.

These include:

  • following a healthful diet
  • reaching and maintaining a healthy weight and body mass index (BMI)
  • doing physical activity
  • getting enough sleep
  • avoiding or quitting smoking
  • taking medications or insulin as the doctor recommends

Outlook

There is currently no cure for diabetes, but most people with the condition can lead a healthful life by managing their condition properly.

People who maintain a healthy weight, follow a healthful diet, and do regular exercise may not need medication. Taking these steps can help manage blood sugar levels.

Routine screening can alert a person to high blood sugar levels in the early stages, when there is still time to slow, stop, or reverse the progress of diabetes.

Current guidelines recommend regular screening from the age of 45 years, or younger if an individual has other risk factors, such as obesity. A doctor can advise on individual needs.

It is important to have support from people who understand what it is like to receive a diagnosis and live with type 2 diabetes. 

What is shingles?

Shingles is a viral infection that results from the varicella-zoster virus (VZV), the same virus that causes chickenpox. It typically affects a single sensory nerve ganglion and the skin surface that the nerve supplies.

Anyone who has had chickenpox can later develop shingles.

In fact, according to the Centers for Disease Control and Prevention (CDC), an estimated 1 in 3 people in the United States develop shingles during their lifetime.

However, a person can only develop shingles if they have had chickenpox or exposure to the virus that causes it. This virus can lie dormant for years.

Most adults with the dormant virus never develop shingles, but for some, the virus reactivates several times.

Shingles is most common after the age of 50 years, but it can appear at any age if a person has previously had chickenpox.

In this article, learn more about shingles, including symptoms, complications, and treatments.

Symptoms

Shingles usually affects one side of the body. This is most often the waist, chest, abdomen, or back. Symptoms can also appear on the face and in the eyes, mouth, ears. The virus can also affect some internal organs.

Shingles typically affects a single sensory nerve ganglion near the spinal cord, called a dorsal root ganglion. This is why the symptoms occur in specific areas of the body, rather than all over it. The pain results from nerve involvement, rather than the rash itself.

In fact, some people have pain but no rash. Others, meanwhile, may have a rash with pain that is accompanied by other symptoms, such as fever, chills, or headache.

Symptoms can vary in nature, depending on where on the body they appear.

Common symptoms

Some of the most common symptoms of shingles include:

  • a constant dull, burning, or gnawing pain, or a sharp, stabbing pain that comes and goes
  • a skin rash that resembles a chickenpox rash but only affects certain areas
  • fluid-filled blisters that develop as part of the rash

Symptoms on the body

A blistering skin rash may appear in one or more distinct bands with sensory nerves of the skin, called dermatomes.

Common locations for this include:

  • the chest
  • the abdomen
  • the back
  • around the waist

It usually occurs only on one side of the body.

The location of the symptoms will depend on which dermatome distribution the virus affects.

Facial symptoms

If the rash affects the face, symptoms usually appear on one side only — usually around one eye and the forehead.

They can include:

  • pain over the affected dermatome
  • a rash
  • muscle weakness
  • headache

Eye symptoms

If the virus affects an ophthalmic nerve, it means that a person has herpes zoster ophthalmicus.

This can cause pain, redness, and swelling in and around the eye, as well as temporary or permanent loss of vision.

Ear symptoms

Shingles can also occur in or around the ear, leading to problems with balance and hearing, as well as muscle weakness on the affected side of the face.

These changes can be long term or even permanent. A person who develops symptoms in or around the ears and eyes should seek immediate medical attention to reduce the risk of complications.

Mouth symptoms

If shingles affects the mouth, a person may experience:

  • facial tenderness
  • pain in the mouth
  • toothache
  • lesions in hard and soft palate tissues

The pain and discomfort of these symptoms can make it difficult to eat or drink.

Internal shingles

Shingles can also affect the internal organs. There will not be a rash, but other problems can arise.

For example, researchers have found evidence of shingles in the digestive system, which can lead to gastrointestinal dysfunction, and in the arteries in the brain, which may increase the risk of stroke and dementia.

Other symptoms

There may also be other symptoms, including:

  • fever
  • fatigue
  • chills
  • headache
  • upset stomach

Symptom progression

Symptoms typically progress as follows:

  • Pain, tingling, numbness, and itching start to affect a specific part of the skin.
  • After up to 2 weeks, a rash appears.
  • Red blotches and itchy, fluid-filled blisters develop and continue to do so for 3-5 days.
  • The blisters may merge, forming a solid red band that looks similar to a severe burn. The gentlest touch may be painful.
  • Inflammation may affect the soft tissue under and around the rash.
  • After 7–10 days, the blisters gradually dry up and form scabs or crusts. As the blisters disappear, they may leave minor scarring.

Shingles usually lasts around 2–4 weeks. It is contagious until the blisters dry up and crust over.

Most people will only have an episode of shingles once, but it can recur in some people.

Complications

Rarely, complications can arise — especially in people with an impaired immune system.

Possible complications of shingles include:

  • postherpetic neuralgia (PHN)
  • inflammation of the brain or spinal cord, increasing the risk of stroke, encephalitis, and meningitis
  • eye and vision problems
  • weakness
  • problems with balance and hearing
  • damage to blood vessels, which could lead to stroke
  • pneumonia

According to the CDC, around 10–18% of people who have shingles will develop PHN, a long term complication wherein the pain of a shingles rash lasts long beyond the rash itself.

It is more likely to occur if a person develops shingles after the age of 40 years, and the risk continues to increase with age.

In people with weak immune systems

People with a weakened immune system will have a higher risk of developing shingles and of experiencing severe symptoms and complications.

This include people who:

  • have cancer, especially leukemia or lymphoma
  • have HIV
  • have undergone an organ transplant
  • are taking medications to suppress the immune system, including chemotherapy drugs

These people should seek medical attention as soon as possible if they have concerns about shingles-related symptoms.

Is shingles contagious?

It is not possible to directly transmit shingles to another person. However, a person who has never had chickenpox can contract VZV by coming into direct contact with the fluid in the blisters of a person who currently has shingles.

If this happens and the person has not received vaccination against chickenpox, they would develop chickenpox first, not shingles.

Shingles does not spread through coughing or sneezing. Only direct contact with fluid from the blisters can spread the virus. Therefore, covering the blisters reduces the risk of contagion.

It is important to note that the virus is only active from when the blisters first appear to when they dry up and crust over. Transmission is not possible before the blisters develop and after the crusts form. If a person does not develop blisters, the virus cannot spread in the traditional sense.

Taking the following precautions can help prevent the transmission of the virus:

  • Cover the rash.
  • Wash the hands often.
  • Avoid touching or scratching the rash.

It is also important to avoid contact with:

  • infants who are preterm or have a low birth weight
  • pregnant women who have never had chickenpox or the vaccine for it
  • those with a weakened immune system

Treatment

A doctor may prescribe antiviral drugs to stop the virus from multiplying.

Antiviral treatment

Antiviral treatment can help:

  • reduce the severity and duration of symptoms
  • prevent complications from developing
  • lower the risk of the rash coming back

Managing symptoms

Tips for managing symptoms include:

  • using pain relief medication
  • reducing stress as much as possible
  • eating regular, nutritious meals
  • getting some gentle exercise
  • wearing loose fitting clothes, for comfort

To relieve itching, the CDC recommend:

  • applying calamine lotion
  • taking a lukewarm, oatmeal bath
  • placing a cool, damp washcloth on the blisters

Most people will recover with home treatment, but a person should seek medical help if other symptoms appear, such as a fever. Around 1–4% of people will need to spend time in the hospital due to complications.

Abortion

Abortion, sometimes known as a ‘termination of pregnancy,’ is the medical process of ending a pregnancy to ensure that it does not end in the birth of a baby. Women have abortions for many reasons, including personal circumstances, a risk to the mother or a high chance that the baby will have a serious genetic or physical abnormality.

There are a number of types of abortion, and options depend on the duration of the pregnancy. An abortion is a medical means of ending a pregnancy.

Worldwide, around half of all reported unintended pregnancies end in abortion. Abortion is legal throughout the majority of the United States and in many other countries.

When can a woman have an abortion?

Where abortion is legal in the U.S., doctors usually perform them in the first trimester or the early part of the second trimester.

The first trimester lasts from conception to week 12 of pregnancy. The second trimester is from week 13 to week 28. Some states allow abortion in the latter part of the second trimester. In 2015, two-thirds (65.4%) of reported abortions in the country took place when the pregnancy had lasted fewer than 8 weeks.

In the first trimester, options for abortion commonly include:

  • medical abortion
  • vacuum aspiration

A woman can usually access medical abortion until about 10 weeks after her last period. It involves taking two types of medication.

Surgical options, such as vacuum aspiration and dilation and evacuation, are more common after 10 weeks.

In the second trimester, a woman may undergo:

  • dilation and evacuation
  • labor induction abortion

Abortion is rare during the third trimester, but a doctor may perform it after 29 weeks of pregnancy if a woman’s life is in danger. They may use the same methods that are used during the second trimester.

Medical abortion

A medical abortion requires a woman to take pills at separate times.This type of abortion involves taking two medications, mifepristone and misoprostol.

A doctor or nurse will advise about the timing, but a woman should take the second medication, misoprostol, no more than 48 hours after taking the first, mifepristone.

Mifepristone stops the pregnancy from developing. Misoprostol triggers the uterus to empty, which will begin 1–4 hours after taking the pill.

A woman will experience cramping and bleeding as the uterus empties, which may feel like having an unusually heavy period. Some women feel more severe cramping than others.

Within around 4–5 hours, the pregnancy tissue will likely have passed from the body, but it can take longer.

Advantages

Some advantages of a medical abortion are:

  • It does not involve surgery.
  • It is available in the first trimester.
  • It does not require an anesthetic.

Disadvantages

Some disadvantages of a medical abortion are:

  • It is not available in the second trimester.
  • Only part of the treatment takes place in a clinic.
  • It may cause painful cramping.
  • Rarely, it is not effective.

It may be a good idea to have a partner or friend close by for support while the tissue is passing.

Recovery

Recovery from a medical abortion involves:

  • some bleeding and spotting that may last for several weeks
  • a check-up with the doctor to monitor recovery

Risks

Some women experience side effects of the medications. These can include:

  • nausea
  • heavy vaginal bleeding
  • dizziness
  • fatigue
  • diarrhea
  • mild fever

Vacuum aspiration

Vacuum aspiration is a type of surgical abortion that involves using gentle suction to end a pregnancy. Doctors typically recommend this during the first trimester.

How it works

A doctor begins the vacuum aspiration procedure by inserting a speculum into the woman’s vagina. They then apply medication or use an injection to numb the area.

Next, they use thin rods called dilators to open the cervix, then insert a tube into the uterus. Then, they use either a manual or mechanic suction device to empty the uterus.

Advantages

The advantages of vacuum aspiration are:

  • It is available in the first 12 weeks of pregnancy.
  • It is quick, with the procedure only taking 5–10 minutes.
  • It is relatively pain-free, though some women experience cramping, sweating, nausea, or a combination.
  • It does not require a general anesthetic.

Disadvantages

The main disadvantage of vacuum aspiration is that it is not available in the second trimester.

Recovery

Recovery from vacuum aspiration involves:

  • resting for up to 1 hour after treatment
  • taking antibiotics to prevent infection
  • avoiding sex for 1 week after treatment

Also, some women experience cramping for a few days following the procedure, and irregular bleeding or spotting can occur for several weeks.

Risks

The potential complications of vacuum aspiration include bleeding and infection. However, the risk of these complications is low.

Speak to the doctor right away if signs of bleeding or new symptoms occur.

Dilation and evacuation

Dilation and evacuation is a type of surgical abortion that doctors commonly use during the second trimester.

How it works

A doctor may give a general anesthetic before performing a dilation and evacuation. This type of anesthetic ensures that a person does not feel anything during the procedure.

The doctor begins by inserting a speculum into the woman’s vagina. Then, they use dilators to open the cervix.

Next, they remove the pregnancy tissue with small forceps. Finally, they use suction to remove any remaining tissue.

Advantages

The advantages of dilation and evacuation are:

  • It is available in the second trimester.
  • It is a safe and effective way to end a pregnancy.

Disadvantages

The disadvantage of dilation and evacuation is that it can require a general anesthetic.

Recovery

Recovery from dilation and evacuation involves resting.

Mild pain and cramping can occur for a few days after the procedure, and there may be some bleeding for up to 2 weeks.

Risks

Potential complications of dilation and evacuation include:

  • infection
  • heavy bleeding
  • injury to the uterus

The risk of injury to the uterus or other organs during a second-trimester abortion is less than 1 in 1,000, according to The American College of Obstetricians and Gynecologists.

Labor induction abortion

Labor induction abortion is a late-term method of ending a pregnancy in the second or third trimester.

This type of abortion is rare, and a doctor may recommend it if a woman’s life is in danger.

How it works

Labor induction involves using medications to start labor, which causes the uterus to empty over a period of around 12–24 hours. A woman can take these medications by mouth or the doctor may place them into the vagina or inject them into the uterus.

Doctors usually also administer pain relief medication or a local anesthetic, as intense cramping occurs during this type of abortion.

Recovery

After the abortion is complete, a woman tends to remain in the clinic or hospital for anywhere from a few hours to 1–2 days, depending on health and other factors.

The doctor can help determine the length of the stay, and they may be able to estimate it before the abortion.

Risks

The medications that induce labor can cause side effects, such as:

  • nausea and vomiting
  • fever
  • diarrhea

Complications are rare but can include:

  • hemorrhage
  • cervical injury
  • infection
  • rupture of the uterus
  • incomplete release of the pregnancy tissue