Medicine Explained @Medexplained15

ADHD. Iron. Dopamine. Restless nights. What’s the real connection between these seemingly unrelated things? One messes with focus. The other with sleep. Iron sits in the middle. Spoiler: it’s not just “low dopamine”. Let’s dig in. x.com/i/article/2113…

A Common Stomach Bacterium Can Cause Cancer. But We Can Treat It. Helicobacter pylori: what everyone should know. A recent article in The BMJ highlights an important global health issue: a common bacterial infection that can remain unnoticed for decades, cause stomach ulcers, and increase the risk of stomach cancer. The good news? We can detect it, treat it, and potentially prevent some of its most serious consequences. Let's explain. 1. What is Helicobacter pylori? Helicobacter pylori, or H. pylori, is a bacterium that lives in the stomach. Around 40–45% of people worldwide are estimated to carry it, although prevalence varies considerably between countries. Most people become infected during childhood, often through transmission within families. But here's something interesting. Your stomach produces extremely strong acid to help digest food and protect against germs. So how does this bacterium survive? It produces an enzyme called urease, which helps neutralize the acid immediately around it. This allows the bacterium to survive within the protective mucus lining of the stomach, sometimes for decades. 2. Does it cause symptoms? Most people infected with H. pylori have no symptoms at all. Others may experience: Burning or discomfort in the upper abdomen. Nausea. Bloating or feeling unusually full after eating. Persistent indigestion. But these symptoms are not specific to H. pylori. Many other digestive conditions can cause similar complaints. And importantly, having no symptoms doesn't necessarily mean the bacterium is harmless. 3. What makes H. pylori potentially dangerous? The bacterium can cause long-lasting inflammation of the stomach lining, known as chronic gastritis. Over time, this inflammation can damage the stomach. Two important complications are: Stomach and duodenal ulcers H. pylori is one of the main causes of peptic ulcers. These are open sores that develop in the lining of the stomach or the first part of the small intestine. They can cause pain and occasionally serious bleeding. Stomach cancer This is the most concerning long-term complication. Years of chronic inflammation can gradually change the cells lining the stomach. In a small proportion of infected individuals, these changes may eventually contribute to cancer. H. pylori is officially classified as a cancer-causing agent by the World Health Organization's International Agency for Research on Cancer. But an important clarification: Most people carrying H. pylori will never develop stomach cancer. Infection increases the risk. It does not mean cancer is inevitable. 4. How can we detect it? Fortunately, the most commonly used tests are relatively simple. The breath test You drink a solution containing a special form of urea. If H. pylori is present, the bacterium breaks it down, producing a substance that can be detected in your breath. The stool test A laboratory looks for H. pylori antigens in a stool sample. Both tests can identify an active infection. In some situations, particularly when there are concerning symptoms, a doctor may recommend a gastroscopy to examine the stomach directly and take small tissue samples. A blood antibody test is generally less useful because it cannot reliably distinguish a current infection from one that has already disappeared. 5. Should everyone get tested? Not necessarily. Recommendations vary between countries, depending on local infection rates and stomach cancer risk. Testing is particularly worth discussing with a doctor if you have: A current or previous stomach or duodenal ulcer. Persistent indigestion. A close family history of stomach cancer. Certain unexplained conditions, such as iron-deficiency anaemia. Some countries and regions with higher rates of stomach cancer are also considering broader screening programmes. The goal isn't simply to test as many people as possible. It's to identify those most likely to benefit. 6. Can we eliminate the bacterium? Yes. And this is where treatment becomes particularly important. H. pylori is usually treated with a combination of antibiotics and medication that reduces stomach acid. Treatment commonly lasts 10–14 days, depending on the regimen. However, there is a growing problem. Antibiotic resistance. In many parts of the world, H. pylori has become resistant to commonly prescribed antibiotics. That means a treatment that works well in one country may be less effective in another. This is one of the central messages of the recent BMJ article: treatment strategies need to account for local antibiotic resistance. Whenever possible, knowing which antibiotics the bacterium is sensitive to can help guide treatment. And there is one more important point. After treatment, we need to check that the bacterium is actually gone. This is usually done with another breath or stool test, at least four weeks after antibiotics have finished and after stopping proton pump inhibitors for around two weeks. Feeling better does not necessarily prove that the infection has been eliminated. 7. Can treating H. pylori really prevent stomach cancer? This is perhaps the most encouraging part. A Cochrane review including more than 8,000 participants found that eliminating H. pylori reduced the relative risk of developing stomach cancer by approximately 46%, compared with placebo or no treatment. That is a relative reduction, not a 46-percentage-point decrease in an individual's absolute risk. Most of the trials were conducted in Asian populations, so the exact benefit may differ elsewhere. And eradication does not completely eliminate cancer risk, particularly if precancerous changes are already present. Nevertheless, the evidence supports an important conclusion: Treating an infection today can help prevent some cancers many years later. The Takeaway H. pylori is extremely common. Most infected people have no symptoms, and most will never develop serious complications. But it is also a major cause of stomach ulcers and an established risk factor for stomach cancer. Unlike many other cancer risk factors, this is one we can sometimes directly eliminate. Testing the right people, choosing effective antibiotics, and confirming successful treatment can make a real difference. And that's an encouraging example of what preventive medicine can achieve. If you have persistent digestive symptoms or a family history of stomach cancer, discuss with your doctor whether testing is appropriate. Vomiting blood or passing black, tar-like stools requires urgent medical assessment. This information is educational and does not replace an individual medical evaluation. Sources BMJ (October 8, 2026) — Helicobacter pylori: a global problem needing local solutions doi.org/10.1136/bmj-20… BMJ — Clinical update: Assessment and management of Helicobacter pylori infection doi.org/10.1136/bmj-20… Cochrane — Helicobacter pylori eradication for the prevention of gastric neoplasia doi.org/10.1002/146518…

Chest Pain: When Should You Worry? Chest pain is one of the most common reasons people seek medical attention. Fortunately, most chest pain is not caused by a heart problem. But some symptoms deserve particular attention. The important thing is not just how much it hurts, but when it happens, what makes it worse, and your personal risk factors. Let's break it down. 1. Chest pain during exercise This is one of the most important warning signs. If you develop chest pain while walking uphill, climbing stairs, running, or exercising, and it improves when you stop, a heart-related cause should be considered. Why? During physical activity, your heart needs more oxygen. If a coronary artery is narrowed, the blood supply may become insufficient. The pain is often described as: Pressure or tightness A heavy feeling in the chest A squeezing sensation Discomfort spreading to the arm, jaw, shoulder, or back Chest pain triggered by exercise deserves medical attention. 2. Chest pain at rest Pain occurring at rest is not necessarily reassuring. A heart attack can happen while you're sitting, relaxing, or even sleeping. Particular warning signs include: Persistent or severe chest discomfort Shortness of breath Cold sweats Nausea Dizziness or fainting However, many non-cardiac conditions can also cause chest pain at rest, including acid reflux, muscle pain, and anxiety. New, severe, or persistent chest pain may require emergency evaluation. 3. Chest pain that gets worse when you press on it This is generally more reassuring. If pressing on a specific area of your chest reproduces exactly the same pain, a muscle, rib, or chest wall problem becomes more likely. Common explanations include: Muscle strain Costochondritis (inflammation around the rib cartilage) Minor injuries Repetitive movements or physical activity But an important detail: Pain reproduced by pressing on the chest makes a cardiac cause less likely, but does not completely rule it out. 4. Chest pain when taking a deep breath This is sometimes called pleuritic chest pain. Possible causes include: Chest wall or muscle pain Respiratory infections Inflammation around the lungs But pain that suddenly worsens with breathing, especially when accompanied by sudden shortness of breath, can also suggest a pulmonary embolism or pneumothorax (collapsed lung). Sudden chest pain + sudden shortness of breath = emergency evaluation. 5. Chest Pain With Fever or After a Recent Infection Chest pain during or after an infection is fairly common. But not all chest pain following an infection means something is wrong with your heart. There are several possible explanations, ranging from simple muscle pain to less common inflammatory heart conditions. a) Chest wall pain: often caused by coughing This is one of the most common explanations. When you have a respiratory infection, repeated coughing can strain the muscles between your ribs or irritate the joints connecting your ribs to your breastbone. Typical signs include: Pain that gets worse when coughing, twisting, or moving Pain when taking a deep breath Tenderness when pressing on a specific area of the chest Discomfort that may persist even after the cough improves This is usually a musculoskeletal problem, not a heart condition. b) Pericarditis: inflammation around the heart Your heart is surrounded by a thin protective sac called the pericardium. Sometimes, particularly following a viral infection, this sac becomes inflamed. Typical symptoms include: Sharp chest pain, sometimes behind the breastbone Pain that gets worse when lying flat Pain that increases with deep breathing Pain that often improves when sitting up or leaning forward Sometimes fever Unlike ordinary muscle pain, pericarditis usually cannot be reproduced simply by pressing on the ribs. Most uncomplicated cases have a favorable outcome with appropriate treatment, but medical evaluation is necessary. c) Myocarditis: inflammation of the heart muscle Myocarditis is less common but can be more serious. It can develop during or after a viral infection, sometimes even in young, otherwise healthy people. Possible symptoms include: Chest pain that may resemble a heart attack Unusual fatigue or reduced exercise tolerance Shortness of breath Palpitations or an irregular heartbeat Sometimes dizziness or fainting Some cases are mild, but others can interfere with the heart's pumping function or cause dangerous heart rhythm disturbances. Importantly, myocarditis can occur without fever. How can doctors tell the difference? Symptoms provide clues, but they are not always enough to make a diagnosis. Depending on the situation, doctors may recommend: An ECG to assess the heart's electrical activity Blood tests, particularly troponin, to look for heart muscle injury An echocardiogram to assess heart function and look for fluid around the heart Sometimes a cardiac MRI to investigate inflammation When should you worry? Chest discomfort that clearly appears with coughing and can be reproduced by pressing on the ribs is generally more suggestive of chest wall pain. However, chest pain associated with significant breathlessness, palpitations, fainting, or unusual fatigue after an infection deserves prompt medical attention. New severe or persistent chest pain, significant breathlessness, or fainting requires emergency evaluation. The key takeaway: After a respiratory infection: Pain with coughing + tenderness to touch → Often chest wall pain. Sharp pain, worse lying flat, better leaning forward → Consider pericarditis. Chest pain + unusual breathlessness, palpitations, or reduced exercise tolerance → Consider myocarditis. And remember: Having a fever doesn't necessarily mean your heart is affected. And having no fever doesn't rule out heart inflammation. The context and associated symptoms are what matter most. 6. Chest pain that changes with position Pain that changes when you twist your torso, move your arms, or change positions often suggests a musculoskeletal origin. A burning sensation behind the breastbone after meals or when lying down may suggest acid reflux. However, inflammation around the heart (pericarditis) can also cause positional chest pain. So position alone is not enough to make a diagnosis. 7. Your cardiovascular risk factors matter The same chest pain does not carry the same probability of heart disease in everyone. Important risk factors include: Smoking High blood pressure Diabetes High cholesterol Older age Obesity Chronic kidney disease Previous cardiovascular disease The more risk factors you have, the more seriously unusual chest pain should be assessed. 8. Family history matters too A heart attack or coronary artery disease at a young age in a close relative is an important risk factor. Premature coronary disease is generally defined as occurring before: Age 55 in men Age 65 in women This is particularly relevant when it affects a parent, sibling, or child. It doesn't mean you will necessarily develop heart disease, but it is important information to share with your doctor. 9. Being young doesn't completely protect you Heart disease is less likely in a healthy young adult with no risk factors. But it is not impossible. And the opposite is also true: a 60-year-old person with diabetes, high blood pressure, and a smoking history deserves particular attention, even when the symptoms are not typical. When should you seek emergency help? Seek emergency medical help for new chest pain that is: Severe, crushing, or persistent Accompanied by significant shortness of breath Associated with cold sweats, nausea, or fainting Spreading to the arm, jaw, or back Sudden and unusually intense Occurring at rest or worsening unexpectedly Do not drive yourself to the hospital if you suspect a heart attack. Call emergency services. 10. Rare but Serious Causes of Chest Pain Most chest pain has a relatively common explanation. However, a few uncommon conditions can be life-threatening and require immediate medical attention. Here are three important ones to recognize. a) Aortic dissection: when the wall of the body's main artery tears The aorta is the largest artery in your body. It carries blood from your heart to the rest of your organs. Sometimes, part of the aorta becomes enlarged. This is called an aortic aneurysm. An aneurysm of the ascending aorta, near the heart, often causes no symptoms at all and may be discovered incidentally during an imaging examination. But if the inner layer of the aortic wall tears, blood can enter between its layers. This is called an aortic dissection. Warning signs may include: Sudden, severe chest or back pain Pain that is extremely intense from the very beginning Sometimes a tearing or ripping sensation Fainting, severe weakness, or neurological symptoms Risk is higher in people with uncontrolled high blood pressure, a known aortic aneurysm, certain inherited connective tissue disorders such as Marfan syndrome, or a family history of aortic disease. Sudden, severe, unexplained chest or back pain is a medical emergency. Not every dissection causes the classic tearing sensation. b) Pulmonary embolism: a blood clot in the lungs A blood clot, often originating in a leg vein, can travel to the lungs and obstruct a pulmonary artery. Possible symptoms include: Sudden shortness of breath Sharp chest pain, often worse when breathing deeply Rapid heartbeat Sometimes coughing up blood or fainting Risk can increase after prolonged immobilization, recent surgery, during pregnancy or postpartum, and in people with certain clotting disorders or cancer. A pulmonary embolism can be serious, even in younger people. c) Pneumothorax: a collapsed lung Sometimes, air leaks into the space surrounding a lung, causing it to partially or completely collapse. It can happen after an injury, but also spontaneously, sometimes in otherwise healthy young adults. Typical symptoms include: Sudden, sharp chest pain, often on one side Pain that worsens when breathing Shortness of breath A pneumothorax can range from relatively mild to life-threatening, depending on its size and effects on breathing and circulation. The key takeaway Sudden, severe chest or back pain → Consider an aortic emergency. Sudden chest pain + unexplained shortness of breath → Consider pulmonary embolism or pneumothorax. These conditions are uncommon, but recognizing their warning signs can save lives. If these symptoms occur, call emergency services immediately rather than driving yourself to the hospital. Remember: most chest pain is not caused by these conditions, but sudden, severe, or unusual symptoms should never be ignored. Final Takeaway Pain during exercise: Think about the heart. Pain reproduced by pressing on the chest: Often muscular or related to the ribs. Pain when breathing + sudden breathlessness: Think about the lungs. Burning pain after meals or when lying down: Acid reflux is possible. Pain after an infection + coughing + tenderness to touch: Often chest wall pain. Pain after an infection + unusual breathlessness or palpitations: Consider myocarditis. Sharp pain, worse lying flat and better leaning forward: Consider pericarditis. Sudden, severe chest or back pain: A medical emergency — rare but serious causes include aortic dissection. Cardiovascular risk factors or family history of premature heart disease, aortic disease, or sudden unexplained death: Be more cautious. And most importantly: No single symptom can reliably rule out a serious cause of chest pain. Chest pain should always be interpreted in context. Severe, sudden, persistent chest pain, or pain accompanied by significant breathlessness, fainting, or cold sweats, requires emergency medical attention. For other new, unusual, or unexplained chest pain, seeking medical advice is the safest choice. This content is for educational purposes only and does not constitute personalized medical advice, diagnosis, or treatment. It is not a substitute for consultation with a qualified healthcare professional. If you experience new or unexplained chest pain, seek medical advice. In case of severe symptoms or a suspected medical emergency, contact emergency services immediately.

Varicose veins: what can actually be done? Varicose veins are enlarged, twisted veins, usually in the legs. They happen when the small valves inside the veins stop working properly. Normally, these valves help blood move back toward the heart. When they become weak, blood can flow backward and pool inside the vein. This can lead to: • visible bulging veins • heavy or tired legs • aching or burning • swelling around the ankles • itching • cramps • skin changes in more advanced cases So how are varicose veins treated? 1. Lifestyle measures Walking and regular exercise help the calf muscles push blood back toward the heart. Avoiding long periods of standing still, elevating the legs, and losing weight when needed can also reduce symptoms. 2. Compression stockings They squeeze the legs and improve venous return. They can reduce swelling, heaviness and discomfort. But they do not remove the varicose vein or fix the underlying faulty valve. 3. Sclerotherapy A medication is injected directly into the vein. It irritates the vein wall, causing the vein to close. The body then gradually absorbs it. It is especially useful for smaller veins and spider veins, although foam sclerotherapy can also treat larger veins. 4. Laser or radiofrequency treatment For larger veins with significant reflux, a thin catheter can be placed inside the vein. Heat from a laser or radiofrequency device closes the vein from the inside. Blood simply redirects through healthy veins. Today, this is one of the main treatments for significant saphenous vein reflux. 5. Phlebectomy Large visible varicose branches can sometimes be removed through tiny skin openings under local anaesthesia. 6. Surgery Traditional vein stripping is still possible, but it is used much less often than in the past because minimally invasive techniques have largely replaced it. How do doctors decide which treatment is best? Usually with a venous Doppler ultrasound. It shows which vein is leaking and where the abnormal backward blood flow is coming from. That matters because treating only the visible vein without treating the underlying source of reflux may increase the chance of recurrence. Most varicose veins are not dangerous. But seek medical advice if you develop: • persistent swelling • skin discoloration or eczema • a leg ulcer • repeated superficial thrombosis • bleeding from a varicose vein • sudden pain and swelling in one leg And one question I get asked very often: do varicose veins increase the risk of a blood clot? Yes, slightly. Varicose veins are associated with a higher risk of superficial vein thrombosis and, to a lesser extent, deep vein thrombosis (DVT). But having varicose veins does not mean you are likely to develop a DVT. The risk becomes more relevant when other factors are present too, such as prolonged immobility, recent surgery, cancer, pregnancy, obesity, previous thrombosis, or certain hormonal treatments. If one leg suddenly becomes painful, swollen, red, or noticeably larger than the other, it deserves prompt medical assessment. The key message: Varicose veins are not just a cosmetic problem. When they cause symptoms, modern treatments can often treat the underlying faulty vein through a small, minimally invasive procedure.

Creatine without exercise: can it actually increase muscle mass? Following our previous post on creatine and cognition, a new randomized study found something interesting. Adults aged 45–65 took 10 g of creatine per day for 12 weeks. Even without an exercise program, the creatine group gained around 1 kg of lean mass and showed improvements in strength and muscular endurance. But an important nuance: Lean mass ≠ necessarily 1 kg of new muscle. Creatine pulls water into muscle cells, so part of the increase may simply reflect greater intracellular water rather than true muscle growth. Still, the strength improvements suggest the effect may not be only water. So the current picture is: Creatine alone → may modestly increase lean mass and muscle performance. Creatine + resistance training → much stronger evidence for real muscle gain. And don’t forget: creatine is a supplement, not a substitute for exercise. But it may be doing a little more than we previously thought. Study: doi.org/10.1080/155027… Medicine, Explained.

Obesity medications: what do we really know about their potential side effects? In my daily practice, both in the clinic and in the hospital, more and more patients are asking me about GLP-1-based treatments for weight loss. Where I practice, in Europe, this is still a relatively new conversation. Just a few months ago, hardly anyone brought it up. Today, the subject comes up regularly. And one question almost always follows: “What are the risks?” To answer that, we need to distinguish well-established side effects, rare complications, and signals that still need confirmation. This overview mainly covers GLP-1 receptor agonists, such as semaglutide, as well as tirzepatide, which acts on two receptors: GLP-1 and GIP. Not all obesity medications have the same safety profile. 1. Digestive side effects: the most common Nausea, diarrhea, vomiting, constipation, abdominal pain, and reflux are the most common side effects. For example, in adult trials of injectable semaglutide at 2.4 mg, approximately 44% of participants reported nausea, 30% diarrhea, 24% vomiting, and 24% constipation. These figures describe events reported during the studies—not persistent symptoms in every affected patient. They also cannot be used to directly compare medications evaluated in different trials. Symptoms are often more noticeable when treatment starts or the dose increases. They may improve over time, but they are not always minor. In SELECT, adverse events led to permanent treatment discontinuation in 16.6% of participants receiving semaglutide, versus 8.2% receiving placebo. Digestive problems accounted for much of that difference. These results apply to a population with established cardiovascular disease followed over several years. 2. The gallbladder: a real risk Gallstones and gallbladder inflammation can occur. Substantial or rapid weight loss itself increases the risk of gallstones. However, that does not necessarily mean the medication plays no role: the official semaglutide prescribing information states that weight loss alone does not explain the entire increase observed. Persistent pain in the upper-right abdomen, particularly with fever or jaundice, warrants medical assessment. 3. Pancreatitis: rare, but potentially serious Acute pancreatitis is inflammation of the pancreas. Trials have not consistently shown a clear increase in risk, but this complication remains a recognized warning for these treatments. In January 2026, the UK medicines regulator strengthened its warnings, including those concerning necrotizing pancreatitis and fatal cases. Severe, persistent abdominal pain, sometimes radiating to the back, with or without vomiting, requires urgent medical assessment. Treatment should be stopped if pancreatitis is suspected and should not be restarted if it is confirmed. 4. Slower stomach emptying and precautions before anesthesia These treatments slow gastric emptying. For some patients, this can mean prolonged fullness, significant nausea, or vomiting. They are not recommended in people with severe gastroparesis. Intestinal obstruction has also been reported after these medications reached the market. Such reports alone cannot establish its precise frequency or prove that the medication caused each case. Delayed gastric emptying also matters before general anesthesia or deep sedation: stomach contents may remain despite fasting, creating a risk of aspiration into the lungs. Patients should therefore inform the anesthesia team about their treatment. The plan should be individualized—not decided alone. 5. The kidneys: watch for dehydration Significant vomiting or diarrhea can cause dehydration, which can then lead to acute kidney injury. This does not necessarily mean the medication is directly toxic to the kidneys. But an indirect complication can still be treatment-related. An inability to drink, markedly reduced urination, or significant dizziness should prompt medical attention, especially in vulnerable patients or those with existing kidney disease. 6. The eyes: two different situations Diabetic retinopathy should not be confused with non-arteritic anterior ischemic optic neuropathy, known as NAION. In some people with diabetes and existing retinopathy, a rapid improvement in blood glucose can be accompanied by an initial worsening of the eye disease. Appropriate monitoring is important. NAION affects the optic nerve. In June 2025, the European Medicines Agency recognized it as a very rare side effect of semaglutide, potentially affecting up to one person in 10,000. Any sudden loss of vision requires urgent assessment. If NAION is confirmed, semaglutide should be stopped. This signal should not automatically be extended to every obesity medication. 7. Lean mass loss: it is not all muscle When someone loses a substantial amount of weight, they do not lose only fat. In a SURMOUNT-1 substudy, approximately 75% of the weight lost with tirzepatide was fat mass and 25% was lean mass. The proportions were similar in the placebo group, despite less overall weight loss. This therefore does not demonstrate that the medication preferentially destroys muscle. Importantly, lean mass and muscle mass are not interchangeable: lean mass also includes water, organs, and other tissues. The clinical question remains important: does the patient maintain strength, mobility, and independence? Experimental approaches aim to better preserve muscle. In COURAGE, adding trevogrumab to semaglutide reduced the loss of thigh muscle volume measured by MRI at 52 weeks by approximately 70%, in the evaluated subgroup. That does not mean 70% of all lean mass loss was prevented, or that an equivalent improvement in physical function has been demonstrated. This approach remains experimental. 8. Certain neuropathies: a signal to interpret cautiously Common fibular nerve injuries, which can cause difficulty lifting the foot, have been described in people receiving GLP-1 treatments. An observational study found an association. However, it does not prove that the medication directly damages the nerve. Substantial weight loss could contribute, including by reducing the tissue cushioning certain nerves. Several mechanisms remain possible. New weakness, a foot that catches when walking, or persistent sensory changes should not be dismissed. 9. Hair loss Hair loss is among the adverse effects reported in trials of these treatments. It may occur in the context of substantial weight loss and changes in nutritional intake. This does not establish direct toxicity to hair follicles in every case. Persistent hair loss deserves assessment rather than being automatically attributed to the medication. 10. Thyroid cancer: distinguish animal findings from human evidence The US warning about thyroid C-cell tumors is based in part on findings in rodents. Their relevance to humans remains uncertain. A large Scandinavian study did not find a substantial increase in overall thyroid cancer risk over an average follow-up of approximately four years. However, this cannot definitively exclude a very rare risk or one emerging after longer exposure. In the United States, semaglutide and tirzepatide are contraindicated in people with a personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia type 2. This is not a general contraindication for every thyroid condition. Regulatory wording differs between countries. 11. Mood, suicidal thoughts, and the relationship with food Available evaluations have not identified an increased risk of suicidal thoughts or behavior with GLP-1 receptor agonists. In January 2026, the FDA requested the removal of this warning from the relevant medications after an assessment that included 91 randomized trials and more than 107,000 participants. But we also need to listen to each patient’s experience. One patient told me that eating was one of his main daily pleasures. As his appetite decreased, that pleasure diminished, and he felt it was affecting his mood. This account does not demonstrate that the treatment causes depression. It simply reminds us that our relationship with food is also emotional and social. Successful weight loss on the scale does not capture the whole patient experience. 12. Hypoglycemia, pregnancy, and contraception The risk of hypoglycemia increases particularly when these treatments are combined with insulin or certain diabetes medications, notably sulfonylureas. The accompanying treatment may need adjustment. These medications should not be used for weight loss during pregnancy. Pregnancy planning should be discussed with the prescriber: European product information recommends stopping semaglutide at least two months beforehand and tirzepatide at least one month beforehand. For tirzepatide, the US prescribing information recommends switching to non-oral contraception or adding a barrier method for four weeks after starting treatment and for four weeks after each dose increase. Regulatory recommendations are not identical everywhere: patients should follow local guidance and discuss this with their prescriber. 13. Could new side effects still be discovered? Yes, that is possible. It does not mean a hidden complication is necessarily waiting to emerge. For some molecules, we already have several years of follow-up. In the 176-week SURMOUNT-1 follow-up among participants with obesity and prediabetes, no new safety signals were identified with tirzepatide. That is reassuring, but it applies to a specific population and duration. Very rare events, populations underrepresented in trials, and much longer exposure require continued monitoring. Each new molecule or combination also needs its own evaluation: we cannot automatically assign it the safety profile of an established treatment. The takeaway These treatments can provide important benefits. They are neither risk-free nor inherently dangerous. An event occurring during treatment is not automatically caused by it. Conversely, a complication resulting from dehydration or weight loss can still be treatment-related, even when the mechanism is indirect. The right question is therefore not only: “How much weight can someone lose?” But also: “With what tolerability, what quality of life, and what preservation of strength and independence?” The goal is not simply to lower a number on the scale. It is to improve the patient’s health over the long term. This content is for educational purposes and does not replace an individual medical assessment.

Magnesium and ADHD: is there really a link? A meta-analysis published in Psychiatry Research looked at a simple question: do people with ADHD have lower magnesium levels than people without ADHD? Researchers pooled 7 observational studies comparing blood magnesium levels in people with ADHD and healthy controls. The result: magnesium levels were, on average, lower in the ADHD group, by about 0.105 mmol/L. So does low magnesium cause ADHD? We don’t know. These studies show an association, not cause and effect. It could mean magnesium plays some role in brain mechanisms involved in ADHD. But it could also reflect differences in diet, lifestyle, or other factors. And most importantly: This does not mean magnesium supplements treat ADHD. A few small supplementation studies have shown interesting signals, but the evidence is still too limited to recommend magnesium as a routine treatment for ADHD. The key takeaway: - ADHD ↔ lower magnesium levels: interesting signal. - Low magnesium = cause of ADHD: not proven. - Magnesium = treatment for ADHD: not proven either. If magnesium deficiency is suspected or documented, correcting it makes sense — although serum magnesium is an imperfect marker of the body’s total magnesium store Study: pubmed.ncbi.nlm.nih.gov/30807974/

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Vital Viz @VitalViz

a month ago

How the Kidneys Clean Your Blood ?

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DOES CREATINE SLOW DOWN ALZHEIMER’S DISEASE? Maybe. But we are nowhere near proving it yet. In 2025, researchers gave 20 people with Alzheimer’s disease 20 g/day of creatine for 8 weeks. Brain creatine increased by about 11%. Several cognitive scores also improved, including global cognition, working memory and attention/inhibitory control. That sounds impressive. But there is one major limitation: There was no placebo group. This was a small, open-label pilot study. So we cannot say that creatine caused the cognitive improvement. And we definitely cannot say that it “slowed cognitive decline by 30%.” There was no control group and no measurement showing a 30% reduction in disease progression. A follow-up analysis published in 2026 added another interesting signal. ATP and ADP increased in blood lymphocytes, and several measures of mitochondrial respiration improved in women. But these were blood cells, not the brain. Brain markers including NAA and glutathione did not significantly change. And as of 2026, there are still no randomized controlled trials testing creatine in people with dementia. So where are we? Creatine reaches the brain: yes. Interesting biological signal: yes. Possible cognitive benefit: worth investigating. Creatine slows Alzheimer’s progression: not demonstrated. Creatine is a treatment or prevention for Alzheimer’s: far too early to say. Promising pilot study ≠ proven treatment. Study: doi.org/10.1002/trc2.7… Medicine, Explained.

VITAMIN D: ARE WE UNDERESTIMATING WHAT IT CAN DO? Most people think of vitamin D as something we need for strong bones. But vitamin D receptors are found throughout the body — including in many immune cells. And low vitamin D levels have been associated with a surprisingly large number of diseases. But remember: association does not necessarily mean causation. So what benefits are actually supported by evidence? 1. Bones and muscles Vitamin D helps us absorb calcium. Severe deficiency can cause rickets, osteomalacia, muscle weakness and bone fragility. Correcting a true deficiency is clearly beneficial. But high-dose vitamin D does not appear to prevent fractures in people who are already sufficient. 2. Pregnancy Trials suggest supplementation may modestly reduce risks such as: – pre-eclampsia – preterm birth – small-for-gestational-age babies – neonatal mortality This is one reason pregnancy is considered a group that may benefit from supplementation. 3. Prediabetes In people with high-risk prediabetes, vitamin D may slightly reduce progression to type 2 diabetes. The effect is modest — and it does not replace exercise, nutrition or weight loss. 4. People over 75 Trials suggest a very small reduction in overall mortality. The effect is small, but consistent enough for the Endocrine Society to suggest supplementation in this age group. 5. Autoimmune diseases This is one of the most interesting areas. In the large VITAL trial, 2,000 IU/day was associated with fewer newly diagnosed autoimmune diseases during supplementation. Interesting? Yes. Proof everyone should take vitamin D to prevent autoimmunity? Not yet. 6. Multiple sclerosis Low vitamin D has long been associated with a higher risk of MS. In 2025, a randomized French trial went further: In very early MS, high-dose vitamin D reduced overall disease activity, mainly new MRI lesions. This does not mean vitamin D replaces disease-modifying treatments. But MS is probably one of the most interesting examples of a possible benefit beyond bone health. 7. Depression? Maybe. People with depression often have lower vitamin D levels. Some meta-analyses suggest a small improvement in symptoms, especially in people who are already depressed. But other analyses become negative when weaker studies are removed. Correcting a deficiency? Reasonable. Calling vitamin D an antidepressant? No. 8. Fertility? Caution again. Women with low vitamin D often have poorer outcomes during assisted reproduction. But that does not prove causation. A large 2026 trial in women with PCOS undergoing IVF showed something very instructive: Vitamin D corrected the deficiency… but did not increase live births. A perfect example of the difference between: a marker associated with disease and a treatment that changes the outcome. So what is the “right” vitamin D level? A level around 30 ng/mL (75 nmol/L) is generally considered adequate. But we still do not know the optimal level for many possible extra-bone benefits. And there is no strong evidence that pushing everyone from 30 to 40–50 ng/mL provides additional protection. Many large trials also included people who were already vitamin D sufficient — which may partly explain why supplementation often showed little benefit. The bottom line: Vitamin D is essential. Deficiency can have real consequences. Correcting it may improve specific outcomes in certain situations. But once your needs are covered, more is not necessarily better.

ERECTILE DYSFUNCTION IN YOUNG MEN Contrary to what many people think, this is actually a fairly common reason for consultation. And in a man in his 20s or 30s, erectile dysfunction does not necessarily mean there is something physically wrong with the penis. An erection is actually a fairly complex process. The brain has to generate sexual arousal. The nerves have to transmit the signal. The blood vessels have to open. And blood then has to remain trapped inside the penis. Stress can interfere with almost every step. One of the first useful questions is therefore: Does it happen all the time? If erections are normal in the morning or during masturbation, but become difficult with a partner, a psychological component — especially performance anxiety — becomes much more likely. And a vicious cycle can quickly develop: one episode of difficulty → fear that it will happen again → stress and adrenaline → even more difficulty getting or maintaining an erection. But saying “he is young, so it must be psychological” is too simplistic. Other possible causes include: • stress, anxiety or depression • relationship difficulties • certain medications, particularly some antidepressants • alcohol or recreational drugs • nicotine • diabetes • high blood pressure or high cholesterol • hormonal problems, including low testosterone • more rarely, neurological or penile disorders. That is why persistent erectile dysfunction deserves a medical assessment — even at 20. The initial evaluation is usually quite simple: understand when the problem occurs, ask about morning erections, assess libido, review medications and substances, perform a clinical examination and, when appropriate, check blood glucose, cholesterol and morning testosterone. And treatment is not necessarily just “take Viagra.” Sometimes understanding what is happening and being reassured already helps a lot. Psychological or sex therapy can help break the performance-anxiety cycle. Any underlying medical or lifestyle factors should also be addressed. And medications such as sildenafil can be very effective — sometimes only temporarily, to help restore confidence while the underlying cause is being addressed. Most importantly: do not hesitate to talk to a doctor about it. Erectile dysfunction is common, including in younger men, and in many cases it can be significantly improved or treated. It is not something you should simply accept and allow to affect your relationships, confidence or quality of life for years. Erectile dysfunction is a symptom. The important part is understanding why it is happening.

COMMON REASON FOR VISIT #3 — SHOULDER PAIN After low back pain and kidney stones, another very common reason to see a GP: a painful shoulder. The shoulder is one of the most mobile joints in the body. Every time you lift your arm, reach overhead, get dressed, carry something or put your hand behind your back, several muscles and tendons have to work together. So what usually hurts? Rotator cuff tendinopathy The rotator cuff is a group of tendons that stabilizes the shoulder and helps move the arm. With repeated movements, overhead work, sport, housework or simply age-related changes, these tendons can become painful. Typical clue: pain when lifting the arm, often worse at night. “Tendinopathy” does not necessarily mean the tendon is torn. Bursitis The bursa is a small fluid-filled sac that helps the tendons glide smoothly. It can become irritated and painful. Bursitis and rotator cuff tendinopathy often occur together, which is why the symptoms can look very similar. Frozen shoulder This is different. The shoulder becomes painful AND progressively stiff. The key point: movement is limited even when someone else tries to move your arm for you. It can develop without any obvious cause and is more common in people with diabetes. Recovery can take months. Rotator cuff tear A tendon can partially or completely tear, either gradually over time or after a fall or sudden effort. A major loss of strength, especially after trauma, should raise suspicion. How do we tell them apart? • Tendinopathy / bursitis → pain mainly with movement • Frozen shoulder → pain + true

Could epilepsy beginning later in life sometimes reveal early Alzheimer-type changes? A new study explored this possible connection. When epilepsy begins after age 55, doctors usually look for a cause such as a stroke, tumour or previous brain injury. But sometimes the MRI shows no clear explanation. This is called late-onset unexplained epilepsy. Researchers studied 85 people with this condition. They measured: • memory and cognitive performance • brain activity during 24 hours, including sleep • p-tau217 in the blood p-tau217 is a blood marker associated with the brain changes seen in Alzheimer’s disease. An elevated level does not diagnose Alzheimer’s on its own. The researchers also examined what happened during sleep. During deep sleep, the brain produces slow waves and short bursts of activity called sleep spindles. These rhythms need to coordinate properly to help the brain store new memories. People with higher p-tau217 levels had: • poorer cognitive performance • less coordination between these sleep rhythms The link with cognitive difficulties was strongest in people whose seizures remained uncontrolled despite medication. This suggests that, in some people, late-onset epilepsy, disrupted sleep and memory difficulties may be connected to the same underlying neurodegenerative process. But the study does not prove that epilepsy causes Alzheimer’s disease, or that a seizure after age 55 means someone has Alzheimer’s. It also does not prove that better sleep can prevent the disease. What we do know is that sleep is essential for memory and brain health, while chronic sleep disruption is associated with a higher risk of cognitive decline. This was a small observational study involving only 85 people. More research is needed to understand which condition comes first and whether treating sleep problems could change the outcome. The takeaway: When epilepsy begins later in life without a clear cause, memory and sleep may deserve closer attention. Study: neurology.org/doi/10.1212/WN…

Kidney stones — when “back pain” is not really back pain For this second episode of our series on common reasons people see a doctor, we stay close to back pain — but from a different angle. In episode 1, we talked about low back pain. But pain felt in the back or side does not always come from the spine. Doctors call this a differential diagnosis: the same symptom can have several possible causes. One classic example is a kidney stone. A kidney stone is a small hard deposit that forms when substances normally dissolved in urine crystallize and stick together. A stone can sit silently inside the kidney. Pain usually starts when it moves into the ureter — the narrow tube connecting the kidney to the bladder — and interferes with urine flow. This can cause the intense, wave-like pain known as renal colic, often felt in the side or back and sometimes radiating toward the groin. Step 1 — Confirm the diagnosis Symptoms can strongly suggest a kidney stone, but imaging helps confirm it and answer three important questions: Where is the stone? How big is it? Is it blocking urine flow? Ultrasound uses sound waves and involves no radiation. It can detect many kidney stones and show whether the kidney is becoming obstructed. A CT scan — often called a uroscanner — gives a more detailed view and can precisely show the stone’s size, location and degree of obstruction. Step 2 — Choose the treatment Treatment mainly depends on the stone’s size, location and whether it is causing complications. Observation + pain relief → many small stones pass naturally SWL — shock-wave lithotripsy → shock waves break the stone from outside the body Laser ureteroscopy → a thin scope travels through the natural urinary tract and the stone is fragmented with a laser PCNL — percutaneous nephrolithotomy → used mainly for large kidney stones, through a small tract created in the back Surgery → now rare and reserved for special situations In practice Small uncomplicated stone → often wait for it to pass Stone requiring active treatment → SWL or laser ureteroscopy Large kidney stone → often PCNL And one important exception: A blocked kidney + infection or fever is an emergency. The goal is then to drain the kidney and treat the infection before dealing with the stone itself.

Can gum disease affect your brain? A bacterium commonly found in gum disease — Porphyromonas gingivalis — has been linked to Alzheimer’s disease. But what does that actually mean? When you have periodontitis, your gums stay chronically inflamed. Bacteria and bacterial products can sometimes enter the bloodstream, potentially increasing inflammation throughout the body. Researchers have also found signs of P. gingivalis and some of its toxins in the brains of people with Alzheimer’s. So one hypothesis is: gum disease → chronic inflammation → possible effects on the brain over many years Sounds convincing? Not quite yet. People with periodontitis do appear to have a higher risk of cognitive decline and dementia. But that does not prove that gum disease causes Alzheimer’s. Age, diabetes, smoking and many other factors can influence both. And the relationship could partly work the other way too: someone developing cognitive problems may simply take less care of their teeth. So today, the best conclusion is: There is an association. There is a plausible biological mechanism. But causation is not proven. Taking care of your gums is important for your health. Just don’t believe headlines saying that brushing your teeth will “prevent Alzheimer’s.” Medicine, Explained. Source: Association Between Porphyromonas gingivalis and Alzheimer’s Disease: A Comprehensive Review — 2025 Read the full article DOI: 10.2147/IDR.S491628

Welcome to the first post in our new series: the most common reasons people visit their doctor. We’re starting with low back pain. Low back pain is one of the most common reasons people see a doctor. But why does the lower back hurt so easily? Our lumbar spine is made of 5 vertebrae stacked on top of each other. Between them are intervertebral discs: flexible cushions that help distribute loads and allow the spine to move. Around them are muscles, ligaments and small joints called facet joints. So your back is not a rigid column. It is a strong, mobile structure designed to bend, rotate and carry weight. So why can everyday movements hurt? When you bend forward, lift something, twist, sit for a long time or arch your back, the forces acting on the spine change. Some structures are compressed. Others are stretched. Muscles work harder to stabilize the area. Most of the time, this is completely normal. Pain does not necessarily mean that something has been damaged. Sometimes muscles become irritated or tense. Sometimes the small joints at the back of the spine become sensitive. Sometimes a disc becomes painful. And occasionally, a nerve can become irritated. What happens when you arch your back? When you extend your lumbar spine, the facet joints at the back of the vertebrae move closer together. In some people, especially if those joints are already sensitive, this can trigger pain. But again: extension itself is not a “bad” movement. The spine is made to move. And what about a “slipped vertebra”? A vertebra can sometimes move slightly forward relative to the one below it. This is called spondylolisthesis. It can increase local mechanical stress and sometimes cause back pain or nerve symptoms. But many people have spondylolisthesis on an X-ray or MRI and feel absolutely nothing. That is an important point: An abnormal scan does not automatically explain your pain. The same is true for disc degeneration. Discs naturally change with age, just like skin develops wrinkles. These changes are extremely common — including in people with no back pain at all. So the goal is not to protect your back from every movement. It is to keep it moving. Learn to use your whole body during everyday tasks. For activities that keep you bent forward for a long time — such as bathing a baby, making a bed, picking things up from the floor or gardening — try not to stay folded over at the waist. Bend your knees and hips, bring yourself closer to what you are doing, and change position regularly. The goal is not to avoid bending altogether. It is to avoid repeatedly loading your lower back in the same position when another movement strategy is available. Stay active. Change positions regularly. Lift progressively. Strengthen your muscles. And gradually return to normal activity. For most episodes of common low back pain, movement is part of the solution — not the problem.

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A new Nature Medicine paper does not say “a virus causes MS.” It says something more precise. People who already have relapsing MS gave blood over time. Up to 3 months before a flare, two things show up: • B cells (where Epstein-Barr virus hides) look reactivated • monocytes look primed, mostly via interferon EBV is the mono virus. Almost everyone with MS has had it. That part was already known. What’s new: a viral-looking immune signature in blood often precedes the attack — it does not prove the virus started the disease, and it is not a clinic test yet. Paper: nature.com/articles/s4159…