- Menstrual symptoms linked to nearly 9 days of lost productivity through presenteeism every year | BMJ
- Secrets of Longevity The IKARIA Study
- Uric Acid, IQ, Productivity & Lifespan: Is There a Link?
- Longevity & Brain Health
- When to See a Doctor
- Diet & Lifestyle
- Learn More
- Other Benefits of Uric Acid
- How to Increase Uric Acid
- Inosine Effects
- Further reading
Menstrual symptoms linked to nearly 9 days of lost productivity through presenteeism every year | BMJ
But real impact on women and society is underestimated and poorly appreciated, say researchers
Menstrual period symptoms may be linked to nearly nine days of lost productivity every year through presenteeism, suggests the largest study of its kind, published in the online journal BMJ Open.
But the real impact on women and society is underestimated and poorly appreciated, say the researchers.
They set out to evaluate lost productivity associated with menstrual symptoms, as measured by time off from work or school (absenteeism) and working or studying while feeling ill (presenteeism) in 32,748 Dutch women between the ages of 15 and 45.
All the participants were recruited through social media from July to the end of October 2017.
They filled in a comprehensive online questionnaire about the frequency and length of their menstrual cycle and the severity of any associated symptoms, measured using a validated pain score (visual analogue scale or VAS for short).
They were asked if their symptoms had prompted them to take time off from work or school and/or had affected their productivity while working or studying, as well as how often this had happened.
Their blood loss lasted an average of 5 days. Menstrual symptoms prompted nearly a third (31%) of the women to visit their family doctor, and around one in seven (14.4%) to see a gynaecologist.
In all, around one in seven respondents (just under 14%, 4514) said they had taken time off from work or school during their period, with nearly 3.5% (1108) saying this happened during every, or nearly every, menstrual cycle.
The average amount of sickness leave taken came to just over one day a year.
Younger women under the age of 21 were around three times more ly to say they had taken time off because of their menstrual symptoms than were older women.
Most (just under 81%; 26,438) respondents reported presenteeism, and said that they were less productive as a result of their symptoms. In all, productivity was below par on more than 23 days the working/study year, with lost productivity amounting to almost 9 days each year.
The researchers calculated that, on average, each woman was less productive for a third of the time (33%), because of menstrual symptoms.
Notably, when women called in sick because of menstrual symptoms, only one in five (20%; 908) told their employer or school the real reason for their absence. And around two thirds (just under 68%; 22,154) of respondents said they wished they had the option of more flexible work/study hours during their period.
This is an observational study, and as such can’t establish cause. The method of recruitment may also have introduced an element of ‘selection bias’ whereby those with debilitating symptoms might have been more ly to take part; the analysis also relied on what women said rather than objective assessment.
But the researchers nevertheless conclude: “Menstruation-related symptoms cause a great deal of lost productivity, and presenteeism is a bigger contributor to this than absenteeism.
“Taking all the symptoms into account, it seems ly that the real impact of [menstruation related symptoms] is underestimated in the general population.” But it’s not openly talked about, they add. “Despite being almost two decades into the 21st century, discussions about [symptoms] may still be rather taboo.” [Ends]
Notes for editors
Secrets of Longevity The IKARIA Study
Summary: The intriguing finding of longevity among the Ikaria inhabitants was the impetus to perform an epidemiological study. Motivated by the IKARIA study, proposed measures of approaching the goal of longevity through delay of cardiovascular ageing will be discussed in this article.
From the ancient years up until the contemporary societies, the achievement of a long and healthy life has always been the first priority of the human kind. In the last years, there have been important announcements about the longevity records around the world.
The so-called ‘Blue Zones’ are the five places in the world with the highest percentage of octogenarians. Among them, Sardinia, Okinawa in Japan, Loma Linda in California, Costa Rica and the Greek island, Ikaria share the precious gift of longevity.
The intriguing finding of longevity among the Ikaria inhabitants was the impetus to perform an epidemiological study in the island, aiming at investigating the genetic, phenotypic and environmental characteristics that may have contributed to the high longevity rate.
Motivated by the IKARIA study, proposed measures of approaching the goal of longevity through delay of cardiovascular ageing will be discussed in this article.
The beneficial effect of the Mediterranean diet on cardiovascular and holistic health has been highlighted by several studies in the past. In the IKARIA study, in a sample of elderly subjects above 80 years, a significant adoption to the Mediterranean diet was observed (Panagiotakos et al. 2011).
Indeed, the dietary habits of the octogenarians included an increased consumption of olive oil (5-7 times/week), fruits (4-5 times/week) and vegetables (4-5 times/week), moderate consumption of fish (2 times/week) and mild consumption of red meat (1-2 times/week).
Moreover, the Mediterranean diet was associated with low levels of uric acid, while the fish consumption was favourable for the kidney function (Chrysohoou et al 2011; Chrysohoou et al. 2013).
Fish are enriched in polyunsaturated fatty acids, which exert antioxidant and anti-inflammatory properties that may explain, at least in part, the beneficial effects of fish consumption on cardiovascular and renal health.
To strengthen the above, a recent study showed that moderate fish consumption, one or more times per week, is associated with lower cardiovascular mortality compared to the rare consumption, less than once in a month (Owen et al 2016).
The dietary habits of Ikaria inhabitants also included a moderate consumption of wine and coffee.
The main constituents of wine are polyphenols; interestingly, the predominant polyphenol, resveratrol, is associated with longevity through the activation of AMPK and sirtuins.
Furthermore, resveratrol is a powerful antioxidant and an inducer of endothelium-dependent vasodilatation via increased NO synthase. It also improves mitochondrial function and reduces cardiac fibrosis, thereby favouring cardiac function.
Similar to the beneficial effects of wine, coffee is also favourable for cardiovascular health. In the IKARIA study, coffee consumption was associated, in a dose-dependent manner, with improved endothelial function, as this was assessed by flow mediated dilation (FMD).
Moreover, those who consumed Greek coffee had significantly increased FMD compared to consumers of other types of coffee (Siasos et al. 2013).
Polyphenols that enrich coffee, such as chlorogenic acid and its metabolites (caffeic and ferulic acid) may improve vascular function by decreasing the ROS production, increasing the NO bioavailability and exerting an antiplatelet effect.
Most importantly, coffee consumption is related to reduction of all-cause mortality (Gunter et al 2017). To conclude, Mediterranean diet, in which coffee consumption should be included, is beneficial for cardiovascular and total health, thus promoting longevity.
Apart from the beneficial effects of the Mediterranean diet on health and longevity, exercise is also pivotal for increased lifespan. The elderly Ikaria inhabitants reported moderate physical activity, a feature that was common among inhabitants from the blue zone of Sardinia.
Moreover, in IKARIA study, the endothelial function, assessed by FMD, was significantly improved in middle-aged subjects who reported regular exercise, compared to those who did not exercise, whereas FMD in middle-aged, physically inactive, inhabitants did not differ compared to the elderly subjects who exercised, a finding suggesting that exercise may ameliorate the adverse effects of ageing on endothelial function (Siasos et al. 2013).
Exercise exerts beneficial effects on several ageing-related diseases, such as diabetes mellitus and arterial hypertension while its contribution to the reduction of cardiovascular and total mortality is of paramount importance. Long before the current scientific evidence, the greatest Ancient Greek physician and father of clinical medicine, Hippocrates (460-377 B.
C), had underlined, for the first time, the favourable effects of exercise by writing: “If all organs of the body function properly, at a moderate fashion, and if they exercise, they will remain healthy, they will grow-up normally and they will age slowly.
On the contrary, if they remain inactive, then they become vulnerable to diseases, they do not grow up normally and they age faster.”
Data from the IKARIA study demonstrated a potential beneficial role of partnership and marriage to the long living of Ikaria inhabitants. Among the elderly subjects, the marital status exceeded 85% in men and 80% in women (Panagiotakos et al. 2011).
Recent and previous studies have established a favourable effect of a happy marriage on the reduction of cardiovascular mortality. It is of note that marital status has shown to be a more powerful determinant of low mortality compared to financial status.
In line with the above, in the IKARIA study, the majority of the octogenarians reported low income. Hence, a happy marriage might serve as a firm substrate for longevity.
Regarding evidence from the IKARIA study, low levels of psychological stress and depression were common among elderly inhabitants, a finding that might explain part of their longevity (Panagiotakos et al. 2011).
Indeed, in a meta-analysis investigating the role of psychological stress on mortality, a dose-dependent relationship was established between stress and cardiovascular and all-cause mortality (Russ et al. 2012). Contrary to psychological stress and depression, positive feelings contribute to the reduction of mortality.
A large, longitudinal study demonstrated a significant reduction of 17-25% in all-cause mortality among participants who reported high enjoyment of life compared to the non high enjoyment group (Zaninotto et al. 2016).
Aorta is the largest, elastic-type artery of the human body that, due to its elastic properties, ensures the laminar blood flow into the peripheral organs, thus preserving the integrity of microcirculation.
As age progresses, changes in structure and function of the aorta are evident concerning, predominantly, the alterations in the two main constituents of the media, collagen and elastin.
Indeed, ageing is related to degradation of elastic fibres and recruitment of the stiffer collagen fibres. Age and arterial blood pressure are the most significant determinants of aortic stiffness.
The importance of aortic stiffness lies in its prognostic value given that aortic stiffness is an independent risk factor of cardiovascular events, cardiovascular and all-cause mortality (Vlachopoulos et al. 2010).
Interestingly, the effect of age on aortic stiffness was blunted among Ikaria inhabitants.
Indeed, after the age of 50 years, pulse wave velocity, a direct marker of aortic stiffness, was significantly lower in Ikaria inhabitants, compared to the reference population, a finding that may imply lower vascular age with important clinical implications for cardiovascular health and longevity (Pietri et al. 2015).
The first report on longevity comes from a Bishop, almost 400 years before the identification of the ‘Blue Zones’ (Pietri et al. 2017).
Joseph Georgirenes, Arch-Bishop of Ikaria-Samos, in a book published in 1677, described, for the first time, the unique phenomenon of longevity in Ikaria island highlighting the role of favourable environmental conditions, Mediterranean diet, exercise and positive feelings: “The most commendable thing of this island is the air and water, both so healthful that the people are very long lived, it being an ordinary thing to see persons 100 years of age, which is a great wonder, considering how difficult lives they live.”
Long before the identification of the ‘Blue Zones’ and the contemporary epidemiological studies, Joseph Georgirenes describes factors that favour cardiovascular health and may also promote longevity, such as diet, exercise, environmental conditions, a favourable genetic background and a healthy psychological status.
- The ‘Blue Zones’ are the five places in the world with the highest percentage of octogenarians.
- Mediterranean diet is beneficial for cardiovascular and total health, and promotes longevity.
- Exercise exerts beneficial effects on several ageing-related diseases, such as diabetes mellitus and arterial hypertension and contributes to the reduction of cardiovascular and total mortality.
- A happy marriage might serve as a firm substrate for longevity.
- Factors that favour cardiovascular health and promote longevity include diet, exercise, environmental conditions, a favourable genetic background and a healthy psychological status.
Chrysohoou C, Skoumas J, Pitsavos C et al. (2011) Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: the Ikaria study. Maturitas,70:58-64.
Chrysohoou C, Pitsavos C, Panagiotakos D et al. (2013) Long-term fish intake preserves kidney function in elderly individuals: the Ikaria Study. J Ren Nutr, 23:e75-82.
Gunter MJ, Murphy N, Cross AJ et al. (2017) Coffee drinking and mortality in 10 European Countries: A multinational cohort study. Ann Intern Med, 167:236-247.
Owen AJ, Magliano DJ, O’Dea K et al. (2016) Polyunsaturated fatty acid intake and risk of cardiovascular mortality in a low fish-consuming population: a prospective cohort analysis. Eur J Nutr, 55:1605-1613
Panagiotakos D, Chrysohoou C, Siasos G et al. (2011) Sociodemographic and lifestyle statistics of oldest old people (>80 years) living in Ikaria island: The Ikaria Study. Cardiol Res Pract.
Pietri P, Vlachopoulos C, Chrysohoou C et al. (2015) Deceleration of age-related aortic stiffening in a population with high longevity rates: the IKARIA Study. J Am Coll Cardiol, 66:1842-1843.
Pietri P, Papaioannou T, Stefanadis C (2017) Environment: An old clue to the secret of longevity. Nature, 544:416.
Russ TC, Stamatakis E, Hamer M et al. (2012) Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ, 345:e4933
Siasos G, Chrysohoou C, Tousoulis D et al. (2013) Consumption of a boiled greek coffee is associated with improved endothelial function: the Ikaria Study. Vasc Med, 18:55-62.
Siasos G, Chrysohoou C, Tousoulis D et al. (2013) The impact of physical activity on endothelial function in middle-aged and elderly subjects: The Ikaria Study. Hellenic J Cardiol, 54:94-101.
Vlachopoulos C, Aznaouridis K, Stefanadis C (2015) Prediction of cardiovascular events and all-cause mortality with arterial stiffness. J Am Coll Cardiol, 55:1318-1327.
Zaninotto M, Wardle J, Steptoe A (2016) Sustained enjoyment of life and mortality at older ages: analysis of the English Longitudinal Study of Ageing. BMJ, 355:i6267.
Uric Acid, IQ, Productivity & Lifespan: Is There a Link?
One controversial theory claims that high levels of uric acid increase a person’s lihood of both gout and genius. Does such a link really exist? Read on as we explore the strange science behind uric acid and what may increase it.
Scientists believe that uric acid can be both pro- and antioxidant, depending on the circumstances. Most of these mechanisms haven’t been explored in humans [1, 2, 3].
The link between uric acid levels and intelligence, longevity, and neurological or nerve diseases is still unclear.
Plus, the majority of human studies covered in this article deal with associations only, which means that a cause-and-effect relationship hasn’t been established.
For example, just because intelligence has been linked with higher uric acid in the body doesn’t mean that increasing uric acid levels will make you smarter. Data are lacking to make such claims.
Also, even if a study did find that high uric acid levels contribute to intelligence, uric acid is highly unly to be the only cause. Complex traits always involve multiple possible factors – including brain chemistry, environment, health status, and genetics – that may vary from one person to another.
In 1904, Havelock Ellis found in his “Study of British Genius” that there was an unusually high rate of gout among included eminent men. But since gout is associated with higher uric acid (or urate) levels in the blood, Havelock first suggested that uric might have something to do with intelligence .
Mind you, what made a man “eminent,” let alone a “genius,” at the time was a matter of debate.
For example, Ellis excluded less popular writers and “villains.” He said that eminent men are “either shorter or longer than average,” that “some are shortsighted and stammer,” have “illegible handwriting,” and are “merry late” .
More recently, some investigators have examined this relationship, but they stumbled upon a lack of a clear correlation.
Small studies from the 70s and 80s found only a slight correlation between IQ and uric acid. There seemed to be a stronger correlation between uric acid and scholastic achievement after controlling for IQ, but even this remained elusive [5, 6].
Uric acid is chemically somewhat similar chemical to caffeine, since it is a “purine.” Their structural similarity is thought to underlie some antioxidant effects. this, one unverified theory also suggests that uric acid may act as a natural stimulant .
Longevity & Brain Health
Uric acid levels appear to correlate with longevity in monkeys and animals. Scientists say this might be because of urate’s antioxidant properties. Still, no such association has been explored in humans .
Some small studies have suggested a link between low uric acid and certain brain diseases, but large-scale studies haven’t confirmed this connection.
For example, low uric acid levels have been associated with Multiple Sclerosis (MS). One small study of 11 people suggested that correcting uric acid levels may improve MS symptoms and reduce Th1 immune dominance, but this hasn’t been confirmed in large trials .
Lower blood values have also been associated with the following disorders in limited studies:
- Alzheimer’s disease (AD) 
- Huntington’s disease (HD) 
- Parkinson’s disease (PD) 
But remember, these studies dealt with associations only, which means that a cause-and-effect relationship hasn’t been established.
As an antioxidant, urate is hypothesized to provide up to 60% of the antioxidant capacity in human blood .
On the other hand, some researchers consider that uric acid may increase the Th17 immune response in inflammation (IL-1b, IL-18) .
Thus, low uric acid levels are proposed to contribute to oxidative stress and high levels to lead to inflammation, gout, and kidney stones. This has yet to be confirmed in large human studies .
When to See a Doctor
It’s important to speak with your doctor if your uric acid levels are low. Your doctor should diagnose and treat any underlying conditions causing your abnormal levels.
Also, raising uric acid levels is usually detrimental. High uric acid levels signal gout, kidney problems, and other health issues. For example, a meat-heavy diet–high in purines–increases uric acid levels and causes flare-ups in people with gout .
On the other hand, people with low uric acid levels due to Wilson’s disease should follow a special low-copper diet .
Therefore, all dietary and lifestyle interventions should be the cause of your abnormal uric acid levels and your overall health.
With this in mind, you may try the complementary approaches listed below if you and your doctor determine that they could be appropriate. Remember that none of them should ever be done in place of what your doctor recommends or prescribes.
Diet & Lifestyle
Zinc may normalize uric acid levels in people with Wilson’s disease who are deficient .
Animal products meat increase levels in general. This is usually considered detrimental, since a diet high in animal products (and purines) has only been studied in people with gout who have high uric acid levels. It’s unknown how a diet high in meat and animal products impacts low uric acid levels, but this will always depend on the underlying cause .
Dairy and maybe calcium lower uric acid levels. Some authors think that this might explain why vegans have higher levels than omnivores. Soy might also increase urate levels .
Uric acid levels rise after strenuous exercise, potentially a result of purine nucleotide degradation during conditions of high energy usage. Intense exercise is not recommended to most people, since it puts too much stress on the body. Regular, moderate exercise supports overall health .
Also, alcoholic drinks (especially beer) increase uric acid levels and worsen symptoms in people with gout. But since alcohol can have wide-ranging harmful health consequences, doctors will recommend restricting or completely avoiding alcohol in the case of many diseases, including those linked with low uric acid levels .
For example, people with Wilson’s disease who have high copper and low uric acid levels are advised to avoid alcohol. This is because alcohol can damage the liver, which is already vulnerable due to excess copper in the body .
Inosine, a uric acid precursor and nucleoside, increases uric acid levels in animals. Inosine is found in brewer’s yeast, fish, and organ meats. It’s also available as a supplement [22, 23].
In a small clinical trial with MS patients, inosine doubled uric acid levels and decreased nitrotyrosine, a marker of cell damage and inflammation. It increased IL-10 and IL-13, which are Th2 cytokines. IL-10 is an anti-inflammatory cytokine. Larger trials are needed to confirm these findings .
Image taken from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189001/
However, inosine supplements have not been approved by the FDA for medical use. Supplements generally lack solid clinical research. Regulations set manufacturing standards for them but don’t guarantee that they’re safe or effective. Speak with your doctor before supplementing.
Hormones and other medications should only be used with a doctor’s prescription. The following hormonal factors are theoretical. They aren’t backed up by solid science and we bring them up for informational purposes.
Animal studies suggest that estrogen suppresses the production of the protein that eliminates urate in the kidney (proximal tubule epithelial cell organic anion transporter), while androgens stimulate it. Scientists hypothesize that this may explain lower serum urate levels in postmenopausal women as opposed to men, but larger studies are needed .
Parathyroid hormone also increases uric acid in animals .
- Is Low Uric Acid Bad & What Causes It?
Other Benefits of Uric Acid
Uric acid levels correlate with longevity in monkeys and animals. This is presumably because of urate’s antioxidant properties .
Uric acid levels are much lower in people with Multiple Sclerosis (MS) and a study with 11 people found correcting these levels are therapeutic .
In fact, it prevented the progression of MS in all 11 patients tested and even improved the symptoms of some patients .
MS, low uric acid also correlates with Parkinson’s, Alzheimer’s and Huntington’s [2, 3]. Clinical trials are underway to determine if raising urate levels will slow the disease in people.
Uric acid reduced Th1 immune dominance in people with MS , which is good for me.
As a natural antioxidant, urate provides up to 60% of the antioxidant capacity in human blood. It also provides protection from the free radicals that it doesn’t neutralize .
However, recent studies indicate that these mechanisms couldn’t explain all of its beneficial effects in the brain .
Studies have found that urate was neuroprotective by protecting neurons from glutamate-induced toxicity, a central cause of neuron degeneration .
In mice with autoimmune conditions, urate was beneficial and increased the survival rate .
On a cautionary note, uric acid can increase Th17 inflammation if inflammation is present (IL-1b, IL-18) . It can be inflammatory in general if you have too much .
Too high or too low levels of uric acid are not good. Too low leads to oxidative stress, but too high can also lead to inflammation, gout and kidney stones .
How too much uric acid causes inflammation:
How to Increase Uric Acid
Zinc elevates uric acid if you’re deficient .
Animal products increase uric acid in general . Fructose can also increase uric acid , but I don’t know at what dosage or if it does in humans.
Dairy and maybe calcium lower uric acid levels, which explains why vegans have higher levels than omnivores. Soy might also increase urate levels .
Estrogen increases uric acid excretion, which explains why men have higher levels than women .
In general, diet was more of a factor in men in its ability to influence urate levels rather than women .
Inosine, found in liver and fish, is the most powerful way to increase uric acid levels . This is what’s used in studies with MS and Parkinson’s.
Inosine has been shown to have antidepressant effects in mice through increasing brain growth (via BDNF, MAPK, adenosine antagonism).
Inosine increases RNA and DNA production and blood oxygen carrying capacity, which preserves ATP levels.
In a clinical trial with MS patients, Inosine more than doubled uric acid levels (increased from 3.9 to 8.3).
It decreased Nitrotyrosine, a marker of cell damage and inflammation, by more than half (from 73 to 32) .
It increased IL-10 and IL-13, which are Th2 cytokines. IL-10 is an anti-inflammatory cytokine. Mac-1 is a marker of inflammation and it more than halved (from 2.7 to 1.2).
There are some negatives to uric acid/inosine such as gout and kidney stones, so be careful. In studies with MS and Parkinson’s, kidney stones were quite common from inosine treatment (up to 1/4 people got it).
However, in the studies that were in a controlled environment, the patients were properly hydrated and none of them got kidney stones .
You need to drink a ton of water (over a gallon) and take potassium citrate to prevent kidney stones.
Uric acid is also capable of binding iron , so be careful if you’re anemic.
If you need to supplement with calcium because you’re not getting enough from your diet, it’s better to use the citrate form. I also recommend magnesium citrate.
I’m still taking a risk, but I the effect enough that it’s worth it for me.