Why Is PCOS Still So Hard for Doctors to Understand?

When Emily S., 28, was a teenager, more than one doctor told her that irregular periods were normal for her age. Dermatologists said the cystic acne along Emily’s jawline was a natural result of being 15. These explanations never convinced Emily, but the birth control pills she was prescribed did help tame her symptoms. Then, when she was 22, she stopped taking them.

Three months after stopping hormonal birth control, Emily’s breakouts returned with a vengeance. Hair started to sprout just below her belly button. Her irregular periods came back; she’d go three, four months without bleeding. She was no longer a teenager. So what was the excuse now?

A Google search led Emily to information about polycystic ovary syndrome (PCOS). Even though she couldn’t check off every symptom she read about, PCOS seemed to explain a lot. She brought up her suspicions to a new doctor and received a PCOS diagnosis after a transvaginal ultrasound confirmed her ovaries had the excess follicles (sacs that hold eggs) associated with this disease.

Now, Emily wonders whether she’ll have trouble getting pregnant, as many people with PCOS do. She wonders whether there’s a link between PCOS and other health problems she experiences, like her blood sugar issues.

“That’s the thing about PCOS,” she tells SELF. “I’m like, ‘what the hell is actually going on?’”

Doctors would like to know, too.

Searching for answers to questions surrounding PCOS—like what is really is, why it happens, how to diagnose it, and how to treat it—often only leads to more questions. That’s true even for PCOS experts, many of whom consider this condition to be something of a medical mystery.

Based on what we do know, PCOS is a hormonal and metabolic disorder. Its diagnostic criteria can vary, which is a complicated issue we’ll explore in a bit. In general, though, getting a PCOS diagnosis involves some combination of irregular or absent ovulation, ovaries with excess follicles (not cysts, that’s a bit of a misnomer), and high levels of androgens, or hormones that have historically been viewed as “male,” like testosterone. These issues can present as symptoms like irregular periods, acne, excess face and body hair, scalp hair loss, and weight gain, according to the Centers for Disease Control and Prevention (CDC). Per the CDC, the disorder affects an estimated 6 to 12 percent of women of reproductive age, which translates to about 5 million people dealing with this confusing condition.

The good news is that experts aren’t giving up on figuring out PCOS. Here, SELF explores the current state of PCOS knowledge and where experts believe research on the condition is headed.

What causes PCOS?

There isn’t one definitive cause of PCOS, but researchers know of several suspected factors that might play off each other. It’s possible that PCOS is always caused by some combination of these factors, but pinpointing the exact triggers in one person is a little ambitious, even for experts, Richard Legro, M.D., chair of the Department of Obstetrics and Gynecology at Penn State, tells SELF.

Excess insulin brought on by insulin resistance is thought to be a significant factor. This gets pretty complicated, but bear with us. Your cells need the hormone insulin to absorb glucose (sugar from food) for energy, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). But if you have insulin resistance, your cells don’t absorb glucose like they should. This can confuse your body into thinking you just need more insulin to compensate and be able to absorb glucose normally, so your pancreas might churn out higher levels of this hormone. Long story short, doctors believe this excess insulin due to insulin resistance might make your ovaries produce extra androgens, like testosterone. (Insulin resistance can also lead to prediabetes and type 2 diabetes over time.)

Some of the most familiar markers of PCOS (think acne, excess face and body hair, scalp hair loss, and irregular or absent ovulation) can happen as the result of extra androgens, though it’s not clear if the excess androgens are an actual cause of PCOS or just a symptom of another potential cause (like excess insulin from insulin resistance). It’s probably pretty easy for you to see how extra testosterone could translate into something like more face and body hair, but you might find it harder to pin down how this would relate to irregular ovulation. Well, you’re in great company, because doctors aren’t too sure, either.

One possible explanation for how androgens mess with ovulation is that these hormones build up inside ovarian follicles, keeping the follicles from maturing and releasing eggs, which can lead to the excess follicles seen on an ultrasound like Emily’s.

But elevated androgen levels aren’t always a sign of PCOS. This can also happen with other health conditions like Cushing’s syndrome or congenital adrenal hyperplasia, so doctors will try to rule out other health conditions before assuming excess androgen points to PCOS.

Another possibility is that PCOS might happen, at least in part, when the brain’s hypothalamus sends incorrect hormone signals from the pituitary gland (a pea-sized organ that produces hormones) to the ovaries, Leanne Redman, Ph.D., director of the Reproductive Endocrinology and Women’s Health Research Program at Pennington Biomedical Research Center in Baton Rouge, Louisiana, tells SELF. Here’s how that might work: The pituitary gland regulates levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which then prepare ovarian follicles for maturation. If these hormones are thrown off, it can prevent you from ovulating, which can lead to irregular periods—a classic sign of PCOS.

Again, this could be a cause of PCOS or it could be a symptom of another cause, since some evidence suggests that insulin resistance can influence how the pituitary gland regulates LH and FSH (thought the data is too inconsistent to definitely cite it as cause and effect, according to 2012 research on insulin resistance and PCOS in Endocrine Reviews).

Genetics could also be a factor in PCOS development. PCOS tends to cluster in families, which some experts believe may point to a strong genetic link, Redman says. Whether someone develops PCOS could be the result of a genetic variation (i.e., how a DNA sequence varies in each of our genetic material).

Researchers have begun to unravel the genetic origins of this disorder through DNA samples. A 2019 meta-analysis of 261 people in The Journal of Clinical Endocrinology & Metabolism revealed that a gene called DENND1A could have a role in the development of PCOS in white families of Eurpean heritage.

“This may not apply to women of other races and ethnicities, but … it’s really the first gene that seems to play a major role in PCOS development, and it strongly suggests—at least in the women and families that have these rare genetic variants—that altered androgen production is a key abnormality causing PCOS,” Andrea Dunaif, M.D., the chair of endocrinology at Mount Sinai School of Medicine and one of the study authors, tells SELF. Various research groups are also hoping to investigate the role of genes in PCOS in black and Chinese people to see what kind of connection may exist there, Dr. Dunaif says.

Additionally, some experts believe fetuses that are exposed to unusually high testosterone levels while in the womb (like if the pregnant person has PCOS or diabetes) may be more inclined to develop this disorder, Redman says. The excess testosterone could influence the genetic material of the fetus, including any eventual eggs and ovaries it develops. This seems to set up these individuals for developing PCOS later on, though some research suggests the deciding factor could be the environment they grow up in, Redman says. For example, not having access to nutritious foods and being inactive could mean developing insulin resistance that could further predispose someone in this situation to PCOS, she explains.

What PCOS diagnosis and treatment look like

Now that you know more about the complicated tangle of potential PCOS causes, you probably won’t be surprised to find out that diagnosis can be similarly tricky.

There are actually multiple versions of PCOS diagnostic criteria out there. Overall, doctors tend to look for at least two of these symptoms to diagnose PCOS: irregular or absent ovulation (as evidenced by irregular or absent periods), evidence or suggestion of ovaries with excess follicles (like via ultrasound), and symptoms of high levels of androgens (like excess face and body hair, weight gain, and hormonal acne).

But the specific mix of symptoms doctors are looking for depends on the exact diagnostic criteria they’re using. For instance, in 1990 the National Institutes of Health (NIH) created PCOS diagnostic criteria that required signs of hyperandrogenism and absent or irregular ovulation, but the excess ovarian follicles were optional. (Not everyone with PCOS even has these extra follicles, and some people without PCOS have them, the CDC explains.) In 2003, a consensus workshop in Rotterdam, the Netherlands, released their own criteria saying that any two out of those three potential signs of PCOS should be required for diagnosis. Finally, in 2009, the Androgen Excess and PCOS Society said someone would need to exhibit hyperandrogenism plus either of the other possible signs to be diagnosed with PCOS.

Confused yet? It’s no wonder why people like Emily often see multiple doctors before receiving a PCOS diagnosis.

Because the consensus among experts is that PCOS has no cure, researchers focus on treatment. If your doctor thinks you have PCOS, they may recommend hormonal birth control to regulate your hormone levels and menstrual cycle, according to the Mayo Clinic. They may also prescribe drugs like metformin to help your body become more sensitive to insulin, spironolactone for skin issues like acne brought on by androgen excess, or medications to stimulate ovulation if you’re having trouble getting pregnant.

While the FDA has approved medications to treat the symptoms of PCOS, it has yet to approve a drug specifically for the disorder. Many people with PCOS have to mix and match drugs to find relief. Emily, for example, decided to go back on hormonal birth control and added spironolactone to help with her symptoms.

Redman believes more and more research will focus on prevention in at-risk girls, like those who are insulin-resistant or whose mothers or sisters have PCOS. Doctors could, for example, test babies for any potential PCOS-related genes, then test whether certain diets prevent children with those genes from developing issues like insulin resistance that can lead to excess insulin production, Redman says. (Diet has been shown to help reduce PCOS symptoms in some people. You can read all about that here.)

“The future needs to be on prevention,” Redman says. “I think with more prevention in younger girls, we can also improve the dialogue and the conversation about symptoms so that we can tackle them earlier.”

The challenges of researching PCOS

So, why don’t we know enough about this disorder? Recruiting participants and keeping them enrolled is one major challenge in investigating PCOS, Redman says. Researchers typically want to recruit more patients than necessary since some people drop out of studies, she says, and this can be tough to do.

For patients with PCOS, the major benefits of participating in research could include free testing, evaluations, and recommendations that would otherwise cost them. It’s not just about the personal payoff, though. “My experience over more than 30 years has been that women with PCOS are very interested in helping us better understand their problem,” Dr. Dunaif says. “They’ve been so frustrated with their own cases that they want to help out.”

But participating in PCOS studies often requires that patients stop other medications, including hormonal birth control and insulin-sensitizing drugs, Redman says. She speculates that people do not want to give up medications that manage their symptoms for an unknown result, which can lead to less than ideal sign-up numbers.

Then there’s the process of actually participating in the studies. In general, the more prolonged studies are, the higher the dropout rates are, Dr. Dunaif adds.

“The highest dropout rates in these studies are usually in your control group, your normal subjects. They really have no incentive other than getting compensated for time and effort, and we don’t compensate them enough just on that basis,” Dr. Dunaif says. Controls can generally earn between $5 to $25 for one blood sample to hundreds of dollars for studies that last eight hours or so and require intravenous procedures, she tells SELF.

Dr. Dunaif has found that getting participants on board with gene-sequencing research has been easier because it usually involves getting their blood drawn once without the need for follow-up visits. “We really have to be very pragmatic when designing studies with human participants to not make it a burden,” she says.

A lack of financial backing is another huge barrier in PCOS research. The NIH is the largest public supporter of biomedical research in the world, according to the World Health Organization (WHO). Looking at how much of that funding goes to PCOS paints a pretty telling picture.

A 2017 study in The Journal of Clinical Endocrinology & Metabolism used the NIH Research Portfolio Online Reporting tool to look at how many grants the organization awarded to PCOS, rheumatoid arthritis, lupus, and tuberculosis between 2006 and 2015. Those last three illnesses affect about as many people in the U.S. as PCOS (or fewer) and appear to have a similarly negative impact on quality of life, according to past research. The study found that the NIH awarded less funding to PCOS ($215.12 million) than to these other conditions ($454.39 million for rheumatoid arthritis, $773.77 million for tuberculosis, and $609.52 million for lupus). The study authors concluded that “PCOS research may be underfunded considering its prevalence, economic burden, metabolic morbidity, and negative impact on quality of life.”

There are a few reasons why this may be the case.

“Most of the studies, most of the researchers, and most of the administrators tend to be [men] who are not necessarily interested in women’s health,” Ricardo Azziz, M.D., M.P.H., M.B.A., chief officer of academic health and hospital affairs at the State University of New York and lead study author of the NIH grant report, tells SELF. “The reality is that while some disorders of women have received a lot of attention, like breast cancer, others have not.”

Funding agencies prioritize disorders that have the greatest public health impact, like the highest death rates, Dr. Dunaif says. This helps explain why conditions like heart disease and breast cancer (which kill around 300,000 and 41,000 women each year, respectively) have so much research behind them.

The confusion about the causes of PCOS may also make it a bit easier to fall through the research cracks. Institutes within the NIH tend to consider PCOS a reproductive disorder rather than a reproductive and metabolic disorder, Dr. Azziz says. So, most of the funding (about 68 percent) that goes toward PCOS research comes from the National Institute of Child Health and Human Development (NICHD), which focuses on reproductive issues. Limiting PCOS to being viewed as just a reproductive disorder means researchers who are interested in metabolic aspects of PCOS, like its link to diabetes and nutrition, can have trouble securing funding, Dr. Azziz says. That doesn’t mean this doesn’t happen, but it’s less common.

The lack of funding for PCOS research also discourages some young scientists from entering this field, Dr. Dunaif says. On top of student-loan debt hanging over new graduates’ heads, a dearth of research money can steer potential scientists away from taking a chance on grant writing, she explains.

In addition to all of that, sometimes good researchers end up leaving the field, Dr. Azziz says. His own data shows that the number of PCOS research grant applications dropped 42 percent from 2006 to 2015, much more than any of the other conditions studied. With fewer competitive researchers come fewer breakthrough studies, Dr. Azziz explains.

What really needs to happen next

We need groundbreaking research on how to better diagnose PCOS, better treat it, and better understand its causes so that experts may be able to help prevent it.

One proposed solution to expand the PCOS funding pool is a name change to be more all-encompassing. (This would also nod to the fact that not everyone with this condition has excess ovarian follicles and people with excess ovarian follicles don’t always have this condition.) Experts haven’t agreed upon a new name yet. As Dr. Azziz describes in a fascinating 2014 paper in The Journal of Clinical Endocrinology & Metabolism, potential options might include “metabolic hyperandrogenic syndrome,” “polycystic ovary-hyperandrogenic syndrome,” and “polycystic ovary-anovulatory syndrome,” which would each correspond to different mixes of symptoms this condition most commonly causes.

As Dr. Azziz notes in the paper, the final consensus from an earlier NIH meeting about PCOS said, “The right name will enhance recognition of this major public health issue for women, educational outreach, ‘branding,’ and public relations and will assist in expanding research support.” Ideally, it could have a domino effect that would address many of the research-related barriers in learning more about PCOS.

On-the-ground advocates are helping to push for this much-needed research as well.

Sasha Ottey founded PCOS Challenge in 2009 with the goal of mobilizing PCOS advocates to reach out to their representatives on behalf of people with the disorder. Congressional action can lead to more awareness and research funding, Dr. Azziz says. “PCOS Challenge has been doing a tremendous amount of work trying to move awareness forward,” he adds.

Ottey and her team found that other conditions had earned spots on the calendar of National Health Observances. So, the organization decided that PCOS needed an awareness month. PCOS Challenge formed a caucus to scout out members of Congress who were willing to work with the organization as its advocates on Capitol Hill, Ottey says.

Fast forward to December 2017, and the U.S. Senate passed a resolution introduced by Senator Elizabeth Warren to acknowledge “the seriousness of” PCOS, dubbing September 2018 as the first official PCOS Awareness Month. In February 2019, the U.S. House introduced its resolution to make September 2019 the second official PCOS Awareness Month. (These resolutions are generally introduced and passed every year, even for observances that are more established, like American Heart Month in February.)

“We’re taking back control by sharing our stories,” Ottey tells SELF. “Patients with PCOS, physicians, and researchers are now feeling more empowered because there is a sort of pipeline to get to an end result: more financial resources for PCOS research, awareness campaigns, and other initiatives to educate patients and health care providers.”

That’s what so much of this quest to demystify PCOS comes down to: the need for validating, illuminating, potentially life-changing knowledge about this disease. “When I was diagnosed, I was more relieved than anything,” Emily says. “Why would you subject yourself to being uncomfortable or in pain or internally struggling with whether or not something’s wrong with your body? I would just rather know.”

Related:

Smart sleepwear: Introducing ‘phyjama,’ a physiological-sensing pajama

Scientists expect that in the future, electronically active garments containing unobtrusive, portable devices for monitoring heart rate and respiratory rhythm during sleep, for example, will prove clinically useful in health care. Now researchers at the University of Massachusetts Amherst have developed physiological-sensing textiles that can be woven or stitched into sleep garments they have dubbed “phyjamas.”

Graduate students Ali Kiaghadi and S. Zohreh Homayounfar, with their professors Trisha L. Andrew, a materials chemist, and computer scientist Deepak Ganesan, will introduce their health-monitoring sleepwear at the Ubicomp 2019 conference this week in London, U.K. A paper detailing the work has been chosen for publication in the Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies (IMWUT).

As Andrew explains, “The challenge we faced was how to obtain useful signals without changing the aesthetics or feel of the textile. Generally, people assume that smart textiles refer to tightly worn clothing that has various sensors embedded in it for measuring physiological and physical signals, but this is clearly not a solution for everyday clothing and, in particular, sleepwear.”

Ganesan adds, “Our insight was that even though sleepwear is worn loosely, there are several parts of such a textile that are pressed against the body due to our posture and contact with external surfaces. This includes pressure exerted by the torso against a chair or bed, pressure when the arm rests on the side of the body while sleeping, and light pressure from a blanket over the sleepwear.”

“Such pressured regions of the textile are potential locations where we can measure ballistic movements caused by heartbeats and breathing,” he explains, “and these can be used to extract physiological variables.” The difficulty is that these signals can be individually unreliable, particularly in loose-fitting clothing, but signals from many sensors placed across different parts of the body can be intelligently combined to get a more accurate composite reading.

Andrew, Ganesan and colleagues explain that their team had to come up with several new ideas to make their vision a reality. They realized that there is no existing fabric-based method to sense continuous and dynamic changes in pressure, particularly given the small signals that they needed to measure. So they designed a new fabric-based pressure sensor and combined that with a triboelectric sensor — one activated by a change in physical contact — to develop a distributed sensor suite that could be integrated into loose-fitting clothing like pajamas. They also developed data analytics to fuse signals from many points that took into account the quality of the signal coming in from each location.

The authors report that this combination allowed them to detect physiological signals across many different postures. They performed multiple user studies in both controlled and natural settings and showed that they can extract heartbeat peaks with high accuracy, breathing rate with less than one beat per minute error, and perfectly predict sleep posture.

“We expect that these advances can be particularly useful for monitoring elderly patients, many of whom suffer from sleep disorders,” says Andrew. “Current generation wearables, like smartwatches, are not ideal for this population since elderly individuals often forget to consistently wear or are resistant to wearing additional devices, while sleepwear is already a normal part of their daily life. More than that, your watch can’t tell you which position you sleep in, and whether your sleep posture is affecting your sleep quality; our Phyjama can.”

This work was enhanced by Ganesan and Andrew’s affiliation with UMass Amherst’s Institute of Applied Life Sciences (IALS), which focuses on translating life science research into products that improve human health. Director Peter Reinhart at IALS says, “It’s exciting to see the next generation of wearable technology that is zero effort and addresses the issue of comfort and unobtrusiveness head-on. The data generated by fabric-based sensors have the potential to improve health and well-being, and could possibly contribute to the early diagnosis of multiple disorders.”

How Bad Is It to Use Expired Sunscreen?

I was pretty proud of my extensive sunscreen collection until I started wondering if I just had a ton of expired sunscreen on my hands. (Not literally, but you know.) I don’t mean the moisturizer with SPF I wear every day. Naturally, I go through that stuff quickly. No, I mean the bevy of sunscreen options with higher SPF I had stashed away specifically for skiing and going to the beach, which I only do a few days a year, plus some physical sunscreens I use sporadically to protect any new scars. Unfortunately, in the process of reporting this story, I learned that only two of the seven sunscreens in my stockpile were actually usable.

Just as you shouldn’t take expired medication, you shouldn’t use expired sunscreen. “A sunscreen is an over-the-counter drug—a medicine—and it should be viewed as such,” cosmetic chemist Konstantinos Lahanas, Ph.D., founder of the cosmetic science research company The Lahanas Group, LLC, tells SELF.

The weird thing is that some sunscreen bottles don’t come with expiration dates. Even if yours does, the date can become basically illegible over time. So, why should you buy a new bottle of sunscreen if yours is expired, and how can you tell it’s too old if you’re not sure? Here, experts answer those questions and more.

Here’s why sunscreen expiration dates exist and how they work.

The chemicals in any kind of sunscreen break down over long periods of time, eventually becoming less potent, John G. Zampella, M.D., instructor in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, tells SELF. Dr. Zampella has a pretty sweet analogy to drive home this point.

“Think about those week-old strawberries in your refrigerator. After being in the fridge for so long, they start to decay,” he says. “At first, you might still recognize them as strawberries, but eventually, they become covered in mold and don’t even look like strawberries anymore.”

It’s a similar story with your sunscreen, he explains: “Eventually, just like your strawberries, all of those compounds break down, and the sunscreen becomes useless.”

That’s where expiration dates come in (on the bottles that have them, anyway). All drug manufacturers (including the ones who make sunscreen) have to perform stability testing before they can sell their products, the U.S. Food and Drug Administration (FDA) explains. Based on that testing, they can submit a drug application with a proposed expiration date and usage instructions so you don’t accidentally spoil your sunscreen before that date arrives.

The FDA recommends drug manufacturers follow standardized guidelines for stability testing, like those outlined by the International Council for Harmonization. The guidelines are full of complicated technical terms and scientific hurdles for manufacturers to clear. To sum it up, these recommendations essentially ask that manufacturers expose at least three batches of the product to multiple storage conditions over the course of months or years. Then manufacturers are supposed to conduct all sorts of tests—physical, chemical, microbiological, etc.—to figure out how long their drugs will reliably stay safe and effective under different conditions over time. (There’s flexibility in these recommendations, but that’s the gist.)

So, behind that tiny expiration date on your sunscreen bottle is a lot of scientific effort to make sure the drug will be as effective as possible up to that point—but not after. This is why the FDA and American Academy of Dermatology (AAD) both recommend tossing your sunscreen as soon as it reaches its expiration date.

OK, but what happens if you do use expired sunscreen?

Honestly, it’s anyone’s guess, and that’s why you probably just shouldn’t. “If you use sunscreen after the expiration date, it might still have some UV-blocking power, but it won’t be the full strength that’s listed on the label,” Dr. Zampella says. Even sunscreen with a high SPF, like 75, can’t reliably protect you once it’s expired, he adds. You can’t know if its post-expiration SPF has dropped to 70 or, say, 5 unless you happen to have a chemical laboratory in your home that you can use to analyze the product, in which case, cool and can we come over?

“Sunscreen does not have a timebomb embedded within that will [immediately] render it useless” once it expires, Lahanas says. But since there’s no way to know how much (if any) of its SPF has stuck around past its expiration date, any expired sunscreen should be considered ineffective, Lahanas says.

What if your sunscreen doesn’t have an expiration date?

Sunscreens that aren’t labeled with expiration dates have been proven to stay stable for at least three years, the FDA says. So any sunscreen without a listed expiration date “should be considered expired” three years after purchase, the FDA says.

One interesting point here is that your sunscreen could have been sitting on the shelf for a while before you bought it, so by the time it’s hit three years in your possession, it will have been more than three years since it was manufactured and the stability countdown clock began. But all sunscreens without an expiration date have been proven effective for at least three years—not exactly three years—so its time on the shelf won’t necessarily impact its efficacy. Obviously, this depends on how long the specific sunscreen was found to be effective and how long it was sitting on the shelf, but it’s not enough of a concern to make the FDA change its recommendation to consider sunscreen without an expiration date expired three years after purchase.

Basically, if you find a sunscreen container in the bottom of your beach bag without an expiration date and you have zero idea when you bought it, you might as well toss it.

“Like with any other medicine, if you’re in doubt, throw it out,” Lahanas says.

The same goes if your sunscreen hasn’t reached its labeled expiration date or you bought it more recently than three years ago, but its color or consistency has changed in a funky way, the AAD adds. That can be a sign that it’s no longer safe to use. Sometimes that can happen earlier than expected if you store your sunscreen in a way that makes it degrade faster than usual.

Per the FDA’s guidelines, you should stash sunscreen at room temperature to keep the chemicals stable for as long as possible. That’s a tough ask if you’re taking sunscreen to a setting like the beach so you can dutifully reapply it. (Good job, by the way.) In that case, the FDA recommends wrapping the sunscreen container in a towel or throwing it into your cooler if you have one. Along the same lines, you shouldn’t store sunscreen in your car, where it can overheat.

If you buy sunscreen that doesn’t have an expiration date, the AAD recommends writing your purchase date on the container. That will help you have a better idea of when its time has come. (Even if your sunscreen does have an expiration date, you might want to write the date over again just in case the original one wears off.)

Finally, if you hate the idea of buying sunscreen without an expiration date because you don’t know how much its time on the shelf could be cutting into that three-year stability guarantee, you could stick with sunscreens that have listed expiration dates or buy new sunscreen much more frequently than once every three years, like once a year right before summertime when you need maximum protection from the sun.

So you don’t need to buy new sunscreen every year, but you probably should.

Dermatologists often say that you really should be using enough sunscreen that it doesn’t have time to go bad. It’s a common derm refrain: If it takes you fooorever to get through a bottle of sunscreen (like if you only make your way through one bottle all summer), you’re probably not using enough.

Granted, this type of thing is somewhat dependent on your habits, like if you prefer to spend every weekend in the company of some blessed air conditioning instead of frolicking in some waves or otherwise spending a lot of time outdoors. Overall, though, it definitely wouldn’t hurt to be so diligent about applying your sunscreen the right way and often enough that you never even have to worry about it expiring.

Related:

How to Find a Threesome or Triad on Dating Apps

I had the phrase “not a unicorn” in my Tinder profile for years. It wasn’t to indicate distaste for the mythical being because, hey, I change my hair color enough to be in solidarity with their rainbow aesthetic. Instead, it was to cut down on messages from couples who were “unicorn-hunting.”

For the uninitiated, the term “unicorn-hunting” typically describes the practice of an established couple searching for a third partner to engage in either threesomes or triads (relationships between three people). Often, though not always, the couple is made up of a straight cisgender man and a queer (usually bisexual, pansexual, or omnisexual—“bi+” for short) or bicurious cisgender woman, and they’re looking for a bi+ cisgender woman who is equally attracted to both of them and interested in whatever arrangement they had in mind.

The joke is that the existence of such a woman is so elusive, she may as well be a mythological creature.

If you’re a queer woman who uses dating apps, chances are, like me, you’ve been hit up at least once by a couple looking for a “unicorn.” Obviously, wanting to have a threesome between consenting adults is a common and totally healthy fantasy, and triads are one of many relationship models that can work for different people. The problem here isn’t in the desire. It’s in the harmful and objectifying ways some people go about finding someone to fulfill that desire.

As a pansexual cisgender woman who also happens to be polyamorous, I am frequently “hunted” as a unicorn. I find the verb apt for how I’m often treated on dating apps. When I had “not a unicorn” in my profile, it wasn’t because I was against threesomes or triads. It was because I was tired of the way couples objectified me as fantasy fodder in their search, calling the potential thirds they sought anything from “a wild night” to “a birthday gift” to the vague yet ubiquitous “fun.” And that’s only when the couples were actually upfront.

“I think people believe they have to lie or mislead us in order for things to work out how they’d like,” MJ R.*, 32, a bisexual woman who has participated in threesomes as a third, tells SELF. “A man and woman want a threesome, but first they’ll send the woman to flirt one-on-one and only reveal later that her male partner is also hoping to be involved. Or they approach us as if they’re looking to date a third, when really they’re only looking for sex or ‘experimentation.’”

To put it lightly, this is Not Cool. Realizing potential thirds need to feel safe, seen, and have their boundaries respected should be non-negotiable, Rachel Simon, L.C.S.W., a sex and gender therapist who specializes in queer issues, tells SELF.

I want you to find your third, and I want your third to feel safe and respected. So let’s talk about how to ensure that everyone’s desires and needs are fulfilled responsibly.

Before you begin your search, there are a few things you should do first.

Engaging in sexual relationships—whether with one, two, or 10 partners—involves navigating individual desires, setting boundaries, and communicating. If you want this search to be successful (and by that, I mean positive, safe, and respectful for everyone involved), you’ll have to put a little work into it.

Start by asking yourself, “What do I want?”

If you approach the topic of threesomes or triads as a couple, it can be easy to prioritize what feels best for the relationship without thinking about what you personally want. So check in with yourself first: What are you looking for? Is it a one-off sexual encounter? A three-way relationship? Something in between? Do you really even want your partner involved? Where are you willing to compromise those desires and where aren’t you?

“It’s important that you want this,” Sarah L.*, 29, a queer woman who is open to thirds with her straight male partner, tells SELF. She suggests that you ask yourself, “Who is this really for? Whose pleasure is being prioritized?” Seriously, pretend you’re a potential third for a moment. You would want to have total confidence in the fact that both people you’re getting involved with are super excited, on board, and sure of what they want. Otherwise, you could be putting yourself in a situation that could be anything from awkward to dangerous. This is why it’s important to really make sure you know where you stand before bringing this up with your partner and before the two of you look into finding a third.

Then, try to be steadfast in asserting your boundaries, though that’s much easier said than done. If you need help defining your desires and boundaries, I highly recommend checking out the book The Ethical Slut by Janet W. Hardy and Dossie Easton for an introduction on non-monogamy. And for a look at what navigating non-monogamy is like specifically for people of color, Kevin Patterson’s work, specifically Love’s Not Color Blind, is a good alternative or addition. You can also fill out a yes, no, and maybe list of what you’re okay with your partner doing with other people (and ask your partner to do the same).

Make sure you and your partner are on the same page.

When practicing non-monogamy, communicating in ways that are open, authentic, and not harmful becomes especially important. You can tell your partner something like, “I’m interested in trying x, and I imagine that looking like y. I’m wondering how you feel about that.” Give them space to consider how they feel about introducing another person into the relationship and what their desires look like. Then you can get into the nitty-gritty together.

This will most likely take several conversations. That’s okay! You want to be sure that your individual needs within the established relationship jive and that you mutually agree upon (and are excited about!) any tweaks you make to find a middle ground.

After you’ve concluded that you’re both on the same page, make sure you’re both on the right page. If you haven’t considered the potential third as a person with their own needs and not just an extension of your own sex life, it might be time to pause. “Couples lose themselves in a fantasy and forget that it involves another human being with their own complex feelings, desires, and boundaries,” Ivy Q.*, 30, a sexually fluid woman, tells SELF.

Talk through how you’ll handle things if someone gets jealous or hurt.

A common misconception is that those who practice non-monogamy don’t get jealous. Which, no. “It’s okay to have insecurities and feelings of jealousy,” Lucius K.*, 29, a straight man who looks for thirds with his sexually fluid partner, tells SELF. But you have to be open to discussing them.

This can be as simple as talking through what you’ll do if feelings like jealousy arise. For example, if you’re in the middle of a sexual situation and you find yourself feeling insecure, will you pause and discuss your feelings?

“If couples aren’t ready to talk about all the possibilities, they’re not ready to have a threesome,” Sarah says. That could be even more true for triads, since a prolonged relationship between the three of you can provide even more jealousy fodder.

This is also a good opportunity to assess how you communicate in general. If the communication between the two of you isn’t regularly free-flowing and direct, it’s not time to bring in a third, says MJ. No one wants to get caught up in your drama, so clean up your (emotional) house before you have a guest over!

Now it’s time to actually search for your third.

Just like solo-dating on apps, it may take a hot sec to find someone you want to meet up with, but there are ways to up your chances. It comes down to honesty, respect, and communication. Noticing some common themes?

Make it obvious that you’re a couple.

Many apps have settings you can use to indicate that you’re a couple or practicing non-monogamy. On Tinder, for example, you can set your gender to “couple” (which, OK, whatever) and on OKCupid, you can signal your relationship status and the type of relationship it is, including non-monogamous. Utilizing that can help more of the right people swipe right and the wrong people swipe left.

Some apps, like OKCupid or Feeld, allow you to link two separate profiles, which is a good option if you and your partner are using apps to find partners both separately and together. But when you’re just starting to look for a third, setting up a joint profile tends to be better because you can more easily communicate what the two of you are after.

Next up: If you’re sharing pictures (which I would recommend), use pictures of both of you. Setting the first five pictures to be of a woman and then—surprise!—introducing a dude at the end doesn’t count. Both of you should be prominent on the profile so potential thirds can decide if they’re attracted to the two of you.

Craft a bio that’s respectful and accurate.

Writing a bio as a couple is pretty similar to what you’d do if you were solo dating: You want to be engaging, cute, witty, or whatever represents you. You might find it helpful to use even more detail as a couple than you would on your own, though. In the best unicorn-hunting profiles I’ve seen, one-third describes one person, one-third describes the other, and then the final third goes into what they’re searching for.

That last part is so, so important. Please, be honest about your needs. “Whatever you’re looking for—whether it’s sex, romance, or something casual—you should own it and be able to communicate it,” MJ says. “If a couple is dishonest with me, themselves, or each other, that’s a red flag for me.”

You might have a mental image of your ideal third. It’s okay to want what you want, but being super specific gets real tricky real fast. It’s generally considered uncool within non-monogamy to create checkboxes that a potential third has to tick off. This is because of what we call “couple privilege,” wherein your needs are (even subconsciously) placed higher than the third’s. It can be dehumanizing to ask someone to scrunch themselves into a box for your benefit, so don’t.

Remember: There’s someone else on the other side of that screen! You’re not building someone made-to-order; you’re dealing with fully-formed human beings.

Finally, be mindful of your language. It’s often pretty clear when someone sees a potential third as a means to a sexual end rather than as a whole person. Most of us don’t want to be referred to as a birthday gift or a wild night. “Many couples approach us like we’re some exciting new sex toy or an object that exists solely to spice up their relationship,” MJ explains.

When messaging with potential thirds, be upfront.

I recommend striking up a conversation in a way that feels natural, like by showing interest in something you’ve learned from this person’s profile. Once rapport is established, you can ask something like, “What are you looking for on this app?” This shows that you’re interested in their needs, desires, and boundaries.

After they respond, if it seems to line up with your own desires, you can say something like, “My partner and I are interested in x. What are your thoughts on that?” Then, hear them out. You can’t get close to a truly mutually beneficial arrangement unless you’re all honest with each other.

Remember that the goal is a satisfying experience for all three of you.

In the end, each of these strategies is getting at one overarching idea: When you want to bring a third person into your relationship, you have to consider all three people. You and your partner may be an established couple, but the three of you are individuals. The potential third has sexual and emotional needs they’re hoping to have met, too.

“There are so many ways of making people feel secondary, unseen, and worthless,” Simon explains. “The easiest way to validate everyone’s experience is to have each person be able to be clear about what they do and do not want, what they expect, and also for each person to feel respected and humanized by each other person in the experience.”

*Names have been changed to grant anonymity upon request.

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Veggie Chips are No More or Less Healthy Than Regular Chips

The chip aisle is wonderfully colorful and crowded these days, with potato chips cuddling right up next to their newer counterparts: veggie chips chips made from roots and tubers. These bags containing a crispy rainbow of thinly sliced sweet potatoes, beets, parsnips, and the like seem to have earned a permanent place next to their conventional cousins. (Unlike, say, kale or green bean chips, which are a whole ‘nother sector of the alterna-chip economy we’re not even going to get into here.) You might have grabbed them over the bag of regular ol’ potato chips they sit next to, maybe because you think they’re tastier or you feel like being fancy.

But if you’ve been tempted to forsake your beloved potato chips (and shell out a premium, btw) in the name of your health, we need to talk. Because the fact is, veggie chips are no more or less healthy than regular potato chips .

Quick question: Why do people even eat veggie chips?

Potatoes in just about any form are undeniably delicious, but they kind of have an image problem. “Culturally, we’ve all been taught that potatoes in all forms, including potato chips, are unhealthy and ‘fattening,’ per se,” Colleen Tewksbury, Ph.D., M.P.H., R.D., senior research investigator and bariatric program manager at Penn Medicine and president-elect of the Pennsylvania Academy of Nutrition and Dietetics, tells SELF.

The potato chip, in particular, is often attacked in a way that feels a little personal. Diet culture has done a fine job of positioning potato chips as a junk food or guilty pleasure. Once maligned for being too fatty during the low-fat craze; these days, at the height of the low-carb diet trend the starchy root vegetables are just too carby. Classic chips are also on the hit list of processed food-naysayers. These innocent little crisps can’t catch a break.

Enter: the veggie chip, strategically marketed as a more natural, more wholesome, more nutritious chip. “People perceive them as being healthy: Oh, they’re vegetables!” Beth Kitchin, Ph.D., R.D.N., assistant professor in the UAB Department of Nutrition Sciences, tells SELF. And, I get it, veggie chips seem like the perfect answer to someone who’s looking for a salty, crunchy snack but has been told that potato chips are bad for you.

“I think a lot of their appeal is playing into individuals’ desire to have a yummy snack with a healthy angle they can feel better about,” Tewksbury explains. Veggie chips are basically viewed as a way to incorporate more vegetables in your diet while still eating chips, producing a subtle but powerful “health halo” effect, Cara Harbstreet, M.S., R.D., L.D., of Street Smart Nutrition, tells SELF.

The thing is, “Foods that carry the ‘health halo’ don’t necessarily translate into foods that are nutritionally superior,” Harbstreet says, “as is the case with veggie chips versus regular potato chips.”

Get ready for some nutrition label truth-bombs.

Let’s set curious tuber branding conventions aside and turn the bag over to compare what’s actually inside them, nutrition-wise.

Classic potato chips, including Lay’s and Ruffles, typically contain just three ingredients: Potatoes, some kind of vegetable oil (sunflower, corn, and/or canola oil), and salt. (That’s for the plain ones; flavored varieties also contain other ingredients, like food coloring, sugar, cheese, and any number of seasonings and flavorings.)

The ingredient labels for other veggie chips are nearly identical; just swap out the vegetable. For instance, Terra chips—which contain a rotating variety of seasonal root veggies, like sweet potatoes, taro, parsnips, and cassava—have a similarly simple recipe: vegetables, beet juice (for coloring), vegetable oil (canola, safflower, or sunflower), and salt.

The nutrition facts also look strikingly similar. “Depending on the brand you’re looking at, they usually have comparable fat, calorie, carb, and fiber content,” Tewksbury says. The nutritional profile for a 1 oz serving of Classic Lay’s (about 15 chips) and a 1 oz serving of Original Ruffles (about 12 chips) are the same: Both contain 160 calories, 15 g carbs, 1 g fiber, 2 g protein, 10 g fat, and 1.5 g saturated fat.

Meanwhile, a 1 oz serving of the original Terra chips blend contains 150 calories, 16 g carbs, 3 g fiber, 1 g protein, 9 g fat, and 1 g saturated fat. So these contain ever so slightly fewer calories, protein, and fat, as well as marginally more carbs and fiber. (Other options, like sweet potato or beet chips, will contain a bit more naturally-occurring sugar.) So this particular brand and variety does offer two additional grams of fiber, which isn’t nothing but also isn’t huge. And as Harbstreet points out, “since the majority of fiber in the U.S. diet comes from whole grains, it ends up being a negligible difference in most cases.”

“But I’m eating vegetables!” you exclaim, while clutching your bags of veggie chips at Whole Foods. Correction: You are eating chips made of various root vegetables. Know what else is a root vegetable that makes a delicious chip? A POTATO.

“There really aren’t any meaningful nutritional benefits to veggie chips in particular over potato chips,” Tewksbury says. Both are, at the end of the day, just root vegetables that have been thinly sliced, fried, and salted for your snacking pleasure. Or, as Kitchin puts it, “Potato chips aren’t as bad for you as you think they are, and veggie chips aren’t as good for you as you think they are.”

Now, it is true that “you’re getting slightly different sets of vitamins and minerals because you’re eating different tubers,” Tewksbury says. And it is generally great to mix up your veggie intake. But the small differences between different varieties of tubers aren’t enough to make an impact, Tewksbury explains, especially since they’re a snack and not a major component of your diet anyway.

Also, I don’t know who needs to hear this, but veggie chips probably shouldn’t be your main source of vegetables. Yes, they’re mostly made of vegetables. But en route from fresh veggie to crispy chip, vegetables lose nearly all of their water content and gain a good amount of oil. This renders a pretty calorically dense snack that, serving per serving, probably won’t provide quite the same satisfaction or nutritional quality as, say, a baked sweet potato or raw beet salad. “They don’t really fill you up a ton because they’re not heavy,” Kitchin says. “And that also makes it easier to eat a lot of them mindlessly.”

So, from an R.D.’s perspective, the most legit potential downside of veggie chips is not what you’re getting from them, but what else you could be missing if they’re not an addition to other vegetables, but a substitute for them, Tewksbury says.

In summary: All chips are good chips.

If there’s no significant difference in their nutritional value here, there’s a great case to be made for just eating the damn chip, whatever plant it came from.

“In the absence of a significant nutritional difference,” Harbstreet says, “[ask yourself] whether your preference for veggie chips is a true food preference—as in, you genuinely enjoy the flavor and texture more than any other available option—or a food swap or ‘safe food’ that makes you feel more comfortable with the idea of eating chips.”

In other words: If you actually enjoy the veggie chips more—maybe for the novelty factor, the variety, the earthier taste—that’s awesome. If you actually enjoy regular potato chips more, this is an equally awesome and acceptable option. And if you like ‘em both and are just craving something salty and crunchy, either will do. “Either one can really be a fantastic snack option for some people,” as Tewksbury puts it.

But, if you’re just choosing the veggie chips as a consolation prize for denying yourself potato chips, you’re not doing yourself any favors. In fact, you’re more likely to become fixated on the potato chips as a result. “What we restrict or avoid tends to become more tempting over time,” Harbstreet explains, “so that’s something to consider next time you’re faced with the dilemma of choosing what you really want, versus what diet culture says you should have.”

If you’re reaching for the veggie chips “[with] a restrictive mindset whispering that regular potato chips should be avoided, it’s likely going to prompt you to keep thinking about them,” Harbstreet says. You might also be more likely to eat more chips than you usually would—and enjoy what you’re eating less—in an attempt to scratch that potato chip itch.

So eat whatever chips you’re craving. And also eat a variety of vegetables, because they’re delicious and great sources of tons of vitamins of minerals. “If you find yourself relying on veggie chips as a replacement for actual produce in your diet, you might consider some of the barriers preventing you from enjoying vegetables in other forms,” Harbstreet says. For many people, it’s how to prep and cook them in a way that is cost and time effective, as well as lip-smackingly delicious. In that case, Harbstreet recommend working with a dietitian or culinary expert if it’s within your means. For everyone else, here are some recipes and tips for incorporating more vegetables into your diet to get you started.

But also, please continue to eat potato and/or veggie chips every damn day if you please.

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GymCam tracks exercises that wearable monitors can’t

Wearable sensors such as smartwatches have become a popular motivational tool for fitness enthusiasts, but gadgets do not sense all exercises equally. Researchers at Carnegie Mellon University have found that a stationary camera is a better choice for gym exercises.

The vision-based system, called GymCam, detects repetitive motions. By doing so, Rushil Khurana and Karan Ahuja, both Ph.D. students in CMU’s Human-Computer Interaction Institute (HCII), found that they could detect exercises in a gym. Moreover, they could recognize the type of exercise and reliably count repetitions.

“In a gym, the repetitive motion almost always is an exercise,” said Mayank Goel, assistant professor in the HCII and Institute for Software Research. “If you are moving both your arms, you tend to move them together in time. However, if two people are exercising next to each other and performing the same exercise, they are usually not in sync, and we can tell the difference between them.”

Because the system only needs motion information, the camera feed can be reduced to pixel-by-pixel changes and eliminate identifiable faces that would intrude on privacy.

Khurana said that reliance on motion information also addresses a problem for single-camera systems in a crowded gym environment — the inability to see a person’s whole body. Gym equipment or other people can often obscure the camera’s view. GymCam, however, can detect exercise as long as its camera can see any body part moving repetitively.

Khurana and Ahuja will present their findings Thursday, Sept. 12, at the International Joint Conference on Pervasive and Ubiquitous Computing (UbiComp 2019) in London.

Ahuja said smartwatches and other wearables do a reasonable job of tracking many cardio exercises and some strength-training exercises. But their effectiveness depends on where the wearables are worn. A smartwatch might sense a dumbbell lift, but is useless for leg presses. Moreover, it is hard for a watch to differentiate between several body motions. Instrumenting the exercise machines is an option, but an expensive one. A camera, however, is relatively cheap and provides spatial as well as motion information.

The system can also learn the location of types of exercise machines or certain exercise stations in a gym. It can then use an individual’s location, in addition to their movements, to determine the exercise they’re doing.

The researchers tested their algorithm in a crowded gym. But Goel said that the same algorithm works perfectly on a smartphone as well, so a person can use their phone to record and track their workouts at home. Some companies have already expressed interest in using the system for tracking in-home exercises.

The system also might have uses beyond physical exercise. Goel said the camera system, combined with smartwatches worn by individuals, might help people with visual disabilities navigate shopping malls, airports and other public spaces. Instead of using the person’s face as their identity, the system will use their motion as their signature. It allows people to easily opt-out of being tracked or located.

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Heterogeneity in the workplace: ‘Diversity is very important to us — but not in my team’

Diversity in the workplace is highly sought in theory, but often still lacking in practice. A new study shows that people tend to favor diversity for others, but prefer to work with people who are as similar to themselves as possible. A team of researchers from the universities of Basel and Koblenz-Landau published their report in the Journal of Experimental Social Psychology.

Today, many large corporations tout the importance of diversity on their websites, but current statistics show that the typical manager still tends to be white and male. Obviously, there is a dissonance between the desire to bring about diversity and corporate reality.

A team of researchers led by Dr. Mariela Jaffé from the Department of Psychology at the University of Basel studied this discrepancy from a social psychology perspective. This involved conducting four studies with a sampling of 605 people in total. The results showed a significant difference in how people select colleagues for themselves versus for other people.

How do people value diversity?

People have a wide spectrum of opinions concerning diversity. On the one hand, people see value in diversity, which can contribute a variety of perspectives, new ideas and innovative solutions. On the other hand, they assume that it might be difficult to work with someone who has completely different views, speaks a different language, or has a different style of work.

The actual value they attribute to diversity depends on the decision-making perspective. Building on current theories, the researchers have shown that doubts about the practicability of diversity have a greater weight if a person is directly affected. In other words, when a person’s own work group is involved, they tend to prefer team members who are similar to themselves, whereas when people make decisions for other people, these reservations play a lesser role. Typically, a person will then put together a more diverse team.

Consequences of differing preferences

This leads to the conclusion that organizations could become more diverse if hiring and team decisions were not (only) made by those directly affected, but (also) by other people who are not directly involved in the group’s daily work later.

“Research shows that people’s perception of and the importance they attach to diversity have key implications for people’s decision making,” explains lead author Dr. Jaffé. “In a next step it would be important to gain a better understanding of the evaluation of diversity to discuss and resolve concerns about potential disadvantages. This way, people may then be more willing to include dissimilar people in their own teams.”

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Diet impacts the sensitivity of gut microbiome to antibiotics, mouse study finds

Antibiotics save countless lives each year from harmful bacterial infections — but the community of beneficial bacteria that live in human intestines, known as the microbiome, frequently suffers collateral damage.

Peter Belenky, an assistant professor of molecular microbiology and immunology at Brown University, studies ways to minimize this side effect, which can lead to C. diff infections and other life-threatening imbalances in the microbiome. In a new study published on Thursday, Sept. 12, in Cell Metabolism, Belenky and his colleagues found that antibiotics change the composition and metabolism of the gut microbiome in mice, and that a mouse’s diet can mitigate or exacerbate these changes.

The findings are a step, Belenky said, toward helping humans to better tolerate antibiotic treatment.

“Doctors now know that each antibiotic prescription has the potential to lead to some very harmful microbiome-related health outcomes, but they do not have reliable tools to protect this critical community while also treating deadly infections,” Belenky said. “The goal of my lab is to identify new ways to protect the microbiome, which may alleviate some of the worst antibiotic side effects.”

The gut microbiome is an ecosystem comprising trillions of bacteria that have specifically coevolved with its host. This community helps the host in many ways such as breaking down dietary fiber and assisting in the maintenance of overall intestinal health — by ensuring the intestinal cells form a tight barrier and competing for resources with harmful bacteria, Belenky said.

Lead study author Damien Cabral, a doctoral student in Brown’s pathobiology program, treated three groups of mice with different antibiotics, then monitored how the composition of bacteria in the mouse guts changed and how the bacteria adapted at a metabolic level after antibiotic treatment.

Amoxicillin, commonly used to treat ear infections and strep throat, drastically reduced the kinds of bacteria present in the gut and changed the genes used by the remaining bacteria. The researchers also studied ciprofloxacin, used to treat urinary tract infections and typhoid fever, and doxycycline, often applied in treating Lyme disease and sinus infections. The changes associated with those drugs were less pronounced.

One type of potentially beneficial bacteria common in the human gut, Bacteroides thetaiotaomicron, actually flourished after amoxicillin treatment. Following treatment, this bacteria increased its reliance on enzymes that digest fiber, a change that appears to both allow it to thrive in the changed ecosystem and somehow protected it from the antibiotic, Belenky said.

In general, the bacteria decreased the use of genes involved in normal growth, such as making new proteins and DNA. At the same time, they also increased use of genes critical for stress resistance.

Interestingly, Belenky’s team found that adding glucose to a mouse’s diet — which is typically high in fiber and low in simple sugars — increased Bacteroides thetaiotaomicron’s susceptibility to amoxicillin. This hints that diet can protect some beneficial gut bacteria from the ravages of antibiotics.

“For a long time we’ve known that antibiotics impact the microbiome,” Belenky said. “We have also known that diet impacts the microbiome. This is the first paper that brings those two facts together.”

Belenky cautioned that the study was conducted in rodents, and there is still much to learn about the interplay between host diet, microbiome metabolism and vulnerability to different antibiotics.

“Now that we know diet is important for bacterial susceptibility to antibiotics, we can ask new questions about which nutrients are have an impact and see if we can predict the influence of different diets,” he said.

Belenky’s team is exploring how different kinds of dietary fibers impact how the microbiome changes after antibiotic treatment, and how diabetes might impact the microbiome’s metabolic environment and antibiotic susceptibility.

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What multilingual nuns can tell us about dementia

A strong ability in languages may help reduce the risk of developing dementia, says a new University of Waterloo study.

The research, led by Suzanne Tyas, a public health professor at Waterloo, examined the health outcomes of 325 Roman Catholic nuns who were members of the Sisters of Notre Dame in the United States. The data was drawn from a larger, internationally recognized study examining the Sisters, known as the Nun Study.

The researchers found that six per cent of the nuns who spoke four or more languages developed dementia, compared to 31 per cent of those who only spoke one. However, knowing two or three languages did not significantly reduce the risk in this study, which differs from some previous research.

“The Nun Study is unique: It is a natural experiment, with very different lives in childhood and adolescence before entering the convent, contrasted with very similar adult lives in the convent,” said Tyas. “This gives us the ability to look at early-life factors on health later in life without worrying about all the other factors, such as socioeconomic status and genetics, which usually vary from person to person during adulthood and can weaken other studies.”

Tyas added, “Language is a complex ability of the human brain, and switching between different languages takes cognitive flexibility. So it makes sense that the extra mental exercise multilinguals would get from speaking four or more languages might help their brains be in better shape than monolinguals.”

The researchers also examined 106 samples of the nuns’ written work and compared it to the broader findings. They found that written linguistic ability affected whether the individuals were at greater risk of developing dementia. For example, idea density — the number of ideas expressed succinctly in written work — helped reduce the risk even more than multilingualism.

“This study shows that while multilingualism may be important, we should also be looking further into other examples of linguistic ability,” said Tyas. “In addition, we need to know more about multilingualism and what aspects are important — such as the age when a language is first learned, how often each language is spoken, and how similar or different these languages are. This knowledge can guide strategies to promote multilingualism and other linguistic training to reduce the risk of developing dementia.”

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Shifting attention can interfere with our perceptions of reality

We live in a world of distractions. We multitask our way through our days. We wear watches that alert us to text messages. We carry phones that buzz with breaking news.

You might even be reading this story because you got distracted.

A new study suggests that distractions — those pesky interruptions that pull us away from our goals — might change our perception of what’s real, making us believe we saw something different from what we actually saw.

Even more troubling, the study suggests people might not realize their perception has changed — to the contrary, they might feel great confidence in what they think they saw.

“We wanted to find out what happens if you’re trying to pay attention to one thing and something else interferes,” said Julie Golomb, senior author and associate professor of psychology at The Ohio State University. “Our visual environment contains way too many things for us to process in a given moment, so how do we reconcile those pressures?”

The results, published online recently in the Journal of Experimental Psychology: Human Perception and Performance, indicate that, sometimes, we don’t.

Results showed that people sometimes confused the color of an object they were supposed to remember with one that was a distraction. Others overcompensated and thought the color they were supposed to remember was even more different from the distraction object than it actually was.

“It implies that there are deeper consequences of having your attention drawn away that might actually change what you are perceiving,” said Golomb, who is director of Ohio State’s Vision and Cognitive Neuroscience Laboratory. “It showed us that we clearly don’t understand the full implications of distraction.”

To evaluate how distraction interacts with reality, the researchers showed study participants four different-colored squares on a computer screen. The researchers asked participants to focus on one specific square. But sometimes a bright distractor appeared around a different square, pulling the participant’s attention away, even briefly, from the original square of focus.

The researchers then showed study participants a color wheel containing the entire color spectrum and asked them to click on the wheel where the color most closely matched the color of the original square.

Participants then highlighted a range of the color wheel to indicate how confident they were in their choice. Highlighting a narrow range indicated great confidence; highlighting a wider range indicated less confidence.

The results showed that the distraction color “bled” into the focus color in one of two ways: Either people thought the focus square was the color of the distraction square, or they overcompensated, choosing a hue of the focus color that was farther away on the color wheel from the distraction color.

For example, if the focus square was green and the distraction color orange, participants clicked in the blue-green area of the wheel — close to the original color, but farther away from the distraction color, as if to overcompensate.

Even more striking, the results showed participants were just as confident when they clicked on the distraction color as when they selected the correct color.

“It means that, on average, those two types of responses were associated with the same confidence range size,” Golomb said. “On the trials where they reported the distractor color, they didn’t seem aware that it was an error.”

This study included 26 participants. Additional research is already underway at Ohio State to attempt to answer more questions about the ways in which distractions interact with reality.

“It raises an interesting consequence for memory — could it be that, if distraction happens with the right timing, you might adopt elements from the distraction into the thing you think you remember? Could it mean that some of our memory errors might be because we perceived something wrong in the first place?” said Jiageng Chen, lead author and graduate student researcher at Ohio State’s Vision and Cognitive Neuroscience Laboratory. “We don’t know yet, but it is an interesting area for future study.”

Andrew Leber, an associate professor of psychology at Ohio State, is also co-author of this research, which was funded by grants from the National Institutes of Health and the National Science Foundation.