We took Ozempic thinking we’d lose weight — we didn’t, and here’s why
Alex Mitchell – April 1, 2024
Turns out drugs like Ozempic may not be the wonder cure many praised them to be for weight loss.
Here’s a sad jab of the truth.
More evidence is coming out that pricey semaglutides like Ozempic and Wegovy — diabetes medications lauded for secondary weight loss capabilities through appetite suppression — aren’t necessarily helping as many people shed pounds as previously thought.
“There was appetite suppression the first 1½ months but it’s kind of just fallen off after that,” Nashville, Tennessee, resident Melissa Traeger, 40, told the Wall Street Journal regarding her lack of success on the medication type, also known as GLP-1s.
At first, the 300-pound Traeger quickly dropped 10 pounds, but the next five came more stagnantly — and then she said no more weight was lost.
Another man, Anthony Esposito, 68, of Austin, Texas, saw no success on either Ozempic or Wegovy, just feelings of sickness while he took them.
“It did not budge the needle,” he said.
Traeger and Esposito are among many frustrated users, according to the Journal, which also cited a trial that showed only about 14% of patients cut more than 5% of bodyweight, while only one-third lost 10% of it.
Another report published on Epic Research saw that 17.7% of semaglutide users regained all of their weight — if not more — upon stopping.
Ozempic apparently isn’t helping as many people as typically thought. Wild Awake – stock.adobe.com
Doctors have also observed many “non-responders” — about 10% to 15% of people who lose 5% or less of their body weight.
“There’s going to be extreme variability in how people respond,” Dr. Eduardo Grunvald, an obesity-medicine physician at UC San Diego Health, told the Journal.
Grunvald added that issues of weight gain may go beyond something in hormones that the drugs imitate to regulate appetite. He also said that peoples’ other medical issues may play a factor, such as how those with Type 2 diabetes typically lose less than those without the disease.
The doctor added that prior exercise and eating habits before starting the drugs are also highly influential factors.
Those who have made healthy lifestyle changes and already lost weight likely don’t get that much added bonus from the medications.
People who have struggled with obesity for a lifetime may additionally have a genetic mutation that prevents the drugs’ potency, according to Dr. Steven Heymsfield of Louisiana State University’s Pennington Biomedical Research Center.
Some patients on drugs like Ozempic aren’t losing weight. myskin – stock.adobe.comDrugs like Ozempic reportedly aren’t showing be-all, end-all impacts on patients’ lives. Natalia – stock.adobe.com
He added that those who can metabolize drugs quickly also might not see much out of them in this case.
Taking other medications as well, especially antipsychotics or antidepressants, can be associated with weight gain as a side effect.
“You could have some other drug interactions that prevent the effect of the GLP-1 drugs from working,” Heymsfield told the Journal.
5 Sneaky Signs You Have Insulin Resistance, According to Dietitians
Allison Knott, MS, RDN, CSSD – April 1, 2024
Some of the symptoms on this list are easy to miss.
Getty Images
Reviewed by Dietitian Emily Lachtrupp, M.S., RD
Four out of 10 adults between the ages of 18 and 44 have an often-overlooked health condition that can lead to type 2 diabetes, according to research published in 2022 in The Journal of Clinical Endocrinology & Metabolism: Insulin resistance.
When you have insulin resistance, your body doesn’t respond effectively to insulin, a hormone that pushes blood glucose into your cells where it can be used for energy, says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Because of this, the body demands more insulin to help the cells absorb glucose. “This leads to higher levels of both insulin and glucose in the bloodstream,” says Emily Cornelius, RD, a registered dietitian and insulin resistance expert. “Over time, this can lead to various health complications like prediabetes and type 2 diabetes,” she explains.
The catch? Insulin resistance often doesn’t have any signs or symptoms. This can make it difficult to identify before it progresses to prediabetes or type 2 diabetes. But the good news is that insulin resistance can be managed and even reversed when addressed early. That’s why paying attention to the signs of this condition—many of which are sneaky—is so important. Here’s what you need to know.
Changes to the skin are one of the lesser-known signs of insulin resistance. In some people, insulin resistance can lead to the development of skin tags or acanthosis nigricans (dark patches of skin on the neck or under the armpits), both of which are thought to be related to excess insulin production, according to the NIDDK. If you have questions about your skin, talk to a dermatologist.
2. You May Have Gained Weight
Weight gain may be a sign of insulin resistance, particularly if you have excess abdominal fat called visceral fat, according to the Journal of Clinical Medicine in 2019. Weight gain alone puts you at risk for developing insulin resistance, but insulin resistance itself can also lead to weight gain resulting in a cycle that can progress over time. That said, it doesn’t have to be a large amount of weight gain, either. Data in The Journal of Clinical Endocrinology & Metabolism in 2022 found that half of adults with insulin resistance did not have weights that were considered obese.
3. You Experience Brain Fog
Being insulin resistant means that glucose isn’t as readily available to provide energy for cells, including those in the brain. Because of this, you may feel what’s commonly referred to as “brain fog.” Research suggests that people who have insulin resistance may have worse cognitive performance compared to those who don’t have the condition, found a study in Diabetes Research and Clinical Practicein 2020. Insulin resistance may impair important brain processes that affect mental clarity.
4. You’re Always Hungry
Hunger is influenced by a combination of hormones, one being insulin. With insulin resistance, you may experience frequent hunger. Why? Insulin resistance causes high blood sugar, a symptom of which is increased hunger.
Because the cells don’t get the energy they need from glucose, you may also feel fatigued. It’s important to note that many other health conditions can affect energy levels. Be sure to talk to your doctor about persistent fatigue.
How Is Insulin Resistance Diagnosed?
Many of the tests to diagnose insulin resistance are time-consuming and expensive. For this reason, they’re often only used in research studies and not in medical offices, according to the NIDDK. Prediabetes is a condition that is diagnosed, which is done through blood testing like a fasting plasma glucose test or A1C test. The Centers for Disease Control and Prevention points out that having a combination of high blood sugar, high triglycerides, high “bad” LDL cholesterol and low “good” HDL cholesterol can alert you to the fact that you probably have insulin resistance.
Strategies to Improve and Prevent Insulin Resistance
Balance Meals
The foods you eat have a significant effect on blood glucose and can help to stabilize levels throughout the day. “When working on reversing insulin resistance, it’s critical to look at it from a holistic perspective, but the diet plays a foundational role,” says Cornelius. “Eating a balanced diet that includes protein, fat and fiber helps to lessen spikes during meals,” she says.
Focus on Minimally Processed Foods
Many processed foods—fast food, packaged desserts, snack mixes, sodas, chicken nuggets, hot dogs and more—are rich in saturated fat or sugar or both, and are calorically dense, making them easy to overeat, something that can lead to weight gain and the development of visceral fat.
“Prioritizing whole-nutrient dense foods such as fresh fruits, vegetables, whole grains and lean proteins along with controlling portion sizes and consistent and spaced meal timings can help improve insulin sensitivity,” says registered dietitian nutritionist Cari Riker. Eating this way can also help with weight management.
Don’t Fear Carbohydrates
Fiber-rich carbs are the way to go. “Carbohydrates often get a bad reputation when it comes to blood sugar discussions; however, fiber is a type of carb that doesn’t get fully digested and absorbed. So its impact on your blood sugar levels is significantly different than that of added sugars,” says registered dietitian Alyssa Pacheco. Choose high-fiber foods often as part of a balanced diet. Foods like whole grains, beans, vegetables and fruits, nuts and seeds can all contribute to the recommended 25 to 38 grams of daily fiber.
Eat Magnesium-Rich Foods
Foods that are a good source of fiber are also often a good source of magnesium, a nutrient that plays a critical role in glucose metabolism. “Magnesium is another nutrient to make sure you’re getting enough of, since a deficiency can worsen insulin resistance. Good food sources of magnesium include beans, spinach, almonds, pumpkin seeds, cashews and avocados,” says Pacheco.
Fit in Physical Activity
It’s time to get on the move. “Another important strategy is moving your body throughout the day, since it lowers blood sugar,” says Cornelius. Physical activity improves insulin sensitivity, according to the American Diabetes Association, helping to manage or reverse insulin resistance. Find an activity you enjoy and do it regularly to combat insulin resistance.
According to the CDC, no single test can determine if you have insulin resistance. Having health conditions like high blood sugar levels, high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol and high triglycerides may indicate insulin resistance.
What is the main cause of insulin resistance?
A family history of type 2 diabetes, being overweight or having obesity and a sedentary lifestyle can all increase the risk of developing insulin resistance.
How do you fix insulin resistance?
Strategies like increasing activity, weight loss, a healthy diet, improving sleep quality and reducing stress can all help improve insulin resistance.
The Bottom Line
Maintaining a healthy blood sugar range is essential for longevity and the prevention of chronic disease. Regular physical activity and eating a balanced diet can help with preventing insulin resistance, but because many other factors are at play in the development of this condition, it’s equally as important to know the signs and symptoms for early detection. If you suspect you have insulin resistance, reach out to your doctor or registered dietitian to help you develop a plan to manage or reverse it over time.
Gastrointestinal (GI) symptoms affect most people from time to time. The gastrointestinal tract is the body’s digestive system. Common GI symptoms include bloating, indigestion, and heartburn. Other symptoms that may indicate a health problem may include sudden abdominal pain, constant diarrhea, and bloody stool.
This article discusses serious GI symptoms that should never be ignored, their possible causes, and what to do about them.
Kate Wieser / Getty Images
Stomach Cramps
Stomach cramps are a common GI symptom that often feels like a dull, aching pain. The discomfort may be constant or come and go. Common causes of stomach cramps include constipation, gas, diarrhea, a virus, hormonal medication, a menstrual period, pregnancy, and ovulation.
Kidney stones: hard deposits that may become lodged in the urinary tract or ureter
Diverticulitis: occurs when small sacs or pouches in the colon become inflamed and cause pain and cramping
Appendicitis: an inflammation of the appendix that causes significant abdominal pain and cramping
Pancreatitis: an inflammation of the pancreas that causes abdominal pain, cramping, and vomiting
Endometriosis: when endometrial tissue grows outside the uterus and causes significant pain and cramping during the menstrual cycle
Swollen Belly
If you notice a swollen belly, it is likely due to bloating. Common causes of bloating are gas, indigestion, premenstrual syndrome (PMS), IBS, or lactose intolerance, which causes bloating, gas, and diarrhea after ingesting lactose (dairy products).
Serious causes of a swollen belly include:
IBD
Ascites: a buildup of fluid in the abdomen caused by chronic liver disease
Gallstones
Pancreatitis
Ovarian cyst: a fluid-filled sac on or in the ovary that causes abdominal pain and swelling
Bloody vomit indicates bleeding somewhere in your digestive tract. Never ignore bloody vomit because the cause of the bleeding requires treatment. Possible causes of bloody vomit include:
Bleeding ulcer: a sore on the lining of the stomach or small intestine that may bleed and cause vomiting
Chronic pancreatitis: may lead to bleeding in the upper part of the GI tract
Tumor: a tumor in the GI tract may irritate the tissues and cause bleeding
Traumatic injury: an injury to the abdominal area that may lead to internal bleeding (see a healthcare provider immediately if this happens)
Blood in the stool or urine means you are bleeding somewhere in your lower GI or urinary tract. A small amount of bright red blood with straining may indicate hemorrhoids. Serious causes of bloody stool may include:
Anal fissure: a small tear in the lining of the rectum that causes drops of red blood when you wipe after using the bathroom
Diverticulitis: a condition that can lead to diverticular bleeding
Infectious colitis: an infection in the colon that causes inflammation and bleeding
Colon polyps: growths on the lining of the colon and rectum that may become irritated and start bleeding
Colorectal cancer: cancer of the colon or rectum in which cancerous growths may cause bleeding
A small amount of blood in the urine after a procedure on the bladder or urinary tract is common. For example, you may experience a small amount of bleeding after having a catheter. People who menstruate may notice blood in their urine caused by their menstrual period. Serious causes of bloody urine may include:
Sexually transmitted infections (STI): Blood in the urine is a possible sign of chlamydia or gonorrhea
Bladder or kidney cancer: the cancerous growth may cause irritation and bleeding
Sickle cell disease: an inherited red blood cell disorder that causes pain and bleeding
Pain in the Upper Stomach
Pain in the upper area of your stomach may indicate indigestion or heartburn. Sudden upper abdominal pain may indicate a problem with the organs located in that area. The stomach, pancreas, spleen, liver, gallbladder, and bile ducts are in the upper abdomen. Serious causes of upper stomach pain may include:
Splenomegaly: an enlarged spleen may cause upper abdominal pain
Gallstones
Cholecystitis: an inflammation of the gallbladder that often causes nausea and upper abdominal pain
Hepatitis: Inflammation of the liver is usually caused by an infection; one sign of hepatitis is upper abdominal pain
Cancer: cancer of the stomach, pancreas, liver, gallbladder, or bile ducts may cause pain
Lower Right Abdominal Pain
Pain in the lower abdominal area may indicate constipation, diarrhea, or menstrual cramps. If you notice pain localized in the right side of the lower abdomen, it may be your appendix. Lower right quadrant pain could mean inflammation in your appendix (appendicitis). Rarely, it could indicate appendix cancer.
Constantly Feeling Full
Feeling full without eating or after eating only a small amount is not normal. Temporary causes of feeling very full could be eating habits, indigestion, or constipation. More serious causes of constantly feeling full may include:
Gastroparesis: a disorder that causes the stomach to empty slowly
Gastritis: an inflammation of the stomach lining that may cause you to feel full
Pancreatitis
Black Stool
Black stool usually means that there is bleeding in the digestive tract. Certain foods and supplements, such as blueberries or iron supplements, can make stool appear darker. Black stool could mean esophagus, stomach, or small intestine bleeding. It may also mean that you have a bleeding ulcer.
Sudden Pulsing Pain
It is possible to feel a pulsing sensation in the abdomen because of a large blood vessel called the abdominal aorta. You may feel the abdominal aorta pulse when there is more blood flow due to pregnancy, eating, or positioning (lying down). An abdominal aortic aneurysm could cause sudden pulsing pain in the abdomen.
Strong Hunger Pangs
It is normal to feel hunger pangs when you have gone a long time without eating. Hunger is your body’s way of communicating that it is time to eat. Common causes of hunger pangs include hunger, dehydration, and constipation. Serious causes of intense hunger pangs may include:
IBS
Peptic ulcer
Anxiety: causes physical symptoms, including stomach discomfort and intestinal spasms that may feel like hunger pangs
Medications: including antidepressants, antipsychotics, diabetes medications, steroids, and anticonvulsants (seizure medications), which can cause hunger and weight gain
Constant Diarrhea
Most people experience diarrhea or loose stools from time to time. If you have been experiencing constant or chronic diarrhea, see a healthcare provider. The types of diarrhea that may indicate a health problem include:
Watery: may be caused by an infection, food poisoning, or IBS
Inflammatory: occurs when the colon is inflamed from infection, IBD, diverticulitis, or cancer
Bloody: indicates inflammation or colon cancer
Summary
Gastrointestinal symptoms are common and often include heartburn, indigestion, bloating, and cramping. Other GI symptoms are more serious and may indicate a health problem. If you ever experience bleeding with vomiting, urinating, or releasing stool, see a healthcare provider. Seek medical attention if you notice sudden abdominal pain that does not improve.
The pandemic played a role in increased consumption, but alcohol use among people 65 and older was climbing even before 2020. (Luisa Jung/The New York Times)
The phone awakened Doug Nordman at 3 a.m. A surgeon was calling from a hospital in Grand Junction, Colorado, where Nordman’s father had arrived at the emergency room, incoherent and in pain, and then lost consciousness.
At first, the staff had thought he was suffering a heart attack, but a CT scan found that part of his small intestine had been perforated. A surgical team repaired the hole, saving his life, but the surgeon had some questions.
“Was your father an alcoholic?” he asked. The doctors had found Dean Nordman malnourished, his peritoneal cavity “awash with alcohol.”
Doug Nordman, a military personal finance author living in Oahu, Hawaii, explained that his 77-year-old dad had long been a classic social drinker: a scotch and water with his wife before dinner, which got topped off during dinner, then another after dinner, and perhaps a nightcap.
Having three to four drinks daily exceeds current dietary guidelines, which define moderate consumption as two drinks a day for men and one for women, or less. But “that was the normal drinking culture of the time,” Doug Nordman, now 63, said.
At the time of his hospitalization, though, Dean Nordman, a retired electrical engineer, was widowed, living alone and developing symptoms of dementia. He got lost while driving, struggled with household chores and complained of a “slipping memory.”
He had waved off his two sons’ offers of help, saying he was fine. During that hospitalization, however, Doug Nordman found hardly any food in his father’s apartment. Worse, reviewing his father’s credit card statements, “I saw recurring charges from the Liquor Barn and realized he was drinking a pint of scotch a day,” he said.
Public health officials are increasingly alarmed by older Americans’ drinking. The annual number of alcohol-related deaths from 2020 through 2021 exceeded 178,000, according to recently released data from the Centers for Disease Control and Prevention. That is more deaths than from all drug overdoses combined.
An analysis by the National Institute on Alcohol Abuse and Alcoholism shows that people over 65 accounted for 38% of that total. From 1999 to 2020, the 237% increase in alcohol-related deaths among those over age 55 was higher than for any age group except 25- to 34-year-olds.
Americans largely fail to recognize the hazards of alcohol, said George Koob, director of the institute. “Alcohol is a social lubricant when used within the guidelines, but I don’t think they realize that as the dose increases it becomes a toxin,” he said. “And the older population is even less likely to recognize that.”
The growing number of older people accounts for much of the increase in deaths, Koob said. An aging population foreshadows a continuing surge that worries health care providers and elder advocates, even if older people’s drinking behavior doesn’t change.
But it has been changing. The proportions of people over 65 who report using alcohol in the past year (about 56%) and the past month (about 43%) are lower than for all other groups of adults. But older drinkers are markedly more likely to do it frequently, 20 or more days a month, than younger ones.
Moreover, a 2018 meta-analysis found that binge drinking (defined as four or more drinks on a single occasion for women, five or more for men) had climbed nearly 40% among older Americans over the past 10 to 15 years.
What’s going on here?
The pandemic has clearly played a role. The CDC reported that deaths attributable directly to alcohol use, emergency room visits associated with alcohol, and alcohol sales per capita all rose from 2019 to 2020, as COVID-19 arrived and restrictions took hold.
“A lot of stressors impacted us: the isolation, the worries about getting sick,” Koob said. “They point to people drinking more to cope with that stress.”
Researchers also cite a cohort effect. Compared with those before and after them, “the boomers are a substance-using generation,” said Keith Humphreys, a psychologist and addiction researcher at Stanford. And they’re not abandoning their youthful behavior, he said.
Studies show a narrowing gender divide, too. “Women have been the drivers of change in this age group,” Humphreys said.
From 1997 to 2014, drinking rose an average of 0.7% a year for men over 60, while their binge drinking remained stable. Among older women, drinking climbed by 1.6% annually, with binge drinking up 3.7%.
“Contrary to stereotypes, upper-middle-class, educated people have higher rates of drinking,” Humphreys explained. In recent decades, as women grew more educated, they entered workplaces where drinking was normative; they also had more disposable income. “The women retiring now are more likely to drink than their mothers and grandmothers,” he said.
Yet alcohol use packs a greater wallop for older people, especially for women, who become intoxicated more quickly than men because they’re smaller and have fewer of the gut enzymes that metabolize alcohol.
Seniors may argue that they are merely drinking the way they always have, but “equivalent amounts of alcohol have much more disastrous consequences for older adults,” whose bodies cannot process it as quickly, said Dr. David Oslin, a psychiatrist at the University of Pennsylvania and the Veterans Affairs Medical Center in Philadelphia.
“It causes slower thinking, slower reaction time and less cognitive capacity when you’re older,” he said, ticking off the risks.
Long associated with liver diseases, alcohol also “exacerbates cardiovascular disease, renal disease and, if you’ve been drinking for many years, there’s an increase in certain kinds of cancers,” he said. Drinking contributes to falls, a major cause of injury as people age, and disrupts sleep.
Older adults also take a lot of prescription drugs, and alcohol interacts with a long list of them. These interactions can be particularly common with pain medications and sleep aids like benzodiazepines, sometimes causing oversedation. In other cases, alcohol can reduce a drug’s effectiveness.
Oslin cautions that while many prescription bottles carry labels that warn against using those drugs with alcohol, patients may shrug that off, explaining that they take their pills in the morning and don’t drink until evening.
“Those medications are in your system all day long, so when you drink, there’s still that interaction,” he tells them.
One proposal for combating alcohol misuse among older people is to raise the federal tax on alcohol, for the first time in decades.
“Alcohol consumption is price-sensitive, and it’s pretty cheap right now relative to income,” Humphreys said.
Resisting industry lobbying and making alcohol more expensive, the way higher taxes have made cigarettes more expensive, could reduce use.
So could eliminating barriers to treatment.
Treatments for excessive alcohol use, including psychotherapy and medications, are no less effective for older patients, Oslin said. In fact, “age is actually the best predictor of a positive response,” he said, adding that “treatment doesn’t necessarily mean you have to become abstinent. We work with people to moderate their drinking.”
But the 2008 federal law requiring health insurers to provide parity — meaning the same coverage for mental health, including substance use disorders, as for other medical conditions — doesn’t apply to Medicare. Several policy and advocacy groups are working to eliminate such disparities.
Dean Nordman never sought treatment for his drinking, but after his emergency surgery, his sons moved him into a nursing home, where antidepressants and a lack of access to alcohol improved his mood and his sociability. He died in the facility’s memory care unit in 2017.
Doug Nordman, whom his father had introduced to beer at 13, had been a heavy drinker himself, he said, “to the point of blackout” as a college student, and a social drinker thereafter.
But as he watched his father decline, “I realized this was ridiculous,” he recalled. Alcohol can exacerbate the progression of cognitive decline, and he had a family history.
He has remained sober since that pre-dawn phone call 13 years ago.
PCOS symptoms are still difficult for doctors to diagnose and treat. Here’s why
Caroline Hopkins – March 31, 2024
Every morning, Jeni Gutke swallows 12 pills. In the evening, she takes 15 more, then another before bed. She also takes an injectable medication once weekly, and two other medications as needed.
Gutke, of Joliet, Illinois, has polycystic ovary syndrome, or PCOS, and the medications and supplements help the 45-year-old cope with migraines, high blood pressure, diabetes, high cholesterol, anxiety and depression that come with the complex hormonal condition.
Not one of Gutke’s medications are technically “PCOS drugs.”
portrait (Courtesy Jeni Gutke)
The Food and Drug Administration has not approved a medication specifically for PCOS, which is often linked to infertility, irregular or missed periods, weight problems, and other debilitating symptoms. Gutke’s array of medications is typical of how many of the estimated 5 million women in the U.S. diagnosed with PCOS deal with it.
“It’s such a vast syndrome that affects everything from your head to your toes,” she said. She was diagnosed with endometrial cancer — another risk linked to PCOS — at age 37.
After nearly a century of disagreements over what, exactly, defines the condition, as well as a lack of research, PCOS is still poorly understood. The symptoms vary so widely that any single drug would be unlikely to help all patients, said Dr. Heather Huddleston, a reproductive endocrinologist at the University of California, San Francisco and director of UCSF’s PCOS Clinic.
Women with PCOS and the doctors who care for them say they want better options — treatments for the condition’s root causes rather than bandages for individual symptoms. Even as calls for better treatments grow, the lack of investment in PCOS research has limited doctors’ ability to help their patients.
“It gets very messy to try to identify one treatment that’s going to work for everybody,” Huddleston said.
Many women with the condition end up taking off-label prescriptions — meaning drugs technically approved for other conditions, like diabetes or obesity — to help PCOS-related symptoms. Navigating insurance coverage for off-label prescriptions can be challenging.
“There’s no magic pill,” said Tallene Hacatoryan, 31, a registered dietician from Orange County, California. “There are too many components for there to be a one-size-fits-all treatment.”
Hacatoryan was diagnosed with PCOS at age 18 and now works as a diet and lifestyle coach for women with PCOS.
Although research is murky when it comes to the best diet for women with PCOS, the most up-to-date international guidelines recommend exercise and a healthy diet. There’s no evidence that any particular diet improves symptoms, although some women have found lifestyle coaching helpful.
A spokesperson at the NIH said that it’s too early to know which women’s health conditions will receive funding under the new initiative.
“Given how common PCOS is, the amount of funding it’s gotten is proportionately extremely small,” Huddleston said.
Government funding is just one part of the total research budget for a given disease. While it’s tough to pin down a dollar figure for private industry spending, experts say the lack of FDA-approved PCOS treatments reflects a lack of investment from drugmakers, too.
Developing PCOS treatments requires a better understanding of the condition. This, in turn, requires far more research tracking thousands of women over many years, which can be extremely expensive, experts say.
However, there are some promising signs.
Although research is early and only in a few dozen women, there are a handful of small drug companies studying possible PCOS treatments. A Menlo Park, California-based company called May Health, for instance, is developing a one-time surgical procedure it thinks could help with PCOS. Spruce Bio, a San Francisco biotech firm, is running a small clinical trial with a drug called tildacerfont for PCOS. It is not clear yet if the oral drug works. President and CFO Samir Gharib said larger clinical trials will depend on the company’s ability to “secure additional financing” or partner with another drug company.
The FDA recently attended a meeting with advocacy group PCOS Challenge where women shared their experiences with the agency’s scientists and drug companies. No PCOS drug trials were announced after the meeting, but the FDA’s interest shows a growing push for improved treatment, said William Patterson, a spokesperson for PCOS Challenge.
No known cure for PCOS
Doctors recommend hormonal contraceptives — most commonly the birth control pill — to regulate heavy, irregular periods;, acne;, and unwanted hair growth. Others say taking the pill just masks, rather than treats, their PCOS symptoms and the symptoms return as soon as they stop taking it.
“PCOS is unfortunately not curable, so treatment is about managing its symptoms,” said Dr. Jessica Chan, a reproductive endocrinologist at Cedars-Sinai. Chan said birth control can be a good option for some, but not all, of her PCOS patients.
For women with PCOS whose main concerns are insulin resistance or stubborn weight gain, Chan often prescribes off-label diabetes medications like metformin.
Some doctors who treat PCOS, including OB-GYNs or endocrinologists, have also begun prescribing GLP-1 agonists like Ozempic and Wegovy, which have shown promise for some women with PCOS, although studies have been small and early -stage.
Novo Nordisk, the company that makes Ozempic and Wegovy, said it has no plans as of now to seek FDA approval for PCOS. Still, the company mentions PCOS on its Truth About Weight website, part of its marketing campaign for Wegovy
Causes and symptoms of PCOS
“We don’t know the initial spark leading to PCOS or where it arises from,” Chan said.
PCOS affects an estimated 6% to 12% of reproductive-age women in the U.S. The real prevalence is likely higher since an estimated 70% of cases go undetected.
Experts generally agree that PCOS, at its core, is a hormone-related condition. Women with PCOS have higher levels of androgen hormones, which can cause a range of symptoms, including:
Missing, irregular, or heavy periods
Acne
Excess hair growth on the face or body
Thinning or balding scalp hair
According to endocrinologist Dr. Andrea Dunaif, some doctors have been pushing to separate PCOS into two different diagnoses: one having more to do with the reproductive cycle and fertility issues and another having more to do with metabolism, high body weight, and diabetes.
“PCOS looks to be at least two or three different conditions we’re lumping together, but they’re genetically distinct,” said Dunaif, the chief of the endocrinology, diabetes and bone disease division of Mount Sinai Health System and the Icahn School of Medicine.
The confusion surrounding PCOS diagnosis is partly why it’s been hard to get large pharmaceutical companies to invest in PCOS treatment, she said.
In Dunaif’s view, it’s not accurate to call the condition “PCOS” at all, because it has more to do with excess hormones than it does with actual cysts on the ovaries. PCOS got its name from the bumps on the ovaries appearing like cysts on an ultrasound image. These are not cysts, but instead egg follicles that are, as Dunaif described them, “arrested in development.”
As it is, many doctors diagnose the condition based on two of three factors:
Irregular periods
High androgen levels
Multiple follicles on the patient’s ovaries
But these three factors don’t account for some of the most challenging symptoms of PCOS: insulin resistance and stubborn weight gain. Excess androgen hormones can spike insulin levels, which interferes with how the body processes sugar. Doctors aren’t sure whether the hormonal dysregulation causes insulin resistance, or whether insulin resistance causes excess androgen hormones.
Either way, women with PCOS have a higher risk of diabetes, excess weight gain, high cholesterol, and high blood pressure. Yet these metabolic conditions aren’t included in the criteria many doctors use to diagnose PCOS. The result? A missed diagnosis.
This was initially the case for Candice Bolden, 35, who started noticing acne and excess facial and body hair several years before she was diagnosed with PCOS in 2021. Bolden, a lifelong dancer, also had unusually low energy.
portrait (Courtesy Candice Bolden)
“The final straw was excess weight gain that I could not take off no matter what I did,” said Bolden, who lives in Los Angeles. “All the other things I had kind of just stuffed under the rug. I’d just chalked it up to being a hairy, Haitian woman.”
After gaining 35 pounds, the 5-foot-2-inch Bolden, who exercised twice a day and followed strict diets, saw multiple doctors who she said ignored her symptoms.
“Doctors kept telling me I was fine, and to go home, work out, and eat clean,” she said. “It was the most frustrating thing ever.”
‘We don’t have to live underneath this dark cloud’
Women living with PCOS say the rise of online communities, including on social media apps like TikTok and Instagram, has given them a place to speak out, share the treatment approaches working for them, and meet other women with PCOS.
When Bolden finally got a diagnosis, she wasn’t sure what to do next. Gutke and Hacatoryan had similar experiences.
“I was like, ‘Wait, I have so many questions,’ and the doctor just told me, ‘It is what it is,’” Hacatoryan said.
Hacatoryan calls women in her online community her “cysters.”
Bolden said she’s noticed more women turning to social media to learn how others manage their PCOS and share their own stories.
On her own social media accounts, she’s been trying to change the narrative about PCOS being primarily a fertility problem, which she sees as an outdated perception.
“When I was diagnosed, my doctor mentioned PCOS being the No. 1 reason for infertility, and that shattered me,” said Bolden, who was newly engaged at the time and eager to start a family. “I was happy I was diagnosed, because it showed me something was actually happening and I wasn’t just crazy. But I was heartbroken.”
Things changed after Bolden moved; found a new doctor; and worked closely with her husband and the online PCOS community to find a system that worked to manage her PCOS symptoms.
Bolden is now pregnant and expecting a baby girl.
“I want people diagnosed with PCOS to know there’s hope, and we don’t have to live underneath this dark cloud all the time,” she said.
‘After Years Of Failed Fad Diets And Workouts, I Started Lifting Heavy Weights At 43′
Jenna Seguin, as told to Andi Breitowich – March 30, 2024
‘I Tried Every Diet, But This Changed Everything’Courtesy of Jenna Seguin
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I’ve always tried to eat well and exercise, but I lacked consistency. Whether it was the Whole30 diet, 75 Hard challenge, or a month-long bootcamp, everything always had a clear start and end date. I was quick to move on and, consequently, never saw lasting results.
In April 2021, I finally had enough. I realized doing the same thing over and over without results is scarier than trying something new, so I set up a meeting with a personal trainer at my local gym. I experimented with lifting weights in my early 20s here and there, but I was never consistent and didn’t follow a program. But I’m a lifelong learner who enjoys getting out of my comfort zone. My goals were simple, yet ambitious: I wanted to master the big lifts—bench press, squat, and deadlift—and I wanted to understand how to increase weight progressively to reach my full potential.
My first session was tough. Everything was hard, my form was all over the place, and the moves felt awkward. I was also nervous that people thought I didn’t belong in the gym. But instead of saying, “This is hard I can’t do it,” I said, “How can I improve?” Approaching this new challenge with curiosity, rather than fear, empowered me. I was determined to get stronger, and I was ready to put in the work.
I committed to training four times a week: two days with my trainer and two days on my own. I wanted to stay consistent, improve my form, and build muscle. I was excited for the challenge and motivated to get better.
After consistently working with my trainer for a year, I was craving more.
On Instagram, I came across a video of Michelle MacDonald bench pressing and was in awe of her form and heavy weight. I wanted to level up, so I applied to Michelle’s personal training community, The Wonder Women.
In August 2022, I started virtual training with The Wonder Women five days a week: three lower body days and two upper body days. I prioritized form and focused on progressive overload, but I also got curious about bodybuilding.
I decided to start training for my first bodybuilding competition in June 2023, but 12 weeks into prep, my competition was canceled. The Wonder Women didn’t have spots available to transfer into the current bodybuilding training group, so I switched teams and joined Dynasty Training.
Now, I train four days a week—two for lower body and two for upper body.
I’m preparing for my first show at the end of 2024, so I recently started my “build phase,” which consists of four days of weight training: two lower body days and two upper body days. My goal is to build muscle, but instead of only focusing on how much weight I can lift, I also prioritize tempo and increasing my reps and sets.
For lower-body workouts: I do a glutes and quads day and a posterior chain day. My workouts are typically an hour and a half, and I do seven to 10 moves per session. The number of reps and sets varies, but most of my current lower-body lifts are based on a ladder model: 12 reps, 10 reps, eight reps, and six reps of each move, increasing weight as the number of reps decreases.
For upper-body workouts: I do a shoulders and back day and a chest and arms day. These workouts are typically an hour, and I do seven to 10 moves per session, including bench press, pullups, man makers, lat pulldowns, and pushups.
I also do 35 minutes of cardio six days a week and have one day designated to core and high intensity intervals, and one day of stretching. Sunday is my day off.
Lower body is my favorite to train and I especially love deadlifts, Bulgarian split squats, and hip thrusts. Now, I can deadlift 195 pounds and thrust 300 pounds. I’m currently working on adding a pause at the top of each hip thrust and let me tell you… it adds a whole other level of intensity.
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I learned to count macros and let go of the belief that I needed to restrict food.
I’ve tried every diet in the book, but nothing was ever sustainable or satisfying. Then, I learned to count macros and realized I could still eat my favorite foods when I paid attention to portion size and nutrition labels.
I eat four to five meals a day and focus on my protein, carb, and fat intake. I always prioritize protein, and chicken, turkey, and fish are my go-to sources. It’s also fun to try new macro-friendly recipes, and meal prepping on Sunday sets me up for success during the week.
That said, it took me a long time to get over the idea of restriction. I was so used to eliminating foods and eating as little as possible, but once I learned nothing is off limits and macros are about balance and variety, I felt better than ever. Instead of a month-long, restrictive, fad diet, I realized the most sustainable plan is listening to my body and eating the foods I love.
These three things were key to my strength transformation success.
1. I let go of the notion that my strength journey needs to be perfect.
When I started strength training in 2021, it wasn’t necessarily the “perfect time” to embark on a new journey. But I decided to stop waiting and took control of my situation. Is every workout perfect? Nope! But that’s okay. I realized if I keep trying and continue to show up it’s going to pay off in the long run.
2. I became more self-aware and understood the value of the mind-body connection.
It’s so easy to operate on autopilot, but I’ve learned to evaluate my *entire* lifestyle when something feels off. If my energy levels are low, I look at my diet and sleeping habits. When I’m stressed, I reflect on why instead of letting anxiety rule my day.
As a result, I’ve learned the importance of the mind-body connection. How I’m feeling physically and mentally can have a direct impact on each other and the overall sense of self-awareness has gotten me closer to my goals.
3. I gave myself the opportunity to be good at something and realized consistency is key.
Most of my life, I participated in diets and fitness programs that had a clear start and end date. Once I understood that people become good at things by being consistent, a light bulb went off. I realized I had never given myself a chance (or the time) to get good. I always expected quick results and a long-term program seemed daunting, but when I challenged myself to start weight lifting without an end date in mind, my whole mindset changed.
Not only do I love that consistency brings me closer to my goals, but I found value and motivation in the process. Whether it’s perfecting my form or mastering a recipe, the sense of accomplishment after nailing a new skill keeps me determined to get better and stronger. It’s fun to show up for yourself and consistency in the gym has given me the opportunity to believe in myself.
Do turmeric supplements really treat pain, boost mood, and improve allergies? Experts say they work best for 2 conditions
Stephanie Watson – March 30, 2024
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Americans spend around $50 billion a year on vitamins and supplements. One of the most popular is turmeric, a bright orange root that has its roots in both traditional Eastern medicine and cuisine. Proponents are willing to pay $20 or more for a bottle, hoping to relieve arthritis pain and inflammation, lower cholesterol and blood sugar levels, and treat whatever else happens to ail them. But is it worth the money?
While a lot of research has highlighted turmeric’s antioxidant and anti-inflammatory properties, the wide range of supplement potencies and doses used in studies has made it hard to confirm any health claims.
Dr. Keith Singletary, professor emeritus of nutrition at the University of Illinois Urbana-Champaign, has reviewed the evidence on turmeric. His take? “I think it’s promising,” he says, but he stresses that it isn’t “the cure-all that marketing would make it appear.”
Health benefits of turmeric
The health properties attributed to turmeric come from natural compounds called curcuminoids. “Curcumin, which is the major one, is believed to be largely responsible for the health benefits of turmeric,” says Singletary.
What might curcumin do? The best evidence centers on two conditions: arthritis and metabolic syndrome.
Arthritis
Considering turmeric’s anti-inflammatory properties, it’s not surprising that researchers have investigated its use for arthritis. The supplement does appear to reduce pain and stiffness from osteoarthritis, the most common form of this achy joint disease.
“It’s not a miracle drug, but it probably works as well as ibuprofen or acetaminophen,” says Dr. Janet L. Funk, professor of medicine and vice chair of research for the Department of Medicine at the University of Arizona College of Medicine-Tucson. Her lab studies plant-derived dietary supplements for inflammatory diseases.
Metabolic syndrome
This isn’t a disease, but rather a cluster of conditions like obesity, high blood pressure, high blood sugar, and high triglycerides that collectively increase the risk for diabetes, heart disease, and stroke. About 1 in 3 American adults have metabolic syndrome, according to the National Heart, Lung, and Blood Institute (NHLBI).
Studies have looked at the effects of turmeric on blood sugar, triglycerides, and insulin levels, as well as on inflammation (which also plays a role in metabolic syndrome). “In general, there was a strong preponderance of evidence that it might help reduce all those things. So it might have some benefit in people who are overweight and concerned about inflammation and diabetes,” Funk says.
But—there’s a very big caveat. “There’s a lot of inconsistency between studies,” Singletary says. And therein lies the problem in evaluating turmeric.
An imperfect science
Though plenty of research is being done on turmeric, the studies aren’t consistent. Researchers have tested different amounts of the supplement in different groups of people for different amounts of time. Some studies added a compound like piperine, found in black pepper, to make turmeric more active in the body (researchers call this increased “bioavailability”).
For example, one study on knee osteoarthritis had participants take 180 milligrams (mg) of curcumin for eight weeks. Another one used doses of 500 mg plus 5 mg of BioPerine (black pepper) extract three times a day for six weeks.
Because most of the studies have lasted four months or less, researchers don’t know what might happen with long-term use. “The bottom line is, there’s no definitive, well-designed studies at this point,” Funk says. She’s skeptical that there ever will be, given that the nutraceutical industry and the National Institutes of Health aren’t funding them.
The risks of turmeric
Turmeric is probably safe if you get it from the spice or you take only the recommended amount in supplements, says the National Center for Complementary and Integrative Health. In larger quantities, it could cause GI side effects like nausea or diarrhea.
Piperine poses its own set of issues, because it increases the bioavailability of curcumin by inactivating an enzyme in the liver that would otherwise break it down. “That enzyme is really important for [breaking down] most drugs people take,” says Funk. Theoretically, piperine might cause a buildup of medications in the body, thus increasing the risk for side effects. “Generally speaking, if you’re taking other medications, I would shy away from any product that has piperine in it, just in case it could interfere with the metabolism of your other drugs,” she adds.
An even bigger concern is a rare but serious risk of liver damage from turmeric supplements, as well as high levels of lead in these products. Several studies, including one that Funk co-authored, found excessive amounts of lead in some turmeric supplements—especially those that contained turmeric root. Exposure to lead in large quantities can have toxic effects on the body, including heart and kidney problems.
Should you take turmeric?
Is it worth taking turmeric? “That’s the million- dollar question,” says Singletary. Given the lack of clear evidence on its benefits and the potential risks, he says you’re safest getting turmeric through your diet. You can add the spice to soups, stews, sauces, and smoothies. Top them with a pinch of black pepper or cook turmeric in oil to enhance its bioavailability.
If you do use turmeric supplements, it can be difficult to know which form is best, or how much to take. The best advice is to ask your health care provider, says Singletary. Start out with a low dose to see how your body responds to it. And don’t expect turmeric to be a “cure-all for all your ailments, which is unlikely to be the case,” he adds.
New report finds striking parallels between tobacco, gas stove campaigns: ‘This is intentional; it’s by design’
Ben Stern – March 22, 2024
For decades, tobacco companies misled the public about the dangers of their products, engaging in multipronged PR campaigns and spreading disinformation.
Today, nicotine and smoking are widely acknowledged to be addictive, and cigarettes are known to cause cancer. But it took years to expose these truths, all while massive tobacco corporations profited from the harm they caused.
In a striking new report titled “Cooking with Smoke: How the Gas Industry Used Tobacco Tactics to Cover up Harms from Gas Stoves,” the Public Health Law Center has revealed how Big Tobacco’s playbook of deception was also used to convince the public that gas stoves are safe.
The beginning of the gas stove fight
While news coverage on the potential dangers of gas stove pollution has recently picked up, researchers have been trying to sound the alarm since at least the 1970s.
Early studies conducted by the Environmental Protection Agency were primarily focused on investigating the health impacts of nitrogen dioxide (NO2) pollution from gas stoves.
After it was determined that such NO2 exposure could cause or worsen asthma and other respiratory problems, the American Gas Association (AGA), fearing public outcry, began to fund its own research claiming that gas stoves weren’t associated with respiratory issues.
Yet the current scientific consensus is that gas stoves are burdening the public with health issues, specifically our children. One peer-reviewed study from the nonprofit think tank RMI found that more than one in eight cases of childhood asthma in America is associated with a gas stove in the home.
The full health impacts of exposure to gas stove pollution are unfortunately not yet known. Pediatrician Dr. Lisa Patel, the Executive Director of the Medical Society Consortium on Climate and Health, believes it’s critical to learn more about gas stoves’ potential dangers sooner rather than later.
“Because the oil and gas industry has been so successful in pulling the wool over our eyes, suppressing the research, we’re still figuring out which of the pollutants [from stoves] is the ‘worst’ in terms of risk,” Dr. Patel told The Cool Down.
Cooking with smoke
The Public Health Law Center’s new report lays out how eerily similar the disinformation campaigns of the gas and tobacco industries are.
“Cooking with Smoke” describes seven of the deceptive tactics used by both the tobacco and gas industries to mislead the American public.
One such tactic is hiring the same scientists and research labs to provide biased or partial information pointing to desired results — namely, downplaying the health impacts of tobacco products and gas stoves. The AGA has hired the exact same laboratory as the Council for Tobacco Research, a tobacco industry trade group, for its sponsored research.
Last year, a New York Times exposé revealed that not only did the AGA hire a toxicologist to obscure the relationship between gas stoves and health impacts, but that same toxicologist was hired by the cigarette company Philip Morris to provide testimony claiming that Marlboro Lights were “safer for smokers.”
Another strategy utilized by both industries is the marketing of deceptive media to children. As outlined in the report, gas companies have used social media influencers to promote gas stoves to young people. Within the past two years, the gas industry has also sent coloring books to schools, telling children that “natural gas [is] your invisible friend,” as the report noted.
We deserve better
Due to decades of industry disinformation, the health harms caused by gas stoves have largely gone unnoticed or misunderstood by the American public. But just as Big Tobacco couldn’t hide the truth about cigarettes, the gas industry won’t be able to successfully hide the dangers of its stoves from the public forever.
“The gas industry wants us to accept health harms that we don’t have to. This is intentional; it’s by design,” Joelle Lester, Executive Director of the Public Health Law Center, told The Cool Down. “That’s where the gas industry is similar to Big Tobacco. They will continue to resist regulation and restriction to protect their profits.”
Change is coming
Both Lester and Dr. Patel believe that more information about the true health risks of gas stoves will inevitably emerge. When it does, change will follow.
“Jurisdictions will make changes [to transition away from gas stoves],” Lester told The Cool Down, “and once the sky doesn’t fall, and the health benefits can be measured, it will be so powerful.”
And according to Dr. Patel, “in the end, science and wanting to take care of each other will always win out.”
Actions you can take now
For those worried about the impacts of gas stoves, waiting on policy fixes isn’t necessary. The best way for an individual to eliminate the health risks of a gas stove is to replace it with an induction or electric range.
Induction cooktops have already proven to be the superior option in many ways, cooking food more quickly, evenly, efficiently, and safely than gas stoves.
While replacing your gas stove may seem daunting, the federal government, through the Inflation Reduction Act, will offer up to $840 to those who make the switch.
Even renters will be able to take advantage of this point-of-sale rebate by purchasing plug-in induction cooktops.
Some landlords may also be amenable to electrification projects, like installing induction stoves, once they find out how much more energy-efficient the devices are. The nonprofit Rewiring America has an in-depth guide for talking to your landlord about upgrading.
Of course, even with an $840 upfront discount, not every family will be able to make the switch. For those families, many options still exist to protect their respiratory health. Dr. Patel told The Cool Down: “If they can’t get that gas cooktop out, using electric appliances, opening windows, [or] using an overhead vent helps.”
In this article, we are going to discuss the top 20 tobacco growing countries in the world. You can skip our detailed analysis of the global tobacco market, the heavy investments in marketing by tobacco companies, and the rising popularity of flavored tobacco, and go directly to the Top 5 Tobacco Growing Countries in the World.
Tobacco was first used by the people of pre-Columbian Americas. Archeological studies suggest that the Maya people of Central America started using tobacco leaves as far back as the 1st century BC, mainly for smoking in sacred and religious ceremonies. By the time Columbus arrived in the New World in 1492, the Native Americans were already cultivating and smoking tobacco in pipes, cigars, and snuff. Although Cristopher Columbus brought with him a few tobacco leaves and seeds back to Europe, most Europeans didn’t get their first taste of the plant until the mid-16th century, when adventurers and diplomats like France’s Jean Nicot – for whom nicotine is named – began to popularize its use. Tobacco was introduced to France in 1556, Portugal in 1558, Spain in 1559, and finally England in 1565. By the early 17th century, smoking was common in all of Europe’s maritime nations, and their colonial empires soon carried tobacco all over the world.
Global Tobacco Market:
As we mentioned in our article – Top 20 Most Valuable Tobacco Companies in the World – the global tobacco market is expected to reach $1.049 trillion by 2030, with a CAGR of 2.1% during the forecast period. The market is fuelled by a growing demand from developing nations, coupled with the rising proliferation of next-generation products (NGPs) across the globe. The high marketing expenditure and discounting of products undertaken by major tobacco companies is also adding to the growth of the industry.
While tobacco consumption is leveling off and even decreasing in some countries, the number of people smoking is still increasing globally, and smokers are smoking more than before. An estimated 1.3 billion people worldwide use tobacco products, 80% of whom are in low- and middle-income countries.
Heavy Investments in Marketing:
The WHO Framework Convention on Tobacco Control (FCTC) has led to widespread restrictions on tobacco advertising, promotion, and sponsorship around the world. This, coupled with the evidence of the causal role of marketing in the tobacco epidemic, has inspired more than half the countries worldwide to ban some forms of tobacco marketing.
Yet, tobacco companies have found creative ways to maneuver their way around these barriers, using a variety of marketing strategies to create demand for cigarettes and other tobacco products by urging the youth to experiment, reducing smokers’ motivation to quit, and encouraging former smokers to take it up again. According to the Federal Trade Commission, in 2020 alone, the American tobacco industry spent over $8.4 billion on marketing for cigarettes and smokeless tobacco, spending more at the point-of-sale than anywhere else. They spent nearly $66 million on advertisements at the point of sale alone.
However, this hasn’t been without consequences. In September 2023, the e-cigarette company Juul, which at the height of its success dominated the market with its sweet flavors, agreed to pay $438.5 million in a settlement with 33 states and one territory over marketing its product to teens. The case ends major litigation over claims about the marketing of e-cigarettes to adolescents, resolving thousands of lawsuits and amounting to billions of dollars in payouts to states, cities, and people.
Sales of Juul products were sky high a few years ago and the company was even eyeing a market valuation of around $38 billion. However, it was discovered that Juul use among teens and young adults spiked heavily from 2018 to 2019. An estimated 27.5% of high schoolers reported using e-cigarettes during the period, with more than half naming Juul as their brand of choice. To add to the company’s woes, the FDA banned Juul products on U.S. shelves last summer, citing a lack of evidence demonstrating their overall safety. The regulator also noted Juul’s ‘disproportionate role in the rise in youth vaping.’
The Rising Popularity of Flavored Tobacco:
Flavors improve the taste and mask the harshness of tobacco, making flavored tobacco products more appealing and easier to smoke for beginners, who are often young. In 2022, cigars were the second most commonly used tobacco product among U.S. middle and high school students. The availability of flavors in cigars that are prohibited in cigarettes (such as cherry), and the fact that they are commonly sold as a single stick, has raised concerns that these products may be especially appealing to youth. According to a 2021 survey by the CDC, among middle and high school students who smoked cigars in the previous 30 days, 44.4% reported using a flavored cigar during that time.
A popular name among the machine made, flavored cigars is Middleton’s Black and Mild. Designed for the occasional smoker, these pipe tobacco cigars boast a smoke smooth enough to satisfy an aficionado in a pinch. Owned by Altria Group, Inc. (NYSE:MO), Black & Mild cigars are available in a variety of flavors like apple, cherry, cream, and more.
The John Middleton Co., a famous name in the pipe tobacco and machine cigars industry, was acquired by the Richmond-based Altria Group, Inc. (NYSE:MO) in 2007 in a deal worth $2.9 billion, thus enabling the tobacco giant to break into the growing American cigar business as it tried to expand beyond the shrinking U.S. cigarette market. The net cost of the acquisition of Middleton, maker of Black & Mild cigars, from the privately held Bradford Holdings was $2.2 billion, after deducting $700 million in tax benefits arising from the deal.
With that said, here are the Largest Tobacco Growing Countries in the World.
Top 20 Tobacco Growing Countries in the World
Methodology:
To collect data for this article, we have referred to FAOSTAT, looking for the Countries that Grow the Most Tobacco. The following countries have been ranked by their respective land areas dedicated to tobacco production (measured in hectares) in 2021.
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20. Ivory Coast
Total Area Dedicated to Tobacco Production: 15,979 ha
Ivory Coast is a significant producer and consumer of tobacco in Africa, with an estimated 9.4% of the adult population classified as smokers. However, the West African nation has taken significant steps to reduce the smoking rate among its people. In fact, Côte d’Ivoire became the first country in Africa to require plain packaging on tobacco products in 2022.
19. North Macedonia
Total Area Dedicated to Tobacco Production: 16,617 ha
North Macedonia has a long tradition of cultivating and exporting oriental tobacco, mainly of the types Prilep, Jaka, and Basma. Due to the large number of families working in tobacco agriculture, it also receives the largest share of crop subsidies, comprising on average a quarter of total agricultural subsidies for the period 2008 – 2019.
18. Cuba
Total Area Dedicated to Tobacco Production: 16,682 ha
Cuban cigars have long been a symbol of luxury and prestige, and the country produces some of the Most Expensive Cigars in the World. Due to consistently warm temperatures, high humidity, and regular rainfall, Cuba has excellent conditions for growing tobacco and it has been a mainstay crop for thousands of years.
Total Area Dedicated to Tobacco Production: 21,059 ha
Tobacco leaves are produced in 20 provinces in the North and Northeast of Thailand and last year, around 50% of Thai tobacco farmers grew burley, while 26% grew turkish leaf, and 24% grew virginia leaf. Most of this produce supplies the local market, monopolized by the Tobacco Authority of Thailand under government supervision for setting quotas and producing cigarettes.
Thailand is included among the Top Producers of Tobacco in Asia.
16. Uganda
Total Area Dedicated to Tobacco Production: 21,998 ha
Tobacco growing and manufacturing in Uganda was introduced in the 1920s by British American Tobacco, and around 75,000 of the nation’s farmers are now involved in tobacco agriculture, based mainly in the northwest and southwest of the country.
15. Philippines
Total Area Dedicated to Tobacco Production: 28,380 ha
First introduced in the 1950’s, tobacco is widely grown in various provinces in the Philippines, with the industry supporting over 2 million jobs nationwide. The country exported 53% of its total tobacco produced in 2022, while 47% was supplied to local tobacco manufacturers.
14. Pakistan
Total Area Dedicated to Tobacco Production: 47,332 ha
Although tobacco is grown on only about 0.23% of total irrigated land of Pakistan, the crop plays an important role in the country’s economy by generating income and employment for over 50,000 farmers in all four provinces. However, the total land area under tobacco cultivation has been rapidly decreasing over the last decade, mainly due to climate change and negligence by the government authorities.
13. Bangladesh
Total Area Dedicated to Tobacco Production: 47,523 ha
The cultivation of tobacco is increasing alarmingly in Bangladesh, with the crop now being grown in every part of the country. Farmers are encouraged to continue and expand tobacco cultivation with various incentives, including loans and buyback guarantees.
12. Argentina
Total Area Dedicated to Tobacco Production: 53,840 ha
Argentina stands among the Largest Tobacco Producers in South America, with the country producing 95.6 thousand tons in 2022, representing approximately 1.7% of the global production of tobacco of 5.8 million tons. Most of the tobacco cultivation happens in the north, with the provinces of Jujuy, Salta, and Misiones taking the lead.
11. North Korea
Total Area Dedicated to Tobacco Production: 56,995 ha
The tobacco industry plays a significant role in the North Korean economy, with around 2.3% of the country’s total arable land dedicated to cultivating the cash crop. North Korea’s counterfeit cigarette production capacity is estimated to exceed two billion packs a year, and is a major source of income for the regime.
10. Tanzania
Total Area Dedicated to Tobacco Production: 80,678 ha
Tobacco has been grown in Tanzania since the 1950s and is an important source of foreign exchange for the country. Tanzania produced 125 million kg of tobacco in 2023 and for the first
time, more than 50% of this produce was bought and sold abroad by local companies.
9. Turkey
Total Area Dedicated to Tobacco Production: 83,166 ha
Tobacco was introduced to the Ottomans by the Spanish in the 17th century, and the country is now the world’s largest producer of aromatic oriental tobacco – a small-leafed variety which is sun-cured. Around 400,000 Turks are dependent on the tobacco industry for their livelihood.
8. Mozambique
Total Area Dedicated to Tobacco Production: 91,469 ha
Tobacco cultivation has been considered a mainstay of Mozambique’s economy and the country exported $49.4 million of it in the first nine months of 2023, a quarter less than in the previous year. Most of this tobacco is grown in the regions of Tete and Niassa, representing over 89% of the country’s total production.
7. United States of America
Total Area Dedicated to Tobacco Production: 95,730 ha
Although America has significantly decreased cultivating tobacco since the 1980s, it still ranks among the largest producers of the crop. North Carolina and Kentucky are the States that Grow the Most Tobacco in America.
Total Area Dedicated to Tobacco Production: 100,962 ha
Tobacco is the backbone of the Malawian economy, historically generating about 70% of the country’s export revenue and now accounting for over 50%. In 2015, tobacco farming took up more than 5% of all of Malawi’s farming land – the highest percentage anywhere in the world at that time.
Malawi ranks among the Largest Producers of Burley Tobacco in the World.
‘Humbling, and a bit worrying’: Scientists fail to fully explain record global heat
Hayley Smith – March 27, 2024
The sun sets over Huntington Beach at the end of a hot December day in 2023. (Luis Sinco / Los Angeles Times)
Deadly heat in the Southwest. Hot-tub temperatures in the Atlantic Ocean. Sweltering conditions in Europe, Asia and South America.
That 2023 was Earth’s hottest year on record was in some ways no surprise. For decades, scientists have been sounding the alarm about rapidly rising temperatures driven by humanity’s relentless burning of fossil fuels.
But last year’s sudden spike in global temperatures blew far beyond what statistical climate models had predicted, leading one noted climate scientist to warn that the world may be entering “uncharted territory.”
“It’s humbling, and a bit worrying, to admit that no year has confounded climate scientists’ predictive capabilities more than 2023 has,” wrote Gavin Schmidt, director of NASA’s Goddard Institute for Space Studies, in a recent article in the journal Nature.
Now, he and other researchers are scrambling to explain why 2023 was so anomalously hot. Many theories have been proposed, but “as yet, no combination of them has been able to reconcile our theories with what has happened,” Schmidt wrote.
Misters spray water on a young boy at Kauffman Stadium in Kansas City, Mo., as as temperatures approached 100 degrees in June 2023. (Charlie Riedel / Associated Press)
Last year’s global average temperature of 58.96 degrees Fahrenheit was about a third of a degree warmer than the previous hottest year in 2016, and about 2.67 degrees warmer than the late 1800s pre-industrial period against which global warming is measured.
While human-caused climate change and El Niño can account for much of that warming, Schmidt and other experts say the extra three or four tenths of a degree is harder to account for.
Theories for the increase include a 2020 change in aerosol shipping regulations designed to help improve air quality around ports and coastal areas, which may have had the unintended consequence of enabling more sunlight to reach the planet.
The 2022 eruption of the Hunga Tonga-Hunga Ha‘apai volcano also shot millions of tons of water vapor into the stratosphere, which scientists say helped to trap some heat. What’s more, a recent uptick in the 11-year solar cycle may have contributed about a tenth of a degree of additional warning.
But these factors alone cannot explain what’s happening, Schmidt said.
“Even after taking all plausible explanations into account, the divergence between expected and observed annual mean temperatures in 2023 remains about 0.2 °C — roughly the gap between the previous and current annual record,” he wrote in his report.
Heat ripples from hot asphalt in downtown Phoenix in July 2023. (Matt York / Associated Press)
Reached by phone, Schmidt said he thinks one of three things could be going on.
It’s possible that 2023 was a “blip” — a perfect storm of natural variables and Earth cycles lining up to create one freakishly hot year. Should that prove to be the case, “it won’t have huge implications for what we’re going to see in the future, because it would have been just such a rare and unlikely thing that is not going to happen again anytime soon,” he said.
However, he indicated that’s unlikely, as those elements “have never lined up to give us a blip this large.”
Another possibility is that scientists have misunderstood the driving forces of climate change. While greenhouse gases, volcanic eruptions and aerosols are known to affect global temperatures, perhaps the full extent of their effects have been underestimated or miscalibrated. Should that be the case, he said, research and data sets will hopefully catch up soon.
The last explanation he offered is that the system itself is changing — and changing in ways that are faster and less predictable than previously understood.
“That would be worrying because science is really all about taking information from the past, looking at what’s going on, and making predictions about the future,” Schmidt said. “If we can’t really trust the past, then we have no idea what’s going to happen.”
Not everyone agrees with his assessment, however. Michael Mann, a professor in the Department of Earth and Environmental Science at the University of Pennsylvania, said the premise that 2023’s warmth cannot be explained — or that it is inconsistent with model simulations — is “simply wrong.”
“The situation is extremely similar to what we saw during the 2014-2016 period as we transitioned from several years of La Niña conditions to a major El Niño event, and then back to La Niña,” Mann said in an email.
In fact, he said some recent modeling shows the global temperature spike in 2016 was even more of an outlier than that of 2023.
“The plot shows that the surface warming of the planet is proceeding almost precisely as predicted,” Mann said. “And the models show that the warming will continue apace as long as we continue to burn fossil fuels and generate carbon pollution.”
When asked about this interpretation, Schmidt said it’s true that the 2014 to 2016 period was similarly anomalous. But there is a key difference between then and now, he said.
The 2016 temperature spike came on the heels of an El Niño event, with the biggest anomalies in February, March and April of the year following its peak, he said. He noted that similar patterns occurred after previous El Niños in 1998 and 1942.
Conversely, last year’s spike arrived in August, September, October and November — before the peak of El Niño — “and that has never happened before,” Schmidt said. “It never happened in the temperature record that we have. It doesn’t happen in the climate models.”
Alex Hall, a professor of atmospheric and oceanic sciences at UCLA, said he largely agrees with Schmidt’s assessment that the hypothesized factors alone can’t account for the large temperature anomaly experienced in 2023 and early 2024. He likened it to the emergence of megafires, or extreme wildfires, in the last decade, which wasn’t entirely foreseen.
“What we’ve learned is that there’s an aspect of this that isn’t fully predictable — that we don’t fully understand — and that we are tempting fate here a little bit by continuing to interfere with the climate system,” Hall said. “It’s going to do things that we don’t understand, that we don’t anticipate, and those are going to have potentially big impacts.”
Hall said the rapid transition from a persistent La Niña to a strong El Niño last summer likely played a role, as did the change in aerosol regulations.
He also posited that the rapid loss of Antarctic sea ice in 2023 — itself an outcome of the warmer planet and oceans — could have created a kind of feedback loop that contributed to more warming. Ice and snow are reflective, so when they melt, it can result in a darker ocean that absorbs more heat and sunlight. (Antarctic sea ice coverage dropped to a record low in 2023, according to the National Oceanic and Atmospheric Administration.)
“It’s sort of a planetary emergency for us to figure out what’s going on when we see these types of changes,” Hall said. “There should be large teams of people working on it to try to understand it, and we don’t really have those kinds of efforts, so I think there’s lessons, too, for the need for focus on this particular topic.”
Tourists seek shade and water while visiting the Acropolis of Athens during a heat wave in July 2023. (Petros Giannakouris / Associated Press)
While he and other scientists may not agree on just how extraordinary 2023 was — or what was behind its exceptional warmth — they all acknowledged the clear signs of a planet being pushed to its limits.
“I think it’s unfortunate that so much has been made of the El Niño-spiked 2023 global temperatures, where in my view there is nothing surprising, or inconsistent with model predictions, there,” said Mann. “There are much better, scientifically-sound reasons to be concerned about the unfolding climate crisis — particularly the onslaught of devastating weather extremes, heat waves, wildfires, floods, drought, which by some measures are indeed exceeding model predictions.”
Last year was marked by extreme weather events, with more billion-dollar disasters in the United States than any other year, according to NOAA. Among them were the Lahaina wildfire in Hawaii in August; Hurricane Idalia in Florida that same month; and severe flooding in New York in September.
Already this year, January and February have continued the global hot streak, marking nine consecutive months of a record-breaking temperatures.
In his Nature article, Schmidt said the inexplicable elements of the recent warming have revealed an “unprecedented knowledge gap” in today’s climate monitoring, which drives home the need for more nimble data collection that can keep up with the pace of change.
He noted it may take researchers months or even years to unpack all the factors that could have played a part in the sizzling conditions.
“We need answers for why 2023 turned out to be the warmest year in possibly the past 100,000 years,” he wrote. “And we need them quickly.”
Though El Niño is expected to wane this summer, there is still a 45% chance that this year will be warmer than 2023, according to NOAA.
It is a near certainty however that 2024 will rank among the five hottest years on record — so far.
