Are your medications and supplements safe together? Plus, insomnia and ovarian cancer prevention

Welcome to Health(y) Discourse.

This week, I’m looking at whether chronic insomnia could affect more than your sleep, how removing the fallopian tubes may help prevent ovarian cancer and why your prescriptions, over-the-counter drugs and supplements may not always mix.

While I was away last week, I took you behind the scenes of how my background as an epidemiologist shapes my journalism — from how I evaluate new studies and navigate scientific uncertainty to why I think acknowledging what we don’t know is critical to rebuilding trust in health and science.

Other stories that caught my eye this week:

• The health effects of a wildfire may linger long after the smoke clears. A new study of roughly 1,400 Maui residents found elevated levels of toxic metals in their bodies up to 18 months after the 2023 fires, and higher exposures were associated with worse lung function. Researchers couldn’t determine how much of the exposure came directly from the fires, but the findings suggest communities may need health and environmental monitoring well beyond the immediate aftermath of a disaster.
• Next month, the FDA will close a loophole that has allowed Americans to buy cheaper prescription drugs from foreign mail-order pharmacies, many based in Canada. The change could cut off access to lower-cost medications for millions who have relied on these “gray market” pharmacies.
• A Swedish study of 3.7 million people found that children born with certain infections such as rubella or herpes simplex virus were more likely to be diagnosed with autism or an intellectual disability. But these infections were rare and accounted for only a small fraction of autism cases overall. 
• The Ebola outbreak in the Democratic Republic of Congo has surpassed 8,000 cases and 3,900 deaths, making it the second-largest on record, as health officials struggle with delayed detection and limited treatment options for the strain causing the outbreak. 

Peer Review

Rehashing the week’s health headlines

💤 Reality Check

How bad is insomnia for your health?

Most of us know how miserable a bad night of sleep can feel. But a major new review suggests chronic insomnia may be associated with much more than next-day exhaustion.

Researchers reviewed dozens of studies examining insomnia and health outcomes. Among the findings, an analysis involving more than 1.3 million people found that insomnia was associated with a 26% higher risk of stroke, while another involving more than 500,000 people found a 28% higher risk of hospitalization. The broader evidence also linked insomnia with increased risks of depression, dementia and suicidal behavior.

That sounds alarming, but there are two important distinctions.

First, researchers are talking about chronic insomnia — persistent difficulty falling asleep, staying asleep or logging high-quality sleep despite having the opportunity to do so — not occasionally lying awake worrying about work or getting too little sleep because you stayed up watching Netflix. Second, much of the research is observational. It can show that people with insomnia are more likely to experience certain health problems, but it can’t prove insomnia caused them. The relationship can run in both directions: Depression, cardiovascular disease, chronic pain and other illnesses can themselves interfere with sleep.

Still, researchers increasingly view sleep as an important component of health rather than simply downtime. Persistent sleep problems can affect hormones, inflammation, blood pressure and other biological systems, providing plausible ways chronic insomnia could contribute to disease.

Bottom line: A few restless nights aren’t likely to damage your health. But persistent insomnia is more than an inconvenience, and increasingly strong evidence links it with serious physical and mental health problems. If you’re regularly struggling to sleep and it’s affecting your daytime life, it’s worth discussing with a health care provider — especially because insomnia can be treated. And if you want to know more about how naps can affect your health, take a peek at this deep dive I wrote. 

♀️News You Can Use

Could removing fallopian tubes prevent ovarian cancer? 

Doctors are increasingly rethinking where ovarian cancer actually begins — and that discovery is changing how they work to prevent it.

For years, scientists assumed most ovarian cancers originated in the ovaries. Researchers now believe many of the most common and aggressive ovarian cancers actually begin in cells at the ends of the fallopian tubes before spreading to the ovaries and elsewhere. Because of this development, the American College of Obstetricians and Gynecologists now encourages doctors to discuss with patients the option of removing both fallopian tubes when someone who has finished having children is already undergoing another appropriate abdominal or pelvic surgery, such as a hysterectomy.

The recommendation is supported by accumulating evidence that removing the tubes could substantially reduce ovarian cancer risk. In one large Canadian study involving roughly 86,000 patients, people who had their fallopian tubes removed during other surgical procedures had a nearly 80% lower risk of developing ovarian cancer than comparison patients.

Bottom line: Doctors aren’t recommending that average-risk women undergo surgery solely to have their fallopian tubes removed. Any surgery carries risks. The idea is that if someone is already undergoing an appropriate operation and doesn’t want future pregnancies, removing the tubes at the same time may offer cancer protection without requiring another surgery. And unlike removing the ovaries, removing only the fallopian tubes doesn’t trigger surgical menopause. That’s because the ovaries remain in place and continue producing hormones.

💊Consumer Watch

Are your medications and supplements safe to take together? 

Your doctor probably knows which prescription medications you’re taking. But do they know about the ibuprofen in your medicine cabinet, the sleep aid you occasionally take or the supplements you ordered online?

A new study suggests that question matters. Researchers examining medication use among older Americans found that more than one in five adults ages 62 to 85 were taking combinations of drugs with the potential for a major interaction.

The researchers looked beyond prescriptions, also including over-the-counter drugs and dietary supplements — an important distinction because patients may see those products as separate even though they can interact inside the body.

Some combinations can increase the risk of bleeding, alter heart rhythms, cause excessive sedation or change how effectively another medication works. And the more medications someone takes, the more opportunities there are for interactions.

There was some encouraging news: Major drug interactions were less common than they were several years earlier. But the findings highlight a persistent problem with fragmented medical care. One specialist may prescribe one drug, another clinician prescribes something else and patients may add over-the-counter medications or supplements without any one provider seeing the complete picture.

Bottom line: Don’t assume “over the counter” or “natural” means something can’t interact with your prescriptions. Keep a list of everything you take — prescriptions, OTC medications, vitamins and supplements — and periodically ask your doctor or pharmacist to review the entire list for potential interactions.

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Get in Touch

That’s all for this week. If you have questions about a health-related story or study you saw in the wild, send me an email at jcraig@san.com or share them below.
— Jess