Year: 2026

Thesis on Impact of Treatment Choice in Anterior Cruciate Ligament Injury

Photo by Natanael Melchor on Unsplash

An anterior cruciate ligament injury is a serious knee injury that often affects young, physically active people. On April 30, Dzan Rizvanovic will defend his thesis “Anterior cruciate ligament reconstruction: rationale for graft choice and treatment of associated injuries” in which he has investigated how treatment choice affects outcomes after ACL reconstruction.

“An anterior cruciate ligament injury (ACL injury) is a serious knee injury that primarily affects young and physically active individuals and can have long-term consequences for knee function, work capacity, and quality of life. Each year, a large number of patients in Sweden undergo surgical reconstruction of the injured ligament (ACL reconstruction), and this is the focus of my thesis”, says Dzan Rizvanovic, doctoral student at the Sports Medicine research group at the Department of Molecular Medicine and Surgery, Karolinska Institutet and specialist in orthopaedic surgery at Capio Artro Clinic.

“Using data from the Swedish Knee Ligament Registry, we studied tens of thousands of patients to investigate which factors are associated with different treatment strategies, and how these in turn relate to patients’ perceived knee function and the need for further surgery (revision). The thesis also has a particular focus on how the surgical volume of both the surgeon and the clinic is associated with treatment choices and outcomes”.

Which are the most important results?

“The main findings show that treatment strategies in ACL reconstruction are not solely related to the patient’s injury, but also to organizational factors. Surgeons and clinics with higher surgical volume are more likely to use different types of grafts (tendons used to replace the injured ligament), which may increase the opportunity for individualized treatment. They also repair meniscal injuries more frequently, a strategy that has been shown to be beneficial for long-term knee health. The management of cartilage injuries is also partly influenced by surgical volume”.

“Patients operated on by high-volume surgeons report better knee function two years after surgery and experience shorter waiting times from injury to surgery as well as shorter operative times. In contrast, the need for additional ACL reconstruction in the same knee is more related to patient- and injury-factors than to surgical volume”.

“The thesis also shows that graft choice influences subjective knee function at two years after surgery, particularly among females, which is an important finding”. 

How can this new knowledge contribute to the improvement of people’s health?

“This knowledge can contribute to more equitable and individualised care. By clarifying how surgical experience and surgical volume are associated with treatment decisions and outcomes, healthcare systems can better organise resources and create conditions for strengthened competence and improved decision-making in ACL reconstruction”.

“The results can also be used in the dialogue between patient and surgeon to select the treatment that best matches the individual’s needs and circumstances, which in the long term may improve knee function and increase quality of life in this young and working-age population”.

“Furthermore, the results from this thesis highlight the need for discussion regarding clearer national guidelines for referral pathways, minimum surgical volume requirements, and follow-up of treatment outcomes. It is also important that reporting to national quality registers is complete and made mandatory in order to enable transparency and continuous quality improvement”.

What are your future ambitions? 

“I hope to continue combining research with my clinical work to drive development forward and contribute to ensuring that patients with knee and sports-related injuries receive the best possible treatment. I also aim to contribute to a more equitable organization of healthcare, in which access to the right expertise at the right time does not depend on where in the country a patient lives”, says Dzan Rizvanovic.

Dissertation

The dissertation seminar will be held on Thursday, April 30th 2026 at 09:00, CIFU, Capio Artro Clinic, Valhallavägen 91, lecture hall house R. The doctoral thesis has been supervised by Anders Stålman

Thesis

Rizvanovic, Dzan (2026). Anterior cruciate ligament reconstruction : rationale for graft choice and treatment of associated injuries. Karolinska Institutet. Thesis. https://doi.org/10.69622/31333828.v1

Source: Karolinska Institutet

Anaemia Linked to Increased Cancer Risk

Anaemia detected in healthcare is associated with an increased risk of both cancer and higher mortality. This is shown in a new population-based study from Karolinska Institutet, published in BMJ Oncology. The findings may help guide clinical follow-up of patients with anaemia in routine care.

Anaemia is common among patients in healthcare and is defined by haemoglobin levels below the normal range. In this study, the researchers analysed the association between newly detected anaemia and the risk of cancer and mortality, and examined whether different types of anaemia, classified by the size of red blood cells, play a role. 

The study is based on register data from the Stockholm Early Detection of Cancer Study (STEADY‑CAN) and includes almost the entire adult population of Stockholm County between 2011 and 2021. In total, just over 190 000 adults with newly detected anaemia were included, along with an equal number of age- and sex-matched individuals without anaemia. All participants were over 18 years of age and cancer-free at study entry. 

The participants were followed for up to 18 months after anaemia was detected. During this period, 6.2 per cent of men and 2.8 per cent of women with anaemia developed cancer. The corresponding figures among individuals without anaemia were 2.4 per cent and 1.1 per cent, respectively. Mortality was also higher in the group with anaemia. 

“We found that both the risk of cancer and the risk of death are highest during the first months after anaemia is detected, but that the increased risk persists later during follow-up as well,” says Elinor Nemlander, researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and first author of the study. 

Type of anaemia matters 

The study also shows that the type of anaemia is important. Individuals with small red blood cells, known as microcytosis, had a particularly high risk of cancer, especially cancers of the gastrointestinal tract and the haematopoietic system. By contrast, individuals with large red blood cells, macrocytosis, showed a stronger association with increased mortality, but not with cancer to the same extent. Red blood cell size is measured using the laboratory value MCV, which is included in routine blood tests. 

“Our findings suggest that anaemia may be a sign of underlying disease rather than a condition in its own right. Blood tests that are already part of routine care can provide important information about which patients need closer follow-up,” says Elinor Nemlander. 

Source: Karolinska Institutet

Long COVID Associated with Increased Risk of Cardiovascular Disease

Photo by Joice Kelly on Unsplash

People with long COVID are at increased risk of developing cardiovascular disease, according to a new study from Karolinska Institutet published in eClinicalMedicine. The results show that the risk of conditions such as cardiac arrhythmias and coronary artery disease is higher even among those who were not hospitalised during the acute infection.

Long COVID has become an increasingly significant health problem worldwide, and a growing number of studies suggest that the condition can lead to secondary cardiovascular diseases. To date, research has mainly focused on people who were hospitalised, whilst the risks for those who stayed at home or were treated at a GP are less well known. In the current study, the researchers investigated how often major cardiovascular events occur in these individuals compared with those without the diagnosis.

Of the just over 1.2 million people aged between 18 and 65 included in the study, around 9,000 had been diagnosed with long COVID, corresponding to 0.7 per cent. Two-thirds of them were women. People who had previously had cardiovascular disease or been hospitalised for COVID-19 were excluded from this group.

During the follow-up period of around four years, people with long COVID were more likely to suffer from cardiovascular disease: 18.2 per cent of women and 20.6 per cent of men experienced some form of cardiovascular event, compared with 8.4 per cent of women and 11.1 per cent of men in the group without long COVID.

When the researchers then adjusted the results for factors such as age, socio-economic status and other known risk factors, the differences remained. Women with long COVID had just over twice the risk of receiving a cardiovascular diagnosis compared with women without long COVID. Men had approximately a third higher risk.

“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease. However, no clear association was found between long COVID and stroke,” says lead author Pia Lindberg, a nurse and PhD student at the Department of Medicine, Solna, Karolinska Institutet.

Need to be monitored more systematically

As many people with long COVID never required hospitalisation during their acute infection, there is a risk that secondary conditions may be missed, says Pia Lindberg, pointing out that the results suggest these patients may need to be monitored more systematically.

”Our results show that long COVID can be a risk factor for cardiovascular disease, even in younger people who were previously healthy. This underlines the need for structured follow-up that takes gender differences into account, particularly as cardiovascular disease in women often presents with more diffuse symptoms that can make diagnosis more difficult”, concludes Pia Lindberg.

Source: Karolinska Institutet

Opinion Piece: Medical Aid Out-of-pocket Healthcare Expenses are the Highest Ever

14 April 2026

Photo by Towfiqu barbhuiya on Unsplash

By James White, Director: Sales and Marketing at Turnberry Management Risk Solutions

Many South Africans assume that belonging to a medical scheme means their hospital treatment will be fully covered. In practice, this is often not the case. Patients are increasingly encountering co-payments, specialist shortfalls and benefit sub-limits that leave them responsible for part of the bill. This happens because medical schemes pay according to their own tariff structures, while specialists often charge significantly more than those tariffs, sometimes as much as 500% of the scheme rate.

The difference between the scheme tariff and the provider’s invoice is then billed to the patient, and it can amount to tens of thousands of Rands. Gap cover exists specifically to address these shortfalls by covering the gap between what medical schemes pay and what healthcare providers charge, offering peace of mind and greater financial certainty.

Healthcare costs are rising faster than household incomes

Medical inflation in South Africa has consistently outpaced general inflation. While many employees receive annual increases of around four or five percent, healthcare costs often rise by nine or ten percent. Hospital tariffs, specialist fees and the cost of advanced medical technology continue to increase each year.

Medical schemes therefore face a difficult balancing act: keeping contributions affordable while managing rising provider costs. To do this, schemes increasingly rely on co-payments, tighter benefit limits and reimbursement based on scheme tariffs. For members, this means that belonging to a medical scheme does not always guarantee that every medical expense will be fully covered.

The shortfall between tariffs and specialist fees

One of the most common out-of-pocket expenses occurs when a healthcare provider charges more than the scheme rate. Medical schemes reimburse treatment according to their own tariffs, while specialists may charge several times that amount. This can create confusion for members, because policies often state that they pay “100% of the scheme rate”. In practice, this means the scheme pays up to its tariff limit, not the full amount charged by the provider.

From a gap cover perspective, this tariff shortfall accounts for the majority of claims. In many cases it represents roughly 78% to 80% of claims, making it one of the most common funding gaps patients experience.

Co-payments and sub-limits add further pressure

Shortfalls are not the only challenge patients face – medical schemes increasingly rely on co-payments and sub-limits to manage rising healthcare costs.

A co-payment is a fixed amount that the member must pay before treatment takes place. Depending on the procedure and scheme rules, these amounts can range from around R5,000 up to R30,000, and in some cases even higher. For many households, being asked to produce this amount upfront can create significant financial strain.

Sub-limits can create a similar problem. Even when a procedure is covered, schemes may limit how much they will pay for certain treatments, scans or specialist services. Once the limit is reached, the remaining cost falls to the patient.

Why adviser education matters

Because the system is complex, many clients only discover these gaps when they receive a bill after treatment. They assume their medical aid will cover the full cost of care, only to find that co-payments, benefit limits or specialist shortfalls still apply.

This is why it is important for advisers to explain clearly how medical schemes pay claims, particularly the difference between scheme tariffs and provider fees. When clients understand how these shortfalls arise, the role of gap cover becomes easier to understand. Rather than being seen as an optional extra, gap cover becomes part of the overall structure of healthcare cover alongside medical aid.

Understanding your healthcare cover before you need it

Healthcare funding in South Africa is unlikely to become less complex in the near future. As costs continue to rise, it is essential to understand how your medical scheme operates and where potential shortfalls may arise.

Many people only learn how their cover works when a claim is processed and an unexpected bill appears. Understanding the difference between scheme tariffs, provider fees, co-payments and benefit limits can help prevent these surprises.

Gap cover plays an important role in addressing these shortfalls by covering the difference between what medical schemes pay and what healthcare providers charge. Speak to a broker about what your medical aid covers, where shortfalls may occur, and how gap cover can help protect you from unexpected medical bills.

Turnberry Management Risk Solutions (Pty) Ltd is an authorised Financial Services Provider (FSP no. 36571). Underwritten by Lombard Insurance Company, an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

World Voice Day: UP Researchers Develop Low-cost Voice Screening Device for SA

Dr Maria du Toit takes a close-up look at vocal cords, capturing high-resolution images and video using widely available mobile technology. Traditionally, this type of examination requires expensive equipment and specialist doctors, making it difficult to access in many parts of South Africa

Ahead of World Voice Day on 16 April, researchers at the University of Pretoria (UP) are inviting the public to take part in free voice checks using a new, locally developed device that could significantly expand access to vocal health services across South Africa.

The groundbreaking, low-cost, smartphone-compatible device, which is currently being tested as part of ongoing research, enables clinicians and trained users to take a close-up look at the voice user’s vocal cords by capturing high-resolution images and video using widely available mobile technology. Traditionally, this type of examination – known as laryngoscopy – requires expensive equipment and specialist doctors, making it difficult to access in many parts of South Africa.

“Your voice is something you use every day – whether for work, social interactions, or simply being heard. Yet many people ignore early warning signs of vocal problems,” says Professor Jeannie van der Linde, who is leading the research team and is Head of UP’s Department of Speech-Language Pathology and Audiology in the Faculty of Humanities.

Voice disorders are more common than many people realise. Prof Van der Linde adds: “International estimates suggest that up to one in five people will experience a voice problem at some point in their lives, with higher risk for those who rely heavily on their voices for work, such as teachers, healthcare workers and call centre agents. Despite this, access to specialised diagnostic services remains limited, particularly outside major urban centres.”

The research and device are part of a broader effort to rethink how vocal health services are delivered in South Africa. “Our aim was to develop a solution that is more portable, more affordable and easier to integrate into different healthcare contexts,” says Dr Maria du Toit, a Lecturer in Speech-Language Pathology and member of the research team.

“Many people ignore early signs like hoarseness or vocal fatigue, often because they don’t have easy access to assessment services,” Dr Du Toit says. “If we can identify these issues earlier, we can intervene sooner and potentially prevent more significant problems from developing.

The development of the device forms part of ongoing efforts within the department to explore how mobile anddigital technologies can be used to increase the availability of vocal health assessment and care.

Dr Roxanne Malan, a postdoctoral fellow, speech therapist and research team member, highlights the importance of designing technology that balances functionality with affordability and ease of use. “We wanted to ensure that the device is not only clinically useful but also practical in a range of settings, including those withlimited resources,” she says. “The goal is to make vocal health screening more widely available without compromising on quality.”

The technology, which has not been named yet, is being developed at UP and is currently undergoing testing to compare its performance with gold-standard laryngoscopy. “We started feasibility testing in June 2025 and preliminary tests have been very positive, demonstrating that the device is usable and produces high-quality images of the relevant structures,” Dr Malan says. “It consists of a low-cost, off-the-shelf borescope – typically used industrially – adapted with a 3D-printed handle to ensure optimal placement of the scope in the patient’s mouth, as well as the correct angle for visualisation. We have also assessed its safety for human use and its ability to be properly disinfected.”

In addition to testing the device, the World Voice Day initiative seeks to increase general awareness about theimportance of vocal health. “Your voice is central to how you communicate, work and engage with others,” Dr DuToit says. “Taking care of it should be seen as an essential part of overall health, not something to think aboutonly when there is a problem.”

Dr Malan says the team’s vision is for the scope to be readily available as a screening device in public hospitalsand clinics all over South Africa and other low- and middle-income countries. “But we still foresee numerousphases of testing to ensure that it can be used by a range of healthcare professionals, and that it makes asignificant difference in the target healthcare sectors. We will name and launch it at a stage when this has beendone.”

Dr Du Toit says members of the public can support the research by booking their free voice health check. “Byattending, you’re not only taking care of your own vocal health – you’re helping researchers develop solutionsthat could make voice care more easily available to thousands of people who currently don’t have access tothese services.”

Event details: Members of the public are invited to take part in free voice checks on World Voice Day, 16 April 2026, at the Department of Speech-Language Pathology and Audiology at the University of Pretoria’s Hatfield Campus.

Participants will have the opportunity to learn more about their vocal health and contribute to research that aims to make voice care more accessible across South Africa.

Who should consider a voice check?

This free check is especially recommended for:

● Teachers and lecturers

● Singers and performers

● Healthcare workers

● Clergy and public speakers

● Call centre workers

● Anyone who uses their voice extensively

You should also consider attending if you:

● frequently experience hoarseness or voice changes;

● feel your voice tires easily;

● have ongoing throat discomfort when speaking; and/or

● simply want reassurance that your voice is healthy.

To register, visit: https://forms.gle/imqeHnpGveQaEuDD6


Stopping Beta-Blockers After Heart Attack is Safe for Low-Risk Patients

Findings suggest lifelong beta-blockers may be unnecessary in some patients

Human heart. Credit: Scientific Animations CC4.0

Among stable, relatively low-risk patients who had previously suffered a heart attack, discontinuing beta-blockers after at least one year was found to be non-inferior, or comparable, to continuing beta-blockers in terms of death, another heart attack or hospitalisation for heart failure, according to a study presented at the American College of Cardiology’s Annual Scientific Session (ACC.26).

Beta-blockers, which lower heart rate and blood pressure by inhibiting adrenaline and other hormones, have long been a mainstay of treatment to reduce the likelihood of subsequent cardiac events following a heart attack. However, many studies confirming their benefits were conducted decades ago, when procedures and medications for secondary prevention were more limited than they are today. More recent studies suggest the benefits of beta-blockers may vary depending on the overall health of a patient’s heart.

“In appropriately selected patients who survived a heart attack and do not have heart failure or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary,” said Joo-Yong Hahn, MD, a cardiologist at Samsung Medical Center in Seoul, South Korea, and the study’s senior author. “In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate. For patients with beta-blocker-related side effects – fatigue, dizziness, bradycardia, hypotension – the case for discontinuation is even stronger.”

The study evaluated 2,540 patients at 26 sites in South Korea between 2021 and 2024 who had no subsequent cardiac events after taking beta-blockers for at least one year following a heart attack. Participants’ average age was 63 years and 87% were men. At a median of 3.5 years following randomisation, the primary endpoint – a composite of all-cause death, recurrent heart attack or heart failure hospitalisation – occurred in 7.2% of those who discontinued beta-blockers and 9% of those who continued taking the medication. The results met the threshold for non-inferiority because of a lower rate of this composite endpoint in the group that stopped taking beta-blockers.

Discontinuation of beta-blockers was also found to be similar for secondary endpoints, including each of the components of the primary composite endpoint, new-onset atrial fibrillation, unfavourable changes in left ventricular function, changes in quality of life and serious adverse events.

“In current practice – where revascularisation rates are high and secondary prevention is strong – we expected that the incremental benefit of continuing beta-blockers indefinitely in stable patients might be small,” Hahn said. “We found that discontinuation did not worsen major outcomes, cardiac function or quality of life in this selected stable population.”

Since most study participants had been taking beta-blockers for several years before discontinuing, Hahn said that the results may not apply to patients who have been taking beta-blockers for a shorter amount of time. The study also does not definitively establish the earliest timepoint at which it is safe to stop taking beta-blockers.

The results were generally consistent across prespecified subgroups. However, women and patients with mildly reduced left ventricular ejection fraction made up a small proportion of the trial population, limiting the interpretation of results for these subgroups. In addition, the study was conducted only in South Korea, potentially limiting its generalisability to other areas of the world.

Hahn said future studies could help to clarify whether and when it is safe to discontinue beta-blockers among higher-risk groups, women and those with mildly reduced left ventricular ejection fraction and to better define the optimal timing of discontinuation. Pooled analyses across contemporary randomised trials could provide additional insights and help guide practice decisions. The researchers also plan to conduct further analyses to assess potential differences in health care costs.

The study was funded by the Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare of the Republic of Korea.

This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.

Source: American College of Cardiology

Some Common IBS Treatments Linked to Higher Risk of Death

Photo by Towfiqu Barbhuiya on Unsplash

A large, long-term study led by Cedars-Sinai Health Sciences University investigators suggests that some medications commonly prescribed to treat irritable bowel syndrome (IBS) – including antidepressants – may be associated with a small but measurable increase in the risk of death.

The findings, published in Communications Medicine, are based on nearly two decades of electronic health records from more than 650 000 US adults with IBS, making it the largest real-world study to examine the long-term safety of IBS treatments.

IBS is a chronic gastrointestinal condition which has no cure, but dietary modifications, behavioural therapy and medications can help manage symptoms.

“Many patients are diagnosed with IBS at a young age and may remain on medications for years,” said Ali Rezaie, MD, medical director of the GI Motility Program at Cedars-Sinai and senior author of the study. “However, most clinical trials of these medications last less than a year, so we know very little about their long-term safety. This study begins to address that gap.”

Researchers assessed patients taking Food and Drug Administration-approved IBS medications, as well as antidepressants, antispasmodics and opioid-based antidiarrhoeal drugs, such as loperamide and diphenoxylate – widely used and recommended in IBS care. They found that long-term antidepressant use was associated with a 35% higher risk of death, and that loperamide and diphenoxylate use were associated with roughly double the risk of death.

The study does not establish that these medications directly cause death; rather, the observed associations may reflect higher rates of adverse outcomes, such as cardiovascular events, falls and stroke, which were more frequent among exposed patients.

Although antidepressants are not FDA-approved for IBS, they are commonly prescribed for IBS patients to help reduce pain, calm symptoms and make the condition easier to manage. The study found that other recommended treatments, including FDA-approved medications and antispasmodics, were not associated with increased mortality risk.

Researchers emphasised that while the increase in risk is significant and may sound concerning, the overall risk to any individual patient is small.

“IBS patients should not panic, but they do need to understand and weigh the small but meaningful risks when considering long-term treatments,” said Rezaie, the director of Bioinformatics at the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai. “Patients should speak with their healthcare provider about the safest and most effective options for managing their symptoms.”

Rezaie said more research is needed to confirm these findings and identify which patients may be at greatest risk. He also called for future treatment guidelines to better address the long-term safety of medications commonly used to manage IBS.

In the meantime, he emphasized a more personalised approach to IBS patient care.

“Treatment for IBS patients should focus on identifying the underlying causes and using the safest, evidence-based options available rather than relying on a single class of medications for long-term management,” Rezaie said.

By Kristin Reynolds

Source: Cedars-Sinai Medical Center

How Women Are Harmed When Clinicians Rely on the Lab More Than the Patient

Photo by Karolina Grabowska on Pexels

Across the world, countless women enter perimenopause only to be told that “everything is normal” because their blood tests do not match their symptoms.

This is one of the most damaging failures in modern women’s health. Perimenopause is not a laboratory diagnosis. It is a clinical diagnosis, made by listening to the woman and recognising the pattern of hormonal transition. Yet many clinicians continue to rely on FSH, LH and oestrogen levels – tests that were never designed to diagnose perimenopause and are physiologically incapable of doing so.

1. Hormone levels in perimenopause are wildly erratic

Oestrogen does not decline smoothly. It surges, crashes, and oscillates unpredictably. FSH and LH follow the same chaotic pattern. A single blood test captures only a moment in this turbulence. It cannot represent the hormonal instability that defines the transition.

This is why women with severe vasomotor symptoms often have “normal” results, while women with mild symptoms may show “abnormal” ones.

Erratic physiology produces erratic numbers. The numbers do not reflect the suffering.

2. Lab ranges do not correlate with symptoms

Laboratory ranges were created for research and population studies – not for diagnosing perimenopause. They do not account for:

  • daily hormonal swings
  • stress
  • sleep deprivation
  • illness
  • cycle timing
  • individual sensitivity to hormonal change

A woman may be drenched in night sweats, unable to sleep, emotionally unstable, and struggling to function – yet her blood tests may look “normal”. This leads to the most common and harmful phrase in women’s health: “Your results are normal, so this is not hormonal.”

3. The harm of relying on lab results

When clinicians wait for “abnormal” results before offering help, women suffer. They are:

  • dismissed
  • misdiagnosed
  • told they are anxious or depressed
  • denied treatment
  • left to struggle through years of avoidable distress

Or are treated inappropriately for life with antidepressants, mood stabilisers, axyiolytics and sedatives. These do little to address the underlying problem but create another set of problems: addiction and a range of side effects. This is not medicine. This is neglect disguised as protocol.

Suffering is prolonged because clinicians rely on lab results rather than the woman’s symptoms. Treating the lab instead of the woman is a betrayal of clinical responsibility.

4. The only test worth doing

There is one test that adds value: TSH and T4 – to exclude thyroid disease, which can mimic some perimenopausal symptoms. Beyond this, further hormone testing wastes time, money, and emotional energy.

5. The clinical truth

Perimenopause is diagnosed by listening to the woman, not by chasing fluctuating hormones. If she has:

• hot flushes

• night sweats

• irritability

• emotional instability

• sleep disturbance

• cycle changes

— she is in perimenopause, regardless of what the blood tests say.

The woman’s story is the evidence.

The numbers are often unreliable and misleading tools.

Dr E.V. Rapiti • April 2026

www.drrapiti.com

Simple Rituals Like Tea Drinking Help Rewire Focus

Scientists use cutting-edge imaging to explore how Rooibos may support healthy brain cells. From left: Catherine Smit, Dr Sholto de Wet and Prof Ben Loos.

In a world of endless notifications, relentless multitasking and constant information overload, the ability to focus is slipping through our fingers. Research suggests the human attention span has shrunk dramatically over the past two decades, with a widely cited Microsoft study putting it at just eight seconds today, down from 12 seconds in 2000. That’s shorter than the attention span of a goldfish.

Meanwhile, chronic stress and cognitive overload are now recognised as major contributors to burnout, anxiety and reduced productivity.

The role of simple rituals in restoring focus

Against this backdrop, scientists are beginning to explore not only what we consume, but also how we consume it, including the role of simple rituals like tea preparation, in restoring mental clarity.

Emerging research into Rooibos, a naturally caffeine-free herbal tisane indigenous to South Africa, suggests that both its bioactive compounds and the act of drinking it may support the brain under pressure.

How stress impacts the brain

From a neuroscience perspective, chronic distraction has measurable consequences.

According to Prof Ben Loos from Stellenbosch University’s Department of Physiological Sciences, stress isn’t good for the brain and can affect how well it functions. “It can contribute to a pro-inflammatory state and neuro-inflammation.” He explains that prolonged cognitive overload increases the production of reactive oxygen species (ROS), creating a damaging cellular environment that impairs brain function.

Over time, this affects critical regions, such as the prefrontal cortex, responsible for attention and decision-making, and disrupts neuroplasticity – the brain’s ability to adapt and learn. “Individuals may feel depleted due to an overload of the prefrontal cortex,” Prof Loos notes, adding that unmanaged stress can impair memory and learning capacity.

While much of the modern response to fatigue involves stimulants like caffeine, researchers are increasingly interested in alternatives that support the nervous system without overstimulation. Naturally caffeine-free Rooibos presents one such option.

Antioxidants and cellular protection

At a molecular level, Rooibos contains potent antioxidants, notably aspalathin and quercetin, which have been studied for their neuro-protective potential.

Prof Loos explains that Rooibos works in different parts of the body to help protect cells from the kind of damage that can build up as we age. “In simple terms, the compounds in Rooibos help keep brain cells healthy, support the body’s natural energy levels and keep cells working as they should, which is important for maintaining a sharp, active mind.

“A big part of this comes down to structures in our cells called mitochondria. These are like tiny energy generators that turn the food we eat into fuel, giving both the body and brain the energy they need to function properly, grow and stay healthy,” he says. For the brain cells, this means, making new connections with other brain cells and simply aging healthier.

Research has highlighted that mitochondrial dysfunction is closely linked to cognitive decline and neurodegenerative diseases. By supporting mitochondrial health, Rooibos compounds may help create a more stable internal environment for cognitive function.

This microscopic image shows active mitochondria (in red) inside brain cells. Rooibos appears to help these energy-producing structures stay strong and adaptable, supporting overall cell health. (Image: Catherine Smit)

Supporting brain chemicals linked to learning and memory

Dr Taskeen Docrat from the Applied Microbial Health and Biotechnology Institute (AMHBI) at CPUT explains that the natural compounds in Rooibos not only help protect our cells, but might also support the brain chemicals that are important for memory and learning. These antioxidants help the body manage and reduce harmful stress that can damage cells.

Dr Taskeen Docrat, researcher from the Applied Microbial Health and Biotechnology Institute (AMHBI) at Cape Peninsula University of Technology (CPUT) explores how Rooibos antioxidants may support cognitive health.

She mentions that Aspalathin, one of the compounds in Rooibos, helps protect the brain by lowering this kind of stress. Quercetin, another compound, may boost the levels of a protein called BDNF, which plays an important role in helping the brain learn, adapt and store new information.

The science of ritual and the nervous system

But beyond biochemistry, there is growing recognition of the psychological benefits of ritual. Structured, repetitive behaviours, such as preparing and drinking tea, can activate the parasympathetic nervous system, which promotes relaxation and recovery.

Dr Docrat explains that ritualised behaviours activate the part of our nervous system that calms us down. This can lower stress hormones in our body, specifically, cortisol. When cortisol levels drop, we tend to feel less stressed, which can lead to better emotional regulation and clearer thinking.”

This aligns with broader psychological research showing that small, intentional rituals can reduce anxiety and improve focus by creating a sense of control and predictability in otherwise chaotic environments.

Importantly, Rooibos offers these benefits without the potential downsides of caffeine. While moderate caffeine intake can enhance alertness, excessive consumption – particularly in high-stress contexts – may increase heart rate, anxiety and sleep disruption.

“Opting for a caffeine-free drink like Rooibos could provide safer support for the nervous system without the crash,” Dr Docrat notes.

A holistic approach to focus and mental clarity

Although direct evidence linking Rooibos consumption to improved focus is still emerging, the underlying mechanisms are compelling. Prof Loos cautions that it’s not easy to correlate what they see on the molecular level to high-level functions, such as mental focus, but adds that improved cellular health in the brain likely supports better neuronal function overall.

In a world where distraction is the norm, the solution may not lie in pushing the brain harder, but in creating conditions that allow it to function optimally. Incorporating simple, non-caffeinated rituals like drinking Rooibos may offer a dual benefit – biochemical support for brain health and a psychological pause that resets attention.

As Prof Loos concludes, we need moments of calm, silence and focus to manage stress, sharpen the mind and support resilience and creative thinking.

How Oestrogen in the Brain Impacts Stress and Trauma Response

New research reveals how oestrogen levels in the brain influence vulnerability to stress-related memory problems, helping explain sex differences in PTSD risk.

Photo by Sherise Van Dyk on Unsplash

For some people, a single traumatic event like a shooting, a natural disaster or a violent assault, can leave an imprint that lingers long after the immediate danger has passed. Memories of that event may return with unusual intensity, shaping mood, behaviour, and mental health in ways that are difficult to predict. Others exposed to similar trauma recover without developing lasting memory problems or trauma-related symptoms.

Why those outcomes diverge is a central question in stress and trauma research. Clinicians have long observed that severe acute stress can permanently alter memory for some people but not others, and that women face roughly twice the lifetime risk of posttraumatic stress disorder (PTSD). Recent research from the University of Pennsylvania in collaboration with the University of California-Irvine suggests that part of the answer may lie in the brain’s biological state at the precise moment trauma occurs.

Elizabeth Heller, PhD, an associate professor of Pharmacology in the Perelman School of Medicine at the University of Pennsylvania, and her team in the Heller Lab, have now shed light on how the brain’s biological state at the time of stress, particularly its oestrogen levels, can shape vulnerability long after the acute stress has lifted. Heller helped uncover that oestrogen levels in the brain may play a surprising role in this vulnerability, and for both sexes. The study, published in Neuron, also provides new insight into why women are more likely than men to develop post-traumatic stress disorder (PTSD) and to face higher dementia risk later in life.

Unpacking oestrogen’s role in memory vulnerability

Oestrogen is widely known to support learning and memory. This study found that high levels of oestrogen in the hippocampus, a brain region critical for memory, help the brain’s cells change and adjust more easily. However, in the context of severe acute stress, this flexibility can increase vulnerability to stress-related memory problems.

Heller and the Penn team mapped how high levels of oestrogen interact with chromatin structure (the storage packaging up DNA inside cells) in the hippocampus to make some brains more susceptible to PTSD‑like memory changes.

The findings help explain why traumatic events such as natural disasters, mass violence, and assaults can cause long-term memory problems, and why women are roughly twice as likely as men to develop PTSD.

“A lot of what determines vulnerability is the state your brain is already in,” Heller explained. “If a traumatic event hits during a period when oestrogen is already unusually high, the resulting plasticity can amplify the impact in lasting ways, promoting vulnerability to stress. Even with these findings in hand, the word oestrogen can mislead readers into assuming the biology applies only to women. That assumption shaped public understanding for decades, but it doesn’t hold up against what this research, and years of foundational neuroscience, actually shows.

As Heller notes, oestrogen is a critical brain hormone in both sexes. It is produced locally in regions like the hippocampus where it helps regulate learning, mood, and responses to stress. Recognising that universality is essential to understanding what this study truly reveals.

“The striking thing is that oestrogen levels are actually high in both males and in females in some parts of the hormonal cycle. Thus, the effects of high oestrogen levels happen in both males and females,” Heller said. “We tend to treat oestrogen as a women’s health hormone, but the brain makes its own oestrogen, and it plays powerful roles in stress, memory, mood, and emotion across sexes.”

By Eric Horvath

Source: Penn Medicine