Medical Bulletin 10/February/2026

The findings come from a large meta-analysis that reviewed all available randomised clinical trials on treatments for Functional Hypothalamic Amenorrhea (FHA). FHA is a common reproductive condition in which menstrual periods stop due to low energy availability caused by eating disorders such as anorexia nervosa or excessive physical activity. It accounts for nearly one-third of all cases of amenorrhea.

When periods stop, estrogen levels fall sharply, leading to rapid bone loss. Around 50% of women with FHA have low bone mineral density, compared with just 1% of healthy women, and their risk of fractures can be up to seven times higher.

Doctors initially aim to restore periods through lifestyle changes such as improved nutrition, reduced exercise, and psychological support. However, these approaches often fail. While international guidelines recommend estrogen therapy, there has been limited evidence on which type works best.

To address this gap, researchers analysed data from 692 women across multiple trials, making it the largest review of its kind. They compared oral HRT, transdermal HRT (applied via patches or gels), the combined oral contraceptive pill, and teriparatide, a bone-building drug.

The study found that transdermal HRT and teriparatide significantly improved bone mineral density, with gains of 2% to 13% over one to two years. In contrast, oral HRT and the oral contraceptive pill showed no meaningful benefit for bone health.

The findings have immediate clinical relevance. A recent UK audit found that many women with FHA are still prescribed the oral contraceptive pill, which this study suggests is ineffective for preventing bone loss.

Experts said the results could improve care across multiple specialties, including general practice, endocrinology, gynaecology, and psychiatry. Researchers stressed that women should discuss treatment options with their GP or bone specialist to ensure early and effective protection of long-term bone health.

REFERENCE: Efthymiadis, A., et al. (2026) Pharmacological interventions to improve bone density in functional hypothalamic amenorrhea: a systematic review and network meta-analysis of randomized clinical trials. The Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/clinem/dgag005. https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgag005/8417524

Astringent Foods May Activate the Brain Through Taste, Study Finds

The dry, puckering sensation felt after eating cocoa, berries, or red wine may do more than affect taste—it could also stimulate the brain, according to new research from Japan. Scientists suggest that flavanols, natural plant compounds found in these foods, may activate brain function through sensory nerves in the mouth rather than through absorption into the bloodstream.

Flavanols belong to a group of compounds called polyphenols and have long been linked to benefits such as better heart health, improved memory, and protection against brain cell damage. However, researchers have been puzzled by the fact that only a small amount of flavanols is absorbed during digestion. Despite this low bioavailability, their effects on the brain appear significant.

To investigate this, researchers led by Dr. Yasuyuki Fujii and Professor Naomi Osakabe at Shibaura Institute of Technology focused on astringency—the dry, rough mouthfeel caused by flavanols. They proposed that this sensation itself may act as a signal, sending messages directly to the brain via sensory nerves.

The study, published in Current Research in Food Science, tested the idea in mice. Animals given flavanols showed increased physical activity, more exploratory behavior, and better performance in learning and memory tests compared to mice given only water.

Further analysis revealed increased activity in key brain chemicals linked to attention, motivation, and stress regulation, including dopamine and norepinephrine. The researchers also observed activation of brain regions involved in stress responses, along with higher levels of stress-related hormones. These responses were similar to those seen after physical exercise.

The findings suggest that flavanols act as a mild, beneficial stressor, stimulating the brain in a way that enhances alertness and cognitive performance. Importantly, this effect appears to occur through taste perception rather than digestion alone.

Researchers say the study highlights the growing importance of “sensory nutrition,” a field that examines how the sensory experience of food affects health. Understanding how taste and mouthfeel influence the nervous system could help guide the development of foods that support brain health while remaining enjoyable to eat.

REFERENCE: Yasuyuki Fujii, Shu Taira, Keisuke Shinoda, Yuki Yamato, Kazuki Sakata, Orie Muta, Yuta Osada, Ashiyu Ono, Toshiya Matsushita, Mizuki Azumi, Hitomi Shikano, Keiko Abe, Vittorio Calabrese, Naomi Osakabe. Astringent flavanol fires the locus-noradrenergic system, regulating neurobehavior and autonomic nerves. Current Research in Food Science, 2025; 11: 101195 DOI: 10.1016/j.crfs.2025.101195

Gut Bacteria Molecule May Help Protect Children From Fatty Liver Disease

A naturally occurring compound produced by healthy gut bacteria may help protect children from developing fatty liver disease, even before birth, according to new research from the University of Oklahoma. The findings suggest that improving the maternal gut environment during pregnancy and breastfeeding could reduce the long-term risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in children.

MASLD is increasingly common among children, particularly those exposed to high-fat, high-sugar diets early in life. The condition often progresses faster in children than in adults and is closely linked to obesity and diabetes. Researchers report that children born to mothers with poor diets face a significantly higher risk, yet the disease often remains silent until liver damage is already present.

The study, published in eBioMedicine, focused on a compound called indole, which is produced by beneficial gut bacteria when they break down tryptophan, an amino acid found in foods such as nuts and poultry. Researchers fed pregnant and nursing mice a Western-style diet high in fat and sugar. A subset of these mice also received indole.

Although all offspring were later exposed to unhealthy diets, those born to mothers given indole showed markedly better health outcomes. They had healthier livers, gained less weight, maintained lower blood sugar levels, and developed smaller fat cells. Importantly, they showed significantly lower rates of fatty liver disease as they aged.

The researchers found that indole activated a protective gut–liver pathway involving the aryl hydrocarbon receptor (AHR) and altered lipid metabolism in a favorable way. Levels of harmful liver fats remained low, while beneficial lipid types increased. When gut bacteria from protected offspring were transferred to other mice, those animals also experienced reduced liver damage, highlighting the central role of the microbiome.

While the research was conducted in animals and cannot yet be directly applied to humans, the findings point to promising prevention strategies. Currently, weight loss is the only effective treatment for pediatric MASLD, and no approved medications exist.

The researchers say that targeting maternal diet and gut health may offer a powerful way to reduce the burden of fatty liver disease in future generations.

REFERENCE: Ashok Mandala, Ram Babu Undi, Rachel C. Janssen, Kameron Y. Sugino, Wanke Zhao, Benjamin N. Nelson, April M. Teague, Nikhil Y. Patil, Karin Zemsky Berry, Rohan Varshney, Bryan C. Bergman, Michael C. Rudolph, Aditya D. Joshi, Raju V.S. Rajala, Karen R. Jonscher, Jacob E. Friedman. Reprogramming offspring liver health: maternal indole supplementation as a preventive strategy against MASLD. eBioMedicine, 2026; 123: 106098 DOI: 10.1016/j.ebiom.2025.106098