• Impaired balance and gait
  
• Decreased muscle strength, slower reflexes, and vestibular (inner ear) issues
  
• Common conditions such as sarcopenia (age-related muscle loss) and neuropathy
  
• Drugs that affect the central nervous system, such as antidepressants, sedatives, antipsychotics, and antihypertensives that can cause dizziness, drowsiness, and orthostatic hypotension (drop in blood pressure)
  
• Vision impairment, such as cataracts, glaucoma, and age-related macular degeneration (which reduce depth perception and hazard awareness)
  
• Foot problems and improper footwear, such as painful feet, deformities, or wearing slippery, loose, or overly soft shoes that can destabilize walking
  
• Underlying medical conditions such as stroke, Parkinson’s, arthritis, diabetes, and cognitive decline (for example, dementia), all of which can impair movement, judgment, or strength
  
• Environmental hazards such as slippery floors, poor lighting, loose rugs, and clutter are frequent causes of trips and stumbles at home or in care facilities
  
• Alcohol use
  
• Cannabis use

While the most direct cause of a fall is often loss of balance, it usually stems from a multifactorial mix of aging physiology, chronic disease, and medication side effects. It's important to note that:

A recent online Medical Xpress article discussed the seriousness of this medication issue (Macquarie University, 2025, April 13).1 Research conducted at Macquarie University and the Australian Institute of Health Innovation illustrated the growing concern surrounding psychotropic medication use in aged care homes, particularly its link to serious fall injuries among older adults. Published in BMJ Open, the findings raise urgent questions about how mental health is managed in residential aged care facilities, and the need to re-evaluate the long-term use of medications like antidepressants, antipsychotics, and sedatives (Batool, Raban, Seaman, Westbrook, and Wabe, 2025).2​

• Slower reflexes, weaker bones, and reduced balance increase the risk of a severe fall
• Many older adults have already developed osteoporosis, making fractures more likely
• Vision or hearing problems can make sudden movements from pets more difficult to anticipate

Older adults can significantly reduce the risk of disabling or fatal falls through a combination of home safety improvements, physical conditioning, medical management, and lifestyle adjustments.

Although falls are the leading cause of fatal and disabling injuries in older adults, most are preventable. Enroll in fall prevention classes. Many classes are free through community or senior centers. And always carry a phone with you in case you fall and need help. ​

​1. Macquarie University. (2025, April 13). Falls prevention: Call for review of antidepressant medication use in aged care homes. Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-04-falls-antidepressant-medication-aged-homes.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter#google_vignette

2. Batool, N., Raban, M. Z., Seaman, K., Westbrook, J., and Wabe, N. (2025). Impact of potentially inappropriate psychotropic medicines on falls among older adults in 23 residential aged care facilities in Australia: a retrospective longitudinal cohort study. BMJ Open, 15:e096187. Retrieved from https://bmjopen.bmj.com/content/15/4/e096187

When treating MC, sometimes the smallest details can foil an otherwise valid treatment program. For those of us using hormone replacement therapy (HRT), or even something as simple as thyroid hormones, for example, hormones may have different effects at different times, depending on the situation. Some hormones (such as estrogen and thyroid hormones) can be pro- or anti-inflammatory depending on their levels and the surrounding environment. Balance is critical. The body carefully balances these hormones, and too little or too much of almost any hormone can tip the scale toward unwanted inflammation.

Cortisol, melatonin, progesterone, testosterone, and adiponectin are mainly anti-inflammatory. And high estrogen, high insulin high leptin, high catecholamines, and high thyroid hormones are inflammatory.  

It's well known, and verified by published research, that vitamin D deficiency during pregnancy can be associated with adverse outcomes, such as preterm birth, gestational diabetes, and low birth weight. So it doesn't take much of a stretch of the imagination to rationalize that vitamin D supplementation during pregnancy might provide benefits. And indeed, even the new guidelines of the Endocrine Society recommend that pregnant people should take supplemental vitamin D above the recommended intake levels of the Institutes of Medicine (IOM), because of the potential to reduce the risk of pre-eclampsia, intra-uterine mortality, preterm birth, small-for-gestational age birth, and neonatal mortality (Press release, 2024, June 03).1

As a result, many of us have doubted the accuracy of the findings that have been published regarding most of the recently published research articles, because they invariably claim to find that taking supplemental vitamin D provides no benefits. So it was rather surprising to see that some British researchers have recently published the results of a study that showed that taking additional vitamin D during pregnancy provides significant benefits above and beyond those suggested by the IOM (Moon, et al., 2024).2

Unlike most vitamin D studies, this study by researchers at the University of Southampton, took a different approach for studying benefits of vitamin D supplementation. They found that children whose mothers took daily vitamin D supplements during pregnancy had stronger bones, with higher bone mineral density.

In the study, assessments made at age four showed improved bone health in these children. And follow-up assessments made at age seven also showed significant improvements in bone health. This implies that vitamin D supplementation contributes to a lasting increase in calcium and mineral content in bones, reinforcing the value of maternal vitamin D as a preventative measure against future bone health issues, including osteoporosis.

This suggests that epigenetic mechanisms may also be involved in the impact of vitamin D supplementation on bone outcomes later in childhood, although this has not yet been verified by research. In other words, although vitamin D supplementation by their mothers during gestation cannot change their genetics, it may change the way certain genes are expressed during their developmental years. Consider that the vitamin D receptor (VDR) is a nuclear, ligand-dependent transcription factor. When activated by the active form of vitamin D (1,25[OH]2D3), it regulates the expression of more than 900 genes in the body that play a role in a huge variety of chemical and physiological functions.

The results of this study add weight to those guidelines by verifying how supplemental vitamin D during pregnancy reduces the risk of bone-related health issues for newborns and developing children later in life, such as fractures and osteoporosis, this approach could contribute to reducing healthcare costs associated with bone health.

Beyond bone health, earlier findings from the trial indicated that vitamin D supplementation during pregnancy may reduce the likelihood of atopic conditions like eczema in infants up to a year old, showing vitamin D's potential to impact immune health. And the trial also verified that mothers receiving supplemental vitamin D were more likely to have spontaneous vaginal deliveries, potentially reducing the need for medical interventions during childbirth.

1. Press release. (2024, June 03). Endocrine Society Guideline recommends healthy adults under the age of 75 take the recommended daily allowance of vitamin D. Endocrine Society, Retrieved from https://www.endocrine.org/news-and-advocacy/news-room/2024/endocrine-society-recommends-healthy-adults-take-the-recommended-daily-allowance-of-vitamin-d

2. Moon, R. J., D’ Angelo, S., Curtis, E. M., Ward, K. A., Crozier, S. R., Schoenmakers, I., . . . Prentice, A. (2024). Pregnancy vitamin D supplementation and offspring bone mineral density in childhood follow-up of a randomized controlled trial. The American Journal of Clinical Nutrition, 120(5), 1134. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39306330/

For decades we've noted that pregnancy significantly affects the clinical symptoms of microscopic colitis (MC) patients. Many patients who are currently in a flare, tend to experience a remission as their pregnancy progresses. And occasionally, the reverse occurs. In other words, patients who are in remission, experience a relapse of symptoms as their pregnancy develops. Theories about why this happens have usually focused on hormonal changes that occur during pregnancy.

And indeed, the hormonal changes that occur with pregnancy are numerous and relatively complex. Beginning 6 to 12 days after fertilization, trophoblast tissue in embryos (this tissue will eventually be part of the placenta) produces the chemical human chorionic gonadotropin (hCG), which promotes the production of progesterone and estrogen until the placenta takes over. Production of hCG peaks at around 10 weeks. hCG frequently triggers the symptoms of morning sickness.

As the pregnancy proceeds, many additional hormones are eventually produced to enhance the development of the fetus. And soon after these hormonal changes begin, the symptoms status changes for many MC patients, so it seemed logical that the hormonal changes might be the primary reason for the sudden remission of symptoms for some patients, and relapse of symptoms for others.

Enlarged villi and increased intestinal surface area enhance the uptake of essential nutrients, including sugars, proteins, and fats. And slowed food flow through the intestine due to the structural changes further optimizes nutrient absorption.​

The research showed that in mice lacking the RANK/RANKL pathway, the failure of intestinal adaptation led to altered milk composition. Babies born to such mothers exhibited reduced weight and glucose intolerance under metabolic stress, indicating transgenerational health effects.

The study showed that the intestinal expansion is reversed after lactation ends, providing a dynamic physiological adaptation, rather than a permanent change.​

Although this study was primarily conducted on mice, findings from human intestinal studies suggest that similar mechanisms should be applicable to humans.

Since this hasn't been specifically studied by any formal research projects, we can only speculate. However, it's well known that pregnancy itself is an inflammatory state due to the fact that the placenta produces cytokines that are capable of worsening the symptoms of IBD during pregnancy.

According to Doctor Daniel Stein, of RMA of New York, during pregnancy, the immune system must strike a delicate balance to support the developing baby while preventing its rejection as a foreign entity (Stein, 2020, October 26).3 One key component of this process involves T-lymphocytes (T-cells), which have distinct roles in the immune response. Cytotoxic T cells identify and destroy infected cells, while T-helper cells regulate other immune cells. These T-helper cells are further divided into subtypes with contrasting functions:​

TH1 cells produce cytokines that activate and enhance immune cell activity, promoting inflammation.
TH2 cells produce cytokines that suppress the immune response, reducing inflammation and preventing aggressive immune activity.

For a pregnancy to progress without complications, the balance between these cells is critical. A higher ratio of TH2 to TH1 cytokines is necessary to suppress excessive immune responses and avoid the rejection of the embryo.

Additionally, T regulatory cells (Tregs) play a crucial role in promoting the implantation of the embryo and facilitating the placenta's integration into the uterine wall. These cells help maintain immune tolerance to the fetus. Studies have shown that women with recurrent miscarriages or unexplained infertility often have reduced levels of T regulatory cells, highlighting their importance in supporting a healthy pregnancy.

This relatively critical balance between T cells may allow sufficient leeway for the inflammation level associated with pregnancy to overwhelm the state of remission associated with MC, to cause a relapse of MC symptoms. And although this hasn't been documented by research, it's possible that MC might have an effect on the balance between TH1 and TH2 cells under certain circumstances.

The reason why they're especially important is because if we are reacting, we have a malabsorption problem, and even if we're in remission, we're on a restricted diet, which may result in the development of deficiencies in certain vitamins and minerals, if not properly supplemented.​

Adequate nutrition is critical for not only a developing fetus, but the mother-to-be, also. And this is often a problem for mothers who do not have an IBD, making proper supplementation especially important for MC patients. Magnesium is particularly important. Many of us struggle to keep our magnesium reserves at a safe level, and adequate magnesium is especially critical during gestation.

In fact, Dr. Carolyn Dean, author of "The Magnesium Miracle", suggests that increasing magnesium reserves early on during pregnancy can help to prevent morning sickness, although that opinion isn't shared by most physicians.

1. Hashash, J, G. and Kanen S. (2015). Pregnancy and Inflammatory Bowel Disease. Gastroenterology & Hepatology, 11(2), pp 96–102. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4836574/

2. Onji, M., Sigl, V., Lendl, T., Novatchkova, M., Ullate-Agote, A., Andersson-Rolf, A., , , Penninger, J. M. (2024). RANK drives structured intestinal epithelial expansion during pregnancy. Nature, Retrieved from https://www.nature.com/articles/s41586-024-08284-1

3. Stein, D. E. (2020, October 26). The Immune System and Pregnancy: How Your Body Can Turn on Itself. RMA of New York, retrieved from https://www.rmany.com/blog/the-immune-system-and-pregnancy-how-your-body-can-turn-on-itself

For years, antibiotics have been suspected of contributing to the development of microscopic colitis (MC). However, a major new study suggests this link may be overstated, and possibly a result of diagnostic bias, rather than a true biological effect.​

Researchers from the Karolinska Institutet in Sweden conducted a nationwide, self-controlled case series study examining 2,393 individuals aged 65 and older who were prescribed antibiotics and later diagnosed with biopsy-confirmed MC between 2007 and 2017.

The study was published in Alimentary Pharmacology & Therapeutics and also summarized by an online Medscape article under the headline “Antibiotics Getting False Blame for Colitis” (Szilcz. Wastesson, Bergman, Johnell, and Ludvigsson, 2025; Rai, 2025, February 21).”1, 2 The study found that:

​

• During antibiotic treatment there was a 44% increased risk of a diagnosis of MC (adjusted incidence rate ratio [aIRR] = 1.44)
• In the 3–12 months following-treatment, there was a 19% increased risk (aIRR = 1.19)
• The short-term risk (during the first 3 months after treatment) was modest or statistically insignificant

Antibiotics are frequently implicated because they commonly cause chronic, watery, nonbloody diarrhea, suggestive of MC. And because of this characteristic, subsequent investigation frequently uncovers pre-existing, asymptomatic cases of MC.

• 10 to 15% result in a diagnosis of MC.
• 30 to 50% have no visible or microscopic inflammation. This is often diagnosed as "functional diarrhea" or irritable bowel syndrome with diarrhea (IBS-D).
• 5 to 10% are found to be due to other microscopic abnormalities, including nonspecific colitis, drug-induced changes, or early IBD.
• 5 to 10% are found to have macroscopic inflammation, including Crohn's disease or ulcerative colitis (UC), with mucosal changes visible during the colonoscopy.
• 5 to 10% result in other diagnoses, including ischemic colitis, bile acid diarrhea, radiation colitis, or eosinophilic colitis.
• 10 to 15% result in nonspecific findings, or mild histologic changes, which may show subtle lymphocytic infiltration, mild edema, or inflammation without clear diagnostic criteria.
• 1 to 5% are found to have "infectious colitis" (this is often diagnosed by's stool tests, not colonoscopy)
• 1 to 2% may be attributed to colorectal cancer or polyps, although this is a somewhat rare cause of watery diarrhea, unless the tumor is large or secretory.

So based on the statistics, if antibiotics trigger chronic, watery, nonbloody diarrhea, it's not surprising that gastroenterologists might expect to find MC. But obviously a large portion of people with chronic diarrhea (30 to 50%) will have a completely normal colonoscopy, with normal, or near-normal biopsies, resulting in a diagnosis of IBS-D, functional diarrhea, medication -induced diarrhea (for example, metformin, SSRIs, PPIs, magnesium) or bile acid diarrhea (underdiagnosed unless specifically tested).

While it was shown that antibiotics do not cause MC, the study also found that antibiotic associated GI symptoms may lead to additional colonoscopies, thereby increasing the chance of detecting pre-existing MC.

Did the study prove that antibiotics cannot trigger symptomatic flares in previously asymptomatic MC? Well, no, because it didn't test that directly. What it did show was that the rise in MC diagnoses after antibiotic use was matched by a rise in normal colon biopsies, which implies that the antibiotics themselves may not be causing new disease, but rather unmasking existing conditions, by provoking the symptoms of diarrhea.

In other words, the study suggests that antibiotics might provoke symptoms in someone who has asymptomatic or subclinical MC, which then leads to investigation, and a diagnosis of MC. But there's no clear evidence that antibiotics cause MC where it did not exist previously, and no clear evidence that antibiotics convert asymptomatic MC into active disease (this was not specifically investigated).

Medications such as NSAIDs, SSRIs, and PPIs have also long been considered to be possible causes for the development of MC. In view of the findings of this large, well-controlled study that determined the long-held assumption that antibiotics are a significant cause of MC to be without merit, will research soon show that medications such as NSAIDs, SSRIs and PPIs do not cause MC, either?

Probably not, because unlike antibiotics (which don't generally cause chronic inflammation) NSAIDs, SSRIs, and PPIs can definitely cause chronic inflammation, and chronic inflammation commonly causes the development of MC.

1. Szilcz, M. Wastesson, J. W., Bergman, D., Johnell, K. and Ludvigsson, J. F. (2025). Antibiotic Use and Risk of Microscopic Colitis in Older Adults: A Nationwide Self-Controlled Case Series Study. Alimentary Pharmacology and Therapeutics, Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/apt.70028

2. Rai, A. (2025, February 21). Antibiotics Getting False Blame for Colitis, Study Finds. Medscape, Retrieved from https://www.medscape.com/viewarticle/antibiotics-getting-false-blame-colitis-study-finds-2025a10004j5?ecd=mkm_ret_250418_mscpmrk_idhiv_antibiotic_etid7362030&uac=95382HN&impID=7362030