My Health - 7 Simple Tricks To Reduce 500 Calories From Your Diet To Lose Weight Fast !

7 Simple Tricks To Reduce 500 Calories From Your Diet To Lose Weight Fast !

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Can cell phone use cause ADHD?

Anyone who has spent any time around teens, and seen the way they often seem surgically attached to their phones, has likely wondered: is all that time on the phone affecting their brains?

A study in JAMA suggests that maybe it is.

Researchers from California studied the digital media use of more than 2,500 high school students who did not have symptoms of attention deficit hyperactivity disorder (ADHD) at the beginning of the study. The most common symptoms of ADHD include inattentiveness (being easily distracted, having difficulty getting organized or remembering to do things), hyperactivity (having difficulty sitting still), and impulsivity (making decisions without thinking through the possible consequences).

The researchers asked the students how often they engaged in 14 different digital media activities, on a scale from “never” to “many times a day.” These activities included

• checking social media
• texting
• browsing or viewing images or videos online
• streaming or downloading music
• liking or commenting on other people’s posts
• chatting online
• streaming TV or movies
• playing games alone
• playing games with others
• posting on social media
• sharing others’ posts
• reading online blogs or articles
• online shopping/browsing
• video chatting.

They checked in with the teenagers at regular intervals over two years, both about their digital media use and also looking for symptoms of ADHD. They found that 4.6% of teens who didn’t report any high-frequency use of digital media had symptoms of ADHD at the end of the study — but that number jumped to 9.5% of those who reported seven high-frequency activities, and 10.5% for those who reported frequent activity in all 14. Overall, frequent digital media use appeared to increase the risk of having symptoms of ADHD by about 10%. The risk was higher for boys than girls, and for teens who had depression or a previous history of getting into trouble.

To some extent, this is understandable. Compared to more “traditional” media such as watching TV in your living room, digital media has a faster pace and is more stimulating, making it more likely that teens will get, well, sucked in. Also, adolescence is a time when teens develop social identity, and are looking for social connection — and if there were ever a place for social connection, it’s social media.

It’s certainly possible that digital media brought out ADHD symptoms in teens that hadn’t previously been diagnosed — or that the genetic or environmental factors (including parenting) that lead to high-frequency digital media use are some of the same ones that lead to ADHD. It’s also true that the effect was small. It’s also true that the effect was small. It’s also true that having symptoms of ADHD doesn’t mean one has ADHD.

But it’s still a study we shouldn’t ignore, because ADHD can have real negative effects on a teenager. It can lead to poor school performance, which can have lifelong consequences. It can make a teen more likely to do risky, dumb things (which they are already more likely to do just because they’re teens, so making it worse isn’t good). It can lead to substance abuse and legal problems, which we certainly don’t want to see happen. Even a small increase in the chance of any of this is bad.

And this is on top of concerns for device addiction, and concerns that cell phones interfere with learning to read social cues… maybe, just maybe, it’s time to get kids to put their phones down.

We can do it. I know we can. It will mean putting our phones down too, of course. But even just simple steps, like screen-free dinners and other screen-free activities, can make a difference — as can charging phones somewhere central away from the bedroom.

There’s a whole wondrous world out there, and our children need to interact with it in other ways besides with their phones.

Follow me on Twitter @drClaire

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My Health - Top searches on health topics? It may depend on where you live

You can learn a lot about a person’s medical concerns by looking at the health topics they’ve searched for online. It’s fascinating (and a bit creepy) to take a peek at what others are searching — and to compare what you find to what sends you online.

I’ve posted before about how the health issues people report worrying about the most differ from those that are most common, deadly, or have the biggest impact on quality of life. There’s overlap, of course, but certain important conditions (such as lung disease, the third leading cause of death in 2015) did not make the top 10 list of health concerns in a 2015 survey.

In that same post, I discussed how causes of death varied among states. For example, bicycle-related deaths occurred more often in Florida, and deaths due to accidents involving machinery were highest in Iowa and North Dakota. While we can probably come up with reasonable explanations for these, the higher rate of accidental suffocation in Connecticut is perplexing.

Health concerns as reflected by searches on health topics

A new study looks at searches for health information online and how that varies between states. The results are intriguing — and in many cases, quite difficult to understand.

Analyzing health-related Google searches by state, researchers found that:

• The top searches were for ADHD (nine states), syphilis (six states), and HIV/AIDS (four states). This makes sense considering that nearly 10% of school-age children have been diagnosed with ADHD (according to the CDC), more than a million people are living with HIV/AIDS (and even more are trying to avoid infection), and rising rates of syphilis have been reported in many parts of the country.
• The opioid epidemic has affected many states across the country, but it was the top search in only one state (Vermont, a state among the hardest hit by opioid misuse).
• Some of the findings likely relate to recent events in particular states. For example, Kentucky experienced a recent outbreak of hepatitis A, and Idaho had one of the highest rates of coli infection linked to contaminated romaine lettuce in 2017. So it makes sense these would be the top searches in those states.

Other findings were harder to explain. Why would “ear infection” be the most common search in North Dakota? Similarly, many common conditions were the most commonly searched in only one or two states. It’s hard to understand why the top search was for hemorrhoids in Minnesota, insomnia in South Dakota, and hypertension in Delaware and Montana. These conditions are quite common all over the country. (If you can explain these findings, let me know!)

Limitations of this study

It’s important to consider the limitations of this sort of analysis. One issue is that people search for information using a variety of terms, and that might throw off the tally. For example, eating disorders might be a common problem in your state, but if people used several different search terms to get information about them (bulimia, bulimia nervosa, eating disorder, and so on), none might register as a top health concern. In fact, two states (Washington and Nebraska) had top searches that might include eating disorders, but different terms were used most often (anorexia for Nebraska, body dysmorphia for Washington).

Another limitation is that not everyone uses Google for their searches (though estimates suggest it accounts for about two-thirds of them). Data regarding searches on non-Google sites were not included, and it’s possible that the choice of search engines varies by state.

It’s more than just interesting

Health concerns are common everywhere. And while it’s intriguing to see that different states seem to be focused on different health problems, the analysis of searches for health information can provide insights that go well beyond “interesting.” In some cases, through a review of online searches researchers have been able to identify the spread of disease before public health officials. For example, online searches for cold and flu remedies in a community may signal the spread of flu well before patients’ test results or hospital admissions confirm it.

What’s next?

You can expect to hear more about how the things we’re looking for online mirror our health concerns and illnesses. Of course, analysis of search results is nothing new. Advertising and targeted marketing helps to fuel a remarkable amount of commerce on the Internet. And it’s important to point out that in any analysis of online searches, privacy and confidentiality remain important concerns.

My guess is that researchers will refine their methods as they look at the large volume of online searches we generate every day, so that their analyses can help identify and even prevent illnesses as they develop. One can only hope that our searches can be used for more noble pursuits than just targeted advertising.

Follow me on Twitter @RobShmerling

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My Health - 9 Side Effects Of Aloe Vera Juice You Should Know

9 Side Effects Of Aloe Vera Juice You Should Know

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - CPR: A neglected but important part of fighting the opioid crisis

Opioid overdose is a frightening and potentially life-threatening event. Rescue drugs like naloxone are lifesaving, but the value of CPR doesn’t get as much attention. And it should.

How does opioid overdose lead to death?

Opioids (like oxycodone, heroin, and fentanyl) bind to special receptors in the brain called mu receptors. These receptors are responsible for a variety of functions, most importantly breathing. When the mu receptor is stimulated by an opioid, it releases chemicals that work downstream on parts of the brain that tell the body to slow down breathing, or even stop it altogether. This respiratory depression or apnea, when breathing stops, is the primary cause of death in opioid overdose.

Reversing the effects of opioid overdose

Thankfully, there is an antidote that can help to reverse the effects of opioids and save lives. As highlighted by Dr. Scott Weiner in his post in May 2018, naloxone can be used to reverse the effects of opioids and help to restore breathing. As we learned, it does this by displacing the opioid from the mu receptor, which reestablishes the signal to breathe. Naloxone can be given by a variety of routes, including by nasal spray or by an injection. It is easy to use, works quickly, and has saved a lot of lives after an opioid overdose.

But it can take several minutes for naloxone to work. On average, when delivered nasally it takes around two to five minutes for naloxone to take effect. In someone who isn’t breathing, those minutes are critical. Providing rescue breathing or CPR can help to save a life, and is the most important first step in treating an opioid overdose.

So, as important as naloxone is, anyone trained to use this medication should also be trained in another equally important intervention: cardiopulmonary resuscitation (CPR). The first thing, in fact, that a rescuer — be it a family member, friend, or good Samaritan — should do in the setting of an opioid overdose is to provide rescue breaths, or if needed, rescue breaths and chest compressions.

The value of knowing CPR

While traditionally thought of as something reserved for people who have had a heart attack, knowing CPR is growing ever more important in the opioid epidemic. Providing CPR while waiting for naloxone to arrive or waiting for it to work can be of significant benefit and a lifesaving measure. CPR is easy to learn, and training is often offered free or at a nominal cost. Anyone can learn it and anyone can do it.

Knowing CPR is important for other reasons. There are more than 350,000 out-of-hospital cardiac arrests in the United States each year. When bystanders act by providing CPR, the number of lives saved is dramatic. Nearly 45% of individuals who get it survive. Bystander CPR also helps to reduce the negative outcomes, such as injury to the brain or other organs.

Knowing the signs and symptoms of opioid overdose is important. These include: a depressed level of consciousness, small (constricted) pupils, and shallow or absent breathing. Carrying and knowing how to provide naloxone is important too, and so is knowing how to do CPR. If you know someone with an addiction to opioids, it may be one of the most important things that you do.

Follow me on Twitter @stephenpaulwoo4

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My Health - Belly fat linked with higher heart disease risk

Muffin top. Spare tire. Beer belly. Whatever you call it, research shows that extra fat around your belly poses a unique health threat.

The study in the March 6, 2018 issue of the Journal of the American Heart Association involved about 500,000 people, ages 40 to 69, in the United Kingdom. The researchers took body measurements of the participants and then kept track of who had heart attacks over the next seven years. During that period, the women who carried more weight around their middles (measured by waist circumference, waist-to-hip ratio, or waist-to-height ratio) had a 10% to 20% greater risk of heart attack than women who were just heavier over all (measured by body mass index, or BMI, a calculation of weight in relation to height). A larger waist-to-hip ratio, in particular, appeared to be a bigger heart attack risk factor for women than for men. The analysis showed that compared with BMI, waist-to-hip ratio was 18% stronger as a heart attack predictor in women — versus 6% stronger in men.

But the message that you should take from this study should be less about the gender differences and more about the overall risks presented by central adiposity, says Dr. Barbara Kahn, the George Richards Minot Professor of Medicine at Harvard Medical School.

Widening waistline, growing risks

Regardless of whether women are more vulnerable than men to heart problems related to abdominal weight gain, it’s pretty clear that central adiposity presents important health risks, Dr. Kahn says. Researchers have shown that weight gain around the middle represents an increase in the amount of visceral fat, the type of fat that encases your internal organs. “There are many studies showing that an unfavorable waist-to-hip ratio is highly associated with diabetes and cardiovascular risk,” says Dr. Kahn.

So, if your waistband has been feeling a little tighter these days, it may be time to take some action.

Strategies to whittle your waist and lower your risk

Keep weight gain in check. “The focus should be on limiting weight gain over all,” says Dr. Kahn. Women tend to put on pounds as they get older and after menopause. This occurs for many reasons, among them hormonal changes, a decline in muscle mass (because fat burns less calories than muscle), and in some cases lifestyle changes. Keeping tabs on your weight — and your waist — and making changes to your daily routine can help prevent the pounds from creeping up as you go through this transition. “I don’t talk with patients as much about going on a diet as I do about creating a long-term lifestyle program that includes physical activity and sustainable dietary changes,” says Dr. Kahn. Weight that comes off slowly tends to stay off. By contrast, very rapid weight loss can trigger your body to slow its metabolism, setting the stage for the weight to be regained quickly.

Get moving. It’s probably no surprise that increasing the amount of exercise you do should be a goal if you’re looking to keep your waistline in check. “I’m a big proponent of regular exercise,” says Dr. Kahn. If you’re squeezed for time, fit it in where you can — for instance, a half-hour walk outside the office at noon or before you drive home for the day. “It doesn’t have to be excessively vigorous. You don’t need to go to the gym and change your clothes,” she says. Just being physically active can help improve your metabolic health. Even getting up to walk around periodically during work can be beneficial. Regular physical activity may not always help you lose weight, but again, it can help you maintain a healthy weight, and also improve blood sugar for people with diabetes. Having a higher proportion of muscle mass can help you burn more calories, so adding strength training at least twice a week, focusing on all the major muscle groups, may also help you maintain your weight.

Unfortunately, avoiding weight gain around the middle may be easier for some women than others, as some people are simply more prone to adding extra pounds in the belly. Research may one day help to uncover new ways to head off this dangerous type of fat and, in turn, reduce the risk for diabetes and cardiovascular disease. Certain newer medications used to treat people with diabetes — known as sodium-linked glucose transport inhibitors — have the interesting side effect of inducing weight loss and reducing visceral fat, says Dr. Kahn. “This does point to the possibility that there may be some physiological mechanisms that target visceral adiposity,” says Dr. Kahn. In the meantime, focus on lifestyle changes and exercise, and keep an eye on your belt buckle to gauge your progress.

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My Health - Health benefits of coffee and a proposed warning label

Coffee is among the most popular beverages ever, enjoyed by millions of people worldwide each day. Estimates suggest that Americans consumed 3.4 billion pounds of coffee last year. When it comes to its health effects, coffee is also among the best studied beverages. How much is too much? Does coffee cause cancer? What is behind the proposed new warning label for coffee?

Fortunately, the news on coffee is mostly good. This includes a recent study that found coffee drinkers live longer, a conclusion that held up even for heavy coffee consumption (eight or more cups of coffee each day), and regardless of whether the coffee was caffeinated or not. And longevity was linked to coffee consumption regardless of what type of caffeine metabolism genes you carry. The authors concluded that the health benefits of coffee go beyond caffeine.

Prop 65 warning label

Perhaps you saw articles like this one describing an effort in California to require a notification to coffee consumers of a possible link to cancer. Here’s the reason: in 1986 California passed Proposition 65, which requires businesses to provide a warning label when exposing any consumer to any item on a long list of potentially harmful chemicals. Acrylamide is on that list, and coffee contains acrylamide, a chemical produced during the roasting process.

How worried should we be about acrylamide in coffee?

Nothing has changed in our understanding regarding the potential side effects of coffee, or its benefits. No study has convincingly linked acrylamide in coffee (or coffee in general) to one’s risk of cancer, and there is plenty of research. Many studies have explored whether there is a potential link between drinking coffee and cancer. Perhaps the most damning are ones (such as this one) suggesting hot beverages and foods may increase the risk of esophageal cancer. But that concern isn’t particular to coffee, and the specific temperature at which this risk appears has not been well defined.

The amount of acrylamide in coffee varies, and is quite small compared to amounts found to cause cancer in animals. In addition, there are other sources of acrylamide exposure no one is making a fuss over, including bread, potato chips, and breakfast cereals. It’s also found in cigarettes.

The challenge of proving a negative

The Los Angeles judge ruling on the new labeling requirement for coffee wrote that the coffee companies did not prove that acrylamide was safe. In essence, the judge was asking that the coffee makers prove a negative (the absence of risk), and that’s hard to do!

For example, if a particular food (or other exposure) is safe, studies finding no connection to harm can always be criticized — a different analysis, more time, or more study subjects could have led to different findings. Or, it might take a long and expensive study that hasn’t happened yet. For a particularly dangerous exposure (such as cigarette smoking), establishing a link is much easier. (As an aside: the difficulty proving a negative is a major reason that unfounded conspiracy theories persist.) The judge also discounted the extensive research linking coffee consumption to health benefits; exactly why he did is unclear.

While future research could find a link between coffee and cancer, there’s no particular reason to expect that to happen.

Health benefits of coffee

A partial list of potential coffee health benefits includes a lower risk of:

• liver cancer (and perhaps colon cancer as well)
• liver failure due to cirrhosis
• dementia
• type 2 diabetes (which accounts for more than 90% of all diabetes)
• gout
• death (as noted above, a number of studies have linked coffee consumption with living longer).

So, even if the trace amounts of acrylamide in coffee were found to increase cancer risk or cause other harms, these risks might be outweighed by the benefits of drinking coffee.

What’s next for coffee lovers?

Additional legal wrangling is expected, so it may be a while before California’s plans regarding warning labels for coffee are settled. In the meantime, you can take steps to limit your exposure to acrylamide by not smoking, eating less fried, burnt, or charred foods, and avoiding instant coffee. And perhaps we will discover ways of reducing or even eliminating acrylamide in the coffee roasting process. But it’s not clear that changing how coffee is roasted will actually improve your health. As is so often the case with potentially carcinogenic toxins, we’ll need additional research to determine whether the amount of acrylamide in coffee and other foods and drinks matters a little, a lot, or not at all.

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My Health - 7 Flax Seed Benefits That Everyone Must Know

7 Flax Seed Benefits That Everyone Must Know

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Common food additives and chemicals harmful to children

What do a can of corn, a take-out pizza, a reusable water bottle, a bright green yogurt, and an inflatable pool toy have in common? They all contain food additives or chemicals that can be dangerous for children.

Over the last few decades, the number of chemicals added to foods and other products has skyrocketed. We have created all sorts of plastics that are used in innumerable ways. We add preservatives to foods to keep them fresh. We add chemicals to foods to make them look more appealing. We have made food packaging to keep food fresh. We add chemicals to lotions and beauty products to make them feel, look, and smell nice… the list goes on and on of the ways we have invented and used chemicals.

We did all of it for what seemed like good reasons at the time, but we are learning that many of those chemicals can cause real harm.

In a policy statement entitled Food Additives and Child Health, the American Academy of Pediatrics warns about these harms — and points out that they often are worse for children. Children are smaller, so their “dose” of any given chemical ends up being higher. They put their hands in their mouths more than adults do, so they are likely to ingest more. Their bodies are still developing, so they can be more at risk of harm — and they are young, so the chemicals have more time to do more damage.

In particular, the policy statement warns about:

• Bisphenols, such as BPA. They can act like the hormone estrogen and interfere with puberty and fertility. Bisphenols can also increase body fat, and cause problems with the immune system and nervous system. They are found in the lining of food and soda cans, plastics with the number 3 or 7, and cash register receipts, among other places. They used to be found in plastic baby bottles and sippy cups; while this has been banned, older bottles and cups may still contain them.
• These can also act like hormones, interfering with male genital development, and can increase the risk of obesity and cardiovascular disease. They are ubiquitous, found not just in plastic packaging, garden hoses, and inflatable toys, but also in things like nail polish, hairsprays, lotions, and fragrances.
• Perfluoroalkyl chemicals (PFCs). They can lead to low-birthweight babies, as well as problems with the immune system, the thyroid, and fertility. They are commonly found in grease-proof paper, cardboard packaging, and commercial household products such as water-repellent fabric and nonstick pans, among other places.
• Perchlorate. This chemical also interferes with thyroid function, and can disrupt early brain development. It’s found in some dry food packaging — it’s used to decrease static electricity — and sometimes in drinking water.
• Artificial food colors. These have been found to increase symptoms in children who have attention deficit hyperactivity disorder, or ADHD. They are found in all sorts of food products, but especially those marketed for children.
• Nitrates and nitrites. These can interfere with the thyroid, as well as with the blood’s ability to deliver oxygen to the body. They can also increase the risk of certain cancers. They are used to preserve food and enhance its color. They are commonly found in processed foods, especially meats.

So what is a parent to do about food additives and chemicals?

These chemicals are truly everywhere, and impossible to avoid completely. Here is what the AAP suggests:

• Buy and serve more fresh or frozen fruits and vegetables, and fewer processed meats, especially during pregnancy.
• Since heat can cause plastics to leak BPA and phthalates into food, avoid microwaving food or beverages in plastic containers. Also: wash plastics by hand rather than putting them in the dishwasher.
• Use more glass and stainless steel instead of plastic.
• Avoid plastics with the numbers 3, 6, and 7 on them.
• Wash hands thoroughly before and after touching food, and clean all fruits and vegetables well.

And here are a few more ideas:

• Cut back on canned foods and beverages in general.
• Cut back on fast food and processed foods.
• Read labels. Get to know what is in the products you use.
• Look for lotions, soaps, and other products that are made naturally — and are fragrance-free.
• Consider making your own home cleaning products. You’d be amazed what a little baking soda or vinegar can do.

The idea isn’t to get paranoid (although that’s an understandable feeling) ;the idea is to get informed — and to make some simple changes that can go a long way toward keeping children and their families healthier.

Follow me on Twitter @drClaire

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My Health - Is Eating Brown Rice Every Day Good for You?

Is Eating Brown Rice Every Day Good for You?

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Do I have anxiety or worry: What’s the difference?

Have you ever thought about starting a new job or school, and found your heart pounding and your mind racing with a series of “what ifs”? If so, you may wonder “do I have anxiety?”

Anxiety is your body’s natural threat response system. When your brain believes you are in danger, it sends out a series of signals to your body, resulting in the fight-or-flight response.

Worry is a component of anxiety symptoms

Anxiety has three main components: emotional, physiological, and cognitive.

Imagine you have a presentation coming up at work. You might notice feelings of fear and dread, two examples of the emotional component. You may also notice bodily sensations, such as heart palpitations, sweating, or a tightness in your stomach, which represent the physiological component. Finally, you might be thinking, “I can’t do it,” or “I’m going to embarrass myself.” Worries and negative thoughts like these about what might happen in the future are the cognitive component. So, while worry is an important part of anxiety, it is only one of the three main building blocks.

The anxiety disorder spectrum

Anxiety in itself is not bad. Normal levels of anxiety lie on one end of a spectrum and may present as low levels of fear or apprehension, mild sensations of muscle tightness and sweating, or doubts about your ability to complete a task. Importantly, symptoms of normal anxiety do not negatively interfere with daily functioning. They may actually improve your attention and problem-solving, motivate you to work harder toward a goal, or warn you about a potential threat. For example, anxiety about an upcoming exam will likely drive you to prepare fully, and the anxiety a hiker might experience when encountering a bear allows the hiker to run away to safety. These examples demonstrate how normal levels of anxiety can be adaptive and helpful to your everyday life.

Clinical levels of anxiety fall toward the other end of the spectrum. Diagnosable anxiety disorders occur when anxiety levels rise enough to rapidly decrease performance and cause impairment.

How would you know if you have crossed over into the zone of a full-blown anxiety disorder? Anxiety disorders are characterized by severe, persistent worry that is excessive for the situation, and extreme avoidance of anxiety-provoking situations. These symptoms cause distress, impair daily functioning, and occur for a significant period. For instance, a person who needs to stay home from work several days in a row due to panic attacks is likely suffering from an anxiety disorder.

Different evidence-based treatments are most effective for different anxiety disorders. For example, a man suffering from panic disorder would likely benefit from exposure therapy, while a woman suffering from social phobia might be best treated with cognitive behavioral therapy (CBT). If you believe you may have an anxiety disorder, seek help as soon as possible.

What Is “almost anxious” and how can you handle it?

As anxiety moves along the spectrum from normal to clinical, a gray area in the middle may still have a negative impact on your life: the “almost anxious” region. When the level of anxiety you experience is no longer adaptive or helpful to your performance and becomes a barrier to your enjoyment of life, but does not yet meet the diagnostic threshold for an anxiety disorder, you are “almost anxious.” You might find yourself struggling to focus your attention on tasks, distracted by negative thoughts, fear, or unpleasant body sensations. For example, someone who is “almost anxious” may sit at their desk all day, making minimal progress on an assignment due to constant worries and tightness in the stomach. While anxiety did not make it impossible to come to work, the level of anxiety experienced is making it hard to function. Using this concept of “almost anxious” can help you catch anxiety before it becomes too extreme, and target it using evidence-based strategies that help move anxiety back along the spectrum to an adaptive level.

When you find yourself feeling too anxious, try evidence-based techniques highlighted in the book Almost Anxious to bring your anxiety levels back to normal. Here are a few tools to try:

• If you find yourself thinking, “I can’t do this,” “I’ll never get this assignment done,” or a similar negative thought, challenge this by asking if it is valid or helpful. You will likely find that these thoughts are merely fueled by your anxious brain, so stopping them in their tracks is important.
• If your thoughts seem to be spiraling out of control, take a few minutes to practice mindfulness. Focusing on the present moment takes your thoughts away from the past and future, helping you re-center yourself.
• Identify situations that make you anxious, and approach them instead of avoiding them. For example, if you are afraid of public speaking, talk in front of others as often as possible. Over time, you will find the discomfort fades away as you face the very things that used to cause you anxiety!

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My Health - 10 tricks to reduce salt (sodium) in your diet

The average adult eats about 3,400 milligrams (mg) of sodium per day — far more than the recommended daily goal of 2,300 mg. Here are the top 10 types of food that account for more than 40% of the sodium we eat each day, along with some ideas for simple swaps to help you eat less salt.

1. Breads and rolls

This category tops the list not because bread is especially salty (a slice contains about 100 to 200 mg of sodium), but because we eat so much of it.

Smart swaps: Instead of toast or a bagel for breakfast, have a bowl of oatmeal prepared with just a pinch of salt. Bypass the dinner breadbasket for a serving of whole grains, such as barley, brown rice, farro, or quinoa.

2. Pizza

All the essential pizza ingredients — the crust, sauce, and cheese — contain a lot of salt. Adding cured meats such as pepperoni or sausage adds even more sodium.

Smart swap: Make a homemade pizza using a whole-wheat, pre-baked pizza crust with low-sodium pizza sauce and slivers of part-skim mozzarella or other light cheese. Top with sliced bell peppers, mushrooms, or any other vegetables you like. Bake at 450° until the cheese melts.

3. Sandwiches

Like pizza, most sandwiches contain salty ingredients (bread, cheese, and cold cuts and cured meats).

Smart swap: Load up your sandwich with veggies such as tomato, avocado, and lettuce. Skip the cheese and add hummus, or try peanut butter with sliced apple or banana.

4. Cold cuts and cured meats

These processed meats include bacon, ham, salami, sausage, hot dogs, and deli or luncheon meats. Not only are they high in sodium chloride (salt), they also contain sodium nitrate as a preservative, which further boosts the sodium count.

Smart swap: Cook your own fresh chicken or turkey breast to slice up for sandwiches.

5. Soups

Some varieties of canned soup have as much as 940 mg of sodium per serving.

Smart swap: Look for low- and lower-sodium varieties. Or make a large batch of homemade soup, adding just enough salt to taste, and freeze it in individual serving containers for convenience.

6. Burritos and tacos

Like pizza, these popular Mexican dishes combine a number of high-salt ingredients, such as white flour tortillas (an 8” diameter one contains about 400 mg of sodium), cheese, and seasoned, salty beans and meat.

Smart swaps: Use whole-grain corn tortillas (just 5 mg of sodium each) and fill with grilled chicken or a mild white fish. Choose low-sodium canned beans, and top burritos and tacos with chopped vegetables and salsa.

7. Savory snacks

This includes chips, popcorn, pretzels, snack mixes, and crackers.

Smart swap: Choose low- or reduced-sodium versions of these snack foods.

8. Chicken

This popular protein is often prepared in commercial kitchens, which means added salt. Rotisserie or fried chicken from a grocery store or restaurant contains up to four times the sodium of plain chicken prepared at home.

Smart swap: Bake or sauté plain chicken breasts seasoned with salt-free herb blends.

9. Cheese

The amount of sodium in cheese varies widely, even among the same varieties, so check the labels carefully. Feta and blue cheese are among the saltiest varieties, while goat cheese and ricotta are on the lower end.

Smart swap: Try low-sodium cheese, or substitute small amounts of finely grated, savory hard cheeses such as Parmesan or Romano as a replacement for other cheeses.

10. Eggs and omelets

An egg contains only 62 mg of sodium, so this category again reflects other ingredients and cooking methods. For example, most fast-food egg breakfast sandwiches are made with cheese and ham on an English muffin, and omelets are also often full of cheese, bacon, and ham.

Smart swap: Make your own poached or soft-cooked eggs. Many grocery stores now carry hard-boiled eggs, which are even more convenient.

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My Health - 8 Secret Tips How To Lose Belly Fat In 1 Week

8 Secret Tips How To Lose Belly Fat In 1 Week

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - How long will my hip or knee replacement last?

For people considering hip or knee replacement surgery, it’s something they want — and need — to know.

In the US alone, surgeons perform more than 600,000 knee replacements and about 330,000 hip replacements each year. These operations can provide a major improvement in quality of life and function for those with severe arthritis. On the other hand, there are risks associated with the operation (as is true for any major surgery), there is a long road to recovery even when all goes well, and these operations aren’t cheap. For knee replacement surgery alone, an estimated $9 billion or more is spent each year in the US (although economic analyses suggest the surgery may actually be cost-saving over the long run).

So, if the first joint replacement is unsuccessful for some reason (such as infection or loosening), a second (or even third) operation may be necessary. And that’s a big deal, especially since “revision surgery” is technically more difficult, recovery can take longer, and success rates may be lower than first operations.

There’s no hip or knee replacement guarantee

Unfortunately, no one can be sure that a hip or knee replacement will be the last operation needed on that joint. No operation is 100% successful, and nothing lasts forever. In addition, a number of factors, including surgical technique and surgeon experience, how many operations a particular hospital or surgeon performs each year, and patient factors (including age, weight and activity level) can all have powerful effects on how long a replaced joint lasts.

But we do have an idea of how long a joint replacement will last based on data from past surgeries. During my training in the 1980s and 1990s, the teaching was that up to 90% or more of hip or knee replacements would last at least 10 to 15 years. We still quote similar numbers. But it might be better than that. With better preparation prior to surgery (including “prehab” exercise and loss of excess weight), improved materials in the replacement, better surgical techniques and anesthesia, and better physical rehabilitation after surgery, your joint replacement of the knee or hip is more likely to be successful and last the rest of your life than ever before. At least we hope that’s the case.

Good data on joint replacement are hard to find

It’s difficult to predict how long a joint replacement will last for several reasons. One is that it can take a decade or more to collect data on past operations to predict the success of future operations. Another challenge is that in recent years, there’s been a tendency to operate on younger people, including baby boomers who are more active in their 50s and 60s and may expect more of their new joints than prior generations. Age is of particular importance, because a person with a life expectancy of 15 years has a much better chance of avoiding a future operation than a person with a life expectancy of 30 years. In addition, younger patients tend to be more active and put more stress on their new joint. For these reasons, some surgeons advise younger patients to put off surgery as long as possible, even if that means suffering with pain, stiffness, and reduced mobility.

New hip and knee replacement data

A recent study examined how long knee or hip replacements last, and how their durability is affected by the person’s age at the time of surgery. As published in the April 2017 edition of the medical journal The Lancet, researchers found that:

• Among more than 60,000 people who had a hip replacement, only 4.4% required revision surgery in the first 10 years after surgery, but by the 20-year mark, 15% required revision.
• Among nearly 55,000 people who had a knee replacement, only 3.9% required revision surgery within 10 years of surgery; by 20 years, 10.3% required revision.
• Age did matter. Of those over 70 having hip or knee replacement, the lifetime risk of having a second operation on the replaced joint was about 5%. But this risk was much greater in younger individuals, especially for men. Up to 35% of men in their early 50s required a second operation.

Some orthopedic surgeons might scoff at these findings and say, “My patients do better than those in in this study.” And that may be true. But increasingly, hospitals and surgeons are being required to make public their results, so if you’re considering hip or knee replacement and your surgeon’s results are truly better, or worse, than average, hopefully you’ll be able to find out.

So what does this mean for me and my terrible joint?

When a hip or knee joint is “worn out” and conservative treatments (such as medications and exercise) aren’t helpful enough, there aren’t many good options. So, this new study won’t necessarily change how often surgeries are performed or who gets them. On the other hand, having this information is valuable. And based on the numbers published in this new report, some people may decide to delay or even forego surgery.

What’s next for hip or knee replacement?

We’ll need more studies like this one in the future to know whether results of knee or hip replacement are getting better over time. Such studies will help doctors and their patients to have realistic expectations. In the meantime, I think anyone considering joint replacement surgery should discuss this new study with their surgeon and ask some basic questions about risks, recovery time, and how long your replaced joint is likely to last.

Follow me on Twitter @RobShmerling

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My Health - An insider’s guide to a hospital stay

Hopefully, you’ll never experience what it’s like to be an inpatient in the hospital. But even if it’s not you, it’s likely that someone — family member, good friend, colleague — will experience a hospital stay at some point. We want you to help you be as informed (and comfortable) as possible.

The emergency room

Although people sometimes use the emergency room for a routine doctor visit, it’s really a place for… emergencies. If you need to go to an emergency room, you’ll first be “triaged.” That means that based on your symptoms or type of injury, you will be assigned to a status that will determine how quickly you are seen and treated. Chest pain, a sudden severe headache, bleeding from a wound that doesn’t stop, shortness of breath: these are all emergencies, and these patients will be seen immediately for urgent evaluation. If you have a cold or a sore ankle, you’ll be assigned a less urgent spot, and may wait hours before being seen. Unless it really is a true emergency, it’s best to call your primary care provider first. She or he can help determine if in fact you need an emergent visit, and can call ahead and let the medical staff know that you’re on your way and what’s wrong. This may expedite your care.

Once you are checked in, you’ll start with an assessment by a nurse, and then a medical assistant may check your blood pressure and heart rate, as well as your temperature and pain level (“vital signs”). You may be assessed by a physician’s assistant (PA). These health care professionals will examine you and take a careful history, and will then “present” your situation to the emergency room “attending,” the senior physician in charge. He or she will likely check in with you as well, but most often, a PA or “house staff” (doctors in training who are often specializing in emergency medicine) will manage your care. Each person who enters your cubicle — and there may not be much privacy — should identify him/herself to you. The team will order and interpret any testing needed, treat your acute issue, and decide whether you need to be admitted or (hopefully) go home with a care plan and follow-up arranged. Never leave the emergency room unless you know exactly what to do if you feel worse or develop new symptoms.

Admission: A hospital sleep-over

If the team decides you are too ill to go home, you’ll stay at the hospital (be admitted).

An ICU stay is for patients who are unstable and need to be closely monitored. ICUs are busy places. Each patient has his/her own nurse. The medical team usually includes interns, residents, and fellows (doctors who have completed residency but are getting additional training). Less-experienced physicians are carefully supervised. There may be PAs or nurse practitioners on the team, and the senior staff physician (attending) has ultimate responsibility for your care. The team may call in specialists (consultants) to help determine your diagnosis and treatment.

If you are more stable/less sick, you’ll go to the “floor” with a similar team of health care professionals caring for you. Many hospitals have only private rooms, but not all. When you feel sick and vulnerable and are lying in a bed wearing a “johnnie” (hospital gown), a roommate is probably the last thing you want. You have the right to have your room be quiet, and if your roommate has visitors, they need to respect your comfort as well. Every day, you’ll have a nurse who is responsible for caring for you and other patients.

Both in the ICU and on the floor, a group of doctors and nurses will likely visit you early in the morning as they make “rounds,” checking on each patient and planning care for that day. Again, if you have a roommate, you’ll have no privacy during medical visits to your bedside. There is an unwritten “code of silence” but patient confidentiality is quickly sacrificed when you’re admitted.

Going home: Discharge from hospital

When you are ready to go home (be discharged), a member of the medical staff will review a care plan with you. This might include follow-up visits with your doctor or specialists, prescriptions, home care instructions, and (for some people) arrangements for a visiting nurse to help during your recovery. Don’t be afraid to ask questions no matter how small or “silly” they might seem. Write down the answers or have a friend or family member write them down for you. You want to be sure you leave feeling a lot better, and empowered, than when you arrived.

Insider tips for your hospital stay

• If time and your situation allow, bring reading material, phone chargers, and a list of all your medications when you go to the emergency room.
• Make sure your primary care doctor stays informed during your stay, and gets written documentation when you are discharged.
• Ask any and all questions. Use the nurse call button if you are in pain or need anything (for example, if you’re feeling worse, or need help using the bathroom).
• Make sure the staff knows how to reach your family or health care proxy.
• If you don’t already have a health care proxy in place, create one as soon as you finish reading this blog post. You want to have someone you trust understand your wishes for medical care should you become unable to express them yourself.
• If any member of the medical staff says something that you don’t understand, ask for an explanation. It’s useful to repeat back what you have heard, so that you are sure you are clear on the explanation.
• Although you sacrifice some of your own autonomy as a patient (you are vulnerable, feeling ill, lying in a bed), take what control you can. Ask each person who cares for you who he/she is, what role that person has, and to explain what is happening (for example, the purpose of any test or procedure).
• There are often services available to help you during your stay, but you need to know about them. Most hospitals have a patient/family liaison who can guide you. For example, you can request a spiritual visit, a pain consult, or a nutritionist to help with your diet. Many hospitals have social workers who can help identify resources when it’s time to go home. Some aspects of care may not go as well as possible. Communication may be the biggest problem. Strong emotions such as fear, guilt about being sick, confusion, and anger are common. Your doctor recognizes what a tough experience this is, and it’s okay to share these emotions with your treatment team. Tending to your emotional health is a part of getting well.

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My Health - Warning signs of a concussion

Every year, hundreds of thousands of children get concussions. They get them from falls, from playing sports, from being hit by objects, from bumping into things. What many people don’t realize is that it doesn’t necessarily take a big impact to get a concussion. One of my daughters got a concussion from bumping into a low-hanging tree branch — and another got one from being elbowed in the head during a swim team practice.

Concussions happen when there is not only impact, but also movement, like jerking back and forth. That’s why helmets such as bike or football helmets don’t necessarily prevent concussions. Helmets can prevent skull fractures and other head injuries, but they don’t hold the head still.

Concussion symptoms

Recognizing a concussion is important. While there is no particular treatment to cure one, allowing children to rest both physically and mentally can help symptoms go away faster. Also — and this is crucial — it’s extremely important to take action to prevent additional concussions, especially in the first few weeks and months after a concussion, while the brain is still healing. Additional concussions can lead to permanent brain damage. An extreme case would be the brain damage we’ve been hearing about in professional football players. But even in less extreme cases, repeated concussions can lead to permanent problems with thinking, learning, memory, and emotions.

Sometimes there are immediate signs after an injury that there has been a concussion. These immediate signs can include:

• losing consciousness (passing out) or being very sleepy, hard to keep awake
• severe head pain
• dizziness, with difficulty standing or walking
• confusion, or not remembering what happened
• severe nausea, perhaps but not always with vomiting
• seizures

If any of these happen, children should get immediate medical attention.

Less obvious signs of a concussion

However, sometimes the signs are subtle, and can last for weeks or months after a concussion. These can include:

• persistent headache
• persistent mild nausea
• trouble concentrating
• difficulty remembering and learning new information
• fatigue, low energy, or feeling slowed down
• moodiness or irritability
• problems with sleep — both having trouble sleeping and sleeping more than usual
• dizziness or trouble with coordination and balance
• blurry vision or other problems with vision.

Now, of course, there are many things that can cause these symptoms. No matter what the cause, these symptoms warrant a call to the doctor. But if you are noticing any of them in someone who had a bump to the head — even if it didn’t seem like such a big deal at the time — they could be signs of a concussion.

To learn more about concussions and how to recognize, treat, and prevent them, visit Heads Up on the Centers for Disease Control and Prevention website.

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My Health - Depression: Common medication side effect?

Do you take medication for acid reflux, allergies, anxiety, birth control, blood pressure, or pain? If so, depression or suicidal thoughts may be listed as a side effect, and those side effects may occur far more often than we realized.

At risk of depression and suicide

A recent study published in JAMA found that people who take medications with depression or suicidal thoughts listed as a side effect are, in fact, more likely to be depressed or suicidal. Researchers looked at data collected between 2005 and 2014 from the large and ongoing National Health and Nutrition Examination Survey, conducted by the US government. This included responses from a nine-item depression and suicidality questionnaire.

In addition, the study found that 37% of respondents used at least one prescription medication with depression as a side effect, that use of these medications had significantly increased between 2005 and 2014, and that people who took them were more likely to be older (65 or older), female, widowed, and have other chronic health problems. For people taking no medications with depression as a side effect, the likelihood of having depression was 5%, and this remained stable regardless of how many other medications they took that did not have depression as a side effect (even if that number was zero).

Likelihood of depression from medication

What was striking was that the likelihood of depression increased significantly for each medication with depression as a side effect a person was taking. For one such medication, the risk was 7%; for two it was 9.5%, and for three or more it was 15%. Put another way, people who took two medications with depression as a side effect had double the likelihood of having depression as those who took none; people who took three had triple the likelihood. They ran the same analysis for medications with suicidal thoughts as a side effect, even correcting for those who were also on antidepressants (and perhaps already at risk for having those thoughts). Those who took no medications with suicidal thoughts as a side effect had a 5% likelihood of having suicidal thoughts. The likelihood of suicidal thoughts increased significantly for each medication with suicidal thoughts as a side effect, so for people taking one it was 8%, for two it was 12%, and for three or more it was 18%.

Also interesting were the findings when the analysis was limited only to people taking antidepressants. Just like everyone else, the more medications with depression as a side effect they took, the higher their risk of depression. So, for people on an antidepressant who took no medications with depression as a possible side effect, the risk of depression was 14%, for one it was 18%, for two it was 27.5%, and for three or more it was 28%.

Medications with depression as a side effect

What are the medications with depression as a side effect? These were among the most common ones listed:

• acid reflux medications like omeprazole, esomeprazole, ranitidine, and famotidine
• allergy medications like montelukast and cetirizine
• anxiety medications like alprazolam, diazepam, and lorazepam (and the sleep medication zolpidem)
• birth control and hormone therapy, which includes anything containing estrogen
• blood pressure medications like atenolol, metoprolol, enalapril, and quinapril
• pain medications like ibuprofen, cyclobenzaprine, hydrocodone, and tramadol
• antiseizure medications (which are often used for other reasons too) like gabapentin, topiramate, and lamotrigine.

What does this mean for you?

This study is especially thought-provoking, given that more and more people are taking medications with depression or suicidal thoughts as possible side effects. The CDC just released updated data showing a troubling recent rise in suicide rates, and that 54% of those who die from suicide do not have a known mental health disorder, so this is an important public health issue.

That said, it is important to note: in this study, people who used these medications were more likely to be widowed and have chronic health problems, both of which are associated with a higher risk of depression. And many (but not all) of these medications are often prescribed to treat symptoms associated with existing depression, such as anxiety, insomnia, pain, and even acid reflux (chronic stress can cause acid reflux).

The next step is to run a study where people are randomly assigned to take these medications, or alternate ones without depression as a side effect, and then follow them over time to see what happens. That’s a randomized, controlled, clinical trial, the gold standard in research studies.

While we’re waiting for that to happen, if you’re suffering from depression, and you’re also taking any of these listed medications, then you may want to consider talking to your doctor about switching to something else for a while, and see if your mood improves.

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My Health - T-ball: The ups and downs, and why it can be worthwhile

I just finished my third season as my oldest son’s T-ball coach. I’ve never missed a game or a practice, and I’m on my second age division where pitching is involved. I only say that stuff to be able to say this: it’s not a good game.

The kids are great. I love that it’s outdoors and I don’t mind overseeing things for an hour. But still, the game is seriously lacking in common sense. There’s too much inactivity and waiting for balls that will never come, stuff that 4-to-7-year-olds aren’t built for, especially at 5:30 on a Thursday afternoon.

I’ve modified where possible. I, along with my first co-coach, developed the I-formation defense. All the kids stand single-file on the pitching mound and each gets their own, non-piled-upon turn to field. And for the kids waiting? I chuck balls into the outfield and they happily chase them down, although one of my players declined with, “I’m not a dog.” It probably looks like pure chaos from the outside. It feels slightly less so in the eye.

T-ball: The rules of the game

The only pushback I’ve ever gotten came from a recreation department email after opening day this season, reminding all the coaches of some rules:

Kids need to keep their helmets on when on base. Safety issue. Makes sense.

No electronic distractions on the field. Full disclosure: one of my players was taking pictures with an iPad. Great pictures, I’ll say. But another safety issue. I support it.

One bat out at a time. Good rule.

No pitching until the third game. Another disclosure: I pitched to kids who wanted it. The reason from the league? So players could work on proper swing technique.

This is where we part ways. Technique might be possible if the season was four months and I was a better coach. But it isn’t and I’m not. Learning is great. I try to slip it in, but it’s not my focus. I want the kids to run around, feel some success, and want to come back. Other than the email, I’ve had zero static from parents about batting orders (we do it by uniform number) or undeveloped potential.

Growing up with T-ball

But the game isn’t without pressure. Mine is an internal one. I had two older brothers. Equipment was a constant part of the house, and I always played something. It wasn’t ever any struggle, but I also never did anything organized until I was 9. Milo goes to his games, with varying levels of encouragement. He holds his own, can make impressive contact with the ball; once he’s there he has fun, but once the game is over, he’s done. It’s hard for me not to project and wonder if he’ll ever have the drive to compete and want to become better, at whatever he chooses.

He’s 6.

I’m left with a question: should kids even be playing T-ball this young?

Yes is the answer, says Dr. Richard Ginsburg, co-director of the parent program in Newton-Wellesley Hospital’s department of child and adolescent psychiatry. Unstructured play is vital, but organized sports get kids out of the house and trying stuff they wouldn’t normally do.

So, second question: what does success look like?

Sports psychology and T-ball

It’s not about skill development. Kids don’t have full coordination or visual acuity yet, and they can only absorb 10-to-15-second bites of instruction, Ginsburg says. When a sport is working, kids are moving — check mark for the balls into the outfield — and becoming comfortable with their bodies. They might get knocked down, but they get back up and laugh. They’re starting to connect with teammates and learning to build relationships, and if they’re more excited about the post-game jungle gym, the league fees were worth it.

Mostly, really, ultimately, it’s about fun. They should want to go. They might need an occasional nudge, and while it’s easy to give them a game off, it’s best to set the precedent of showing up. If there’s regular resistance, talk with the coach and problem-solve about the obstacle. There’s no predictor for talent or desire at that age. The only way those things will ever get a chance to develop is if they love playing. “You can’t force that,” Ginsburg says. “It’s like you can’t force friends.”

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My Health - Art therapy: Another way to help manage pain

When we were kids, art time was often the best part of grammar school. Who didn’t enjoy coloring, drawing, painting, and cutting-and-pasting? It was fun, relaxing, and you got a wonderful euphoric feeling from creating something you made. We need to get back to that child activity. It turns out that making art can be a powerful therapeutic tool for adults, especially in the treatment and management of pain. Called art therapy, this type of psychotherapy can help modify your response to emotional and physical problems related to pain.

“Art therapy does not replace the need for pain medication, but it can be used as an effective complement and reduce perceptions of pain experiences,” says Kelsey A. Skerpan, an art therapist with Harvard-affiliated Massachusetts General Hospital. “It can help people better manage the symptoms of stress and anxiety that accompany pain, which assists with the recovery process and improves quality of life.”

How art therapy helps ease pain

Art therapy helps lower the perception of pain by moving your mental focus away from the painful stimulus. It is not simply a distraction, but rather a way to teach you how to relax and alter your mood, so the pain doesn’t control your emotional state.

A study in the February 2018 issue of The Arts in Psychotherapy looked at almost 200 people hospitalized for a medical issue or surgery. The researchers found that participating in art therapy for an average of 50 minutes significantly improved their moods, and lowered levels of pain and anxiety.

“When people are in pain, they often lose their sense of control since their pain dictates what they can and cannot do,” says Skerpan. “Engaging in art therapy helps them reclaim ownership in their lives in terms of what art they choose and the steps they take to create something unique. It can provide a powerful form of self-expression as well as a creative outlet.”

Art therapy is not to be confused with regular art classes. While they both create art, art therapy involves working with a registered or board-certified art therapist who guides you through the creative process while exploring how it relates to your pain.

For instance, you may focus on making a piece of art that represents what your pain looks like on that particular day, and then discuss how the pain is connected to the different lines, shapes, and colors you create. “Processing art like this can help people further explore their condition, which may encourage them to talk more openly about how making art affects them, their mood, and their pain,” says Skerpan.

Finding the form of art therapy that works for you

You don’t have to be an artist to benefit from art therapy. The type of art you do doesn’t matter either. In fact, Skerpan encourages people to consider all kinds of artistic expression, including printmaking, mixed media, woodworking, and ceramics. “You also could revisit something you enjoyed in the past, or an art form you are interested in learning more about,” she says.

Typical sessions are weekly and last 30 to 60 minutes. The length and number can change as needed. While sessions are often individual at first, they may expand into a group support setting, which offers a chance for people to share their experiences with others. Think of it as a grown-up version of show and tell.

Finding an art therapist

Art therapy is practiced by a registered art therapist (ATR) or board-certified art therapist (ATR-BC) who has earned a master’s degree approved by the American Art Therapy Association, and has had supervised clinical experience in the field. You can find certified art therapists through the American Art Therapy Association.

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My Health - Autoimmune disease and stress: Is there a link?

A new study has raised the possibility that stress may cause autoimmune disease, such as lupus or rheumatoid arthritis, because it found a higher incidence of autoimmune diseases among people who were previously diagnosed with stress-related disorders.

I have patients who heard about this research and are saying, “I knew it!”

But before we accept a potential link between stress and autoimmune disease, let’s look at some details of the study and consider how we define the terms “autoimmune disease,” “stress,” and “stress-related disorder.”

What is autoimmune disease?

These are fascinating and mysterious conditions in which the body’s immune system “misfires” and attacks its own tissues. There are scores of autoimmune diseases out there. Some of the most well-known are rheumatoid arthritis, psoriasis, multiple sclerosis, and type 1 diabetes.

In some cases, a condition is labeled “autoimmune” based on conventional wisdom or expert consensus rather than hard science. And I’ve seen the term “autoimmune” used loosely to apply to any condition of unknown cause in which inflammation is present or the immune system appears to be active. But an infection could do the same thing. So perhaps some of these conditions now considered to be autoimmune will turn out to be chronic infections by an organism we’ve not yet identified.

What is stress?

A common definition of “stress” is any experience that causes tension, whether physical, psychological, or emotional, especially if it sets off the “fight or flight” response (during which the adrenal gland releases adrenaline, leading to rapid pulse and breathing, and increased blood pressure). This serves us well if chased by a lion. But it’s theorized that persistent stress (such as worry about finances, mental or physical health, or interpersonal relationships) could lead to chronic disease such as high blood pressure or autoimmune disease.

What causes stress for a person is highly individual. A common example is having to speak in public. Some people find it easy to give a speech in front of a crowd; for others, however, the exact same situation may feel nothing short of dreadful and causes worry for weeks in advance. A stressful experience can also be something quite positive, like getting married, or walking into a room on your birthday where friends and family are hiding. Surprise!

What is a stress-related disorder?

There is a big difference between stress and having a “stress-related disorder,” in which a particular, well-defined condition or disease develops following a specific and intensely stressful event. A dramatic example is post-traumatic stress disorder (PTSD), in which a serious physical or psychological injury leads to a host of problems including distressing, intrusive memories of the traumatic event; memory problems; apathy; and irritability.

Exploring the connection between stress and autoimmune disease

In this new study, researchers analyzed more than 100,000 people diagnosed with stress-related disorders and compared their tendency to develop autoimmune disease at least one year later with 126,000 of their siblings, and another million people who did not have stress-related disorders.

The study found that individuals diagnosed with a stress-related disorder

• were more likely to be diagnosed with an autoimmune disease (about nine out of 1,000 people who had stress-related disorders, but only about six in 1,000 of those without stress-related disorders)
• were more likely to develop multiple autoimmune diseases
• had a higher rate of autoimmune disease if younger.

A particularly important observation was that, for those with PTSD who were being treated with an SSRI (a type of antidepressant), the increased rate of autoimmune disease was less dramatic. While these observations are intriguing, they don’t tell us why or how a stress-related disorder might provoke or cause autoimmune disease.

The usual caveats about observational studies

It’s important to emphasize that a study of this type (called an observational study) cannot conclude that stress-related disorders actually cause autoimmune disease. There could be other explanations for the findings. For example, it is often impossible to identify a precise date that an autoimmune disease or a stress-related disorder began. So, despite the researchers’ requirement that the autoimmune disease be diagnosed well after the stress-related disorder, it’s possible that the autoimmune condition was already present before the stress-related disorder was diagnosed. If that was the case, the stress-related disorder could not have caused the autoimmune disease.

In addition, it’s possible that something other than the stress-related disorder was to blame for the higher rate of autoimmune disease. For example, people who have been through severely stressful circumstances may be more likely to smoke, and smoking has been linked to an increased risk of certain autoimmune diseases, including rheumatoid arthritis and multiple sclerosis.

One more point: this study appears to have included type 2 diabetes among the 41 autoimmune diseases it considered. Although this is the most common type of diabetes (accounting for more than 90% of all cases), it is not considered an autoimmune disease. Different results might have been noted if stricter definitions of autoimmune disease had been applied.

The mystery of autoimmune illness continues

Whether stress or stress-related disorders play an important role remains speculative. Even more important is the question of whether any particular treatment of these stress-induced psychological illnesses can prevent autoimmune disease. I look forward to a clinical trial that examines this fascinating possibility.

Follow me on Twitter @RobShmerling

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My Health - 5 habits for moms that help prevent childhood obesity

We are in the midst of an obesity epidemic in the United States. Currently 40% of adults and almost 20% of children are obese. The childhood obesity numbers particularly worry us, because the effects of obesity accumulate over time. A child who is obese is more likely to develop diabetes, heart disease, and other complications of obesity earlier in life than someone who develops obesity in adulthood.

When we think about preventing obesity in children, we naturally tend to think of the children themselves. We think about doing everything we can to be sure they follow healthy lifestyle habits, in particular eating a healthy diet and getting exercise. This is obviously important, but a new study suggests that the lifestyle habits of mothers are important too — perhaps even more important.

Using data from two long-running studies, the Nurses’ Health Study and the Growing Up Today Study, researchers looked at associations between the lifestyle habits of mothers and the weights of their children, and found that when mothers followed five health habits, their children were a startling 75% less likely to be obese.

The habits were:

1.  Staying at a healthy weight. To figure out if a person’s weight is healthy, we use the body mass index (BMI), a calculation using height and weight. Having a BMI between 18.5 and 24.9 is considered healthy.

2.  Getting at least 150 minutes a week of moderate or vigorous physical activity.

3.  Not smoking (preferably never smoking).

4.  Consuming some alcohol, but less than 15 grams a day. Interestingly, consuming some alcohol was better than consuming none. For reference, a “standard drink” of 14 g of alcohol would be 5 ounces of wine or 12 ounces of beer.

5.  Eating a healthy diet. The researchers used the Healthy Eating Index, and defined a healthy diet as being in the top 40%. People in the top 40% eat more vegetables, fruits, nuts, whole grains, polyunsaturated fatty acids, and long-chain omega-3 fatty acids — and eat less red and processed meats, sugar-sweetened beverages, trans fats, and sodium.

There was no association between a healthy diet in the mother and prevention of obesity in their children, which was surprising, as you’d think the diet of the mother would affect the diet of the child. But when you start putting the habits together, you start to see the benefits. Mothers who had a healthy diet, got exercise, and had low to moderate alcohol intake cut the risk of obesity in their children by about 25%. Add in not smoking, and you get up to 40%. Add in staying at a healthy weight, and you get to 75%.

What was also very interesting is that the mother’s habits had a bigger effect than the child’s habits when it came to preventing childhood obesity.

It’s hard to know for sure what exactly explains these findings. Certainly role-modeling, and family habits, are important. People who smoke are more likely to be depressed, and drinking low to moderate amounts of alcohol daily is associated with a lower risk of anxiety and depression; as depression is linked with obesity, perhaps these habits help by lowering the risk of depression.

Whatever the explanation, it’s worth a try. At the very least, living by these habits keeps mothers healthy — and if it keeps children healthy too, that’s even better.

Follow me on Twitter @drClaire

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My Health - Multigenerational fitness parks

Public parks look a lot different than they did just a decade ago. Sure, you’ll find swings and seesaws, but today they’re bigger, sturdier, and more ergonomically designed. And they’re often paired with colorful outdoor exercise equipment, making play at multigenerational fitness parks a great workout for kids of all ages, even parents and grandparents. And that’s the intent. “They need an opportunity to be active alongside the kids they’re with,” says Lindsay Adeyiga from KaBoom, a nonprofit playground builder that’s created dozens of multigenerational parks across the country.

But exerting the gusto of your inner 7-year-old at these parks comes with a risk that can set you up for injury. “My concern is that it’s so inviting, someone might be tempted to jump onto the equipment and play without warming up, and injure a muscle,” says Madhuri Kale, a physical therapist at Harvard-affiliated Brigham and Women’s Hospital.

What you’ll find at multigenerational fitness parks

A multigenerational fitness park typically includes a large child-focused structure with places for kids to climb, slide, swing, hang, and jump. The playground equipment is adult-friendly: swings are roomy; slides are wide, with gentle slopes; and seesaws have molded seats that are easy to sit on.

Near the playground you’ll often find fitness equipment, such as ergonomically shaped bars to hold onto for squats or modified wall pushups; recumbent bicycles and leg presses to build leg, hip, and core muscles; an overhead press to build shoulder and arm strength; and even elliptical or cross-country ski machines for a total body workout.

When used properly, the equipment can help you improve balance, strength, flexibility, range of motion, and coordination. To assist you with that, signs with instructions and illustrations are often posted near each exercise station.

There may also be walking paths and places for interaction between older and younger people, like seating and picnic tables painted with tabletop games (like checkers).

Perks of multigenerational fitness parks

Multigenerational fitness parks are free, and you can visit them on your own schedule. And there’s more:

• The exercise machines resemble playground equipment. If you dislike exercising, you may feel like you’re just playing, not working.
• You can exercise with your friends, kids, or grandkids. Being with others helps stave off loneliness and depression, which are associated with chronic disease.
• Exercising with other people is a motivator. “You get a healthy sense of competition if you see other people doing a workout,” says Kale.
• There’s no one judging you or telling you which machines or exercises you should try, or how long to exercise. You can play, just like a kid.

Risks of multigenerational fitness parks

But the parks also have risks, and they go beyond exercising without a warm-up. For example, if you’re exercising without expert supervision, you may do so incorrectly and hurt yourself. If you’re caught up in the spirit of playtime or competition, you may overdo it and risk muscle injury. In addition, it may be tricky to get on and off playground equipment, which can increase your risk for a fall.

What you should do

“Stay away from playground equipment or outdoor exercise machines if you have balance problems and can fall, or if you’ve had surgery anywhere along your torso within the last 12 weeks, because you could rupture an incision,” warns Kale.

If you’re healthy, make sure you warm up before you try the equipment. Take your kids or grandkids for a quick walk. Turn it into a race (but let them win, so you don’t overdo it). “Even just a short brisk walk will help get the blood pumping and muscles primed,” Kale says.

Then, be mindful of the workout you’re getting, and don’t do more than you would at a gym. But do have a good time and enjoy the moments with your kids or grandkids. That’s why these parks are popping up all over the country. It’s a marriage of fun and fitness to encourage quality time and good health for everyone. And that’s a change for the better.

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My Health - Alcohol and heart health

I’m not a regular drinker, nor a teetotaler. But like many people, I enjoy the occasional glass of wine with dinner, and nothing tastes better than an ice-cold beer on a sweaty summer day. Besides, some alcohol is a toast to my long-term heart health. At least that’s what the science says, right? Not really. When it comes to alcohol and heart health, the existing research is quite conflicting — some studies say alcohol improves heart health, while others imply the opposite.

Alcohol and heart health: What’s the real story?

The problem with most alcohol-related research is that it consists almost entirely of observational studies that only show an association, according to Dr. J. Michael Gaziano, a preventive cardiologist with Harvard-affiliated Brigham and Women’s Hospital’s Division of Aging and VA Boston.

So far, the strongest evidence with heart health has shown that alcohol can increase levels of HDL (good) cholesterol. HDL works to keep LDL (bad) cholesterol from clogging your arteries by moving it to the liver, where it’s broken down and removed from the body. Many studies have found that the combination of high HDL and low LDL levels protects against heart attacks and stroke. “However, this is not the most important factor in preventing heart disease, and there are other ways to increase HDL than drinking alcohol, such as regular exercise,” says Dr. Gaziano.

Quantity is a key factor when it comes to alcohol and heart health

While moderate amounts of alcohol can offer some heart benefits, too much can have damaging effects.

For instance, the more alcohol you drink at one time, the higher your heart rate gets, according to research from the European Society of Cardiology. A sudden spike in heart rate is potentially dangerous to people with heart conditions, as it could trigger arrhythmias (irregular heartbeats).

A study in the April 14, 2018, issue of The Lancet looked at the drinking habits of almost 600,000 people without heart disease, and found that people who had 10 or more drinks per week died one to two years earlier compared with those who drank five drinks or fewer per week. Having 18 drinks or more per week cut life expectancy by four to five years.

Focus on moderation

The lack of consistent data means that the takeaway message here is moderation — and the importance of avoiding excessive and binge drinking.

How much is considered moderate? A safe amount is no more than a drink per day, says Dr. Gaziano. “In terms of heart health, there does not appear to be more benefit beyond one daily drink.”

Of course, alcohol content can vary with the type and size of drink. In the United States, a standard drink is approximately 14 grams of pure alcohol, which equates to any one of these:

• 12 ounces of regular beer
• 5 ounces of wine
• 1.5 ounces of 80-proof distilled spirits
• 1 ounce of 100-proof spirits.

To get a more accurate analysis of your drink in terms of alcohol content per serving size, use this drink calculator from the National Institutes of Health.

One type of drink isn’t better than another, as your body reacts to alcohol the same whether it’s from beer, wine, or spirits, according to Dr. Gaziano.

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My Health - Healthy lifestyle: 5 keys to a longer life

How is it that the United States spends the most money on healthcare, and yet still has the one of the lowest life expectancies of all developed nations? (To be specific: $9,400 per capita, 79 years, and 31st.)

Maybe those of us in healthcare have been looking at it all wrong, for too long.

Healthy lifestyle and longevity

Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.

The researchers looked at NHS and HPFS data on diet, physical activity, body weight, smoking, and alcohol consumption that had been collected from regularly administered, validated questionnaires.

What is a healthy lifestyle, exactly?

These five areas were chosen because prior studies have shown them to have a large impact on risk of premature death. Here is how these healthy habits were defined and measured:

1.   Healthy diet, which was calculated and rated based on the reported intake of healthy foods like vegetables, fruits, nuts, whole grains, healthy fats, and omega-3 fatty acids, and unhealthy foods like red and processed meats, sugar-sweetened beverages, trans fat, and sodium.

2.  Healthy physical activity level, which was measured as at least 30 minutes per day of moderate to vigorous activity daily.

3.   Healthy body weight, defined as a normal body mass index (BMI), which is between 18.5 and 24.9.

4.   Smoking, well, there is no healthy amount of smoking. “Healthy” here meant never having smoked.

5.   Moderate alcohol intake, which was measured as between 5 and 15 grams per day for women, and 5 to 30 grams per day for men. Generally, one drink contains about 14 grams of pure alcohol. That’s 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

Researchers also looked at data on age, ethnicity, and medication use, as well as comparison data from the National Health and Nutrition Examination Surveys and the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research.

Does a healthy lifestyle make a difference?

As it turns out, healthy habits make a big difference. According to this analysis, people who met criteria for all five habits enjoyed significantly, impressively longer lives than those who had none: 14 years for women and 12 years for men (if they had these habits at age 50). People who had none of these habits were far more likely to die prematurely from cancer or cardiovascular disease.

Study investigators also calculated life expectancy by how many of these five healthy habits people had. Just one healthy habit (and it didn’t matter which one) … just one… extended life expectancy by two years in men and women. Not surprisingly, the more healthy habits people had, the longer their lifespan. This is one of those situations where I wish I could reprint their graphs for you, because they’re so cool. (But if you’re very curious, the article is available online, and the graphs are on page 7. Check out Graph B, “Estimated life expectancy at age 50 according to the number of low-risk factors.”)

This is huge. And, it confirms prior similar research — a lot of prior similar research. A 2017 study using data from the Health and Retirement Study found that people 50 and older who were normal weight, had never smoked, and drank alcohol in moderation lived on average seven years longer. A 2012 mega-analysis of 15 international studies that included over 500,000 participants found that over half of premature deaths were due to unhealthy lifestyle factors such as poor diet, inactivity, obesity, excessive alcohol intake, and smoking. And the list of supporting research goes on.

So what’s our (big) problem?

As the authors of this study point out, in the US we tend to spend outlandishly on developing fancy drugs and other treatments for diseases, rather than on trying to prevent them. This is a big problem.

Experts have suggested that the best way to help people make healthy diet and lifestyle change is at the large-scale, population level, through public health efforts and policy changes. (Kind of like motorcycle helmets and seat belt legislation…) We have made a little progress with tobacco and trans-fat legislation.

There’s a lot of pushback from big industry on that, of course. If we have guidelines and laws helping us to live healthier, big companies aren’t going to sell as much fast food, chips, and soda. And for companies hell-bent on making money at the cost of human life, well, that makes them very angry.

Follow me on Twitter @drmoniquetello

Sources

Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, April 2018.

National Institute on Alcohol Abuse and Alcoholism, What is a standard drink?

The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed. Health Affairs, August 2017.

The combined effects of healthy lifestyle behaviors on all-cause mortality: a systematic review and meta-analysis. Preventive Medicine, September 2012.

Changing minds about changing behavior. Lancet, January 2018.

The US Food and Drug Administration (FDA) Final Determination regarding Partially Hydrogenated Oils (trans fat)

The US Food and Drug Administration (FDA) Family Smoking Prevention and Tobacco Control Act- An Overview

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