Depression often feeds a substance abuse problem, but the opposite may also be true. Find out just how intertwined these two conditions are.
Mood disorders, like depression, and substance abuse go together so frequently that doctors have coined a term for it: dual diagnosis. The link between these conditions is a two-way street. They feed each other. One problem will often make the other worse, according to the Anxiety and Depression Association of America (ADAA).
About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder, the ADAA reports.
Compared with the general population, people addicted to drugs are roughly twice as likely to have mood and anxiety disorders, and vice versa, according to the National Institute on Drug Abuse (NIDA).
The Shared Triggers of Depression and Substance Abuse
When it comes to substance abuse and depression, it isn't always clear which one came first, although depression may help predict first-time alcohol dependence, according to a study published in 2013 in the Journal of Clinical Psychiatry.
The conditions share certain triggers. Possible connections between depression and substance abuse include:
The brain. Similar parts of the brain are affected by both substance abuse and depression. For example, substance abuse affects brain areas that handle stress responses, and those same areas are affected by some mental disorders.
Genetics. Your DNA can make you more likely to develop a mental disorder or addiction, according to research published in 2012 in Disease Markers. Genetic factors also make it more likely that one condition will occur once the other has appeared, NIDA reports.
Developmental problems. Early drug use is known to harm brain development and make later mental illness more likely. The reverse also is true: Early mental health problems can increase the chances of later drug or alcohol abuse.
The Role of Environment
Environmental factors such as stress or trauma are known to prompt both depression and substance abuse.
Family history is another factor. A study published in the Journal of Affective Disorders in 2014 found that a family history of substance abuse is a significant risk factor for attempted suicide among people with depression and substance abuse.
These types of dual diagnosis may also be traced back to a time in early life when children are in a constant process of discovery and in search of gratification, according to David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and president of the New York Institute for Psychoanalytic Self Psychology.
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Any interruption or denial of this natural discovery process can manifest clinically and lead people to believe that everything they feel and think is wrong, he explains.
This idea, which Dr. MacIsaac says is based on the work of Crayton Rowe, author of the book Empathic Attunement: The 'Technique' of Psychoanalytic Self Psychology, challenges the idea that people dealing with depression try to self-medicate using drugs or alcohol. In fact, people with a dual diagnosis may be doing just the opposite, MacIsaac suggests.
"Individuals who are severely depressed drink to feed this negativity," he explains. "Initially it's soothing, but only for about 15 minutes. After that individuals sink deeper and deeper and feel worse than they did before."
For these people, MacIsaac points out, negativity is "where they get their oxygen." Any inclination that treatment is working will trigger a need to go back into the black hole of negative discovery, and alcohol will intensify their depression, he adds.
Why Simultaneous Treatment Is Important
Successful recovery involves treatment for both depression and substance abuse. If people are treated for only one condition, they are less likely to get well until they follow up with treatment for the other.
If they are told they need to abruptly stop drinking, however, depressed people with a substance abuse problem may be reluctant to undergo treatment, MacIsaac cautions. "They cling to drinking because they are terrified of losing that negativity," he says.
People with dual diagnoses must understand the root of their issues on a profound level, MacIsaac says. Once they understand, he says, they may have the ability to change. Treatment for depression and substance abuse could involve therapy, antidepressants, and interaction with a support group.
If you think you need treatment but are unsure where to start, the American Psychological Association provides the following suggestions:
Ask close friends and relatives whether they have recommendations for qualified psychologists, psychiatrists, or other mental health counselors.
Find out whether your state psychological association has a referral service for licensed mental health professionals.
Some prescription drugs can cause or contribute to the development of depression and other mood disorders.
What do certain asthma, acne, malaria, and smoking-cessation prescription drugs have in common? Answer: Their possible side effects include depression or other mood disorders.
Depression as a side effect of prescription drugs is widespread and increasingly gaining attention. The medications that contribute to drug-induced depression might surprise you. For example, an asthma medication, Singulair (montelukast), is prescribed to help people breathe more easily, but its side effects may include depression, anxiety, and suicidal thinking, according to a research review published in Pharmacology in 2014.
“In 2009, Merck added psychiatric side effects as possible outcomes with Singulair, including tremor, depression, suicidality — suicidal thinking and behavior — and anxiousness,” says J. Douglas Bremner, MD, researcher and professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.
Drugs With Depression as a Side Effect
Dr. Bremner has published studies on the possible relationship between the use of retinoic acid acne treatments and the development of depression. One of the drugs within this category is Accutane (isotretinoin), the oral treatment for severe acne that has been associated with psychiatric problems, including depression.
“The original brand-name version of isotretinoin, Accutane, was taken off the market in 2009, although it continues to be marketed as Roaccutane in the U.K., Australia, and other countries," Bremner notes. "In the U.S. there are three generic versions available that have also been associated with reports of depression and suicide, Sotret, Claravis, and Amnesteem."
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The full list of drugs that could cause depression is a long one. British researchers found 110 different medications between 1998 and 2011 that were associated with increased depression risk, according to a report published in BMC Pharmacology and Toxicology in September 2014.
Besides isotretinoin and montelukast, drugs that can cause or contribute to the development of depression or other mood symptoms include:
Lariam (mefloquine), used to treat malaria. Depression, anxiety, and psychosis are among the side effects of this medication, according to an article in Medical Science Monitor in 2013 that explored the chemical cascade behind mood changes.
Chantix (varenicline), used to stop smoking. The Food and Drug Administration (FDA) lists hostility, anxiety, depression, and suicidal thoughts as possible side effects of this medication.
Inderal (propranolol hydrochloride) and other drugs in the beta-blocker class, used to treat high blood pressure. Research on beta-blockers and depression suggests that some, but not all, of the medications in this class can contribute to depression, according to a report in the February 2011 issue of the Journal of Clinical Psychopharmacology.
Contraceptives. Contraceptives including those delivered by vaginal ring or patch could lead to depression in some people, according to research published in the Cochrane Database of Systematic Reviews in 2010.
Corticosteroids. Some people who take corticosteroids experience side effects such as depression, anxiety, and panic attacks, among other symptoms, according to a review of research published in Rheumatology International in 2013.
Interferon-alpha. As many as 40 percent of people using this immunologic medication may experience depression, according to a 2009 report in Dialogues in Clinical Neuroscience.
Interferon-beta. The link between this immunologic medication and depression is debated, but researchers reporting in Therapeutic Advances in Neurologic Disorders in 2011 note that depression is a concern for those who take it, in part because of their underlying conditions.
Nonnucleoside reverse transcriptase inhibitors. These HIV medications may increase the risk for depression, according to research published in the September 2014 issue of HIV Medicine. Arimidex (anastrozole) and aromasin (exemestane). Both of these long-term breast cancer therapies may contribute to depression, according to the FDA.
Vigabatrin. This anticonvulsant may cause depression, irritability, and psychosis, notes a review of studies in Acta Neurologica Scandinavica in 2011.
The FDA investigates drugs that have many reports of depression symptoms as a side effect. It requires what are called black-box warnings to be clearly printed on medications, like isotretinoin, that have been linked to depression and suicidal behavior, among other serious health threats. Make sure you read the information pamphlets that come with your prescription medications (and ask your pharmacist if you don’t understand what they say). You can stay on top of any news about their side effects by setting up a news alert on Google.
You can get the latest drug safety information on the FDA website.
Also, pay attention to how you feel. Though you may be taking medications that seem unrelated to mood, let your doctor know if you have symptoms such as sadness, difficulty sleeping, hopelessness, sleep changes, or thoughts of suicide.
“If you suspect your medication may be causing depression or similar problems, talk with your doctor and, if necessary, consult with a psychiatrist,” Bremner advises. The good news is that drug-induced depression usually clears up once you stop taking the medication.
Are Your Drugs Causing Depression?
It can be challenging to figure out whether your depression is related to taking a prescription drug, but here are some indicators:
Timeline. Drug-induced depression is defined as depression that appears within a month of starting or stopping a medication, according to the American Society of Health-System Pharmacists (ASHP). The society also advises that other conditions that might cause depression have to be considered in figuring out whether medication is the contributing factor. Bremner found in his research that the timeline varies from weeks to a month or two.
Dose-response relationship. With some drugs, depression symptoms may get better as the dose is reduced or worse as it is increased. This is usually a clear indicator of a relationship.
If you are uncertain about whether your changes in mood or energy are drug symptoms, talk with your doctor. Screening tools and questionnaires can reliably identify depression. You can also send information about your experiences to the FDA.
Prescription Drug-Induced Depression Treatment
In severe cases, people taking prescription drugs have developed depression leading to suicidal behavior. Because of this risk, don’t ignore or try to wait out feelings of depression, even if you believe they are only a prescription drug side effect. Talk with your doctor about these options to correct the situation:
Switching to an alternative treatment. If an equally effective medication that does not have depression as a side effect exists, the easiest option is to switch prescription drugs.
Getting a psychiatric evaluation. This may be recommended in any case to make sure you do not have an underlying psychiatric condition that has gone undiagnosed. People with a history of depression may have a worse response to some medications. An antidepressant might be prescribed in order to help manage depression symptoms.
Talk therapy will not work in this case, says Bremner, because the problem is chemically based. You will need prescription medication to address the depression if you cannot stop taking the drugs that are causing it.
If you think your depression symptoms are linked to a prescription drug you’re taking, talk with your doctor right away, get screened for depression, and find a better way to manage both your health issues and your mood.
Spending time in nature eases depression, and could be a good supplement to medicine and therapy.
Remedies for depression abound, from medications to psychotherapy, or talk therapy. Having a range of treatment options is a good idea because no single treatment works equally well for each of the millions of U.S. adults with depression. Now researchers say a new therapy, proven to relieve depression, should be added to the mix as a supplement to established treatments. It's called nature.
Interacting with nature can have replenishing effects for those with depression, says Ethan Kross, PhD, associate professor of psychology at the University of Michigan and one of many experts who has studied the nature-depression link.
A little dose of nature helps us all recharge, but it may have special benefit for those who are depressed. "It seems that, from our work, the restorative effect of nature seems to be stronger for individuals diagnosed with depression," says Marc Berman, PhD, assistant professor of psychology at the University of Chicago. That might be because they feel mentally fatigued, and being in nature re-energizes them. However, Dr. Berman has a strong caveat: "We're not arguing that interacting with nature should replace clinically proven therapies for depression," he says. Nor should those with clinical depression try to treat themselves.
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However, Berman and others say, interactions with nature could serve as a very effective supplemental treatment.
What Nature-Depression Research Shows
Among the studies finding nature helps with depression:
Adults with depression who took a 50-minute walk in a natural setting for one research session and then a 50-minute walk in an urban setting for another research session were less depressed and had better memory skills after they took the nature walk.
Adults who moved to greener urban areas, compared to less green, had better mental health during follow-up three years after the move.
Those who took group nature walks reported less depression, less stress, and a better sense of well-being than those who didn't take nature walks, according to a study that looked at more than 1,500 people in a walking program.
Being outdoors and in nature boosts vitality, which experts define as having physical and mental energy. Those with depression often report fatigue and decreased energy. Researchers found the energy-boosting effect of nature was independent of the physical activity or social interaction experienced while outdoors.
How Nature Works Its Magic
The phenomenon of how nature helps improve depression is still being analyzed fully, Dr. Kross says.
One possibility, Berman says, is that interacting with nature helps due to the attention-restoration theory. "We have two kinds of attention," he says. "One is top-down (also called directed), the kind we use at work." Directed attention can be depleted fairly quickly, as you can only focus and concentrate for so long.
Another type of attention is bottom-up, or involuntary. "That's the kind automatically captured by things in the environment, such as lights or music." Involuntary attention is less susceptible to depletion. "You don't often hear people say, 'I can't look at this waterfall any longer,'" Berman says.
Why does nature hold this special effect? In a natural environment, we can choose to think or not, Berman says, and this choice is believed to help us rest our brains. You can then pay attention later, when you need to. "It is giving people more ability to concentrate, which is a big problem for those with depression," Berman says. Nature provides an effective setting for resting our brains, unlike urban settings. Even in the most peaceful urban environment, you have to pay attention to such things as traffic and stoplights.
Nature's replenishing effect is fairly instantaneous, Berman says. So if you're depressed and having an especially bad day, a quick dose of nature might help.
However, Berman cautions that anyone with clinical depression needs to be under a doctor's care, with supervision of all their treatments.
Newer antidepressants target brain chemicals involved in regulating mood, but they're not magic bullets. Here are the risks and benefits of these commonly prescribed drugs.
Although mild forms of depression are often treated without medication, those with more severe symptoms may benefit from taking antidepressant drugs. These medications, which target brain chemicals involved in mood, may help people with severe depression who do not respond to talk therapy or healthy lifestyle changes alone, according to the National Alliance on Mental Illness (NAMI).
The Use of Antidepressants Is on the Rise
Roughly 67 percent of people living with depression use medication as their primary form of treatment, NAMI reports. Antidepressants are the second most commonly prescribed drugs in the United States, according to a study published in 2013 in the American Journal of Clinical Hypnosis. Overall, use of antidepressants increased from 6.5 percent in 2000 to 10.4 percent by 2010, a study published in 2014 in the Journal of Clinical Psychiatry reveals.
How Antidepressants May Help
There are many theories about what causes depression, according to the National Institute of Mental Health (NIMH). Brain imaging technology shows that parts of the brain involved in mood, thinking, sleep, and behavior look different in people with depression than in those who are not depressed. Genetics, stress, and grief could also trigger depression, according to NIMH.
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Because specific chemicals called neurotransmitters, particularly serotonin and norepinephrine, are involved in regulating mood, medications that target these chemicals are often used to treat depression. Antidepressants work by increasing concentrations of these chemicals. These drugs include:
Selective serotonin reuptake inhibitors (SSRIs): SSRIs work by making more of the neurotransmitter serotonin available to your brain. Some of the drug names you may be familiar with are Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram).
The most common side effects associated with these medications include sexual problems, headache, nausea, dry mouth, and difficulty sleeping. These symptoms often fade over time, NAMI notes.
Atypical antidepressants: This class of drugs includes serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine) and Cymbalta (duloxetine). In addition to serotonin, these antidepressants may target other brain chemicals such as dopamine or norepinephrine.
Side effects of SNRIs are similar to those associated with SSRI drugs. You may also experience, fatigue, weight gain, or blurred vision.
The antidepressant Wellbutrin (bupropion) affects only the levels of norepinephrine and dopamine. This drug, known as a norepinephrine and dopamine reuptake inhibitor (NDRI), has similar side effects as SSRIs and SNRIs, but it is less likely to cause sexual problems. Rarely, seizures may occur.
Tricyclic antidepressants: Tricyclics also affect levels of brain chemicals, but they are no longer commonly used because they have more side effects, including fatigue, dry mouth, blurred vision, urination difficulties, and constipation. If you have glaucoma, you should not take any tricyclic antidepressant. Some tricyclics antidepressants include amitriptyline, amoxapine, and Norpramin (desipramine).
Monoamine oxidase inhibitors (MAOIs): Like tricyclics, MAOIs are now prescribed less often because of their risk for serious side effects. These drugs work by blocking an enzyme called monoamine oxidase, which breaks down the brain chemicals serotonin and norepinephrine. People taking MAOIs can experience dangerous reactions if they eat certain foods, drink alcohol, or take over-the-counter cold medicines.
In 2006, the U.S. Food and Drug Administration (FDA) approved Emsam (selegiline), the first skin patch for treating major depression. At its lowest dose, this once-a-day patch can be used without the dietary restrictions associated with oral MAOIs. Some other MAOIs include Marplan (isocarboxazid) and Nardil (phenelzine).
Depression Medications and Government Warnings
In 2005, the FDA warned that the risk of suicidal thoughts or behavior could be higher in children and adolescents taking depression drugs. In 2007, the warning was expanded to include anyone under age 25 taking antidepressants.
However, to balance the risks and benefits of antidepressants, the FDA’s so-called black box warning also states that depression itself is associated with a greater risk for suicide, notes a 2014 study published in the New England Journal of Medicine. Nevertheless, if you are taking an antidepressant, especially if you are under 25, let your doctor know if your depression seems to be getting worse or if you have any thoughts of hurting yourself.
Antidepressants Are Not Magic Bullets
It's important to remember that simply taking a pill will not cure depression. It may take up to 12 weeks before these drugs have their full effect. Some people need to take various doses or combinations of different medications before they find the treatment strategy that works best for them, according to NAMI.
It’s also important to take antidepressants as prescribed and to follow up with your mental health professional on a regular basis. Some depression drugs must be stopped gradually — if you suddenly stop taking your medication, you could experience withdrawal symptoms or a relapse of your depression.
Often the most effective treatment for depression involves some form of talk therapy, notes NAMI. Discuss with your doctor how exercise and limiting alcohol can also help ease your symptoms.
Too often, depression and debt are connected — and together, they can spiral out of control. Try these strategies to regain your footing.
Mental problems and money problems often go hand in hand. For one, debt is an increasingly common stressor that can trigger depression. Indeed, people who live with debt are more likely than their peers to be depressed and even contemplate suicide, according to a report on the health effects of debt published in 2014 in BMC Public Health. They're also less likely to take good care of their health. On the other hand, the researchers found that debt management programs can help stave off depression. Here's what else you need to know.
How Debt Leads to Emotional Distress
Debt can make you feel helpless, hopeless, and low on self-esteem — and these are all symptoms and risk factors for depression, says Nadine Kaslow, PhD, professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta.
Credit card debt, mortgage foreclosure, student loan debt, medical debt, and job loss can all contribute to depression, agree the authors of the BMC Public Health article, adding that you might also experience anger and anxiety. Other factors, such as being the sole breadwinner with dependent children, being elderly and not having much saved for retirement, or having very high interest debts, seem to increase depression risk.
When Depression Leads to Debt
It’s easy to understand how the stress of debt can trigger or worsen depression, but you may not realize that depression can also lead to debt problems.
Symptoms of depression can lead some people to accumulate growing piles of debt, Dr. Kaslow says. "Someone with depression may exhibit behaviors that can lead them into a debt crisis."
"Some people may try to relieve feelings of depression by compulsive shopping. Depression is often associated with destructive and addictive behaviors that can result in overwhelming debt. This type of debt can lead to extreme despair and even to suicide," Kaslow warns.
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Compulsive buying, which can lead to debt, is indeed linked to depression, anxiety, and other mood disorders, researchers reported in the American Journal of Addiction in 2013. The researchers note that in addition to depression treatment, support groups using cognitive behavioral strategies can help control compulsive buying.
How to Find Debt and Depression Help
If you find you are dealing with debt and depression, it is important to address both, Kaslow says. Many types of help are available. "If a person is feeling trapped, desperate, and hopeless, they may need help for depression and help getting out of debt," she adds.
Depression is a very treatable disorder. The first step is to recognize the problem and ask your doctor for depression help. Once depression is diagnosed, your doctor might recommend a range of treatment strategies, including talk therapy, medications, and support groups.
For someone with addictive spending behaviors, Debtors Anonymous (DA) is an organization that can be very helpful, says Kaslow. DA has meetings all over the country where people share their experiences with compulsive debt and debt management. There are also online meetings. For help with compulsive debt, check out DA's website.
A good source of advice for getting help with a debt problem can be found via the Federal Trade Commission, which recommends the following strategies:
Develop and closely follow a budget.
Contact your creditors instead of avoiding them.
Know your rights when dealing with debt collectors.
Use a credit counseling or debt management agency.
Seek protection through bankruptcy laws.
Learn about the steps you need to take to repair your credit.
Beware of debt management scams promising an easy fix.
The area of the brain involved in forming new memories, known as the hippocampus, seems to shrink in people with recurring depression, a new study shows.
Australian researchers say the findings highlight the need to spot and treat depression when it first develops, particularly among young people.
Ian Hickie, who co-directs the Brain and Mind Research Institute at the University of Sydney, led the study. His team looked at the neurology of almost 9,000 people from the United States, Europe and Australia. To do so, they analyzed brain scans and medical data for about 1,700 people with major depression, and almost 7,200 people who didn't suffer from depression.
The researchers noted that 65 percent of the participants with major depression had suffered recurring symptoms.
The study, published June 30 in the journal Molecular Psychiatry, found that people with major depression, particularly recurring forms of the condition, had a smaller hippocampus. This part of the brain was also smaller among participants diagnosed with depression before they reached the age of 21.
Many young people diagnosed with depression go on to develop recurring symptoms, Hickie's team noted.
RELATED: Depression as a Risk Factor for Dementia
Recurrence seemed key: About a third of participants had had only one episode of major depression, and they did not show any reduction in the size of their hippocampus compared to non-depressed people.
According to the researchers, that suggests that it is recurring depression that takes a toll on brain anatomy.
The take-home message: Get depression diagnosed and treated before brain changes can occur, the Australian team said.
"This large study confirms the need to treat first episodes of depression effectively, particularly in teenagers and young adults, to prevent the brain changes that accompany recurrent depression," Hickie said in a university news release.
According to co-researcher Jim Lagopoulos, "these findings shed new light on brain structures and possible mechanisms responsible for depression."
"Despite intensive research aimed at identifying brain structures linked to depression in recent decades, our understanding of what causes depression is still rudimentary," Lagopoulos, who is an associate professor at the institute, said in the news release.
The study couldn't prove cause-and-effect, however, and the study authors say that more research could help explain if the brain changes are the result of chronic stress, or if these changes could help spot people who are more vulnerable to depression.
Taking both an antidepressant and a painkiller such as ibuprofen or naproxen may increase risk of a brain hemorrhage, a new study suggests.
Korean researchers found that of more than 4 million people prescribed a first-time antidepressant, those who also used nonsteroidal anti-inflammatory drugs (NSAIDs) had a higher risk of intracranial hemorrhage within the next month.
Intracranial hemorrhage refers to bleeding under the skull that can lead to permanent brain damage or death.
The findings, published online July 14 in BMJ, add to a week of bad news on NSAIDs, which include over-the-counter pain relievers such as aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve).
Last Thursday, the U.S. Food and Drug Administration strengthened the warning labels on some NSAIDs, emphasizing that the drugs can raise the risk of heart attack and stroke.
As far as the new link to brain bleeding in antidepressant users, experts stressed that many questions remain unanswered.
And even if the drug combination does elevate the odds, the risk to any one person appears low.
"The incidence of intracranial hemorrhage in people taking antidepressants and NSAIDs was only 5.7 per 1,000 in a year. So about 0.5 percent of people taking these drugs will develop a (hemorrhage) over one year," said Dr. Jill Morrison, a professor of general practice at the University of Glasgow in Scotland.
Still, she said, it's wise for people on antidepressants to be careful about using NSAIDs.
Both types of drug are widely used, and about two-thirds of people with major depression complain of chronic pain, the researchers pointed out.
Make sure an NSAID is the appropriate remedy for what ails you, said Morrison, co-author of an editorial published with the study.
It's known that NSAIDs can cause gastrointestinal bleeding in some people, and studies have suggested the same is true of SSRI antidepressants -- which include widely prescribed drugs such as Paxil, Prozac and Zoloft.
But neither drug class has been clearly linked to intracranial hemorrhage, said Dr. Byung-Joo Park, the senior researcher on the new study.
So Park's team looked at whether the two drug types, used together, might boost the risk.
RELATED: Some Antidepressants Linked to Bleeding Risk With Surgery
The investigators used records from Korea's national health insurance program to find more than 4 million people given a new prescription for an antidepressant between 2009 and 2013. Half were also using an NSAID.
Park's team found that NSAID users were 60 percent more likely to suffer an intracranial hemorrhage within 30 days of starting their antidepressant -- even with age and chronic medical conditions taken into account.
There was no indication that any particular type of antidepressant carried a greater risk than others, said Park, a professor of preventive medicine at Seoul National University College of Medicine.
He agreed that antidepressant users should consult their doctor before taking NSAIDs on their own.
Park also pointed out that the study looked at the risk of brain bleeding within 30 days. So the findings may not apply to people who've been using an antidepressant and an NSAID for a longer period with no problem.
That's an important unanswered question, said Morrison, noting it's possible that the risk of brain bleeding is actually higher for people who used NSAIDs for a prolonged period.
Why would antidepressants have an effect on bleeding? According to Park's team, the drugs can hinder blood cells called platelets from doing their job, which is to promote normal clotting.
Since NSAIDs can also inhibit platelets, combining the two drugs may raise the odds of bleeding, the researchers said.
It's not clear whether there is a safer pain reliever for people on antidepressants, Morrison said. But it's possible that acetaminophen (Tylenol) could fit the bill.
"Acetaminophen does not have the same propensity to cause bleeding problems as NSAIDs do," Morrison said. "So theoretically, this would be safer."
And since this study was conducted in Korea, she added, it's not clear whether the risks would be the same in other racial and ethnic groups. More studies, following people over a longer period, are still needed, Morrison said.
Slower deterioration seen in people with more satisfying relationships, researchers say.
Loneliness and depression are linked to an increased risk of mental decline in the elderly, a new study suggests.
Researchers analyzed data from more than 8,300 American adults aged 65 and older who were assessed every two years between 1998 and 2010. Seventeen percent reported loneliness at the beginning of the study, and half of those who were lonely had depression.
Over the course of the study, mental decline was 20 percent faster among the loneliest people than among those who weren't lonely. People who were depressed at the start of the study also had faster mental decline.
However, lower mental function did not lead to worsening loneliness, according to the study scheduled for presentation Monday at the Alzheimer's Association International Conference in Washington, D.C. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.
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"Our study suggests that even one or two depressive symptoms -- particularly loneliness -- is associated with an increased rate of cognitive decline over 12 years," study author Dr. Nancy Donovan said in an association news release. She is a geriatric psychiatrist at Brigham and Women's Hospital in Boston and an instructor in psychiatry at Harvard Medical School.
"We found that lonely people decline cognitively at a faster rate than people who report more satisfying social networks and connections. Although loneliness and depression appear closely linked, loneliness may, by itself, have effects on cognitive decline," she explained.
This is important to know for the development of treatments to enhance mental health and quality of life for older adults, she added.
The new study suggested a link between loneliness, depression and heightened risk of mental decline, but it did not prove cause-and-effect.
1 / 8 Serotonin Syndrome
Serotonin is a neurotransmitter (a naturally occurring brain chemical) that helps regulate mood and behavior, and increasing serotonin is one way of treating depression.
But if you're taking antidepressant medication that increases serotonin too much, you could be at risk for a dangerous drug reaction called serotonin syndrome.
"Serotonin syndrome usually happens when a doctor prescribes a drug that increases serotonin to a patient already on an antidepressant," said Mark Su, MD, assistant professor of emergency medicine at Hofstra University and director of the Toxicology Fellowship at North Shore University Hospital in Manhasset, N.Y.
Part of your next visit to your family doctor's office should be spent filling out a questionnaire to assess whether you're suffering from depression, an influential panel of preventive medicine experts recommends.
What's more, people concerned that they might be depressed could download an appropriate questionnaire online, fill it out ahead of time and hand it over to their doctor for evaluation, the panel added.
In an updated recommendation released Monday, the U.S. Preventive Services Task Force urged that family doctors regularly screen patients for depression, using standardized questionnaires that detect warning signs of the mental disorder.
If a patient shows signs of depression, they would be referred to a specialist for a full-fledged diagnosis and treatment using medication, therapy or a combination of the two, according to the recommendation.
These questionnaires can be self-administered in a matter of minutes, with doctors reviewing the results after patients fill out the forms, said Dr. Kirsten Bibbins-Domingo, vice chair of the task force.
"This could be a checklist that patients fill out in the waiting room, or at home prior to the visit," she said. "The good thing is we have many instruments, measures that have been studied for screening for depression."
About 7 percent of adults in the United States currently suffer from depression, but only half have been diagnosed with the condition, said Bibbins-Domingo, who is a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco.
"We know that depression itself is a source of poor health," she said. "It leads people to miss work, to not function as fully as they might, and we know it is linked and associated with other types of chronic diseases."
It makes sense that family doctors perform front-line screening for depression, since they are more likely than a mental health professional to come across a person with undetected symptoms, said Michael Yapko, a clinical psychologist and internationally recognized depression expert based in Fallbrook, Calif.
"Only about 25 percent of depression sufferers seek out professional help, but more than 90 percent will see a physician and present symptoms and signs that could be diagnosed," said Yapko, who is not on the task force.
The panel has recommended regular depression screening for adults since 2002, but their guidelines currently urge doctors to ask two specific questions that provide a quick evaluation of a person's mood. The questions are, "Over the past two weeks, have you felt down, depressed, or hopeless?" and "Over the past two weeks, have you felt little interest or pleasure in doing things?"
The updated recommendation expands doctors' options for depression screening, adding commonly used questionnaires like the Patient Health Questionnaire, or PHQ-9.
The PHQ-9 is a list of 10 questions that focus on problems that a person might have experienced during the past two weeks, including poor appetite, low energy, sleep problems and a lack of interest in doing things.
"These are not instruments that diagnose depression," Bibbins-Domingo noted. "They give clinicians the first indication of something that should be followed up on."
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Yapko said that someone who wanted to could lie on the questionnaires and avoid having their symptoms detected, but he added that in his experience it's not a very likely scenario.
"When you have people who are suffering who genuinely want help, they're happy to give you as accurate a portrayal as they can give you," he said. "Generally speaking, the people seeking help want help and they want to do their best in filling these things out. That's what makes the test worthwhile."
The task force is an independent, volunteer panel of national experts that has been issuing recommendations on preventive medicine since 1984.
Yapko and Bibbins-Domingo said depression screening shouldn't eat into a doctor's time, since patients can fill out and score the questionnaires on their own.
Instead of wasting time reading magazines in the waiting room, patients "could be filling out an inventory that is self-administered, self-scored and wouldn't take any physician time at all," Yapko said.
Patients also could download and fill out a depression questionnaire at home and hand it in when they go to the doctor, but Yapko said patients should make sure they're using the form their doctor prefers.
"Which of the many inventories and questionnaires a doctor might wish to use is a matter of personal and professional judgment," he said. "So, a doctor would need to specify which form to obtain online and the patient would then need to remember to bring it in, not always easy when depression negatively affects your memory. Easier to have the form in the office and have them fill it out in the waiting room."
Yapko added that it's important that doctors who screen for depression follow up by referring patients to a mental health professional, rather than trying to diagnose and treat depression themselves.
"When physicians get a diagnosis of depression, their most immediate thing to do is prescribe an antidepressant," Yapko said, noting that more than 70 percent of antidepressants are prescribed by non-psychiatrists. "Only a minority of people walk out of a doctor's office with a referral to a mental health professional, a fact which drives me a little crazy."
Herbal remedy isn't regulated, and can have side effects and serious drug interactions.
St. John's wort is a popular herbal therapy for depression, but a new Australian study highlights the fact that "natural" does not always equal "safe."
Using reports filed with Australia's drug safety agency, the researchers found that adverse reactions to St. John's wort were similar to those reported for the antidepressant fluoxetine -- better known by the brand name Prozac.
Those side effects included anxiety, panic attacks, dizziness, nausea and spikes in blood pressure, the researchers reported in the July issue of Clinical and Experimental Pharmacology and Physiology.
"It's concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk," lead researcher Claire Hoban, of the University of Adelaide, said in a university news release.
Research has shown that St. John's wort can help ease mild to moderate depression. But the fact that it works also means there is a risk of side effects, said Dr. Samar McCutcheon, a psychiatrist at Ohio State University Wexner Medical Center in Columbus.
"Even if the bottle says 'natural' or 'herbal,' it still has ingredients that are active in your body," said McCutcheon, who was not involved in the study.
It has long been recognized that St. John's wort can have significant side effects and interact with certain medications, McCutcheon pointed out.
But many consumers may not know that, she noted, largely because dietary supplements are not regulated in the way that drugs are.
"I definitely think this [lack of awareness] is still an issue," McCutcheon said. "People think St. John's wort is safe because they can buy it at a health food store."
In the United States, dietary supplements do not have to be studied for safety and effectiveness before they reach the market.
"Plus," McCutcheon said, "you're relying on companies to make sure these products include the ingredients they're supposed to, and keep out ingredients that they shouldn't."
The situation is similar in Australia, and many consumers there are unaware that supplements are largely unregulated, according to Hoban's team.
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The researchers based their findings on doctors' reports to Australia's national agency on drug safety. Between 2000 and 2013, there were 84 reports of adverse reactions to St. John's wort, and 447 reports on Prozac.
But since those are voluntary reports, they do not reflect the actual rate of side effects from either therapy, according to the researchers. And, Hoban said, bad reactions to St. John's wort are particularly likely to go unreported, since the herb is often not even considered a drug.
According to McCutcheon, it's important for people with depression symptoms to see a health professional before self-medicating with St. John's wort. "That will help ensure you have the right diagnosis," she said.
If your symptoms are actually part of a different disorder, St. John's wort may be ineffective -- or possibly even risky. For example, McCutcheon said that in people with bipolar disorder, the herb might fuel a manic episode.
But possibly the biggest concern, she said, is the potential for St. John's wort to interact with commonly used medications.
The herb can dampen the effectiveness of birth control pills, blood thinners and heart disease drugs, along with some HIV and cancer drugs, according to the U.S. National Center for Complementary and Integrative Health.
What's more, it can interact with antidepressants. It's not clear exactly how St. John's wort works, McCutcheon said, but it's thought to boost levels of the brain chemical serotonin -- which is how the most commonly used antidepressants work.
"If you use the two together, you run the risk of having too much serotonin," she said. And that raises the risk of a potentially fatal condition called serotonin syndrome, whose symptoms include confusion, tremors, diarrhea and a drop in body temperature.
Some side effects of St. John's wort are caused by the herb itself, such as skin rash that's worsened by sunlight, said Dr. John Reed, director of inpatient services at the University of Maryland's Center for Integrative Medicine in Baltimore.
But the main concern is still its potential for interacting with other medications, he said. "Compared with other herbs, St. John's has more drug interactions," Reed explained. "So if you're using it, don't take other medications unless it's under medical supervision."
He added that anyone on any medication should do some homework before starting an herbal product. "Go online and do a search for drug interactions. Ask your pharmacist or doctor," Reed advised.
"Unfortunately," he said, "this type of information [on drug interactions] doesn't have to be printed on product labels."
The bottom line, according to McCutcheon, is that people with depression should talk to their providers about any supplements they take, or want to take. And those providers, she said, should be willing to have nonjudgmental discussions.
"I want all my patients to be comfortable enough to bring up anything with me," McCutcheon said.
Women are more likely than men to seek treatment for depression. Why do men try to manage the condition on their own?
Women are 70 percent more likely than men to have depression. It is this feminine predisposition to depression that may contribute to its being underreported among men, says Amit Anand, MD, a professor of medicine at the Cleveland Clinic's Lerner College of Medicine and vice-chair of research for its Center for Behavioral Health.
More than 6 million U.S. men struggle with the condition each year, according to the National Institute of Mental Health (NIMH). And it maybe their reluctance to discuss their depression, as well as several other obstacles, that prevent many of them from seeking treatment, Dr. Anand says. These barriers not only affect how men with depression are diagnosed, he says, but also how they are treated.
Why Depression Is Underreported
Several factors contribute to depression often being unreported and undiagnosed in men. For starters, men who are depressed may not recognize their symptoms. “Women are far more likely to acknowledge that they have depression and seek help,” Anand says.
Also, symptoms of depression vary from person to person, and symptoms may not always be obvious, according to NIMH. Complicating matters is that men who are depressed often suppress their feelings rather than showing sadness and crying,reports the National Alliance on Mental Illness (NAMI).
Men and women also have different risk factors for depression that could affect whether they seek treatment, according to a study published in 2014 in the American Journal of Psychiatry. The factors most directly linked to depression among women are divorce, lack of parental or social support, and marriage troubles. For men, depression is more closely linked to drug abuse as well as financial, legal, and work-related stress, the researchers say. Their research suggests that men are less likely to seek medical attention if they attribute depression to career disappointment or failures. Rather than seek help, Anand says, men with depression are more likely to try to tough it out.
"Men may be more likely to suffer in silence or try to self-medicate with alcohol or drugs," says Dean F. MacKinnon, MD, an associate professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine in Baltimore.
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Men may see their symptoms as a sign of weakness, he explains, likening the situation to the idea that men don't like asking for directions. “Men don't ask for direction because it makes them seem weak, but also they are afraid they won't get the right information,” Dr. MacKinnon says.
Men might also be worried about the social stigma associated with a diagnosis of depression, according to research published in Qualitative Health Research in 2014.
In addition, depression affects men differently than women, according to a 2013 study published in JAMA Psychiatry. Though women usually have traditional symptoms, such as feelings of sadness and worthlessness, the study found that men with depression were more likely to experience anger and irritability, and to engage in risky behaviors. This suggests that if men are using traditional criteria to assess their symptoms, their depression could go unreported.
Why Treatment Is Critical
What sets men and women with depression apart can also make the condition more difficult to treat, Anand says. Men with untreated depression can experience issues like anger, aggression, and substance abuse. Using drugs and alcohol to self-medicate, he says, can complicate treatment for depression.
Untreated depression among men can also have tragic consequences. “Women may talk about suicide more, but men may be more likely to complete suicide,” Anand says. “They may also use much more violent means of trying to commit suicide, like guns or hanging.” In fact, according to NAMI, men are four times more likely to die of suicide than women.
Most adults with depression improve with treatment, usually a combination of talk therapy and medication, Anand says. He notes, however, that it can be difficult to convince some men to try talk therapy.
Medication used to treat depression may also work differently in men and women. For instance, today the most commonly prescribed antidepressants, according to NIMH, are SSRIs — selective serotonin reuptake inhibitors. Tricyclics, which are older antidepressants, are not used as often today because they come with more serious side effects, like drowsiness, dizziness, and weight gain. However, some research suggests that women respond better to SSRIs — like Prozac (fluoxetine) and Zoloft (sertraline) — and that tricyclics, like imipramine, may be more effective for men, Anand says.
SSRIs may also cause more sexual side effects, which tend to bother men more often than women, and could result in fewer men following through on treatment, Anand says.
If your doctor does recommend an SSRI, adjusting the dosage or switching from one SSRI to another can help alleviate unwanted side effects, according to NIMH.
People with psoriasis may be twice as likely to experience depression as those without the common skin condition, regardless of its severity, a new study suggests.
"Psoriasis in general is a pretty visible disease," said study author Dr. Roger Ho, an assistant professor of dermatology at New York University School of Medicine in New York City. "Psoriasis patients are fearful of the public's stigmatization of this visible disease and are worried about how people who are unfamiliar with the disease may perceive them or interact with them."
Genetic or biologic factors may also play a role in the link between depression and psoriasis, which requires more research, he said. Either way, the findings mean that all individuals with psoriasis could benefit from screening for depression, Ho said, and their friends and family members should be aware of the connection as well.
The findings were scheduled for presentation Thursday at an American Academy of Dermatology meeting in New York City. They have not yet been published in a peer-reviewed journal and should be considered preliminary.
Most people with psoriasis have red, raised patches of skin covered with silvery-white scales, the researchers noted. These patches usually appear on the scalp, elbows, knees, lower back, hands and feet.
The researchers analyzed the responses of more than 12,000 U.S. adults in the 2009-2012 National Health and Nutrition Examination Survey conducted by the U.S. Centers for Disease Control and Prevention.
Overall, nearly 3 percent of responders reported that they had psoriasis, and about 8 percent had major depression based on their answers to a depression screening assessment. Among those with psoriasis, 16.5 percent had sufficient symptoms for a diagnosis of major depression.
Those with any degree of psoriasis had double the odds of having depression even after taking into account their age, sex, race, weight, physical activity level, alcohol use and history of heart attack, stroke, diabetes and smoking, the researchers said.
Depression is one of several concerns that someone with psoriasis should look out for, said Dr. Delphine Lee, a dermatologist at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, Calif.
"Patients with psoriasis should be aware that there are several other health issues associated with this condition, including cardiovascular and metabolic diseases, such as diabetes, as well as psychological or psychiatric disorders," Lee said. "To address your health beyond your skin is critical to maximizing a person's quality of life."
Several aspects of dealing with psoriasis may contribute to depression, said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City.
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What matters more than its severity is the location of flare-ups, she said. Some of her patients won't wear shorts if it's on their legs or won't go on dates because they're embarrassed about red spots on their skin, she added.
"Also, because it's a chronic illness, you don't know if it's going to get worse and you don't get to take a vacation from it either," Day said. "You're using topical treatments all year long, and as soon as you stop, it comes right back. It's very depressing, and it can affect your self-esteem and your quality of life."
Anxiety about how psoriasis and its treatment may affect your future health might also contribute to depression, Day explained.
"It's unsightly, it can be itchy, people are worried about it spreading to other parts of their body, they worry about the side effects of medication, they worry about psoriatic arthritis, they worry about taking medications when they're pregnant, and they worry about passing it along to their children," she said.
Day recommended that people with psoriasis seek mental health treatment to get to the bottom of their depression.
"It's about that emotional connection and finding out what about this condition is affecting someone in the way that it is," Day explained.
Not seeking help can make matters worse, said Dr. Tien Nguyen, a dermatologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif.
"Psoriasis can cause severe emotional distress," he said, noting some patients may have suicidal thoughts or attempt suicide. "Stress is a known cause of exacerbation of psoriasis, so this will lead to a vicious cycle."
Day added that it's critically important to continue seeing a dermatologist to learn about new medications that become available.
"There are some really amazing new treatments that have a great safety profile that can have excellent clearance with lasting results," Day said.
Risky behaviors such as reckless driving or sudden promiscuity, or nervous behaviors such as agitation, hand-wringing or pacing, can be signs that suicide risk may be high in depressed people, researchers report.
Other warning signs may include doing things on impulse with little thought about the consequences. Depressed people with any of these symptoms are at least 50 percent more likely to attempt suicide, the new study found.
"Assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications," study lead author Dr. Dina Popovic, of the Hospital Clinic de Barcelona, in Spain, said in a news release from the European College of Neuropsychopharmacology (ECNP).
The findings were scheduled for presentation Saturday at the ECNP's annual meeting in Amsterdam.
One expert in the United States concurred with the findings.
"It has long been known that those patients with depression who also experience anxiety and/or agitation are more likely to attempt or complete suicide," said Dr. Donald Malone, chair of psychiatry and psychology at the Cleveland Clinic. "These symptoms can also be a clue that the underlying diagnosis is bipolar depression (manic depressive disorder)," he added.
In the study, Popovic's team looked at more than 2,800 people with depression, including nearly 630 who had attempted suicide. The researchers conducted in-depth interviews with each patient, and especially looked for differences in behaviors between depressed people who had attempted suicide and those who had not. Certain patterns of behavior began to emerge, the study authors said.
"Most of these symptoms will not be spontaneously referred by the patient, [so] the clinician needs to inquire directly," Popovic said.
She and her colleagues also found that "depressive mixed states" often precede suicide attempts.
RELATED: What Suicidal Depression Feels Like
"A depressive mixed state is where a patient is depressed, but also has symptoms of 'excitation,' or mania," Popovic explained. "We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact, 40 percent of all the depressed patients who attempted suicide had a 'mixed episode' rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide."
The researchers reported that the standard criteria for diagnosing depression spotted only 12 percent of patients with mixed depression. In contrast, using the new criteria identified 40 percent of these patients, Popovic's team said.
"This means that the standard methods are missing a lot of patients at risk of suicide," she said.
Malone agreed that a "mixed state" can heighten odds for suicide.
"This study appropriately cautions caregivers to pay particular attention to suicide risk when treating patients with mixed states," he said.
"Bipolar patients are at higher risk of suicide in general when compared with non-bipolar depression, even when not in a mixed state," Malone said. Drug treatments for bipolar depression "also can differ significantly from those of unipolar depression," he added. "In fact, antidepressants can worsen the situation with bipolar patients."
According to Malone, all of this means that "accurate diagnosis is essential to deciding on effective treatment."
Dr. Patrice Reives-Bright directs the division of child and adolescent services at South Oaks Hospital in Amityville, N.Y. She said that the "more commonly known risk factors for suicide include hopelessness, history of previous attempts and recent loss or change in one's life."
However, the impulsive and risky behaviors outlined in the new study can "also increase the likelihood of someone who is depressed to act on thoughts to end his or her life," Reives-Bright said.
She agreed with Malone that "identifying these symptoms of a mixed state is important when assessing mood symptoms and selecting treatment options for the patient."
Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal. However, according to Popovic, one strength of the new study is that "it's not a clinical trial, with ideal patients -- it's a big study, from the real world."
More than 800,000 people worldwide die by suicide every year, and about 20 times that number attempt suicide, according to the World Health Organization. Suicide is one of the leading causes of death in young people.
Consuming more meals from the sea linked to lower risk, study suggests, but cause-and-effect not proven.
Can eating a lot of fish boost your mood? Maybe, say Chinese researchers.
Overall, the researchers found that people who consumed the most fish lowered their risk of depression by 17 percent compared to those who ate the least.
"Studies we reviewed indicated that high fish consumption can reduce the incidence of depression, which may indicate a potential causal relationship between fish consumption and depression," said lead researcher Fang Li, of the department of epidemiology and health statistics at the Medical College of Qingdao University in China.
But this association was only statistically significant for studies done in Europe, the researchers said. They didn't find the same benefit when they looked at studies done in North America, Asia, Australia or South America. The researchers don't know why the association was only significant for fish consumption in Europe.
The study was also only able to show an association between eating fish and the risk for depression, not that eating fish causes a lower risk for depression, Li said.
Still, Li thinks there may be reasons why fish may have an effect on depression.
"Fish is rich in multiple beneficial nutrients, including omega-3 fatty acids, high-quality protein, vitamins and minerals, which were associated with decreased risk of depression from our study," Li said.
The researchers pointed out that it's possible that the omega-3 fatty acids in fish may change the structure of brain membranes, or these acids may alter the way certain neurotransmitters work. Neurotransmitters are the brain's chemical messengers, sending information from brain cell to brain cell. Some neurotransmitters, such as dopamine and serotonin, are thought to be involved in depression, the researchers said.
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The report was published Sept. 10 online in the Journal of Epidemiology & Community Health.
Depression affects 350 million people around the globe, according to background information in the study. The mood disorder is the leading cause of disability worldwide, according to the World Health Organization.
Past research has suggested that dietary factors may play a role in depression, the researchers said.
To look at the possible connection between eating fish and depression, Li and colleagues reviewed 26 studies published between 2001 and 2014. The studies included more than 150,000 people. Ten of the studies were done in Europe.
This process, called a meta-analysis, attempts to find consistent patterns across multiple studies.
In addition to an overall benefit from fish in curbing depression, Li's team found a difference between men and women. Specifically, the researchers found a slightly stronger association between eating a lot of fish and lowered depression risk in men by 20 percent. Among women, reduction in risk was 16 percent, the researchers said.
Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said it's "impossible to draw any definitive conclusions about direct cause and effect" due to the study's design.
But, he added, "While the exact way fish may prevent depression is unknown, it's promising to learn that depression may be preventable for some people by making simple modifications to their lifestyle, such as by eating more fish."
Rego said it's especially important to look for novel treatments because depression can have a significant impact on people's lives, and many people don't respond fully to first-line depression treatments.
Future research needs to look into whether the effects of fish on depression vary by the type of fish eaten. In addition, this review didn't look at whether or not fish oil supplements could have the same effect.
Influenza, commonly known as "the flu," is a viral infection of the respiratory tract that affects the nose, throat, and sometimes lungs.
tend to happen annually, at about the same time every year. This period is commonly referred .
However, each outbreak may be caused by a different subtype or strain of the virus, so a different flu vaccine is needed to prevent the flu each year.
For most people, a bout of flu is an unpleasant but short-lived illness.
For others, however, flu can pose serious health risks, particularly if complications such as pneumonia develop.
Every year, thousands of Americans die from the flu. According to the Centers for Disease Control and Prevention (CDC), the number of deaths caused annually by flu in the United States ranged from 3,000 to 49,000 between 1976 and 2006, with an annual average of 23,607 flu-related deaths.
The best way to avoid getting the flu is to get an annual flu vaccination, encourage the people you live and work with to do likewise, stay away from people who are sick, and wash your hands frequently.
The aches and pains of rheumatoid arthritis can be hard to overcome, but these strategies may help in treating chronic pain.
From fatigue to loss of appetite, rheumatoid arthritis (RA) can impact your life in a number of ways, but the most limiting symptom for many people is pain. Because that pain comes in different forms, you may need more than one strategy to relieve it.
“The primary cause of rheumatoid arthritis pain is inflammation that swells joint capsules," says Yousaf Ali, bachelor of medicine and bachelor of surgery, an associate professor of medicine at the Icahn School of Medicine and chief of the division of rheumatology at Mount Sinai West Hospital in New York City. Joint capsules are thin sacs of fluid that surround a joint, providing lubrication for bone movement. In RA, the body's immune system attacks those capsules.
The first goal of pain relief is the control of inflammation, Dr. Ali explains. “Inflammation can cause acute (short-term) pain or longer-lasting smoldering pain," he says. "Chronic erosion of joint tissues over time is another cause of chronic pain. But there are many options for pain relief.”
Getting RA pain under control may take some work. You may find that you'll need to take several drugs — some to slow the joint damage and some to alleviate joint pain. Alternative therapies, like acupuncture, combined with drugs may help you to feel stronger. It may take some time, too. Try the following strategies — with your doctor's supervision — to discover which are most effective for you:
Treatments and Strategies to Help Relieve Chronic RA Pain
1. Inflammation Medication "In the case of RA, all other pain-relief strategies are secondary to controlling inflammation," Ali says. The No. 1 option in the pain relief arsenal is to control inflammation with disease-modifying anti-rheumatic drugs, called DMARDs. These drugs, which work to suppress the body's overactive immune system response, are also used to prevent joint damage and slow the progression of the disease. DMARDs are often prescribed shortly after a diagnosis in order to prevent as much joint damage as possible.
"The most commonly used is the drug methotrexate," he says. It's administered both orally and through injections. Digestive issues, such as nausea and diarrhea, are the most common side effect of DMARDs, and of methotrexate in particular, if taken by mouth. Hair loss, mouth sores, and drowsiness are other potential side effects. Methotrexate, which is taken once a week, can take about five or six weeks to start working, and it may be three to six months before the full effects of the drug are felt; doctors may also combine it with other drugs, including other DMARDs.
"Steroids may be used to bridge the gap during an acute flare," adds Ali. "If flares continue, we can go to triple-drug therapy, or use newer biologic drugs that are more expensive but also effective.” The most common side effect of biologics are infections that may result from their effect on the immune system.
The next tier of pain relief includes these additional approaches:
2. Pain Medication The best drugs for acute pain, Ali says, are nonsteroidal anti-inflammatory drugs, called NSAIDs. Aspirin and ibuprofen belong to this class of drugs, as does a newer type of NSAID called celecoxib. While NSAIDs treat joint pain, research has shown that they don't prevent joint damage. In addition, NSAIDs may irritate the stomach lining and cause kidney damage when used over a long period of time.
"Stronger pain relievers, calledopioids, may be used for severe pain, but we try to avoid them if possible," says Ali. "These drugs must be used cautiously because of the potential to build up tolerance, which can lead to abuse."
3. Diet Although some diets may be touted to help RA symptoms, they aren’t backed by the medical community. “There is no evidence that any special diet will reduce RA pain," Ali says. But there is some evidence that omega-3 fatty acids can help reduce inflammation — and the joint pain that results from it. Omega-3s can be found in cold-water fish and in fish oil supplements. A study published in November 2015 in the Global Journal of Health Sciences found that people who took fish oil supplements were able to reduce the amount of pain medication they needed.
4. Weight Management Maintaining a healthy weight may help you better manage joint pain. A study published in November 2015 in the journal Arthritis Care & Research suggested that significant weight loss can lower the need for medication in people with RA. Among the study participants, 93 percent were using DMARDs before they underwent bariatric surgery, but that dropped to 59 percent a year after surgery.
5. Massage A massage from a therapist (or even one you give yourself) can be a soothing complementary treatment to help reduce muscle and joint pain. A study published in May 2013 in the journal Complementary Therapies in Clinical Practice involved 42 people with RA in their arms who received either light massage or medium massage from a massage therapist once a week for a month. The participants were also taught to do self-massage at home. After a month of treatment, the moderate-pressure massage group had less pain and greater range of motion than the others.
6. Exercise Although you may not feel like being active when you have RA, and it might seem that being active could put stress on your body, gentle exercises can actually help reduce muscle and joint pain, too. “Non-impact or low-impact exercise is a proven way to reduce pain," Ali says. "We recommend walking, swimming, and cycling.” In fact, one of the best exercises you can do for RA is water aerobics in a warm pool because the water buoys your body.
The Arthritis Foundation also notes that yoga is another option to help reduce RA pain, and traditional yoga poses can be modified to your abilities. Yoga may also help improve the coordination and balance that is sometimes impaired when you have the disease. When it comes to exercise, though, it’s also wise to use caution. Talk with your doctor if any workouts are making your pain worse, and, in general, put any exercise plan on hold during an acute flare.
7. Orthoses These are mechanical aids that can help support and protect your joints. Examples include padded insoles for your shoes and splints or braces that keep your joints in proper alignment. You can even get special gloves for hand and finger RA. A physical therapist can help you determine the best orthoses options for you.
8. Heat and Cold Heat helps to relax muscles, while cold helps to dull the sensation of pain. You might find that applying hot packs or ice packs, or alternating between hot and cold, helps reduce your joint pain. Relaxing in a hot bath can also bring relief, as can exercising in a warm pool.
9. Acupuncture This Eastern medicine practice, which has been around for centuries, is thought to work by stimulating the body's natural painkillers through the use of fine needles gently placed near nerve endings. “I have found acupuncture to be helpful for some patients, but the pain relief is usually not long-lasting,” says Ali.
10. Transcutaneous Electrical Nerve Stimulation (TENS) TENS is a form of therapy that uses low-voltage electric currents to stimulate nerves and interfere with pain pathways. “TENS is usually used for stubborn, chronic pain and not as a first-line treatment for RA,” Ali says. One of the benefits of this treatment is the low occurrence of side effects. If you're interested in trying it for pain relief, talk with your physical therapist.
Remember, you’re not alone — your doctor and specialists can help you find relief from chronic pain. If you’re experiencing more pain than before, or if pain is interfering with your ability to get things done, don’t hesitate to talk to your doctor. Ask your rheumatologist about pain relief options, like exercise, massage, yoga, and acupuncture, but remember that the first priority on your pain relief list should be to get RA inflammation under control.
Bariatric surgery isn't a spur-of-the-moment operation. In fact, preparing for the procedure may begin a year or more before your surgery date, and lifestyle changes continue well after the surgery has been performed. Be prepared by knowing what will be asked of you every step of the process.
Leading up to the procedure, your surgical team will likely recommend becoming more informed about diet and exercise.The amount of time you spend in this stage depends on several factors, including your insurance and your team’s recommendations, says bariatric surgeon Ann Rogers, MD, director of the Penn State Hershey Surgical Weight Loss Program in Hershey, Pennsylvania.
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“There’s always some component of nutritional education and some expectation that patients will lose some weight in that program,” explains Dr. Rogers. The dietitians and others who work with you during this stage will send reports on your progress to your surgical team before you schedule your surgery date.
In this phase, you may need to make additional lifestyle changes as well depending on the program. Rogers’ program, for instance, requires smoking cessation, though other weight-loss surgery clinics do not.
The final days before your surgery can be extremely emotional, filled with excitement, nervousness, and anxiety. Taking these steps as you prepare for your surgery will ease tension and ensure that everything goes smoothly the day of your procedure:
• Read the materials from your clinic.
• Eat and drink as directed. “We have a preoperative diet for eight days, which consists of bariatric-friendly protein shakes,” Rogers says. “They are high in protein, and they do not have sugar.” Most programs have a preoperative diet, although the duration varies, she says. Make sure you understand how long that diet lasts and exactly what you can eat.
• Adjust medications as needed. Discuss how to manage any other conditions you might have, such as diabetes, with your weight-loss surgery team and your primary care physician.
• Meet with the anesthesiologist. Once your surgery date is scheduled, you'll also meet with the anesthesiologist, who will ask about your health history. Although patients will have lots of tests done and medical information detailed during the months before surgery, the anesthesiologist might ask for more tests, advises Rogers.
• Take a blood thinner. Clotting is a risk associated with surgery, says Rogers. Your doctor might recommend taking a blood-thinning medication before and after the surgery.
What to Pack
Rogers suggests taking the following items with you to the hospital:
• Instructions. Bring the manual or other instructions you’ve been given, as well as any preoperative paperwork.
• Identification. You’ll need it to check in.
• CPAP (continuous positive airway pressure) machine. If you've been using one for sleep, take it with you.
• Laptop and cellphone.
• Pajamas and toiletries.
• Pillow and blanket.
What your weight-loss surgery will entail varies depending on the specific type of surgery you'll be having.
• Roux-en-Y: This procedure is also known as “gastric bypass.” Your stomach will be divided into a small top pouch and a larger lower pouch. Your small intestine will also be divided and the lower part raised up to attach to your new, smaller stomach. This procedure reduces the quantity of food you can eat at any given time.
• Sleeve gastrectomy: In this procedure, the majority of your stomach will be removed, creating a banana-shaped stomach.
• Biliopancreatic diversion with duodenal switch: In this procedure, a portion of your stomach is removed. The remaining portion is then attached to a lower segment of your small intestine.
• Banding: In this procedure, an inflatable band is wrapped around the upper part of your stomach, creating a small stomach pouch. The band can be adjusted as needed.
• Have a ride home in place. Expect to spend at least one night in the hospital, Rogers says. When you're discharged, you'll need to have someone drive you home.
• Prevent blood clots. You will need to adhere to strategies to prevent blood clots from developing. These include taking blood thinners and getting up and walking around while in the hospital and at home.
• Take pain medication. You'll probably get a prescription for pain medication. Laparoscopic surgery reduces pain and hospital stays, but you still may need prescription pain medication for a day or two after discharge, Rogers says.
• Anticipate constipation, as it's a byproduct of the pain medications and the surgery itself. Be sure to talk with your doctor or nurse about how to prevent constipation.
• Eat a restricted diet. Your diet will be restricted to liquid protein shakes for a week or so after the procedure, and then soft foods following that period. Most people can transition to eating food with texture after their one-month follow-up appointment. By three months you should be able to eat fruits and vegetables, Rogers says. The ASMBS recommends cutting down on carbohydrates and increasing protein.
• Drink lots of fluids. The ASMBS recommends at least 64 ounces, or 8 cups, of fluids daily.
• You may need to take supplements. Calcium, vitamin D, and B vitamins are among those your doctor might recommend.
• Exercise – but nothing too strenuous. Walking daily, starting the day you get home, is good for you, says Rogers. However, skip the gym until you have your doctor’s permission. You should be able to lift small weights, she says, but avoid heavy items.
• Plan on missing work for a while. People with desk jobs usually can go back to work in about three weeks, Rogers says. Those with physical jobs or jobs that require extended periods of sitting, such as driving trucks, will have to wait a longer period of time.
Diagnosing irritable bowel syndrome isn’t like diagnosing other diseases. Your doctor can’t take a swab or a vial of blood and test it to determine the problem. There is no single test that can point to IBS as the cause of your symptoms.
Instead, when you go to your doctor about IBS symptoms like diarrhea, constipation, abdominal pain, and stomach cramps, he has to rule out other conditions and then pay careful attention to your symptoms before giving you a diagnosis.
Diagnosing IBS “For years, anyone who had gastrointestinal symptoms that couldn’t be explained was told they had IBS,” says Steven Field, MD, a gastroenterologist and clinical assistant professor of medicine at New York University School of Medicine in New York City. But now doctors use the "Rome criteria," which are a specific set of symptoms that have to be present in order to give a diagnosis. In addition, the criteria designate red-flag symptoms that don’t point to IBS, he says.
Giving your doctor detailed information about your symptoms and when you experience them will go a long way toward getting an accurate diagnosis. Here’s what your doctor considers before he makes a diagnosis:
Laboratory tests to rule out other conditions. To make sure something other than IBS isn’t causing your symptoms, your doctor may run blood tests, test your stool sample, order an X-ray, or perform a colonoscopy (a procedure in which your doctor uses a small flexible camera to look inside your colon).
Your symptoms. Under the Rome criteria, a diagnosis of IBS can be made if you have had abdominal pain during at least 12 weeks during a 12-month period, even if those 12 weeks aren’t consecutive, and if you experience two of these three things:
Other signs of IBS include mucus in your stool, a swollen abdomen, an urgency to have a bowel movement, having trouble passing stool, or a feeling that your bowel isn’t empty after going to the bathroom.
If you have red flag symptoms. Your doctor will also be looking for red-flag symptoms that aren’t associated with IBS, Dr. Field says. Those include:
Stress — which can result from major life changes such as getting married or getting a new job — is also a major trigger for IBS symptoms, Field says. And for women, symptoms are usually more severe during their menstrual period, possibly because of the effect of hormones on IBS.
The bottom line: Giving your doctor detailed information about your symptoms and knowing what triggers them will help with your diagnosis. Many doctors recommend keeping a food diary to determine exactly what brings on your symptoms and sharing that information with your doctor to make a better diagnosis and get you the right treatment.
The keys to successful psoriasis management are working with your doctor to find a treatment plan that’s right for you and then sticking to that plan. But your role in treatment doesn’t stop with medication. Making certain lifestyle changes is important, too.
From the foods you eat to the support you seek, making healthy choices every day can help you ease the discomfort of flaky, red itchy skin, avoid flares, and start living life to the fullest. Follow these 10 steps.
1. Eat an anti-inflammatory diet. Despite extensive research, there’s no evidence supporting a specific “psoriasis diet,” says Caitríona Ryan, MD, a dermatologist at Texas Dermatology Associates in Dallas and vice chair of the dermatology residency program at Baylor University Medical Center. However, many people with psoriasis report feeling better when they avoid foods that have been shown to cause or increase inflammation (such as fatty red meats, processed foods, refined sugar, and nightshade vegetables) and embrace foods that are known to reduce inflammation. Inflammation-fighting foods include those rich in omega-3s, such as salmon, albacore tuna, flaxseeds, and walnuts, and colorful fruits and vegetables, such as spinach, carrots, and blueberries, according to the National Psoriasis Foundation (NPF).
2. Maintain a healthy weight. People who are overweight tend to have more severe psoriasis, according to a study published in November 2012 in Clinical & Experimental Dermatology Research. “We know that adipose tissue (fat) produces inflammatory cytokines like tumor necrosis factor (TNF),” Dr. Ryan says. Overproduction of TNF, a cell signaling protein, can trigger psoriasis. In addition, systemic and biologic agents for treating psoriasis tend to work better in patients who aren’t overweight, she says.
3. Aim for 30 minutes of exercise most days. Physical activity goes along when it comes to maintaining a healthy weight and lowering your risk for comorbid conditions — such as your risk for heart disease and type 2 diabetes, which increase when you have psoriasis. Try to get at least 30 minutes of aerobic exercise five times a week, and add in some strength training. Although a study published in 2012 in the Archives of Dermatology showed that women who exercised vigorously lowered their risk of developing psoriasis, any level of exercise is better than none, says the NPF. That may mean simply taking the stairs at work instead of the elevator or parking farther away in parking lots.
4. Quit smoking and drinking too much. Neither of these habits is good for anyone, says Mark Lebwohl, MD, a professor and chairman of the department of dermatology at Icahn School of Medicine at Mount Sinai in New York. But they may be even worse for people with psoriasis, he says. The chemicals in tobacco may trigger inflammation that can both cause psoriasis and make flares more severe, according to the NPF. In addition, excessive alcohol consumption may interfere with your response to psoriasis treatment and make it less effective. If you need help quitting smoking or drinking excessively, talk to your doctor.
5. Arm yourself with moisturizer to fight dry skin. “The skin of people with psoriasis is very dry,” Dr. Lebwohl says. “Moisturizing makes it feel better.” Apply moisturizer after showering and after washing your hands. The thicker the moisturizer the better — creams and ointments lock more moisture in your skin.
6. Avoid illness. “Infections worsen psoriasis — even mild colds or urinary tract infections,” Ryan says. “So keeping healthy is rather important.” To stay healthy, eat well, wash your hands frequently, get quality sleep, and be sure your immunizations are up to date. Also be sure to get a flu shot before the start of the flu season.
7. Avoid injuries, too. Some people can develop lesions in new areas if their skin is cut, bruised, or burned, according to The Psoriasis and Psoriatic Arthritis Alliance (PAPAA). Try not to scratch, Ryan says. Be sure to protect your hands and skin when doing activities that could lead to injury such as household chores in the kitchen or pruning bushes in the garden.
8. Cut back on stress. Stressed out? Like most inflammatory conditions, too much tension can cause psoriasis to flare or can exacerbate lesions, according to the NPF. If you’re feeling overextended, look for ways to reduce stress in your life — be it meditation, exercise, or talking to a therapist.
9. Reach out for support. “There are a lot of benefits to support groups,” Lebwohl says. Whether the groups meet online or in person, people with psoriasis often share tips that work well for them and that can help others in their group, Lebwohl says. And sometimes, it helps just having someone listen to you who understands what you’re going through.
10. Stick to your treatment plan—even when you feel good. “Many patients think they’re better off minimizing treatment,” Lebwohl says. They stop taking their medication or go longer than they should between injections. But if you want to avoid flares, you need to stick to the plan. Says the NPF: Using your treatments as prescribed makes a big difference in how well they work.
If you have ropy, blue blood vessels in your legs, you may think that they’re unsightly but don't cause any overt symptoms. Yet for some people, varicose veins can cause skin damage and, even worse, lead to dangerous blood clots.
They’re incredibly common: Varicose veins affect about one in four U.S. adults, or about 22 million women and 11 million men between ages 40 and 80.
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Your leg veins face an uphill battle as they carry blood from your toes to your heart. Small flaps, or valves, within these vessels prevent blood from getting backed up on this journey, and the pumping action of your leg muscles helps push the blood along.
But if these valves weaken, blood can pool — primarily in the veins of your legs — increasing pressure in the veins. As a result of this increased pressure, your body tries to widen the veins to compensate, causing them to bulge and thicken, and leading to the characteristic twisted appearance of varicose veins.
To help you learn the facts about these enlarged veins, we've set the record straight on 10 sometimes confusing pieces of information, including who gets varicose veins and why, health problems they can cause, and treatment options.
“A lot of people are told by primary care doctors or others that varicose veins are a cosmetic issue only, when oftentimes they can be much more than that,” saysKathleen D. Gibson, MD, a vascular surgeon practicing in Bellevue, Washington.
“A significant percentage of patients with varicose veins will eventually develop symptoms,” says Pablo Sung Yup Kim, MD, assistant professor of surgery at Mount Sinai's Icahn School of Medicine in New York City. “The most common include dull achiness, heaviness, throbbing, cramping, and swelling of the legs.” Other symptoms include severe dryness and itchiness of the skin near varicose veins. People with varicose veins are also at an increased risk for a dangerous type of blood clot known as deep vein thrombosis.
Other not-so-common signs and symptoms, found in less than 10 percent of patients, include bleeding, skin discoloration, skin thickening, and ulcer formation — all due to varicose veins, says Kim. Unfortunately, once you have skin damage, it’s usually permanent.
“It’s very important to seek medical advice if you have varicose veins and experience symptoms — before changes in the skin are irreversible,” he says.
Aging definitely worsens varicose veins, though not everyone gets them. “It's a degenerative process that gets worse and more prominent as we age,” says Dr. Gibson. But young people can get varicose veins, too. While the average age of patients treated in Gibson’s practice is 52, she and her colleagues have treated patients as young as 13.
If you've got varicose veins, it may run in your family. “The cause of varicose veins is primarily genetic,” Gibson explains.
Changes in hormone levels also come into play as a risk factor for varicose veins. “Your risk can be made worse, especially by pregnancy,” she adds.
While varicose veins are more common in women, men get them, too. About one-quarter of adult women have some visible varicose veins, compared to 10 to 15 percent of men.
Steve Hahn, 51, of Kirkland, Washington, first noticed in his twenties that he had varicose veins in his left leg after he sprained his ankle playing basketball. When he injured his knee about 10 years ago, he noticed that the varicose veins had become more extensive.
“After about five years of thinking about it, I finally had them treated,” he says. “Both of my legs felt very heavy all of the time at this point, as opposed to just after walking a golf course or playing tennis or basketball.”
After treatment, Hahn says, “I feel like I have new legs.” The heaviness is gone, as is the ankle swelling, which he didn't know was related to the varicose veins. And as a side benefit, he adds, he looks better in shorts.
Exercise — including running — is usually a good thing for your veins. “Exercise is always good for the circulation,” Kim says. “Walking or running can lead to more calf-muscle pumping and more blood returning to the heart.”
“Being a runner doesn’t cause varicose veins,” adds Gibson, though there's controversy about whether exercise makes them worse or not.” Compression stockings can help prevent blood from pooling in your lower legs during exercise. “For patients who haven't had their varicose veins treated and are running, I recommend compression. When you’re done running and are cooling off, elevate your legs,” she says.
While the varicose veins you notice are right at the surface of the skin, they occur deeper in the body, too, where you can't see them. “It really depends on the makeup of the leg,” Gibson says. “If you've got a lot of fatty tissue between the muscle and the skin, you may not see them. Sometimes surface veins are the tip of the iceberg and there's a lot going on underneath.”
If you have a job that requires you to be on your feet a lot — as a teacher or flight attendant, for example — you may be more bothered by varicose veins. But the jury's still out on whether prolonged standing actually causes varicose veins. “People tend to notice their varicose vein symptoms more when they’re standing or sitting,” Gibson explains.
Your lifestyle does matter, because obesity can worsen varicose veins, and getting down to a healthy weight can help ease symptoms. Becoming more physically active is also helpful. “Wearing compression stockings, doing calf-strengthening exercises, and elevating your legs can all improve or prevent varicose veins,” saysAndrew F. Alexis, MD, MPH, chairman of the dermatology department at Mount Sinai St. Luke's and Mount Sinai Roosevelt in New York City.
The only treatment available for varicose veins used to be a type of surgery called stripping, in which the vein is surgically removed from the body. That’s no longer the case. While this procedure is still the most commonly used varicose vein treatment worldwide, according to Gibson, minimally invasive procedures that don't leave scars have become much more popular in the United States.
Endothermal ablation, for example, involves using a needle to deliver heat to your vein, causing it to close and no longer function. While the procedure doesn't leave a scar, it can be painful, and you may have to undergo sedation before being treated. “You have to have a series of injections along the vein to numb it up; otherwise, you wouldn't be able to tolerate the heat,” Gibson explains. You may need to take a day off from work to recover, as well as a few days off from the gym.
Some medications, called sclerosing agents, close a vein by causing irritation. Others are adhesives that seal a vein shut and don’t require the area to be numbed. Gibson and her colleagues have helped develop some of the new technologies and products used in treating varicose veins, including adhesives.
Milder varicose veins can be treated by dermatologists with non-invasive approaches, such as laser therapy and sclerotherapy, says Dr. Alexis. “For more severe cases where symptoms may be involved, seeing a vascular surgeon for surgical treatment options is advised.”
Although treatment for varicose veins means losing some veins, you have plenty of others in your body that can take up the slack, explains Gibson. “The majority of the blood flow in veins in the leg is not on the surface at all; it's in the deep veins within the muscle,” she says. “Those deep veins … are easily able to take over for any veins that we remove on the surface.”
Newer treatments have quicker recovery times. “These procedures can be performed in an office within 20 to 30 minutes with no recovery time. Patients can usually return to work or daily activities on the same day,” Kim says.
Treatments are effective, but they aren't a cure, Gibson says. Sometimes, varicose veins can make a repeat appearance after treatment. “What I tell my patients is it's kind of like weeding a garden,” she says. “We clear them all out, but that doesn't mean there's never going to be another dandelion popping out.”
He single-arm is a classic exercise, but it's not always done correctly. You'll often see people rocking their entire upper bodies on the move, putting their lower back at risk for injury and not getting the most out of the row.
That's where this TRX row comes in, because it forces you to keep near-perfect form. It's an exercise that will keep you honest on all your single-arm rows, and combined with a at the end that's also on the , it makes a perfect finishing move to a pull-day workout.
This could be a bad spring allergy season and people with allergies need to be prepared, an expert warns.
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"With the crazy up and down weather, some parts of the country could see worse allergy-provoking conditions. There is likely to be a pollen superburst this season, so sufferers should get ready," Dr. Jordan Josephson, a sinus specialist at Lenox Hill Hospital in New York City, said in a hospital news release.
"It promises to be a nasty spring," he added.
It's crucial to deal with allergy symptoms immediately, according to Josephson.
"Allergies left untreated can cause sinus swelling leading to chronic sinusitis. Allergies can also affect your digestive tract. Gastroesophageal reflux disease (GERD) can be a direct response of the allergic response. So allergies can seriously affect your quality of life. Just ask any allergy or sinus sufferer," he said.
Dr. Punita Ponda is assistant chief in the division of allergy and immunology at Northwell Health in Great Neck, N.Y. She suggested that if you know you have spring allergies, start taking allergy medication at least one to two weeks before the start of allergy season. Then continue taking it throughout the season, she noted in the news release.
Josephson outlined a number of other ways to keep your allergy symptoms under control, including: staying indoors as much as possible between 10 a.m. and 4 p.m., when pollen counts are highest; using your air conditioner, which cleans and dries the air; keeping doors and windows closed; and using an air purifier.
After being outdoors, remove your clothes and wash them immediately. Keep pollen-exposed clothes separate from clean clothes. You should also take a shower after being outside in order to remove pollen from your skin and hair, he suggested.
In addition, irrigate your sinuses daily to flush out pollen. And take antihistamines, but try to avoid decongestants.
Juggling the responsibilities of work, life, and family can cause too little sleep, too much stress, and too little time.
Yet even when you're at your busiest, you should never cut corners when it comes to maintaining a healthy diet. Your body needs food to function at its best and to fight the daily stress and fatigue of life.
Energy and Diet: How The Body Turns Food Into Fuel
Our energy comes from the foods we eat and the liquids we drink. The three main nutrients used for energy are carbohydrates, protein, and fats, with carbohydrates being the most important source.
Your body can also use protein and fats for energy when carbs have been depleted. When you eat, your body breaks down nutrients into smaller components and absorbs them to use as fuel. This process is known as metabolism.
Carbohydrates come in two types, simple and complex, and both are converted to sugar (glucose). “The body breaks the sugar down in the blood and the blood cells use the glucose to provide energy,” says Melissa Rifkin, RD, a registered dietitian at the Montefiore Medical Center in the Bronx, N.Y.
Energy and Diet: Best Foods for Sustained Energy
Complex carbohydrates such as high-fiber cereals, whole-grain breads and pastas, dried beans, and starchy vegetables are the best type of foods for prolonged energy because they are digested at a slow, consistent rate. “Complex carbohydrates contain fiber, which takes a longer time to digest in the body as it is absorbed slowly," says Rifkin. Complex carbs also stabilize your body’s sugar level, which in turn causes the pancreas to produce less insulin. This gives you a feeling of satiety and you are less hungry.”
Also important in a healthy, energy-producing diet is protein (preferably chicken, turkey, pork tenderloin, and fish), legumes (lentils and beans), and a moderate amount of healthy monounsaturated and polyunsaturated fats (avocados, seeds, nuts, and certain oils).
“Adequate fluids are also essential for sustaining energy,” says Suzanne Lugerner, RN, director of clinical nutrition at the Washington Hospital Center in Washington, D.C. “Water is necessary for digestion, absorption, and the transport of nutrients for energy. Dehydration can cause a lack of energy. The average person needs to drink six to eight 8-ounce glasses of water each day.”
Energy and Diet: Foods to Avoid
Simple carbohydrates, on the other hand, should be limited. Ranging from candy and cookies to sugary beverages and juices, simple carbs are broken down and absorbed quickly by the body. They provide an initial burst of energy for 30 to 60 minutes, but are digested so quickly they can result in a slump afterward.
You should also avoid alcohol and caffeine. Alcohol is a depressant and can reduce your energy levels, while caffeine usually provides an initial two-hour energy burst, followed by a crash.
Energy and Diet: Scheduling Meals for Sustained Energy
“I always recommend three meals and three snacks a day and to never go over three to four hours without eating something,” says Tara Harwood, RD, a registered dietitian at the Cleveland Clinic in Ohio. “If you become too hungry, this can cause you to overeat.”
Also, try to include something from each food group at every meal, remembering that foods high in fiber, protein, and fat take a longer time to digest.
Even if life is hectic, it’s important to make wise food choices that provide energy throughout the day. Your body will thank you.
I've never been one of those people. You know the kind, the ones who wake up in the morning or lace up in the evening and "go for a run."
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I've always been envious of my roommates, who can sneak in a jog with ease and carry on with their day, as if they had done something casually simple like taking the trash out. So, I made a vow to give running another chance. After all, the exercise has been shown to make you happier, reduce your risk for disease and even increase longevity.
While group classes and long walks will probably always be more my speed, I did find that I was enjoying running more than I ever did in the past. However, that doesn't come without a few hiccups. Below are a handful of struggles all new runners can probably relate to.
Getting winded in the first few minutes.
Probably one of the most discouraging elements of getting into a running routine is realizing that you're not as in shape as you thought you were. I continuously find myself doing more walking or jogging than actual running. But just because you need those intermittent breaks doesn't mean you aren't a runner. In fact, research shows that walking intervals during your run can help you maintain your overall pace.
Two words: Sore. Muscles.
The second-day pain is real. If you're experiencing those achy muscles, try one of these post-run remedies. Just make sure you're checking in with your body as you establish your routine. A little soreness is OK, but if the pain is more intense you may have sustained a running-related injury.
Feeling overwhelmed by the copious amount of races.
Color runs, beer runs, zombie runs, princess half marathons... the list is seriously endless. However, there are some perks to picking a race. Signing up for one helps you set a goal as you get into a routine, plus there's an opportunity to turn it into a social event by participating with your friends.
If your goal is to become a marathon runner (and props to you!), there are also some benefits there: Research shows consistent long-distance running can improve cardiovascular health and lower the risk for other organ disorders, the Wall Street Journal reported.
The jolting agony of waking up at 6 a.m.
My sleepy brain is constantly telling me my bed feels better than running (and often, the bed wins). If you need a little extra motivation, try one of these hacks to help you jumpstart your morning workout.
Part of the reason I never got into a routine in the first place was because the exercise itself seemed extremely dull to me (the treadmill is my arch-nemesis). Once I discovered more running-path options, I started to have more fun. However, that's not to say that I don't get a little bored sometimes — and that's OK.
Note: If you still just can't get excited by the process most of the time, you may want to try a more entertaining workout option instead. Exercise should be engaging, not mind-numbing.
Trying to find your perfect route.
Finding your favorite place to run is like finding a good apartment: It feels elusive until one day you hit the lottery. Whether you're into lush scenery or a skyline, it's important to find the routes that work for you in order to make the exercise entertaining.
The joy of picking out new workout clothes.
Sleek tanks! Compression pants! Neon shoes!
Running toward (multiple) "finish lines."
If you've ever uttered to yourself just one more pole, you're not alone. In fact, picking out an arbitrary finish line on your run can improve your performance. Research shows those who stare at a target in the distance go faster and feel less exertion than those who don't concentrate on anything, The Atlantic reported.
Bargaining with yourself on your run.
If you run five more blocks, you can binge-watch Scandal when you get home, I tell myself. Chances are I'd probably do it anyway — but at least it encourages me in the moment.
Creating a playlist that will consistently keep you motivated.
No, a simple music-streaming app won't do when your lungs are on fire and your legs feel weak. You need that one specific song that will inspire you to keep going (shout out to all my Shake It Off comrades). If you're looking for a playlist to spice up your run, check out some of these.
You may know Nigel Barker as the encouraging yet truthful judge on America's Next Top Model, or as a famed fashion photographer who has shot pictures for GQ, Lucky, and Town & Country, among others — or as the author of a book about connecting with your best self, Beauty Equation.
He's fit and trim and confident, but under that chiseled frame, the now 44-year-old Barker learned a few years ago that he wasn't nearly as healthy as he'd assumed. And he never would have found out — and had the chance to turn his health around — if it weren't for a routine conversation with his insurance company.
In 2011, when Barker asked for an increase in the amount of coverage on his life insurance policy, what he thought would be a no-brainer (pay more to get more) turned out to be a rude awakening.
The company denied the additional coverage because Barker's cholesterol levels were too high.
Food, Family, and High Cholesterol
Barker was shocked: He'd been following a strict low-carb, high-protein diet for the previous two years and had toned his body in the process, which he thought would be good for his heart and health. But his high-protein diet also included saturated fat-heavy red meat, cheese, and butter, which probably contributed to his total cholesterol level of 253 milligrams per deciliter (mg/dL) and an LDL ("bad") cholesterol level of 155 mg/dL.
"I looked great on the outside," says Barker. But inside, potentially dangerous levels of cholesterol were putting him at risk for heart problems.
The optimal level of total cholesterol is less than 200 mg/dL, and LDL should be less than 100 mg/dL, according to the Cleveland Clinic. Barker's total cholesterol level put him at risk for heart disease. On the plus side, Barker's "good" HDL cholesterol was fine, at 63; anything above 60 is considered cardio-protective. Though it's important to aim for these numbers, the American Heart Association (AHA) advocates looking at a person's overall health and lifestyle as risk factors in addition to cholesterol counts.
What you eat is one of these factors, and — bonus! — the perks of a healthy meal plan can extend beyond your heart. A study published in July 2015 in JAMA Internal Medicine found that people who followed a Mediterranean diet rich in heart-healthy foods like whole grains, olive oil, legumes, fish, and fruits and vegetables had better memories and cognition as they aged.
For Barker, even more concerning than just the numbers was his family history of heart disease: His father had his first of several heart attacks at age 45. Having a parent who had a heart attack predicts your heart disease risk more than any other single factor, according to a study published in February 2011 in the Journal of the American College of Cardiology.
"The combination of Nigel's high LDL levels and family history was really scary," says Barker's cardiologist, Suzanne Steinbaum, MD, director of women's heart health at Lenox Hill Hospital in New York City. "When you have a family history of heart disease, you really have to pay attention to your own health."
Because high cholesterol has no symptoms, it can go undiagnosed for years. And people who have a high risk of heart attack due to family history often have no signs or symptoms until they have a heart attack.
While Dr. Steinbaum encourages everyone to have their levels checked regularly, it's especially important if heart disease runs in your family.
The United Stated Preventive Services Task Force recommends getting your cholesterol levels screened at age 35 for men and 45 for women, although if you have increased risk (such as with Barker), you should be screened as early as age 20.
The AHA recommends a more aggressive screening every five years beginning at age 20, but if you have high cholesterol or other heart disease risk factors, your doctor may recommend more frequent testing.
The main priority is to understand your risk and discuss it with your doctor to determine when cholesterol testing is appropriate for you.
How Barker Lowered His Cholesterol Naturally
Steinbaum recommended that Barker first change his diet instead of immediately turn to cholesterol-lowering drugs to lower his total and LDL cholesterol levels.
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So Barker traded his low-carb, high-protein eating plan for a Mediterranean-style diet. "Before, Nigel was eating exactly what he shouldn't have been eating for his heart health," Steinbaum says. "But he made the decision to change, and stuck with it."
Within a year, Barker's total cholesterol reading dropped to a much healthier 165, and his LDL was about 100.
"He did it on his own by making healthy choices every day," says Steinbaum.
And Barker remains committed to those heart-healthy habits. "Sometimes you need the drugs," he says, "but we decided to try a little bit of common sense and discipline first."
You’d be hard-pressed to find someone who doesn’t hit snooze or experience the midafternoon slump every once in a while, but if you constantly feel like you’re dragging it may be time to take a closer look at your routine. If you don’t have a related health condition and are getting enough shuteye each night, you may be to blame for the constant fatigue. Here are 8 energy-zapping habits that you can change today.
1. You’re eating too much sugar. While the candy jar is an obvious culprit, refined carbohydrates like white bread and rice, chips, and cereal are a major source of sugar,too. This type of simple sugar is digested quickly by the body, leading to a dip in blood sugar levels that leaves you feeling fatigued. Be sure to replace refined carbs with whole grain varieties for a lasting energy boost.
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2. You aren’t exercising enough. It may seem counterintuitive that exerting energy will actually increase it, but adding a workout to your daily routine will give you a short-term energy boost. Plus, regular exercise improves sleep quality, which will ultimately leave you feeling more well rested.
3. You’re skipping breakfast. "Skipping breakfast can definitely contribute to low energy in the morning," says Johannah Sakimura, MS and Everyday Health blogger. "It's important to give your body good fuel to start the day after an extended period of fasting." Without this fuel, your body is running on empty – leaving you famished by lunchtime and more likely to make unhealthy choices that will cause that midafternoon dip in blood sugar. "Try to combine healthy carbohydrates, like fruit, veggies, and whole grains, with a protein source, such as eggs, nuts, or dairy. The carbs give you an initial boost, and the protein helps sustain you until your next meal," says Sakimura.
4. You’re sitting too much. Not only is sitting for prolonged periods of time harmful to your health (just one hour of sitting affects your heart!), but it’s a major energy zapper as well. Standing up and moving for even a few minutes helps get your blood circulating through your body and increases the oxygen in your blood, ultimately sending more oxygen to your brain which increases alertness. If you work a desk job, try this move more plan to keep your blood pumping.
5. You’re drinking too much caffeine. Whether it’s a can of soda or constant refills of your coffee mug, many of the beverages we reach for when we feel tired are packed with caffeine – a stimulant that will give you a quick jolt, but can also leave you crashing soon after if you ingest too much. Plus, if you’re drinking caffeinated beverages into the afternoon, they may start to have an effect on your sleep quality. If you’re a coffee drinker, switch to water late-morning and replace soda with seltzer for a bubbly afternoon pick-me-up without the crash.
6. You’re dehydrated. We all know the importance of drinking enough water – and even mild dehydration can have adverse effects on your energy level, mood, and concentration. Aim for at least one glass of water per hour while sitting at your desk, and be sure to fill your bottle up even more if you’re doing strenuous activity or are outdoors in high temperatures.
7. You have poor posture. A study found that slouched walking decreased energy levels while exacerbating symptoms of depression. The good news: Simply altering body posture to a more upright position instantly boosted mood and energy, while enabling participants to more easily come up with positive thoughts. So sit up straight! Set reminders on your phone or calendar throughout the day to remind yourself to check in with your posture and straighten up.
8. You’re not snacking smart. If you’re running to the vending machine for a quick afternoon snack, your selection – most likely high in simple carbs and sugar – will take your energy levels in the wrong direction. Instead choose a snack that has a combo of protein and complex carbs for an energy boost that will last throughout the afternoon. Think trail mix, veggies and hummus, or peanut butter on whole wheat toast.
Ask the Fitness Expert, Jennifer Bayliss
Q: What’s the best time of day to exercise?
A: The best time of day to exercise is the time that works best for you. Studies go back and forth on this topic and there are benefits in exercising in the morning and later in the day. Ultimately, it comes down to personal preference and lifestyle. Choose a time that helps you make exercise a regular and consistent part of your routine. Here’s why:
It’s all about finding your rhythm.
Ever wonder why some of us are morning people while others are not? This has quite a bit to do with your body’s internal clock, or your circadian rhythms. Circadian rhythms are a daily cycle of sleep and wake cycles. It’s this cycle that regulates physical, mental, and behavioral changes within a 24-hour period. Body temperature, blood pressure, and metabolism are some of the physiological processes that can be affected by your body’s internal clock. These rhythms respond to changes in the environment and can be set and reset. The changes in the environment that can have an effect on circadian rhythms include lightness and darkness, temperatures within the environment, artificial light, the use of an alarm clock to wake, timing of meals, and time of day you exercise. Your personal clock can affect what time of day you prefer to exercise. So, are you a morning person or a night owl?
If you’re a morning person…
It’s a no brainer: You should workout in the AM. Research suggests that those who exercise in the morning tend to be more consistent with their exercise routine. The idea is you’ll get your workout in before any other events or distractions of the day interfere, thus setting yourself up for success. People who exercise earlier in the day generally find they can manage their time better and they feel more energized throughout the day. If you do exercise in the morning, make sure to give yourself a little extra warm-up time to get your body temperature elevated and your muscles warm. Some people have trouble exercising in the morning because of dizziness, fatigue, or lightheadedness experienced when working out on an empty stomach. If that happens to you, try having a small snack, such as a banana or a serving of low-fat yogurt, prior to exercise.
If you’re a night owl…
Afternoon or evening exercise can be the perfect way to unwind. Some people find that afternoon or evening workouts are more productive and help relieve some of the stresses of the day. For others, exercise in the morning doesn’t feel good because, when you wake up, your muscles may feel tight and your blood sugars may be low. Afternoon or evening workouts may just seem that much better because you are more alert, your body temperature is naturally elevated, and your muscles are warm and flexible. You also have the added benefit of having had the opportunity to get some food in your system which can help you feel more energized during your workout.
Whether you exercise for weight loss, stress relief, or one of the many other health benefits, it is important to be consistent. Schedule that time for exercise based on what works best for you — morning, noon, or afternoon. Your body’s internal clock will reset itself and your sleep habits and changes to meal times will either fall into place or can be adjusted based on when you decide to work up a sweat!
Do you have a fitness question for us? Leave a comment below!
Jennifer Bayliss is a fitness expert and coach at Everyday Health. She is a certified strength and conditioning specialist through the National Strength and Conditioning Association, a AFAAcertified personal trainer, and holds both an undergraduate and a graduate degree in exercise science.
Strawberries, lemons, blueberries, and onions – sounds like your average grocery list, right? Just as they are nutritious and important for a well-balanced diet, these ingredients can give your skin and hair a major boost, too.
Read on to learn these six expert-recommended at-home treatments that can help combat your biggest beauty woes.
Solution: Fresh lemon juice and a red onion
Lemon juice and red onions are naturally acidic, and when combined together, they create a gentle-yet-effective at-home alternative to dark spot and hyperpigmentation treatments that are often formulated with harsh chemicals.
For best results, Michael Lin, MD, a board-certified dermatologist in Beverly Hills, California, suggests blending ¼ of a red onion with freshly squeezed lemon juice before applying it to the desired area with a Q-tip. After 10 to15 minutes, wash off the homemade treatment with a mild cleanser.
Solution: Almond milk and coffee grounds
For a smoothing hand and foot scrub, Lin suggests combining almond milk with leftover coffee grounds from your morning roast. Almond milk is rich in antioxidants and vitamin E, which helps protect skin from free radicals that can damage cells and break down collagen. Coffee grounds, on the other hand, offer exfoliating benefits that help reveal radiant skin. “Using a caffeine scrub helps to stimulate cells and elastin, and temporarily firm the skin,” says Lin.
Combine 2 cups of almond milk and the coffee grounds in a bowl, then scrub the formula in circular motions on your hands and feet.
Solution: Peppermint tea
Using topical treatments isn’t the only way to achieve gorgeous, glowing skin. In fact, radiant skin can be attained from the inside out by drinking a generous cup of peppermint tea. Dallas-based celebrity aesthetician Renee Rouleau advises her celebrity clients to drink a cup of the minty stuff before red carpet events.
“Peppermint tea is known to boost blood circulation, giving skin a vibrant glow,” says Rouleau, adding that peppermint can also help decrease stress.
Solution: Strawberries and honey
Strawberries in particular are jam-packed with vitamin C and are a natural source of salicylic acid, which is often found in anti-acne treatments to help clear skin and keep flare-ups at bay. When paired with honey, which has anti-bacterial benefits, they create a powerful at-home alternative to a store-bought mask.
Mash together three strawberries and 1 Tbsp. honey and apply the mixture. Wash off the mask with warm water after 15 minutes.
Solution: Coconut oil
As the weather gets warmer, your hair can become dry, frizzy, and completely unmanageable. Because of its moisturizing benefits, coconut oil is highly effective when it comes to nourishing hair and battling frizz.
For a hydrating hair treatment, New York City stylist Nunzio Saviano, owner of Nunzio Saviano Salon in New York City, recommends working a tablespoon of liquefied coconut oil through your hair post-shampoo. Leave the oil in for five to 10 minutes and rinse it out with chilly water, which will also help close the hair cuticle and seal in moisture, fighting frizz.
Solution: Apple cider vinegar
Product buildup (sometimes confused for dandruff) is residue left behind on your hair and scalp by shampoo, mousse, hairspray, and other styling products. Additionally, dirt, natural oils, and hard water mineral deposits can build up on your hair shaft, leaving locks dull and weighed down. For a quick at-home fix, celebrity colorist Kyle White recommends a five-minute apple cider vinegar treatment.
“Apple cider vinegar is an effective clarifying
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It's unclear what causes binge eating disorder.
Like other eating disorders, BED is probably caused by a combination of genetic, psychological, and social factors.
Some risk factors for binge eating disorder include:
People with binge eating disorder have frequent bingeing episodes, typically at least once a week over the course of three months or more.
Binge eating episodes are associated with three or more of the following:
Some people also display behavioral, emotional, or physical characteristics, such as:
There are several treatments available for BED. Treatment options may include:
Veva Vesper has dealt with more than her fair share of Skin Cancer in the last 25 years. The 69-year-old Ohio resident has had more than 500 squamous cell carcinomas removed since the late 1980s, when the immunosuppressant medication she was taking for a kidney transplant caused her to develop them all over her body — everywhere from the corner of her eye to her legs.
While Vesper’s story is unusual, skin cancer is the most common cancer in the United States. In fact, it’s currently estimated.
Mike Davis, a 65-year-old retired cop, and like Vesper, a patient at The Skin Cancer Center in Cincinnati, Ohio, has a more familiar story. Earlier this year, he had a basal cell carcinoma removed from his left ear — the side of his face most exposed to UV damage when driving on patrol.
If you have high cholesterol and blood pressure, your doctor has probably advised you to start following a healthy diet as part of your treatment plan. The good news is that delighting your taste buds while sticking to a heart-healthy meal plan is easy — and many of the foods you enjoy most likely aren’t off limits. Healthy herbs and spices lend robust and savory flavor, hearty nuts add texture and a buttery taste, and teas infuse a bright flavor and antioxidants. Michael Fenster, MD (also known as Dr. Mike), a board-certified interventional cardiologist and gourmet chef, shares his cooking tips for preparing delicious meals that will boost your heart health. These choices are part of a healthy lifestyle that may reduce your risk for heart conditions like high blood pressure, heart attack, or stroke down the road.
You may feel in complete control of your child's allergies — at least when he or she is under your watchful eye. But you can't be with him or her 24/7, and you want her to live as normal a life as possible. What's the balance between letting your child enjoy life and managing your stress in the face of severe childhood allergies? You’ll need to explain to other parents, teachers, and caregivers all they need to know to try to avoid the allergens, recognize allergy symptoms, and treat an allergic reaction so they’ll be as knowledgeable and vigilant as you are. There are steps you can take to clearly convey this potentially life-saving information about your child’s allergies.
Create an Allergy Action Plan
Before a child with severe allergies goes to school, day care, or a babysitter (even a close relative), put an allergy action plan in place to ensure your child’s safety. First, meet with your child’s doctor and ask for a letter that outlines the following:
This letter is the basis of your written allergy action plan at home, school, and anywhere else your child goes. Send a copy of this letter along with your instructions wherever your child is being watched by others.
Share Your Child’s Allergy Action Plan
Whenever a child with severe allergies is under the care of anyone other than a parent, whether it’s a relative or a babysitter, make sure the caregiver is familiar with your child’s allergy action plan.
However, it's not enough to just hand a written emergency plan to another caregiver, says Scott H. Sicherer, MD, an Elliot and Roslyn Jaffe professor of pediatrics, allergy, and immunology and the chief of the division of allergy and immunology in the department of pediatrics at Mount Sinai Hospital in New York City and author of Food Allergies: A Complete Guide for Eating When Your Life Depends on It. “You should still educate them about avoiding, recognizing, and managing an allergic reaction,” Dr. Sicherer says.
Manage Severe Childhood Allergies at School
Make an appointment to talk with the principal and school nurse before the school year starts, or as soon as you learn of your child's allergy, to discuss the situation and the school’s allergy policy. Take the letter from your child’s doctor along and use the information to work with the school nurse to develop an at-school allergy action plan that meets your child’s specific needs.
Also meet with your child’s teacher and discuss what measures will be taken to prevent an allergic reaction in the classroom, such as regular hand washing, safe foods allowed in the classroom, and allergy-free celebration treats.
"Most schools have allergy policies in place and have had children with allergies before,” Sicherer says. “They may have a variety of approaches for keeping children safe and being ready to recognize and treat reactions." For example, some schools may have special tables in the lunchroom for children with food allergies or offer closer supervision while they’re eating.
Here are three questions to ask about a school’s allergy policy:
“Allergy medications at school must be immediately available with clear instructions, and they should not be locked up,” says Robert Wood, MD, a professor of pediatrics and the chief of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, Md. “Medication needs to be within five minutes of where the child is.”
In October 2013, the Centers for Disease Control and Prevention released its first voluntary guidelines for managing food allergies at school, but there are no mandatory national standards. Some states have their own allergy guidelines in place for schools, which can help you and your school design your own allergy action plan.
Share Information With Your Child About Allergies
How you educate your child to protect him or herself from allergic reactions will depend on his or her age. Preschool and early elementary school kids can’t be expected to speak up for themselves about their allergies and should have close supervision. In the case of a food allergy, there should be very explicit instructions about what they’re allowed to eat, Dr. Wood says.
Young children with severe food allergies may learn that they can’t share food with another child, Sicherer says, or that there are specific people, like Mom, Dad, and their teacher, who know what they're allergic to and what's safe to eat — and that no one else can give them food. But as they get older, they can learn more and take more responsibility for themselves. "They may learn to speak up in restaurants and read food labels to begin to decide what’s safe under supervision," Sicherer says.
Do you have trouble following a conversation in a noisy room? Do other people complain that you have the television turned up too loud? If the answer to either of those questions is yes, you may already have some degree of hearing loss.
Hearing loss can start at any age. According to the National Academy on Aging and Society, the number of affected Americans between the ages of 45 and 64 has increased significantly since 1971. But it’s much more common in seniors: Some 40 percent of the 20 million Americans who have hearing loss are 65 or older.
Contrary to popular belief, however, hearing loss is not an inevitable part of aging. Some causes of hearing loss can be prevented, and most types of hearing loss can be helped.
There are three basic types of hearing loss:
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If you are having trouble hearing or develop sudden deafness, you need to get your hearing checked as soon as possible. Sudden deafness is a serious symptom and should be treated as a medical emergency. For many people, though, hearing loss may be gradual and not obvious. Here are seven warning signs to watch out for:
If you think you have any kind of hearing loss, the place to start is with your doctor. Whether your hearing loss is gradual or sudden, your doctor may refer you to an audiologist (a medical specialist in hearing loss) or an otolaryngologist (a medical doctor specializing in disorders of the ear).
Depending on the cause and type of your hearing loss, treatment may be as simple as removing ear wax or as complicated as reconstructive ear surgery. Sensorineural hearing loss can't be corrected or reversed, but hearing aids and assistive devices can enhance most people’s hearing. For those with profound hearing loss approaching deafness, an electronic hearing device, called a cochlear implant, can even be implanted in the ear.
One type of hearing loss is 100 percent preventable: that due to noise exposure. Noise is measured in units called decibels: Normal conversation is about 45 decibels, heavy traffic may be about 85 decibels, and a firecracker may be about 120 decibels. Loud noise — anything at or above 85 decibels — can cause damage to the cells in the inner ear that convert sound into signals to the brain. Here are some tips for avoiding noise-induced hearing loss:
You should also see your doctor if you have any symptoms of ear pain, fullness, or ringing, or if you experience any sudden change in your hearing. These symptoms could be early warnings of preventable hearing loss.
Hearing loss or deafness can have a serious effect on social well-being. It can cut you off from the world around you. Know the causes of hearing loss, and practice hearing loss prevention to preserve the hearing you still have.
One of the realities of 2014 is that when a baby is born, he or she has already been exposed to toxic chemicals. The evidence is in umbilical cords, which research has confirmed contain pesticides, waste from burning coal and gasoline, and garbage. Even if you try to do everything right (eat organic, buy natural products, live in a cabin in the middle of the woods, etc.), you can’t avoid all of the chemicals that have become pervasive.
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Bruce Lourie and Rick Smith researched the dominance of these chemicals while writing their first book, Slow Death by Rubber Duck: How the Toxic Chemistry of Everyday Life Affects Our Health (2009), which took a look at everyday items, including canned food, pajamas, Tupperware, and rubber ducks, that put toxins into our bodies. Their readers bombarded them with a simple question: If all this stuff is inside us, how do we get it out?
So the two authors, armed with Smith’s PhD in biology and collective decades working in the environmental field (Smith's the executive director of the Broadbent Institute and Lourie is the president of the Ivey Foundation), went out again to determine what actually worked to get toxins out of the body. Through a series of self-designed experiments on themselves and others, they take readers through their journey in Toxin Toxout: Getting Harmful Chemicals Out of Our Bodies and Our World.
Here are some key facts they learned about what actually matters when it comes to detoxing:
1. Chemicals are everywhere, but you don’t have to worry about all of them.Not all chemicals are actually going to damage us, Laurie said, and people have different tolerance to chemicals (though you may find that out the hard way). Some chemicals are disappearing from our lives (DDT, dioxin, lead) because of awareness of their dangers. “I joke sometimes that I’m a worrier, and I carry around a worry list with me,” Smith said. “In the book, we tried to come up with a short worry list.” The list included phthalates, BPA, pesticides, methyl paraben, triclosan, sodium lauryl sulphatel, and metals that can be harmful when they accumulate, such as aluminum, tin, and mercury. Yes, that’s still a long (and confusing) list, but there are some simple ways to avoid or eliminate them.
2. Avoid some toxins by shopping natural. Chemicals don’t just get into our bodies through what we eat — they come in through what we slather on our skin, what furniture we sit on, and what we breathe. While reporting for the book, Smith measured his urine before and after simply sitting and breathing in a new Chevy Tahoe for eight hours, and found that doing so had elevated his body's levels of four chemicals from the worry list. So shop smart (and roll down the windows when driving). “When you’re making a purchase, be it a cosmetic, a shampoo, or a new sofa, ask ‘Is this the most natural thing I could buy?’” Lourie said. Read ingredient labels and look up the ones you can’t pronounce. Do your research and check out eco-certifications before making big purchases like sofas or cars to see which, like the Tahoe, are made with dangerous chemicals.
3. Organic is actually better, if you want to avoid pesticides. Recent research — particularly one study from Stanford that concluded organic produce doesn’t have more nutrients — has ignored the intended benefit of going organic, Smith and Lourie argue. Organic farming isn’t necessarily meant to yield more nutrient-dense food. It’s meant to make food that won’t contain excessive pesticides. (Yes, it may have traces of pesticides, because almost everything does. Remember the umbilical cords?) Smith and Laurie asked nine kids who hadn’t eaten organic before to eat an all-organic diet for five days while giving urine samples. The urine samples showed the switch yielded a big drop in pesticide levels. “Once people start eating organic food, pesticide reduction occurs in a matter of hours,” Smith said.
4. It’s better to adjust your habits than to go through a cleanse. One of the most basic things you can do to get toxins out of your body is to drink more water. Another is to eat less animal fat and more (preferably organic) fruits and vegetables. But is the best way to do that a four-day juice cleanse? Probably not, say Smith and Laurie. "'Cleanse' makes it sound like it’s a special thing,” Lourie said. “If you’re eating more vegetables and drinking plenty of water, and you want to put the vegetables in the water, that’s a good thing to do. Just don’t be mistaken that if you do that for four days out of the year, you’re going to be detoxing your body — it doesn’t work that way.” It’s much better to incorporate fruits, veggies, and water into your daily diet.
5. Embrace sweat — and saunas. Toxins enter your body through what you eat, breathe and touch, and they go out the same way, through breath, digested food and drink, and sweat. While exhaling and urinating are pretty non-negotiable, a lot of us are engaged in a war against sweat. “We’re really confused as to what clean smells like,” Jessa Blades, an eco-blogger, tells the authors in the book.Antiperspirants and some deodorants prevent us from sweating out toxins while using toxic metals to keep the sweat in, a “double toxic whammy” Smith said. Lourie even admitted that he’s stopped using deodorant. Even if you change or quit your antiperspirant, you should try to sweat more, too. You can do this by exercising more or by using saunas to “detox through heavy sweating,” Lourie said. You’ll also end up drinking more water, which is good for eliminating toxins.
6. Be wary of fat. Fat holds on to toxins, which is part of the reason chemicals like DDT still hang around our systems. So if you’re eating lots of animal fat, you’re also eating the chemicals that the animal fat is holding. Then, you’re probably also putting on weight and thus adding fat to your body, which will hold on to those chemicals. “It’s a positive feedback loop,” Lourie said. In fact, if you’re worried about toxins and you’re overweight, losing that extra body fat should be the first step toward reducing the toxins in your body.
7. Push companies to do the right thing, and support regulation of toxins.“Only part of the solution to this problem is being a more careful consumer,” Smith said. ‘The other part is to be a more engaged citizen.” Remember when people learned that Subway bread contained a yoga mat chemical, and took to social media to demand that change? “Never has a company capitulated so quickly,” Smith said. It’s easier than ever to make your voice heard.
For many people, pizza tops the list of favorite foods. Not only is the drool-worthy combo of cheese, bread, and sauce satisfying, but it’s one of the easiest meals to pick up (or have delivered) from your local pizzeria. While your favorite slice may be delicious, it can be easy to go overboard on sodium-laden sauce, toppings, and high-calorie crusts. Luckily it’s just as easy — and delicious — to pop a homemade pie into the oven. With a few simple swaps and key ingredients, you can give your favorite comfort food a wholesome makeover without skimping on flavor. So whether you’re craving a fresh-out-of-the-oven slice or just looking for a hassle-free weeknight meal, these five healthy and delicious pies are better than delivery!
Sweet oatmeal recipes are easy enough to find, but savory ones? Those are a little harder to pull off. With its tomato puree, pine nuts, fresh herbs, and Parmesan cheese, Oatgasm’s tomato and basil oatmeal reminds us of a lower-carb bowl of pasta — one that you’ll want to eat for breakfast, lunch, and dinner. Mangia!
Before you feast on chicken and boycott carbs, take a closer look at the U.S. Food Pyramid.
"Carbohydrate is one of the macronutrients that we need, primarily for energy," says Sandra Meyerowitz, MPH, RD, a nutritionist, online nutrition coach, and owner of Nutrition Works in Louisville, Ky.
While fats and protein are also necessary for energy, they're more of a long-term fuel source, while carbohydrates fulfill the body's most immediate energy needs. "It's your body's first source of energy — that's what it likes to use," adds Meyerowitz.