PERIODS of rapid heartbeats had occurred only a few times for DMV-based writer K.M., but she worried about life-threatening atrial fibrillation (AFib), an electrical disorder of the heart. According to University of Michigan (UM) Health, risk of stroke is three times higher in people with AFib, and their strokes are generally more severe—compared to people without the condition. Still, a highly recommended cardiologist dismissed K.M.’s concerns—even with her red flag family history: two brothers with recent strokes, one of those sudden and lethal.
“AFib is really pretty much an epidemic,” according to electrophysiologist Andrew Rubin at Eisenhower Health in Rancho Mirage, California. “Its incidence is expected to more than double over the next 15 years.” Advancing age increases risk for both AFib and for high blood pressure, which alone accounts for about one in five cases of AFib. And recently developed devices—one that monitors heartbeats and the other that both monitors and treats AFib—have brought renewed attention to the condition.
But symptoms of AFib can be silent—the reason that the 10% reported incidence in over-65-year-olds might be a vast underestimation. And that makes family history, especially involving stroke, an even more crucial diagnostic tool—notably for people such as K.M., who have normal-range scores on other assessments: LDL cholesterol levels, the heart-risk calculator, electrocardiogram (ECG) and exercise stress testing, and coronary artery (CAC) testing for plaque buildup in the arteries.
A fluttering sensation in the chest indicates an irregular heartbeat, or arrhythmia—the most common sign of AFib—a feeling that your heart is beating too hard or faster than normal, over 100 beats/minute. Rapid heartbeat, or tachycardia, is most worrisome when it occurs along with other symptoms such as chest pain, shortness of breath and feeling dizzy or faint. In addition to heart issues, common flutter generators can include exercise, anxiety, fever, dehydration, overactive thyroid and sleep apnea.
Heart problems arise when electrical signals that initiate the heartbeat come from somewhere other than the heart. Normally, electrical signals from cells in the heart, called the sinoatrial (SA) node, trigger the heart’s chambers (upper atria and lower ventricles) to move blood through the heart and out into the body, according to Cedars-Sinai. But electrical signals from outside the heart can cause “the atria to quiver (fibrillate) and [make the ventricles unable] to pump blood efficiently to the body.”
“The quivering atria can lead to blood pooling in the heart because [it] is not pumped efficiently from chamber to chamber,” according to the site. As a result, dangerous blood clots can form inside the heart, and temporarily reduced blood flow to the brain can cause fainting. Paroxysmal AFib refers to arrhythmia that continues, either on and off or without stopping, for less than a week and usually is not treated.
But persistent AFib occurs for a week or longer and requires medical attention. In the past, the first step for someone experiencing persistent AFib has been to wear a somewhat clumsy heart monitor for a week or two. Others prefer using a smart-watch heart rhythm app—although one study on the Apple watch found it detected abnormal heart beats only about one third of the time.
In K.M.’s case, a cardiac electrophysiologist— specialist in heart rhythms—paid attention to her family history and recommended the Implantable Loop Recorder (ILR), a recent monitoring device. The ILR, which is placed under the skin overlying the heart in a minor surgical procedure, can store heart rhythm recordings for up to three years to help diagnose the problem.
For someone who experiences fainting, the ILR tracks heart rhythms from before, during and after the sudden drop in blood pressure that reduces blood flow to the brain—to help detect whether AFib is the cause. Fainting can occur with a variety of heart conditions and for other reasons, such as a stressful event triggering a vasovagal reaction that reduces blood flow to the brain by temporarily slowing the heart.
Lake Tahoe-based nurse and medical writer L.D., who had also received healthy heart assessment scores, described an unusual symptom: feelings of fullness in her chest and pressure in her neck that usually arose about half an hour after she plunged into the icy lake or snowshoed up to a high mountain ridge. But one day after a treadmill test—on which she performed well with the incline set as high as she could manage—as she sat recovering, she requested another measurement, which detected serious arrhythmia.
Another recent AFib implantable device, the Watchman, monitors heartbeats and can then provide stroke-prevention treatment. But because the device requires invasive surgery to implant via an artery in the groin, its best candidates are those with a diagnosis of persistent AFib. According to UM Health, for patients whose AFib is an electrical issue that alters the heartbeat—and not related to mitral valve problems —95% of stroke-causing clots are formed in an appendage to the heart’s left atrial artery, which the Watchman can seal off.
A traditional implantable AFib treatment is the cardiac defibrillator, which can detect arrhythmia and shock the heart back into regular rhythm. In addition, an electrical shock performed under sedation can reset heart rhythms. Another option is surgical ablation, which scars the heart tissue to make the beat more regular—but in some cases fails to stop AFib. After two ablations, Lake Tahoe nurse L.D.’s heartbeats returned to normal.
Finally, medical treatment for AFib includes blood thinners, although they have a high risk for bleeding, and beta blockers that slow the heartbeat to control arrhythmia—which also helps people who have problems speaking to large groups. For me, past experiences with dry mouth that made it hard to talk, along with occasional shortness of breath and dizziness, led to anxious anticipation before speaking dates—surely contributing to my difficulties, and seeming miraculously to disappear with beta blockers.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
FOR COPING with end-of-the-day fatigue, hunger or past trauma, somatic therapies or “experiences” incorporate techniques that involve the body as well as the mind. Feeling irritated when hungry, for example—known as “hangry”—may originate in childhood frustration with delays in getting fed. To return to one’s adult self in the present time, a somatic technique might be to sense the environment, such as the temperature, or to touch one hand to the other.
“I might ask a patient if her hands feel okay and, if she says yes, I’ll ask her to move them, exploring their lightness and warmth and flexibility,” writes Bessel van der Kolk in his 2015 book The Body Keeps The Score—which has remained at or near the top of the New York Times Paperback Nonfiction Bestsellers List for 284 weeks. “Later, if I see her chest tighten and her breath almost disappear, I can stop her and ask her to focus on her hands and move them, so she can feel herself as separate from the trauma.”
Daily stressors have multiplied with the explosion in social media on top of the daily roller coasters of excited highs and disappointing lows—resulting in end-of-the-day overload that may be best relieved with physical activity—a relaxing walk or gentle yoga. Reactions to both present stress and past trauma—fight and flight, along with a third, freeze—can build up in the body over time as persistent muscle tension, tightness of breath and hair-trigger startle responses, which can cause more health problems as people age.
“Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of [and try to change] disturbing thoughts and behavior patterns, explained Mass General clinical psychologist Amanda Baker. “But in somatic therapy, the body is the starting point to achieve healing.” People identify tension points in their body as a way to understand and deal with past trauma—and to learn techniques for feeling safe in their bodies going forward.
Movement and touch are two pillars of somatic therapy, which is usually offered as one of several modalities by practitioners, along with talk therapies—such as CBT, and more often recently, dialectical behavior therapy (DBT) that combines movement with talk. (Practicing also increasingly popular “psychedelic therapy”—either using ketamine, the only psychedelic legal in most locations, or with patients obtaining their own drugs —therapists have learned what questions to ask and how to respond to bad experiences.)
In the trauma resilience model, practitioners use touch, such as a hand on a shoulder “to provide gentle support and endorse a feeling of safety,” according to pacesconnection. A woman who described helplessness and immobility during a traumatic event focused on creating a “strong image of running and [she] sensed strength in her legs,” leading to sensations of release and relief that provided confidence and helped prepare her for action in the future.
Decision-making offers a different use for somatic techniques. “When you get to the point in struggling with a problem that you think, ‘I’m sick of talking about this,’ then it’s time to focus on your body,” said Jonathan Foust, senior teacher at the Insight Meditation Community of Washington (IMCW). Participants in a day-long workshop in DC on “Body-Centered Inquiry: Mindfulness, Focusing and the Power of Questions” practiced describing a difficult decision and seeing how their bodies reacted, first at one of the options and then with the other.
Pushing physically against a pillow or wall until you feel strength in your arms offers both an immediate experience and preparation for situations when “saying no” is difficult, according to somatic therapist Pat Ogden on IntegrativePsych. Alternatively, you can “slowly drop into the sensation of the event [where you wanted to say no, but this time the body does what it needed to do] so you may move your feet as if you’re beginning to walk or run out.”
The person who has trouble speaking up may perform physical movements involved in “hiding” —such as crouching down or looking away—that can lead them to understand “I actually have something important to say,” notes Ogden. The choice of which movements might be most helpful comes from an ability to read the body’s inner state, called interoception—an important tool and often the first step in somatic therapy, but one that benefits from practice over time.
Mindfulness, with its focus on scanning the body for areas of tension and then releasing it, can be another tool of somatic therapy. According to the NewPathwaysTherapy blog, “When you make space for sensory awareness, you may notice that you are sensing more than you think, and through that, you may experience more grounding, stability and stillness.”
But Baker disagrees, pointing out that “mindfulness meditation lets any feeling or emotion come into our mind without judgment, as opposed to [somatic therapy] homing in specifically on bodily sensations that are happening.” Baker also notes that while, anecdotally people find “tremendous benefit” from somatic therapy, the research is lacking—compared to talk therapies such as CBT, which she “always recommends…as a starting point.”
For me, the Jonathan Foust workshop offered a refreshing alternative approach to problems after years of talking about them—and that in turn spurred my interest in somatic therapy. But while techniques of mindfulness can seem obvious, I needed the full eight-week course in Mindfulness-Based Stress Reduction (MBSR) before I could make good use of them on a daily basis. And MBSR is a standardized program that has helped large numbers and a wide range of people, whereas somatic therapy might work better for individuals working with experienced practitioners, both to help select appropriate techniques and to integrate and practice them—in conjunction with other kinds of therapy, which should probably include talking.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
Infrared sauna blanket ($699) from Higherdose.com.
By Mary Carpenter
“A HOST of at-home infrared sauna blankets hitting the market…are the latest wellness trend to have transcended the clinic,” writes Roberta Schroeder in British Harper’s Bazaar. Like the original free-standing infrared sauna cabins, these “body-warming cocoons” not unlike sleeping bags purport to treat everything from knee pain and mood disorders to heart failure—with most users reporting relaxation, reduced anxiety and improved sleep.
Infrared saunas have long been popular in Japan, called “Waon therapy,” with good results treating chronic heart failure—and more recently, chronic fatigue syndrome. While “wet” Finnish-style saunas heat the air from 180-200 degrees to create intense sweating, “dry” infrared saunas that can be set between 100-140 degrees use light—electromagnetic radiation— to warm the body directly. (In contrast to far-infrared waves used in sauna cabins and blankets, near-infrared or red light has different effects that may help with retinal diseases and cosmetic rejuvenation.)
Infrared blankets range from cheaper models under $150 to those costing thousands—on Amazon and elsewhere—depending on the material and add-on features such as “sweat-absorbing inserts,” with the general advice to buy more than one. Commented one Amazon buyer, “I thought there was a soft inside to this. There isn’t. It’s more like crawling into a zip lock bag then putting yourself in the microwave for twenty minutes. You come out dripping wet, feeling gross and usually cold.”
“Individuals with heart conditions should avoid all sauna therapy,” according to medicalnewstoday—albeit based on anecdotal reports. Also with “minimal evidence,” the blankets may benefit blood circulation and metabolism, burn fat and calories and accelerate detoxification.
Far-infrared frequencies penetrate deeper into the body compared with wet saunas, causing greater dilation of blood vessels and capillaries that could decrease inflammation and remove toxins throughout the body. Compared to sweating from exercise, infrared supporters assert that sweat produced in these saunas works better to evacuate body toxins and metabolic waste.
The “most far-reaching assertions for this [infrared sauna] technology center on detoxification,” writes Gary Stix for Scientific American. But, noted USC pharmaceutical sciences professor Roger Clemens, “the most efficient system” for detox is the kidneys, liver, GI tract and the immune system: “Except when one of the major organs breaks down, there isn’t a medical device…that can accelerate the body’s natural process of detoxification.”
And for the best evidence-supported effects of infrared sauna blankets—boosting mood, reducing blood pressure and enhancing circulation—studies have been small. An international literature review of more than 200 research papers, however, found infrared therapy decreased pain levels in patients suffering from musculoskeletal disorders—in particular, knee osteoarthritis—and in those diagnosed with fibromyalgia. The review labeled “debatable” any effects on low back pain and muscle damage from sports injuries.
For my only experience with infrared sauna, recommended by a physical therapist, I hoped to alleviate lingering effects of Lyme disease—on the theory that infrared light kills off endotoxins released by Lyme-causing spirochetes, which can remain in the body after antibiotics kill off the bugs themselves.
In a cabin-style infrared sauna, my main impression was: very hot! I was unable to go much above 125 degrees F without opening the door and fanning in cooler air. But the main drawback was my struggle to get comfortable for 45 minutes on a hard seat that was too short for lying down—and, compared to traditional saunas, I sweated less and thus felt less cleansed.
As with most alternative or complementary therapy options I have tried—acupuncture, myofascial release therapy, flotation therapy—health benefits require more than a one-time try. For detoxing from infrared saunas, the recommendation is once or twice a week in four-to-15-minute sessions—to avoid mobilizing too many toxins at once.
Hence, the allure of infrared sauna blankets that can be used at home. I have thought about giving one to a family member who struggles with stress and anxiety but hesitated after reading Amazon buyers’ complaints, including one that said her blanket burned and then melted (although the manufacturer’s response persuaded her to raise her rating). Most comments, however, rave about the beneficial relaxation and stress relief.
In a physical therapy session, on the other hand, I had a comfortable and pleasantly warming experience of infrared therapy lying on a Biomat—a body-length pad that produces infrared light via amethyst crystals. The cost is daunting, with brand-name Biomats close to $2,000 —though perhaps justifiable compared to the number of therapy sessions that might be needed to achieve similar, ongoing effects.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
ARTIFICIAL SCENTS are popping up everywhere—in taxis and Ubers, in hotel rooms and lobbies, in new cars, and even at the gym. In humid workout rooms and indoor pools, one person’s fragrant spritz can be overpowering. Scents often drive DC resident B.N. to switch hotel rooms. Most hotels save a few odor-free rooms, B.N. says—though she once had to try four rooms before finding one that was okay. For B.N., a sore throat and headache can be set off by scented environments, by highly perfumed dinner guests and Amtrak riders—and recently by the glove compartment scent-disperser in her 2017 car.
Starting with perfumed clothing, the company ScentAir makes Bloomingdales smell like Baby Powder, Lilac and Coconut—except at Christmas when the scent switches to Sugar Cookie, Chocolate and Evergreen. These are a few of ScentAir’s “over four billion ‘enduring impressions’… Other stinkers include the Westin Hotel and Resorts, Anytime Fitness, Jimmy Choo Shoes, Saks…” according to the blogger Multiple Chemical Survivor.
Many people are not so happy about all these scents. In surveys by University of Melbourne environmental pollutant expert Anne Steinemann, 50% of American respondents preferred workplaces, healthcare facilities and professionals to be fragrance-free; more than one-third were irritated by perfumed products worn by others; and about 20% reported ill-health effects including headaches and breathing difficulties. “Lawsuits under the Americans with Disabilities Act concern involuntary and disabling exposure to fragranced products,” according to Science Daily.
Among all those with chronic health issues, 22% suffer from some degree of chemical intolerance—and more than 6% are “greatly affected,” Claudia Miller, an environmental health doctor at the University of Texas, San Antonio, told Jill Neimark of Discover Magazine.
People who object to being forcibly immersed in strong artificial odors—as well as flowers in especially aromatic arrangements —may be afflicted with “hyperosmia,” increased olfactory acuity or heightened sense of smell.
Steinemann receives hundreds of letters, phone calls and emails from people who report respiratory, dermatological and neurological problems that they attribute to scented products. “Adults pass out around air fresheners,” she says. “Children have seizures after exposure to dryer sheets.”
About 2.5 million Americans have “fragrance allergies,” according to the American Academy of Dermatology—although doctors disagree about whether the reaction is truly allergic or rather sensitivity to an irritant, which causes headaches, sore throats, etc. Scented skincare products are the main cause of “cosmetic contact dermatitis,” with symptoms that range from skin itching and redness to blisters and swelling.
Sufferers of Multi-Chemical Sensitivity (MCS; also called Environmental Illness, and IEI for Idiopathic Environmental Intolerance) can have devastating reactions to environmental toxins—although the American Medical Association, many medical professionals and others don’t recognize MCS as a true medical condition. Not until B.N.’s sister broke out in large red welts over her whole body after visiting a scented ladies room were friends and colleagues convinced she had a serious problem. (Some experts trace chemical sensitivity to a genetic component.)
“Odor cues,” i.e. telltale odors, make chemical sensitivity difficult to document. In “studies where the chemical odor was masked or suppressed by menthol,” according to British allergist Adrian Morris, both study and control groups had similar symptoms.
MCS skeptics charge that the impact on health maybe due more to perception than to actual toxic effects–in which case smell alone would influence the perceived IAQ (indoor air quality) strongly enough to spur physiological responses. Even when four commonly studied “abundant indoor fragrances”—pinene (pine), limonene (citrus), linalool (floral, sometimes spicy) and eugenol (clove)—are present at two- to three-fold below their thresholds for sensory irritation in the eyes and airways, they might be close to or above thresholds for odor detection. In that case, smell alone could influence the perceived IAQ (indoor air quality) enough to spur physiological responses, according to Danish researchers Peder Wolkoff and Gunnar Nielsen.
Skeptics also point out that the pinene blamed for negative health effects is the same odor inhaled from pine trees during “forest walking”—a pleasant experience for almost everyone.
Also affecting the perception of toxicity are psychological conditions, like anxiety, which are capable of inciting physical reactions. On the other hand, the mind is increasingly acknowledged by the medical community to play a valid role in chronic health complaints, such as pain. (In studies where placebos are clearly labeled as such, if doctors explain the important role of the mind in causing symptoms, patients often improve—sometimes even more than they do with mainstream medical treatments.
A single fragrance can contain hundreds of chemicals, some of which react with ozone in ambient air to form dangerous secondary pollutants, including formaldehyde. Testing 25 top-selling products including air fresheners, laundry detergents and lotions, Steinemann and colleagues detected 133 VOCs (volatile organic compounds) including ethanol and acetone, which are often used as carriers for fragrance chemicals.
An initial extreme exposure can cause the “neurological setpoint for sensitivity” to fall —an actual change in brain processing which has become evident only with the latest imagining techniques, according to Claudia Miller. The change sets off what she calls TILT—toxicant-induced loss of tolerance, with toxicant referring to manmade poisons versus toxins, which are naturally occurring poisons such as spider venom. TILT is a “genuinely new class of diseases unique to our toxic, modern times,” according to Miller.
A man whose office had been sprayed with a potent pesticide (an organophosphate now banned for indoor use) first developed what felt like a bad flu and afterwards each encounter with fresh paint, gasoline odors and other chemicals provoked symptoms. Following many moves, he finally settled in a renovated travel trailer with porcelain (inert and non-reactive) tile floors but still often needs to sleep outdoors. Chemical-free housing exists in various forms around the country—such as a settlement near Dallas —but can be impractically remote and expensive.
Dallas’s Environmental Health Center, founded by controversial cardiovascular surgeon and “clinical ecologist” William Rea, attracts patients from around the world with complaints Rea traces to environmental sensitivities. Although charged in 2007 by the Texas Medical Board for using pseudoscientific test methods, failing to make accurate diagnoses and providing “nonsensical” treatments,” Rea continues to be a popular lecturer and was keynote speaker at last year’s Environmental Health Symposium in San Diego.
Ann Lloyd, a 70-something socialite, was sleeping on the beach to avoid toxins until Rea diagnosed her as a “universal reactor” (to almost everything) and suggested she move to Seagoville. She lived there for 10 years, afterwards moving to a secluded island in the Bahamas, and credited MCS for causing her to lead a simpler life—one that kept her young.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“SURPRISE” and “startling” were among the responses to last week’s FDA announcement of delayed action on the new Alzheimer disease (AD) drug, donanemab, that combats build-up of amyloid proteins in the brain, according to the New York Times. But reports of the drug trials included two important findings—first, concrete evidence based on participants’ tau protein levels, that “treating people as early as possible in the disease provides a better chance of slowing the symptoms.”
More revelatory was the continued slowing of cognitive decline in participants who stopped taking the drug mid-trial, when amyloid plaques had cleared to a certain extent—and were expected to remain below threshold levels for “nearly four years.” In the same class as donanemab, given by infusion every two weeks, the only other drug that targets mild cognitive impairment (MCI) is lecanemab (Lequembi), requiring weekly infusions. Mild cognitive impairment is greater than that expected for an individual’s age and education level while not interfering with daily activities.
(Makers of the first approved drug in this class, aducanumab (Aduhelm), discontinued sales last year due to “weak evidence for efficacy, serious side effect risks, and a high price point,” according to Very Well Health. Side-effect risks that are also true of donanemab and lecanemab include brain bleeds. And, not approved for MCI, an earlier class of drugs blocks the breakdown of the neurochemical acetylcholine in patients with AD.)
The “high stakes and rocky history of developing treatments” for AD were once again under the spotlight in last week’s decision, notes the NYT. This newer class of drugs may not slow cognitive decline even enough for those with MCI or their families to notice. Also, the research made public the still not-well elucidated roles in AD played by both amyloid and tau proteins—that disrupt neuron cell messaging that results in “widespread loss of brain function as many neurons stop working and eventually die.”
The cause of MCI can be something reversible—vitamin deficiency, medication side effect, high blood pressure, sleep disorder—but is more often, University of Missouri neuroscientist Andrew Kiselica told the New York Times, “the stage before dementia where there are more thinking problems than we would expect for your age.”
Using additional strategies to keep up with basic activities can be an important clue to cognitive difficulties. Said Kiselica, “They’re remembering their medications or what to pick up with shopping, but they have to use a lot more to-do lists to make sure they’re getting those things done.”
“Telling events” of forgetfulness are another example, according to Johns Hopkins geriatrics specialist Halima Amjad. While everyone may have occasional experiences of forgetting their phone or why they went downstairs, Amjad points to a more serious issue of, “Gosh, I had to call someone because I couldn’t find my car in the parking lot.”
“It’s a subtle condition,” Mayo Clinic AD Research Center Director Ronald Petersen told the Washington Post about MCI. “People can still drive, pay their bills and do their taxes —they just do so less efficiently.” Petersen gives the example of missing a date several times in a week, and “people in your family are starting to worry about you.”
For online self-testing, the Self-Administered Gerocognitive Exam (SAGE) is “the gold standard” for MCI—that can be helpful before making a doctor’s appointment or to bring in for the examining physician, according to the Post. But cognitive testing may produce less accurate results for well-educated people—notably those who have scored high on academic tests—who engage in regular cognitive activities, such as reading, writing, teaching and learning a foreign language.
Risk factors most often linked to age-related impairment include those over which people have some control—notably the degree of social engagement, as well as high blood pressure, high cholesterol and smoking. Also on the list but more challenging to control are diabetes, obesity and depression—as well as traumatic brain injuries—notably, from falling down.
Inflammation is emerging as a primary culprit in most of these conditions—linked to “all known genetic and environmental risk factors for AD,” according to one summary report. As a result, keeping a lid on inflammation-inducing stress ranks high on the list of measures to help prevent or postpone dementia—as do anti-inflammatory medications and diets.
Generally, anti-inflammatory protocols emphasize eating a wide variety of fruits and vegetables, unsaturated fats, minimally refined whole grains and oily fish— and avoiding foods such as fatty cuts of red meat, excess alcohol and refined sugary foods and beverages. Sugar is a primary villain, with evidence that fructose provokes many of the brain changes associated with AD.
Among difficult-to-control items on the risk list are high levels of noise and air pollution—along with back sleeping if linked to disordered sleep and trouble breathing at night. For me, sugar remains the main dementia-related demon, but at least I can count the teaspoons. Social engagement, on the other hand, is trickier—requiring a balance of time spent with other people along with enough alone time so that stress levels remain manageable.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“I’M A WOMAN in my 40s recently diagnosed with ADHD. Cool. Explains a lot,” writes “Recently Diagnosed” to the Washington Post help column Dear Carolyn. “Since receiving my diagnosis, I’ve had a major shift in how I perceive myself…a lot of societal expectations I simply don’t conform to…I am not a bad person because I struggle to complete tasks a certain way…very freeing.”
ADHD (ADHD, for attention-deficit, hyperactivity disorder, includes what used to be called ADD and is now considered an outdated term) among adults is on the rise, with a “massive increase” between 2020 and 2022, and a near doubling in the number of women in the 23-to-49 age group receiving this diagnosis, according to National Geographic. National Geographic poses such questions as: “is tech rewiring the brains; ADHD and binge eating—possible connection?”
“Most of the increased incidence in the adult age groups can be attributed to increases in new diagnoses for females,” according to Epic Research. “The ratio of males to females diagnosed with ADHD decreased nearly five-fold” [from 2020-2022; and] an increase in the number of stimulant medication prescriptions is likely driven by the increase in new ADHD diagnoses.”
Untreated adult ADHD, on the other hand, is especially concerning because it appears to “take a toll on cognition,” writes Richard Sima in the Washington Post. In an Israeli study of more than 100,000 adults ages 51 to 70, those with untreated adult ADHD were almost two times more likely to develop dementia than those with the diagnosis who were taking a psychostimulant medication, such as Ritalin or Adderall. Even when accounting for hypertension and depression—known risk factors for dementia, and considered more likely in adults with ADHD—“the increased risk associated with adult ADHD and dementia remained,” according to Sima. Said Toronto cognitive neurologist Sandra Black, “If you do have [ADHD], you’re going to have more trouble with normal brain aging.”
A complicating factor is that ADHD and dementia can have similar cognitive symptoms: Someone who is not paying attention can then have more trouble remembering what was said. And while the study highlighted benefits of psychostimulant medication, these might also pose cardiovascular risks in older adults. Israeli public health professor Stephen Levine, lead author on the study, nonetheless noted the “potential for psychostimulant medication to mitigate the risk of dementia in individuals with ADHD.”
Being easily overwhelmed; becoming hyper-focused on projects or specific areas of interest; having a poor sense of time; difficulty structuring and prioritizing tasks; difficulty managing stress; and extreme sensitivity to rejection—are all signs of ADHD in adults, according to Toronto psychologist Tali Shenfield.
A major problem is that current ADHD diagnostic guidelines require symptoms to be present before age 12. And because many ADHD symptoms are non-specific, adults are more likely to receive a diagnosis of related conditions, such as depression, anxiety, poor sleep quality and other physical ailments. Around 80% of adults with ADHD remain undiagnosed, according to a New York Times article on Jessica McCabe, creator of the YouTube channel “How to ADHD.” And as McCabe points out, living with ADHD itself can cause psychiatric disorders.
Adults without a childhood diagnosis could have had “silent” ADHD, which is more likely in girls; or their ADHD only became fully evident after a challenging event or lifestyle change, writes Shenfield. Alternatively, ADHD in adults could be a distinct syndrome that differs from childhood ADHD in severity and characteristics.
ADHD in adults looks different than it does in children—with the inattention component “felt more internally than observed outwardly,” according to South African clinical psychologist Sybrand Hagan. For adults, inattention tends to appear as making careless mistakes, not paying attention to details, difficulty with organization, “or they try to multi-task without actually completing any of the tasks.”
In addition, adults can experience the hyperactivity component more as general restlessness, difficulty sitting still for long periods of time—rather than the fidgeting children do, writes Hagan. Also, because adults have lived with ADHD for “a much longer time, they’re more likely to have found ways to cover up their symptoms or make excuses for them.”
Under “6 Things That Can Trigger ADHD in Adults,” Shenfield lists: poor sleep habits; stressful life events; medical conditions (thyroid disease, sleep apnea, untreated diabetes); medication side effects (mental health medications including some antidepressants as well as corticosteroids, cholesterol-lowering drugs and sleep aids); nutritional and vitamin deficiency; and “too much screen time.”
When I have trouble paying attention or struggle with restlessness that I think may be signs of ADHD, I am reluctant to make excuses using the label. Especially in the absence of an official diagnosis, most people don’t understand or take ADHD very seriously in adults. If I talk about struggling to read most anything that is dense or very long, friends say, “but you were an English major.” Or if I mention restlessness or having trouble paying attention for long periods of time—not signing up for classes, dreading jury duty or wishing even the most entertaining evenings didn’t last so long—friends say, “but everyone struggles with things like that.” And that’s a problem—because they are correct.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
SENSATIONS in the palm of her hand of painful burning—so hot she could feel it with her other hand—woke DC-area writer C.W. several times a night. While C.W. also had neck and shoulder discomfort, this sleep-interrupting pain—accompanied by intense prickling—could range from mild pins-and-needles like feet going to sleep to those of an electric shock. Changing sleep position sometimes helped, but traveling or even a night at the theater made the attacks return for nights afterwards.
A strong pins-and-needles sensation can be nerve pain that indicates risk of permanent nerve damage. But distinguishing inconsequential discomfort from more risky pain can be difficult. It can be hard to figure out whether pain comes from injured nerves or begins in joints, ligaments and bones—which in turn leads to questions about when to seek medical help and what kind of doctor might respond best to odd complaints, such as a middle-of-the-night very hot hand.
Neuropathic pain rarely responds to NSAIDS—one clue that pain is coming from nerves. The alternative sources—bones or joints— produce “pain messages that are carried along healthy nerves from damaged tissue (for example, a fall or cut, or arthritic knee),” according to researchers in Taiwan and Oxford. The few studies comparing drugs for neuropathic pain found “no difference between NSAIDs and placebo in terms of pain or adverse effects.”
Different sensations during activity can also help distinguish sources of pain. Pain from damaged nerves is “typically a burning or stinging sensation that may be isolated or may spread to different parts of the body…may be accompanied by loss of strength, coordination, or sensation,” according to Sharecare. Joint and bone pain, by contrast, “can be sharp, dull, pressure or throbbing.”
“Pain is the main reason people go to a doctor,” according to NIH Heal Initiative. But “a diverse set of medical conditions is a difficult target to hit…because pain is a lived experience affected by biology…psychology…and cultural expectations (such as the urge by some to just “tough it out”).
The newest drugs in the pipeline for chronic pain focus on neuropathic pain, including one now called VX-548, being tested for radiculopathy (damage to nerve roots) and diabetic peripheral neuropathy. According to the New York Times, among the current options for nerve pain relief, NSAIDs like ibuprofen and Cox-2 inhibitors are “not very effective,” and opioids can be addictive.
Another hopeful nerve-pain drug is low-dose naltrexone (LDN), which can “mitigate the chronic inflammation and central sensitization of neuropathic pain,” according to the American Society of Regional Anesthesia and Pain Medicine (ASRA). But relief of symptoms with LDN can take months, and most insurance does not yet cover the cost.
Meanwhile, demand for ketamine—a drug for which pain is the number one condition for prescriptions—has soared more than 500% since 2017, according to APNews. For ketamine, however, the psychedelic effect—which many patients wish to avoid—may be essential for pain relief. Said L.A.’s Ketamine Healing Clinic owner David Mahjoubi, “We want patients to dissociate or feel separate from their pain…”
C.W. visited a physiatrist (M.D. offering nonsurgical approaches to pain and injury treatment), who suggested possible diagnoses, including cervical radiculopathy and carpal tunnel syndrome (CTS), to be confirmed by further testing. The physiatrist also recommended a nighttime wrist splint, a first line treatment for CTS—which put an immediate stop to the nighttime attacks, after which C.W. learned that almost everything about CTS applied to her.
She had most of the risk factors—recent wrist fracture, arthritis, and being female: “women get carpal tunnel syndrome three times more often than men,” according to HopkinsMedicine. And she’s experienced most of the symptoms, starting with pain first noticed at night, described as “often a sharp burning stab or constant ache that seems to be coming from inside the hand and travel from the wrist up the arm.”
And she’d had most of the listed difficulties: discomfort when holding a phone; weakness in the hand, which results in dropping objects as well as in the thumb’s pinching muscles; and trouble fastening buttons or getting keys into locks.
CTS begins with narrowing of the carpal tunnel that results in pressure on the median nerve—which controls sensation in the palm and the palm sides of the thumb and first three fingers. Created by bones and one thick ligament on top, the carpal tunnel also contains nine muscular tendons. According to StatPearls, “This high-traffic area is a prime spot for compression, and in fact, of all the entrapment neuropathies, carpal tunnel syndrome described below has been reported to be the most common.”
Women are more likely to experience CTS pain because the carpal tunnel is relatively smaller, or due to effects of hormones on the lining of carpal tunnel tendons, according to MayoClinic. Fluid retention can increase pressure and irritate the nerve inside the tunnel; anything that causes swelling in the wrist can put pressure on the median nerve; and narrowing of the tunnel can result from wrist fracture or dislocation as well as arthritis, which can change the small bones in the wrist.
C.W.’s doctor prescribed gabapentin, among nerve pain medications originally designed for treating depression or epilepsy. Gabapentin, an anticonvulsant that helps control seizures by decreasing abnormal excitement in the brain, can relieve neuropathic pain by changing the way the body senses pain, according to Medline Plus. For many people, carpal tunnel problems that significantly affect the median nerve can require surgery, in which the tendon is cut to relieve pressure on the nerve.
Meanwhile, among practical CTS remedies are keeping your hands warm; also, reducing your force, relaxing your grip and watching your form, according to the MayoClinic website. For force and grip, suggestions include pushing down more gently on computer keys as well as taking frequent short breaks and periodically stretching and bending hands and wrists.
And watching “form” means improving posture. For example, rolling shoulders back to avoid shortening neck and shoulder muscles—which can compress nerves in the neck. When using a computer keyboard, keep wrists parallel to the floor to avoid bending the wrist too far up or down. Also, use the keyboard at elbow height or slightly lower; and make sure that using a mouse doesn’t strain the wrist.
For C.W., after a years-long effort to work on posture, the midnight pain was a great motivator —albeit short-lived. After the splint started working, she made more resolutions and put up more self-reminders around her workspaces—trying to forestall backsliding with memories of that terrible midnight pain.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
COVID fatigue—that ranges from disinterest to numbness—at any reference to the virus comes in part from many people believing they are personally well protected, bolstered by recently announced plans to relax Covid quarantine requirements. In addition, along with the similarity of the new requirements to those for RSV (respiratory syncytial virus) and flu, is the most-recent Covid vaccine’s design as the same kind of once yearly shot as the annual flu vaccine.
Covid test positivity and hospital admission rates, however, are rising and falling around the country—with many urban medical centers now requiring their personnel to wear masks. And Covid research continues to produce new findings —such as a recent German study showing that giving vaccinations and boosters in the same arm offers better protection, according to WebMd. Explained Vanderbilt University infectious disease specialist Willian Schaffner, “Same arm vaccinations may work better because cells that provide the immune response are in local lymph nodes.” And people who received the “updated” Covid vaccine targeting the Omicron variant, available since last September, at least four months ago are now eligible for a booster.
“COVID-19 vaccines [including the new one] are most effective during the first three months after vaccination,” according to JohnsHopkinsMedicine. With earlier Covid vaccines, protection against symptomatic Covid fell off every month following vaccination. On the other hand, the site describes the 2023–2024 vaccine as a “one-shot vaccine for most people, and there is no booster this season. (People who are immunocompromised or ages 6 months to 4 years may need more than one 2023–2024 vaccine.)”
With the announcement of reduced quarantine time following Covid infection, “concerns among medically vulnerable people are growing,” according to the Washington Post. Critics say “Covid should not be treated like other respiratory viruses, because it currently hospitalizes and kills more people than flu and can inflict long-term complications.”
Supporters note, however, that “the threat of severe illness has dimmed as a result of vaccination, prior infections and antiviral treatment.” According to the new recommendations, “people could return to school and work if they have been fever-free for at least 24 hours without the aid of medication, and they have mild and improving symptoms.”
The greatest Covid-related worry for many is the risk of lasting symptoms, notably fatigue or PEM (post-exercise malaise). In a Senate hearing last month described by New York Times columnist Zeynep Tufekci, Kansas Senator John Marshall said in a voice “shaking with emotion…‘We’ve taken my loved one to dozens of doctors…I’ve talked to 40,50,60, 80…read everything there is to read about long Covid, talked to other members of the Senate that have had long Covid. What are they doing?’”
“For years, long Covid clinicians hoped for hard information about seemingly promising drugs, including those that are already being prescribed off-label,” writes Tufekci. “I previously brought low-dose naltrexone up to N.I.H. officials as an example of an existing drug they could be testing. They told me that trials for drugs already on the market were imminent. That was 18 months ago.”
“A sea of blue T-shirts reading ‘Long Covid Moonshot,’ the name of a patient campaign calling for at least $1 billion a year for long Covid research,” is how Tufekci described the Senate hearing room during Marshall’s speech. Tufekci wrote about the N.I.H. allocation of about $3 billion annually to H.I.V., for which there is “an effective treatment and affects about 1.2 million people in the U.S.” —versus about nine million people for long Covid, as of the recent 2022 National Health Interview Survey.
Having avoided Covid infection so far, I try to wear a mask in crowded closed spaces, notably theaters and airplanes, but am uncomfortable doing so at festive gatherings where no one else is wearing one. I would feel safer knowing that infected people were quarantining long enough to no longer be contagious. At the same time, I understand Covid fatigue as well as the longing for life before the pandemic.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“OUT OF every 10 women I talk to, eight are microdosing [psilocybin],” a L.A.-based wellness entrepreneur told the Wall Street Journal earlier this month. Of six women featured in the piece, four rave about work-related boosts in mental clarity, creativity, engagement, brainstorming, and enthusiasm for repetitive tasks—while two emphasize relief of depression and social anxiety. Help with high-stress moments was the benefit for a 48-year-old tech executive, who said: “I am on my A-game, the way I felt when I was young, just rapid fire…I’m clear and I’m calm.”
“Performance enhancement” was the main motivation for microdosing listed by participants in a 2023 online survey, according to Birmingham, England researchers. “Improved mood, focus and creativity” were primary “beneficial outcomes,” though some reports included increased anxiety and physiological discomfort. And while many psychedelic microdosers report waning benefits after a few days, 13 participants in the intensive Birmingham research experienced lasting effects “because microdosing acted as a catalyst that encouraged healthy new behaviors.”
My one experience with small-dose psychedelic drugs involved neither work—making me unable to assess productivity or creativity—nor a measurable low dose. According to the New York Times, microdosing refers to “taking 5 to 10% of a full dose of a psychedelic, usually LSD or psilocybin, as a way of getting the supposed mental health benefits of the drug without the hallucinogenic high.”
On a misty vacation day in Lake Tahoe with two friends, sharing a broken Altoid containing LSD (a common preparation), I consumed what looked like a few crumbs. The result: I felt more energetic and had more fun walking around town and along the lake for hours, even as a lovely mist turned into pounding, if beautiful, rain. The drug produced a speedy, slightly nauseating effect that made me unsure how it would be to eat, but hot soup consumed around an outdoor fire pit tasted delicious.
One acquaintance of mine in her late 30s who recently moved to Miami has gone to several parties where low-dose psilocybin chocolates were on offer—though she felt too unfamiliar with the other guests to try them. In San Francisco, another gives afternoon “tea parties” without alcohol, explaining that his “psychedelic friends” don’t drink. In both reports, the doses involved were unknown; and the experiences unrelated to work.
But a good lawyer friend who lives in Europe can order “magic truffles” online from the Netherlands for the “usual” protocol, she said, of microdosing once every four days. While that regimen produced little effect, she experienced some “mood enhancement” on a different plan—taking the same well-measured microdoses four days in a row followed by a pause of three days—developed by mycology expert and author Paul Stamets. Founded by Stamets, Fungi Perfecti researches and markets a wide variety of mushrooms for medicinal uses, though not psilocybin.
The so-called Stamets protocol involves “stacking,” combining psilocybin with substances, such as Lion’s Mane mushrooms, chocolate and the B vitamin niacin that helps the body turn food into energy. According to Nature, the goal is “to accentuate salutary effects” by way of either complementary cognitive-enhancing qualities or potential biochemical interactions.
And Muse, a Denver-based “psilocybin company,” according to the Wall Street Journal, also recommends the four days on/three days off regimen. Muse sells psilocybin in chocolates and capsules, by referral only, and hosts “mushroom bars” at corporate events and birthday parties in L.A. But Muse does not use the word “psilocybin” in its marketing because the drug remains illegal in the U.S.—though several states and research centers have opened the way for legal use and experimentation.
Many aspects of the microdosing experience remain poorly understood, such as how the drugs work in the brain and why effects vary so widely among individuals. Also, there’s the question of what is the best dose and formulation for the desired effects—“sub-perceptual,” i.e., not altering perception of reality— for the two most popular microdosed drugs: psilocybin in about 80% of experiences and LSD in the rest.
Psychedelics primarily work on the chemical messenger serotonin that affects mood as well as cognition and memory. But the two largest placebo-controlled trials of microdosing—from London and the Netherlands—“suggest that the benefits people experience are from the placebo effect,” according to the New York Times. And a third, placebo-controlled trial on microdosing LSD at the University of Chicago also found no difference between the LSD and placebo groups.
“Acute creative enhancement” was the primary experience reported by microdosers in a 2023 review of 42 studies—while psychedelic macrodoses “tended to impair cognitive performance and creativity,” according to researchers in Victoria, British Columbia and at Johns Hopkins University. But inconsistencies plaguing the studies included dosage and intake protocols along with “set and setting”—which refers to the often-affecting preparation of participants for the psychedelic experience.
To date, I have taken psychedelic drugs only with a few most-trusted close friends and family members—who have procured and determined safe amounts, and remained with me during the experience. Now that I have access to psilocybin-infused chocolates at reliably low doses, I am curious about how those might affect my writing work—spur me to new heights of energy, productivity and creativity—or instead send me outside for hours to walk in invigorating rain.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
LittleBird’s Well-Being series responds to reader questions.
Q: I’ve had two eye doctors tell me never to use eye drops for redness (just get more sleep!). Any information on why that is or why it’s actually safe?
A: “It’s fine to treat minor irritation, exhaustion and occasional redness with eye drops,” according to Medicalnewstoday. But eye drops that work as vasoconstrictors, like Visine, can cause redness rebound if used too many days in a row. The alternative, lubricating drops, known as artificial tears, can be more helpful—though the most effective ones require a prescription.
For red eyes—also pink, yellow or orange—the best treatment is usually time. Even when appearing completely bloodshot, they are usually nothing to worry about. In the case of discoloration—the result of tiny blood vessels swelling, leaking or bursting —eyes can take as long as three weeks to absorb the blood and slowly turn white again. When linked to irritation caused by an object like an eyelash, redness should disappear within several hours, although longer-lasting discoloration due to an injury, such as a scratch, can lead to infection and require antibiotic treatment to avoid lasting damage.
Tea bags can help with a variety of eye ills—from red or dry eyes to under-eye bags and circles —due mostly to their soothing effects, similar to those of warm or cool compresses, and to chemical ingredients of certain teas. To prepare, better to use organic tea in unbleached bags without staples: Steep two tea bags, squeeze out excess liquid and leave until lukewarm or refrigerate to cool. Apply to closed eyes for 15 to 30 minutes, keeping liquid out of the eyes, and massage or apply gentle pressure to the eyes or surrounding area.
The caffeine in black and green teas may improve skin elasticity and reduce swelling and pigmentation; and polyphenols can have anti-inflammatory as well as antioxidant effects. Also helping to reduce swelling, flavonoids can relieve eye infections and blocked tear ducts—both in black and green teas, and in herbal teas like chamomile, which also has calming effects to help reduce inflammation.
Cooler bags, or any cool compress, can help shrink dilated blood vessels below the eyes that play a role in dark circles as well as in eye puffiness. And warmer bags can reduce blepharitis, inflammation of the eyelids that can be due to bacteria; and for other causes of swelling, help to loosen flakes of scalp dandruff or unclog oil glands, which can also improve quality of the tears.
(Drinking caffeinated hot tea daily also reduced risk of glaucoma by 74%, in a 2018 analysis at the UCLA School of Medicine, based on 1,678 participants in the NHANES [National Health and Nutrition Examination Survey]. In contrast, neither coffee nor iced or herbal teas had any effect.)
But many eye ills such as highly contagious conjunctivitis—also called pinkeye and characterized by extreme itchiness—require antibiotics as well as frequent hand-washing to prevent spreading. A rare cause of redness, uveitis—inflammation of the eye that can come on suddenly, often accompanied by pain and blurred vision—is a reason to seek immediate medical care. And regular ophthalmological visits can watch out for swelling linked to glaucoma.
Dry eyes alone can be a reason for seeking medical treatment. Dry Eye Syndrome (DES) has been publicized in recent years by Jennifer Anniston talking about her affliction on TV. Also called keratoconjunctivitis, DES includes decreased tear secretion, production of poor-quality tears and/or accelerated evaporation of tears, associated with swelling around and on the surface of the eyes.
Other common causes of excessive dryness include hormonal changes during menopause, air pollution, winter weather and seasonal allergies. Because allergy treatments like antihistamines and decongestants can make dry eyes worse, some allergy sufferers rely on Alaway antihistamine eyedrops in the morning; and Systane Ultra lubricating drops for symptoms of DES at other times of day.
Dry eyes can, alternatively, be a symptom of the immune disorder Sjogren’s syndrome, which affects moisture-producing glands throughout the body and occurs most often in women over 40. They may also be a symptom of other immune-related conditions like rheumatoid arthritis, while deficiencies in vitamin A and thyroid hormone can be other reasons for eye dryness.
Finally, overuse of so-called “redness relief” eyedrops, which prolongs or even increases redness, can be another reason for seeking medical intervention. Writes New Jersey ophthalmologist Sydney Tyson, “Over time [redness relief drops] really prevent your eyes from naturally recovering.”
Redness-relief drops work by constricting superficial blood vessels on the eye surface that may have dilated to help the eyes respond to irritation. When the drops’ effects wear off, vessels can dilate to an even larger degree, which increases redness and is why experts advise using these drops one to two days maximum.
Lubricating drops, on the other hand, increase blood flow to the surface of the eyes and “will actually help repair the damage done by exposure to adverse conditions,” says Tyson. (Concern about preservatives in lubricating drops have led many to choose preservative-free “PF” versions of popular brands, such as Refresh.) Tyson includes redness-relief drops in her category of adverse condition causes.
For sufferers of eye conditions related to insufficient sleep, chronobiotic drugs like melatonin can “open the doors of sleep by inhibiting the propensity to wakefulness” in the brain that can occur in late evening, according to researchers in China and Texas. In addition, melatonin works as “the chemical code of darkness [providing] information crucial to the neuroendocrine system.”
But hearing the advice to “just get more sleep” makes me bristle: Even with the help of nightly melatonin, my best efforts sometimes fail. There are other steps I could take: skipping coffee ice cream for dessert, putting away the mystery page-turner, quitting Words with Friends, closing my cumbersome blinds. First, though, I look forward to trying tea bag treatments—along with my already-soothing afternoon pot of tea.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
Placed under a new spotlight by recent interest in psychedelics, Holotropic Breathwork can offer a similar experience —without the drugs’ risk of unpleasant nausea or scary hallucinations— as reported in by Mary Carpenter following her 2018 three-day holotropic breathing retreat in Joshua Tree, California.
“SOME SHOOK their limbs wildly, looking possessed…the dozens of attendees at the recent breathwork workshop in San Francisco were… health care professionals completing the final step of an eight-month certificate program in psychedelic therapy,” Ernesto Londono wrote last month in the New York Times. “A few minutes into [the breathwork] session, which lasted nearly three hours, several participants began to weep.”
“It was trippy,” said Oregon naturopath JJ Pursell, who compared the “depth of what I experienced” with holotropic breathing to psilocybin, the psychoactive compound in magic mushrooms. Psychedelic research motivated Seattle palliative care physician Caroline J. Hurd to enroll in the training, based on reports that “psychedelics eased the fear and dread of people facing grim prognoses, allowing them to be more present and emotionally resilient in their final days.”
That chronic pain—“often a physical manifestation of repressed emotional trauma” —might respond to psychedelics was the hope of another participant, Oakland psychologist Bayla Travis, according to the New York Times. After “a wave of heavy emotions that made her cry and shake,” Travis had a vision of herself being carried by another adult, which was “deeply soothing” and made her feel “comforted.”
From Mary’s 2018 report:
I AM LYING on a foam mattress wearing an eye mask, with a pillow and blanket, water and tissues by my side—and a “sitter” to hand me any of these things if I need them, also to lead me to the bathroom (still blinded by the eye mask) and call for help if I want or appear to need it from one of six trained facilitators. My sitter, Rosie, is a massage therapist and yoga teacher, and a good childhood friend.
The motivation for creating workshops in Holotropic—from the Greek, growing towards wholeness—Breathwork, also called neurodynamic breathing, began with investigations into LSD as a therapeutic tool by 1960s researcher Stanislav Grof. By 2009, more than 100,000 Americans had participated in these workshops, drawn by the possibilities of achieving relief from anxiety, depression and PTSD without ingesting drugs—as well as of experiencing psychedelic hallucinations and enlightenment.
Deep, fast breathing accompanied by music of specific vibrations can direct blood flow away from brain structures responsible for rigid thinking and background chatter—and can allow for the greater “connectivity and ego-dissolution” associated with the long-term improvement in well-being that can also happen with psychedelic drugs.
Reduced carbon dioxide in the blood (caused either by hyperventilation itself or by the brain stem response) has been shown to “modify emotional states,” UCLA neurobiology professor Jack Feldman told Cosmopolitan.
Wrote Conor Creighton on Vice about Breathwork, the workshops add “after-care and some therapeutic suggestions. Plus, there’s someone to catch you before you fall over.”
Our weekend took place at the Joshua Tree Retreat Center, a collection of aging buildings with a pool, oleander bushes in bloom and one shop that sold crystals and smelly herbs. Among 60 attendees, some said they hadn’t done “other woo-woo things,” while others had participated in several Holotropic Breathwork sessions. But the lingo—“visuals” for hallucinations, “dropping in” for moving away from reality—made it seem like an alternate universe.
For three hours, I worked on breathing in the unusual, difficult way that I’d practiced at an earlier one-hour session. I took very deep gulps of air into the abdomen, then pushed air out with strong, loud exhales, and immediately inhaled again—similar to hyperventilating. Inside my mask, I saw only darkness and felt engulfed by very loud music, moving from fast, intense primitive ritual sounds to slower and quieter, sometimes with lovely women’s voices.
What kept coming into my mind was anger and sadness for women affected by sexual abuse—and for the courage it took those women who spoke publicly, which I had never done about my experience. These thoughts got me to some mattress pounding and kicking, and then to wishing for greater physical strength to fight back, to protect myself and to hurt men who hurt women.
I liked reacting physically—with the eye mask to keep me from seeing myself look silly or from watching others for comparison. But while others around me were groaning, crying and screaming, I couldn’t bring myself to make noise. At one point, I followed blindly as Rosie led me to the bathroom, and having my hands on her shoulders made me feel the power of friendship, of trust, of touch—of someone taking care of me.
Toward the end of my session, visuals emerged: I was high on a mountain ledge, surrounded by dark granite rocks, looking down into a dark valley of shadowy houses and little twinkling lights. The rocks below me morphed into a monster shape, exciting to me, though they quickly morphed back into the cliff. When I heard a bird singing, undoubtedly from the recorded play tape, I was slightly disappointed to find no bird flying around over my head.
After the session, I was unable to extract meaning from the dark landscape, except maybe death. I wasn’t sure anything significant had happened, though the three hours had sped past without me wondering about the time. But leaving the room, I felt relaxed and “floaty”—a popular Breathwork adjective—especially in the retreat’s swimming pool, with the desert landscape, the moon and stars in a deep blue sky, looking sharper and brighter.
Rosie suggested that my experience of looking down from a high perch might mean I was getting a new perspective, although I wasn’t sure of what. And she thought I might benefit from a breathing coach—also by talking more about past experiences—because “getting unstuck” depends on a combination of breath, movement and sound.
I left Joshua Tree slightly disappointed that my three hours hadn’t been more enlightening, but also having new more trust in myself for future experimentation. And I wondered whether doing something like breathwork—or psychedelic drugs—in a smaller group or therapeutic setting, might work better for me than being surrounded by dozens of people sharing their experiences.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
THE SUGARWARS are raging again—spurred by the explosive popularity of new weight-loss drugs that began with the diabetes drug Ozempic—with the familiar question: Can eating too much sugar cause diabetes? The short if complicated answer is no. But high levels of circulating glucose can damage nerves and blood vessels, creating risks for everyone that are similar to those of diabetes: cardiovascular disease including heart attack and stroke; diminished eyesight; damage to kidneys; and rarer, life-threatening problems, such as gangrene in feet and legs.
Circulating is the key word— independent of the amount of sugar consumed and linked to the effectiveness of insulin at moving glucose out of the bloodstream and into fat cells for storage and muscle cells to produce energy. Driven by insulin, healthy processing of glucose alleviates risk to vessels and nerves—and can improve with diet, exercise and most any kind of activity.
Type 2 diabetes develops in response to elevated circulating glucose levels, or hyperglycemia— with early detection of high blood sugar leading to a diagnosis of pre-diabetes that suggests higher risk for full-blown disease. Although most often associated with excess weight, too much sugar remaining in anyone’s bloodstream can create glucose levels too high for the body’s insulin to process—or for the fat cells to store—and over time lead to “insulin resistance” that in turn makes processing glucose more difficult.
(In type 1 diabetes, on the other hand, the pancreas stops producing insulin, causing patients to rely on infusions of artificial insulin. Although type 1 diabetes has similar risks to those associated with type 2, controlling glucose levels can be more difficult with type 1 because of challenges coordinating the amount and timing of infusions. And because it usually begins in childhood, type 1 has many more years for high circulating glucose to damage blood vessels and nerves.)
“Type 3 diabetes” is a label applied to Alzheimer’s disease (AD), with evidence that high blood glucose in the non-diabetic range can affect the brain, as suggested by the occurrence of blood vessel damage in retinal disease as an early indicator of AD. According to a recent Boston University School of Medicine review of more than 5,000 participants in the Framingham Heart Study, “people with normal cholesterol and glucose measurements in early through middle adulthood may be less likely to develop Alzheimer’s as older adults.”
Mild elevations of blood sugar over time can increase the production of inflammatory chemicals linked to dementia as well as to myriad other health problems. At the same time, excess circulating glucose decreases the elasticity of blood vessels and “causes them to narrow, impeding blood flow,” according to Medical News Today. “The reduced supply of blood and oxygen increases the risk of high blood pressure…a risk factor for heart disease.”
Age itself increases risk for type 2 diabetes: an aging pancreas pumps insulin less efficiently; and aging cells become more resistant to insulin. And notably, excess weight and obesity can increase insulin resistance when fat cells become too full to absorb more glucose. According to Honor Health, “More than 90% of people with type 2 diabetes are overweight [or obese].”
“It’s like trying to put furniture in a room that’s already packed” is how Cleveland Clinic endocrinologist Jay Waddadar explains the overloading of fat cells. As a result, “your pancreas produces more insulin to accomplish the job of moving glucose out of the blood…trying to push against the resistance created by the fat…your pancreas becomes overworked…wears out…starts producing less insulin [and] diabetes develops.”
“Reducing excess body weight can help people manage diabetes—and even reverse pre-diabetes and insulin resistance,” according to Medical News Today. And the new weight-loss drugs — developed in the wake of the success of Ozempic—lower blood sugar levels by boosting insulin secretion. In addition, these drugs suppress appetite, making it easier for people to cut back on specific foods, such as sugary treats.
Exercise can also help lower blood glucose because muscle cells have more insulin receptors to process glucose for energy than fat cells, according to Honor Health. Genetics plays a role in the development of type 2 diabetes, as does a diet with insufficient fiber, too much fat and too many simple carbohydrates, notably sugar.
While experts across the board advise consuming less sugary foods and drinks, much remains tentative and unclear about sugar risks and recommendations. Confusion about sugar most often concerns differences between “natural” and “added” sugars. The FDA recommendation that sugar should comprise no more than 10% of one’s daily diet refers not just to table sugar (sucrose) but also to coconut sugar, agave and corn syrup—along with fruit juice, honey and other naturally sugary foods. On the other hand, many dieticians, as well as the World Health Organization, suggest restrictions that exclude sugars in fresh fruits, vegetables and milk.
For me, such uncertainties about limiting sugars provide some leeway to continue allowing myself sugary treats, mainly sugar in afternoon tea and ice cream at night. But all the while I hear and read about how reducing or giving up sugar altogether can improve health—easing immediate problems such as arthritis, and preventing dreaded future conditions such as AD—I am collecting tips on sugar detox with the hope that I might try doing that, some day.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
“MURKY” is how the Washington Post described current Covid infection statistics, while noting: “There’s no question a winter coronavirus wave is washing over the United States.” Last week the CDC reported “high levels of covid-19 activity,” along with a wastewater site examination showing “coronavirus levels in wastewater exceeding last winter’s peak.” But myriad factors could be complicating the numbers, such as how much virus people are shedding—related to levels of immunity and variants; and variations in treatment-plant reporting.
Murky also describes how worried people should be about Covid this winter—just as it has over almost four years to date, as risks of contagion change with the seasons, with different Covid variants and with additional research. While the CDC previously considered 15 minutes to be the exposure threshold for “a meaningful chance of getting sick,” for example, a new British study reported in last week’s Time magazine found “most exposures that result in transmission last at least an hour, if not much longer.” The British research relied on data from 7 million people using a Covid tracking app between April 2021 and February 2022.
And while weekly Covid-related deaths now range around 1,000, the total to date is less than half of that one year ago. Also, symptoms are usually mild for most people who are vaccinated or were previously infected, although they can be more severe or longer lasting–which puts them at higher risk for developing Long Covid, as well as for neurological issues that have arisen and endured following several viral infections.
“The numbers [increased amounts of coronavirus in wastewater] are bigger, but is it meaningfully larger?” CDC Wastewater Surveillance Director Amy Kirby noted in the Washington Post. With Covid infection tracking now limited to lab-confirmed cases, hospitals reported nearly 36,000 new patient admissions for Covid during the week of January 6 —compared to last winter’s weekly peak of 44,000 hospitalized cases that occurred around this time.
“Increased hospitalizations for influenza, COVID-19 and RSV,” however, point to winter surges in all these respiratory infections, according to US News. And the CDC reports seasonal flu activity also “remains elevated” in most parts of the U.S.
Red, swollen eyes, similar in appearance to conjunctivitis or pink eye, are among new symptoms of the current Covid variant, as are skin rashes— in previously reported “covid toes”—most often occurring in younger people, according to New York Presbyterian.While flu and Covid infections share early symptoms of cough and shortness of breath, Covid tends to last longer and often includes loss of taste and smell—up to 55% of patients report loss of taste and around 40% loss of smell—which often appear starting two days after contracting the virus.
Covid remains more serious than flu—affecting multiple organs while flu is mostly a respiratory illness—but a 2022 study of people with various respiratory diseases found “about one half [who were] sick with something other than Covid reported ongoing issues three months later.” St. Louis Veteran Affairs Research and Development Chief Ziyad Al-Aly told Time that “we need to start thinking of viruses differently.”
“Infections deserve respect,” said Al-Aly. “Before the pandemic, I trivialized infections. You get sick for a day or two or three and then you bounce back and it’s all over…that’s not always the case.” Even mild infections have led to long-lasting health problems, as in the 2022 study where “most [patients reporting ongoing symptoms following infections] were not hospitalized.” Common viruses, including flu and Epstein-Barr, have “been thought to trigger myalgic encephalomyelitis/chronic fatigue syndrome…that shares many symptoms with Long Covid.”
The prevalence of Long Covid in U.S. adults is decreasing —in CDC reports, between June 2022 and June 23, from 7.5% to 6%, according to UC Davis Health News. UC Davis Critical Care Director Christian Sandrock notes that new variants and prior infections may play a role but said, “I believe vaccination and better treatments are having the biggest impact.”
By better treatment, most health professions refer to Paxlovid, still under prescribed in the U.S.—which Washington Post contributing columnist Leana Wen calls the “biggest policy failure.” In a new NIH study of more than one million patients, Wen reports, Paxlovid reduced mortality from covid-19 by 73%—but between December 2021 and February, 2023, “the medication was prescribed to less than 10 percent of eligible high-risk individuals.”
And risk of post-Covid symptoms, according to one VA study, decreased by 26 percent for those who took Paxlovid. Yet physicians remain reluctant to prescribe the drug because of reported “rebound symptoms”—despite reviews by the CDC and FDA that found “rebound appears to occur with and without Paxlovid at comparable rates.” Wen and others encourage not just better physician education but explicit instructions from the FDA that doctors issue “just in case” prescriptions to high-risk patients who plan to travel.
Finally, Covid has joined other viruses, including those causing flu, intestinal infections and shingles, in connection to neurodegenerative diseases—documented in a study of 500,000 medical records—that include Alzheimer’s disease, Parkinson’s disease and ALS (amyotrophic lateral sclerosis). An earlier study “of more than 10 million people linked Epstein-Barr virus to a 32-fold increased risk of multiple sclerosis,” according to Science Alert. “The impact of viral infections on the brain persisted for up to 15 years in some cases.”
For me, I try to get each new Covid vaccine as soon as possible but have also updated my masking efforts—based on the newly reported length of exposure most likely to allow Covid transmission. Now any maskless grocery shopping trips resemble Supermarket Sweepstakes, as I rush through the store to complete my list in time. For theaters, airplanes, trips to the Apple store and anything that might last longer than an hour, I have a mask at the ready and backups just in case.
—Mary Carpenter, who regularly reports on topical subjects in health and medicine, has been tracking Covid since early 2020.
THE FILMOppenheimer has once again raised questions about radiation exposure—both during testing of the bombs in 1940s New Mexico, and, more widely relevant today with medical scanning. Issues surrounding medical scans include how often and how much of the body to scan safely—but more often, at what point scans are necessary at all. Notably, common conditions like UTIs and constipation are usually benign but, especially if occurring repeatedly or changing suddenly, can be signs of more serious problems.
“To keep medical radiation exposure to a minimum, ask if the results of a scan or test are likely to change the course of your treatment. If not, it may not be necessary,” writes Florida Mayo Clinic radiologist Patricia Mergo. But Mergo asserts: “there’s no reason to forgo a [well-advised] imaging test or X-ray-assisted procedure…especially true for older adults, as potential radiation-caused cancer development may not occur for decades.”
“The potential for an increased risk of cancer due to medical exams using radiation is small,” she notes. And today’s CT and PET scanners “use a much lower radiation dose than was used even just a few years ago.” Also, compared to whole-body scans, radiation doses are now lower when adjusted for body size and used for specific diagnoses.
“Incidentalomas” and “cascade of care,” however, are terms that have come into recent use to describe pitfalls of unnecessary or “low-value” scans. Incidentalomas refer to the likelihood of a benign finding that can set off a “cascade” of further tests that often include further scans, which in turn detect more incidentalomas.
“Low-value” scans and services refer to those with little to no benefit—and sometimes with potential for harm. Common low-value scan examples are chest-x-rays performed in a pre-surgical work-up, MRIs done early for uncomplicated low-back pain, and most notably, an array of head-CT scans—such as on patients with signs of concussion, “even though CT does not help diagnose concussion but rather other risks of bleeding,” according to Yale ER physician Edward Melnick.
“One in every three CT scans performed on patients with minor head injury is not medically necessary,” according to research by Melnick and colleagues. “Nonclinical factors” leading to unnecessary scans included lack of confidence and experience on the part of doctors; and “empathetic themes,” such as the ability of doctors to listen and care, and of patients to trust medical advice—in particular that advising against a scan.
In Emergency Departments (ED), the “use of imaging has increased disproportionate to the number of visits,” according to 2018 Johns Hopkins research. Between 1996 and 2007, ED visits increased nationwide by 30% but the numbers of scans increased by 330%—while MRI use tripled between 2001 and 2010. “Consistently associated with ED overuse” were severity of injuries and “older patient age.”
For constipation-related complaints, a Swiss study of 1,997 patients found that “most indications for [abdominal x-rays] did not comply with guidelines, and elderly women appeared particularly at risk of being exposed to inappropriate examination.” Importantly, these scans “did not prevent the need for additional examinations.”
Constipation varies widely among individuals; is dependent on diet, activity and hydration; and “is about much more than how many times you go in a day or a week,” warns Cedars-Sinai gastroenterologist Christopher Almario. “Genetics may play a role in chronic constipation as well as how quickly one’s intestines naturally move.” While an abrupt change in bowel movements can suggest a serious problem, the two common complaints, straining and hardness of stools, usually improve with changes in diet and physical activity levels.
“It’s fine to take a gentle laxative every day or on a regular basis,” writes Almario. On the other hand, according to UCSFhealth, “most people who are mildly constipated do not need laxatives and an overuse of laxatives can actually cause constipation [but] they may be recommended for those who are still suffering from the condition even after making diet and lifestyle changes.”
Urinary tract infections—with incidence rising by age, to affect 15 to 20% of women ages 65 to 70 — can cause inflammation anywhere in the urinary tract: in the bladder, called cystitis; and in the kidneys, pyelonephritis. For those with repeated UTIs, physicians can recommend scans to check for unusual physical structures—such as a congenital “duplex” or double-collecting kidney, which has two ureters draining urine from a single kidney.
“Treatment is rarely needed,” according to the Cleveland Clinic website. But because potentially more serious issues can arise when UTIs occur in those with rare problems—such as obstructions that block outflow of urine from the bladder—scans can provide the relief of an explanation and sometimes suggest surgical options.
The dangers of radiation from anywhere —medical scans, bomb testing and myriad other sources —continue to provoke heated arguments with most involving comparisons to background radiation exposure. According to the National Cancer Institute, “Most cancers that have occurred or will occur among the 1945 residents of New Mexico are likely to be cancers unrelated to exposures from Trinity fallout.”
But radiation levels following Trinity, according to a 2010 CDC study, “reached almost 10,000 times what is currently allowed in public areas,” writes Tina Cordova in a New York Times op-ed. “For days after [the test], ash fell from the sky contaminated with 10 pounds of plutonium…has had devastating health consequences…families in New Mexico with four and five generations of cancer since the bomb was detonated.”
Years ago my internist recommended I have a full-body CT scan—for small but invisible amounts of blood in the urine—the kind of scan usually restricted to people with existing cancer diagnoses. After that scan turned up something so small it was undoubtedly insignificant, my doctor continued recommending “follow-up” scans for four more years until I switched doctors.
I had worried because whole-body scans have the highest level of scan radiation, 12 millisieverts (mSv), while targeted scans have closer to 7-8 mSv; bone scans involve closer to 4 mSv, and single x-rays have the lowest at .1 mSv. But reading Patricia Mergo’s reassurance about low radiation levels and slow-growing cancers helped both to reassure me and to convince me most likely to say yes to future scans—from my new doctor.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
UNDERTAKING Dry—or even Damp—January can help merely to reset drinking habits or make for a healthier month—though one study found that six months after Dry January participants were “drinking less than they were before,” according to the New York Times. Otherwise, complete abstinence with the AA 12-step model continues to be the most-often recommended program for anyone wishing to change their drinking habits.
But behavioral approaches that have proved helpful for reducing alcohol consumption in January are also becoming more widely used to treat addiction, called alcohol abuse disorder (AUD), according to American Addiction Centers. And compared to programs that require abstinence, those linked to cognitive behavior therapy (CBT)—“functional analysis” and “rational emotive behavior therapy”—offer help to those with AUD who want to drink in moderation.
“Some people don’t like basing their recovery on the idea that they cannot control their addiction when there is evidence that there are ways of practicing internal control over the recovery process,” according to American Addiction Centers. Programs such as SMART Recovery and Moderation Management follow this “active control model” for those seeking options other than complete abstinence.
“Research shows that when a person has a strong belief in their ability to drink moderately and reach the goals they set for themselves, they will work harder to reach these goals,” according to the site. “For many in moderation programs, they eventually chose goals of abstinence after practicing moderation first.”
Also becoming better accepted for AUD is medication-assisted treatment (MAT), employing drugs as part of addiction recovery. MAT drugs include buprenorphine, which helps block unpleasant effects of withdrawal; and naltrexone, which diminishes pleasurable effects of alcohol.
Even a few well-established 28-day treatment programs—including pricey “resort rehab” in desirable destinations such as Antigua and Malibu—have begun to offer moderation management and MAT. But most continue to employ AA-based 12-step programs despite success rates as low as 5%, according to retired Harvard psychiatrist Lance Dodes in his book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.
(The success rate for everyone who follows the AA 12-steps may be closer to 10%, especially for those who continue attending regular meetings in their communities. But in the absence of such ongoing support, those who attend 28-day residential programs far from home are more likely to relapse.)
Fewer than one third of rehab programs contacted by Yale policy health research Tamara Beetham “offered medication maintenance treatment, which is the gold standard of treatment,” according to a 2021 NPR report on the “Profit-Driven Rehab Industry.” The absence of M.D.’s on staff lists usually indicate that a program does not incorporate MAT.
“It is quite popular to talk about addiction as a health issue now,” Dr. Sarah Wakeman, senior medical director for substance use disorders at Mass General Brigham, told the New York Times. “But our policies and our clinical models still reflect this notion that really, it’s a bad behavior that people need to be punished for.”
“A vast chasm exists between effective addiction medicine and the people who most need it,” New York Times op-ed writer Jeneen Interlandi points out. Interlandi considers “a growing roster of treatments (medications, behavioral therapies, counseling and other supports)…“just as effective at managing addiction as statins are at managing cholesterol or aspirin is at preventing heart attacks.”
Only about 5% of more than 48 million Americans with a substance use disorder are “getting any kind of help for the condition,” Interlandi notes. And according to the National Institute of Alcohol Abuse and Alcoholism, only 2.2% of more than 28 million adults with AUD in 2022 received MAT.
With changing drinking habits the target of most non-AA sobriety methods, CBD-based programs incorporate mental exercises that focus on irrational beliefs as well as insights into reasons for using alcohol. But most Dry January suggestions focus on behavioral efforts: soliciting support from friends and self-care activities, such as spa days; and identifying triggers or cues, including where, what and with whom one’s drinking is usually done, USC psychologist Wendy Wood told the New York Times. Another is creating “friction points,” such as making drink glasses harder to reach or removing favorite alcoholic choices from the house.
For Damp January, tips include reserving alcohol for special occasions or adding dry days to the month. British psychologist Richard de Visser, who has studied Dry January participants and considers each restriction a way to develop better skills for managing drinking, told the Washington Post: “The more training sessions you do, the stronger you get.”
For 25,000 participants of the 2023 “Dry(ish) January” challenge created by Sunnyside—a drinking reduction program available with an app—even those aiming only for Damp January reported sleeping better, eating healthier and feeling more productive,” according to the Post. And for many people, figuring out how to manage triggers and create friction points can create positive feelings of having better control over hard-to-break habits.
During my 30s when I attempted spending a week without wine, I found the effort surprisingly difficult and gave up after a few days. But over the years, sobriety enforced for medical reasons and during pregnancies has revealed unexpected benefits, such as being able to stay up late at night to read—which quickly became a new habit in which I often over-indulge.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
HEREAFTER, a 2010 film starring Matt Damon, illuminated stunning similarities of near-death experiences (NDEs) among some 9 to 20% of people who survive life-threatening conditions, including clinical death. But the film did not address reasons for the similarities in such experiences —occurring for very different people in very different circumstances—which recent research has shown to have remarkable parallels to those produced by psychedelic drugs.
In Hemingway’s “The Snows of Kilimanjaro,” a man dying from gangrene experiences “elements of a classic near-death experience: the darkness, the cessation of pain, the emerging into the light and then a feeling of peacefulness,” writes Seattle consciousness researcher Christof Koch in Scientific American. Shared by “about one in 10 patients with cardiac arrest in a hospital, [NDEs] can lead to permanent transformation of their lives.”
“With greater vividness and detail than either real or imagined situations… as being ‘realer than real’” is the salient characteristic of NDEs recalled by 122 survivors in a 2017 University of Virginia study. And neurobiologists Raymond Romand and Gunter Ehret in Strasbourg, France and Ulm, Germany, in their 2023 overview Frontiers paper highlight this clarity as well as the persistence of NDE memories.
“Startling end-of-life brain activity” has recently become measurable in “dying patients at or near the moment of death,” according to Romand and Ehret. The roughly five-minute “transition from cardiac arrest to beginning brain injury” starts with a decline in cortical activity—followed by rising EEG levels that approach those of “normal consciousness… with a maximum duration of a few minutes” before decline and death.
When the brain reaches a critical level of hypoxia, loss of energy among a large number of neurons “causes a cascade of electrical activity [that] may correspond to cellular energy-saving necessary to preserve brain cell integrity,” write Romand and Ehret. And during NDEs, “gamma waves [working] in a well-coordinated way between sensory, motor and association areas of the brain… are associated with brain activity during states, for example, of sensory perception, memory retrieval, waking, dreaming, meditation.”
Gamma waves also mark increased receptivity and processing of sensory signals in experiences with the drug psilocybin. According to the Frontiers article, features of NDEs similar to those reported by people taking psychedelic drugs include “an elastic bond between body and soul, a dark tunnel, meeting spiritual beings and others, entering another world, reaching an alternate value system; seeing a bright warm light, sensing comfort and peace, wonderful locations, sweet feelings, extreme speed of thought and imagination, a rapid view of the whole course of past life, OBEs [out-of-body experiences]…”
“Very often the content of the reports [from American studies of patients who had survived life-threatening situations—car accidents, drowning, cardiac arrest] was emotionally touching,” the Frontiers researchers write, “when details were given about seeing dead relatives, past experiences, traveling the cosmos, meeting strange entities like divine figures, or visualizing a brilliant entity sometimes called the light.”
Psychedelic studies have made important contributions to research on NDEs—which otherwise faces the enormous challenge of “mimicking clinical death with the progression toward brain death…without allowing permanent brain impairment after resuscitation,” the Frontiers researchers explain. A review of more than 600 patients during experiences with more than 150 different medications “provided very useful insight…uncovered remarkable similarities [between NDEs and] the psychological effects of certain drugs—first of all ketamine.”
With ketamine, widely used as anesthesia, patient MRIs show changes in cerebral blood flow linked to “changes in functional connectivity in the brain that may be responsible for NDE-like perceptions and lead to changes in consciousness,” write the Frontiers authors. Most striking, in the narratives of people who had taken ketamine [as a psychedelic drug], “the five most common category themes” were the same as those from NDEs.
Reports of NDEs have also come with the use of other drugs as well as from epileptic seizures and electrical stimulation of the brain. In contrast to “coma-related experiences (such as conventional dreams, delirium, and delusions, in the intensive care unit or elsewhere),” write the Frontiers researchers, NDEs by definition should include “a sense of transcendence; ineffability; and positive transformative effects (related to meaning and purpose to life).”
Seeing the film Hereafter only recently, I was surprised to learn of similarities in different people’s NDEs—notably the weightlessness—because I had always considered my own long-ago experience to be unique. On an early-1970s ski trip, I clumsily fell backwards off a steep cliff onto a boulder-strewn slope: at once I found myself moving weightlessly along with other people in clouds suffused with soft light, and felt happy to be in heaven. When a ski guide fell against me to stop my tumble, I had no physical injuries but cried uncontrollably—I think because I found myself, not in heaven, but still high up on a long difficult slope that I must ski down. My memories from that heavenly day endure with crystal clarity.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
IS the egg a near-perfect food, with lots of protein, low carbs and low risk of digestive issues? Or is it too high on the dangerous cholesterol list? And about cholesterol: What’s the latest on “good” HDL and “bad” LDL (high- and low-density lipoproteins) for heart and brain health; and for risk assessment—what about blood cholesterol vs. coronary artery calcium (CAC) testing? Finally, do statins enable worry-free cholesterol consumption—including eggs?
One large egg contains about six grams of protein (depending on body weight, most adults should eat about 150 grams/day), very few carbohydrates and “147 mg of choline, which supports memory and mood,” according to VeryWellFit. At about 80 calories, the egg contains five grams of fat, which include “good” polyunsaturated and monounsaturated fats that could help lower LDL cholesterol—along with “bad” saturated fats that The American Heart Association advises to limit to about 13 grams/day.
But one assessment of a two-egg breakfast, compared with an egg-free meal, found “no significant effects on blood cholesterol;” and another study on diabetics showed that eating 6-12 eggs/week “didn’t negatively affect total blood cholesterol levels [and instead] increased HDL,” according to Healthline. Eggs become more nutritious when they contain higher levels of “omega-3 fats” —when specified in the label, these hens have been fed flax seeds; while for eggs labeled “pasture-raised” and “free range,” the hens have eaten “greens, grubs and other natural foods.” (“Outdoor access” can mean nothing more than a little window for hens that are crowded indoors.)
Lowering blood levels of LDL cholesterol, however, can make a big difference in health—at least when measured in patients taking statin medications. In a 2019 meta-analysis that looked at more than 130,000 patients, in the group taking statins “for every 18 mg/dL drop in LDL, there was a 24% reduced risk of major coronary events, such as a heart attack, and a 16% lower risk of stroke,” according to HealthCentral.
The good reputation of HDL, meanwhile, became more complicated—in its links to dementia, as well as heart disease and cancer—with research that followed more than 184,000 adults over 17 years: an elevated risk for dementia occurred at HDL levels that were both below 41 mg/dl but also above 65 mg/dl. Explains study author, Boston University epidemiologist Maria Glymour, “The elevation in dementia risk with both high and low levels of HDL cholesterol was unexpected, but these increases are small, and their clinical significance is uncertain.”
“I’d say the HDL hypothesis is on the ropes right now,” James de Lemos, cardiologist at the University of Texas Southwestern Medical Center, told the New York Times. And in the 10 years since that study, some of the 200 or so subspecies of HDL proteins have shown no association or even association with increased risk of heart disease, while other HDL subspecies continue to prove “good” for the heart.
Testing for heart disease risk also became more complicated with the discovery that coronary artery calcium (CAC) plays an important role in heart disease risk. “Distribution of risk factors in [asymptomatic] individuals is heterogeneous and varies by the presence or absence of coronary artery calcium,” according to researchers at Emory and Johns Hopkins universities—challenging the earlier notion that high LDL levels are, independently, an important risk factor for heart disease and cardiac events.
A high LDL blood cholesterol score suggests the need for intervention—but alongside a zero CAC score, indicates low risk of coronary heart disease, according to MedicalNewsToday. CAC testing that shows high calcium levels in the arteries indicates risk of plaque buildup that may eventually cause a blockage—with risks higher when “estimated arterial age” scores are farthest from a person’s actual age: a score of 40 at age 65 is okay, as is 100 for age 73, while higher than 100 at any age suggests the need for intervention. Taking statins can alleviate some worries about consuming high-cholesterol foods, because these drugs “reduce the synthesis of LDL [cholesterol and help keep it] out of the arteries,” according to HealthCentral. But physicians warn that patients taking statins should still exercise and follow healthy diets, notably the Mediterranean regimen—because inflammation and other factors not addressed by statins continue to play an important role in risk of heart disease and in overall health.
For me, success in lowering LDL cholesterol levels when taking statins has been encouraging to my doctor. But I have been hesitant to take cholesterol numbers seriously ever since, right after a bout with Lyme disease, my LDL levels suddenly shot up more than 150 mg/dl—following decades of impressively low LDL and high HDL cholesterol scores. Eggs, meanwhile, are among my favorite foods—boiled ahead of time for quick and easy breakfasts, or for lunch with spoonfuls of mayonnaise, also rich in cholesterol, as egg salad.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
CONNECTICUT organic farmer L.P. struggled for decades to get a good night’s sleep until, in her early 70s, she engaged a “sleep consultant”—and started cognitive behavior therapy for insomnia (CBT-i). So far, determining the best timing for nighttime sleep, called “sleep consolidation,” has been the most helpful—along with a variety of familiar “sleep hygiene” measures, such as avoiding electronic screens in the hours before bedtime.
The goal of improved sleep—along with reducing pain and anxiety—is currently driving soaring levels of cannabis use among seniors, according to the New York Times. For people age 65 and older—“one of the fastest-growing populations of cannabis users in the United States”—the numbers rose from about .4% in 2007 to about 8% in 2022. Said Denver geriatric psychiatrist Aaron Greenstein, “People are just desperate.”
Numbers of “wisdom customers,” which refers to those 55 and older, have increased each year for grower and seller Trulieve, which has “the largest retail footprint for cannabis products in the United States,” according to the Times. A major drawback to cannabis use, however, is insufficient research and ongoing obstacles: cannabis remains federally illegal; and the wide variability that exists among different cannabis products as well as its effects on different individuals.
And what gives pause to many sleep sufferers about cannabis is the risk of potentially serious side effects, such as dizziness and panic attacks—as well as cannabinoid hyperemesis syndrome, which causes recurrent vomiting. According to the Times, California ER visits associated with cannabis use among older adults rose more than 1,800 percent from 360 visits in 2005 to 12,167 in 2019. Also, as with many medications, any beneficial effects can diminish over time.
For insomnia, CBT is “generally…the first treatment recommended,” according to the Mayo Clinic. “The cognitive part of CBT teaches you to look for and change beliefs that affect your ability to sleep…help you control or get rid of negative thoughts and worries that keep you awake.” One recommendation, for example, is to “remain passively awake”—by suppressing thoughts about falling asleep.
Sleep consolidation, also known as sleep restriction, begins with limiting the time spent in bed—with an initial goal based on hours of actual sleep previously recorded: for example, five hours of sleep out of seven or eight spent in bed. For the first few nights of consolidation, the allowed amount of sleep is insufficient, causing fatigue that slowly helps make it easier to fall asleep, to sleep better during the time allotted and eventually to sleep well for a longer time period.
Improvements in total sleep time and sleep efficiency by eight to ten percent were the findings of a 2015 meta-analysis of CBT-i involving 1162 patients, reported in the Annals of Internal Medicine—with the note: “psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches.”
“The long-term improvements seem to result from the patient learning how to support and promote the body’s natural sleep mechanism,” writes Jeffrey Rossman, “Life Management Director” at Canyon Ranch in Lenox, Mass., in the American Journal of Lifestyle Medicine. “Changing sleep patterns requires changing the negative thoughts and beliefs…like “I dread getting into bed because I won’t be able to get to sleep… and I’ll be a wreck tomorrow!”
“CBT-i produces results that are equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment,” Rossman observes. While sleep medication can be effective short-term, side effects can include episodes of amnesia, cognitive impairment and morning hangover—and in some patients, these can require increasingly higher doses and lead to dependence and tolerance.
Sleep hygiene, in addition to avoiding electronic screens and other bright lights before bed, includes refraining from eating and from drinking alcohol two to three hours before bedtime, and avoiding caffeine in the afternoon and evening. Other recommendations include exposure to bright outdoor light in the morning or early afternoon, and developing a relaxing evening routine.
In addition, CBT-i advocates relaxation training and biofeedback, which involves practicing “how to relax both your mind and your body,” according to Sleep Education. Various devices can help teach relaxation by signaling levels of muscle tension or brain wave frequency, which the user can learn to alter in ways that improve sleep.
Cognitive control and psychotherapy make up another component of CBT-i, to help “identify attitudes and beliefs that hinder your sleep,” according to the sleep education site. One suggestion is to set a “’worry time” in the afternoon or early evening [to] review the day and plan for tomorrow…You focus on getting all your worries out of your system.”
Another suggestion is to use guided imagery: “You imagine you are in a story…try to picture what things look, feel and sound like…try to make it as real as possible,” according to Sleep Education. Keeping your mind away from worries can also help prevent active efforts to sleep and allows the body to relax and eventually to sleep.
CBT-i also includes “stimulus control:” going to bed only when you feel very sleepy; and if you are not asleep after 20 minutes, get out of bed and do something relaxing. But maybe most important, according to Sleep Education, is using the bed “only for sleep and for sex,” and not doing anything else in bed, including watching TV and reading.
But reading before bed, for some people, “actually allows our brain to move from ‘doing’ mode to ‘just being’ mode,” according to Orlando sleep psychologist Sarah Silverman. If you associate reading with sleep, Silver advises to keep it up, with whatever books you are accustomed to choosing before bed. Other sleep experts advise against reading crime, thrillers and books that might be “emotionally distressing.”
To find behavioral sleep medicine specialists, available to meet in person or online, the Mayo clinic recommends checking sleepeducation.org/sleep-center, and behavioralsleep.org. And the site suggests most people need six to eight sessions—which can be covered by insurance.
Although doing much better, L.P. still struggles enough on some nights that she takes Seroquel, the sedative she relied on for years to help with sleep. While I don’t often have trouble sleeping, if I can predict a bad night—such as before early-morning travel plans—I take the antihistamine doxylamine, recommended for sleep. On weekends, I sometimes eat a low-dose cannabis candy because these seem to provide deeper sleep. And on the few nights when I slowly become aware that I’m struggling to get to sleep, I try to figure out what could be bothering me, and then work on sorting it out—or else I start going through lists, such as European countries or U.S. states.
—Mary Carpenter regularly reports on topical subjects in health and medicine.
