QUESTIONS ABOUTpotential bone loss caused by a ketogenic diet (KD) arose with a recent Australian study of athletes, which at first glance looked half-baked: a small sample of 30 competitive athletes; short duration of three weeks; and the self-selection by the athletes of which diet to follow.
But when further digging led to a tangle of earlier KD research that documented bone weakness and loss—and a few small studies that did not—the question came up: Why with the popularity of ketogenic diets starting in the early 2010s have there been no better, more thorough investigations into possible risks?
Ketogenic diets, in which up to 80% of food consumed daily and 90% of calories come from fats, have since the 1930s been the best treatment for those with epilepsy—before the advent of effective drugs and, afterwards, in about 30% of cases where medications fail to reduce seizures.
Renewed interest in the keto diet began in the early 1990s, leading to the creation of the Charlie Foundation for Ketogenic Therapies, both to promote the diet for epilepsy and to spur research into its effectiveness for neurological conditions, including Alzheimer’s disease, sleep disorders, headache and pain.
About 10 years ago, people began turning to the keto diet for weight loss based on “the carbohydrate-insulin hypothesis.” According to the theory, dietary carbohydrates raise insulin levels, leading to excess accumulation of fat and contributing to rising rates of obesity.
For most carbohydrates—whole grains, fruits and legumes—investigators have since raised questions about the hypothesis, but excess consumption of highly processed and refined carbs may contribute to obesity via other mechanisms.
Side effects of the keto diet, familiar since the early 20th century for children with epilepsy, include kidney stones and constipation— and effects on bone growth and health. Children on the diet longer than six years tend to remain in the fifth percentile of the growth curve and have lower bone mineral density with higher risk of fractures.
The International Society of Sports Nutrition’s position paper on the keto diet describes the “ergolytic,” or performance-impairing, effects on workouts: increased perceived effort during physical activity (related to excess oxygen required for the digestion of fat), as well as fatigue and mood disturbance.
And of two groups on an eight-week training course at CrossFit, those randomized to follow the keto diet lost about 3.5 ounces of muscle while the other group eating their preferred diet had average muscle gain of three pounds.
In the Australian study, 30 racewalkers training for international competitions had the choice of either a high-carb or ketogenic diet. After three and a half weeks, markers of bone breakdown were higher and those indicating bone formation lower among athletes on the keto diet than at the start of the study. The same markers for athletes consuming high-carb diets remained unchanged.
“Bone is an active tissue, constantly breaking down slightly and remodeling itself in response to the demands we place on it,” explains New York Times Well columnist Gretchen Reynolds, who describes the Australian study as “thought-provoking.”
Why the keto diet altered the Australian athletes’ bone metabolism remains unclear, as does how exactly it decreases seizures in those with epilepsy. For athletes, the Australian researchers hypothesize that low carbohydrate availability may affect circulating hormones—notably calcium-regulating hormones like estrogen —that inhibit bone breakdown and stimulate its formation.
A 2019 study of rats on a ketogenic diet for 12 weeks found “significant bone loss and reduced biomechanical function” in some bones and a lesser impact on others.
The caveat for all conclusions of existing KD research: Neither children on the keto diet for six years, nor competitive athletes consuming high fats for three weeks, nor rats may be valid yardsticks for typical healthy individuals who go on the keto diet to lose weight. For them, the greatest challenge may arise in maintaining weight loss after discontinuing the KD’s drastic ratios of fat.
“The greatest risk [of the ketogenic diet] may be…the opportunity cost of not eating high-fiber, unrefined carbohydrates,” according to an essay in the Journal of the American Medical Association Internal Medicine. “Whole grains, fruits and legumes are some of the most health-promoting foods on the planet.”
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
Note: This post is intended to help evaluate ongoing public health concerns, not to provide up-to-date statistics on the Wuhan coronavirus, for which most information dates from last week (February 3 to 9). New York Times articles have been updated with new information and headlines since publication.
WHEN A new virus strikes, look at rates of infections and deaths as well as total numbers; consider the intent behind official announcements; and put the new bug into a context of related viruses. Generally ignore early, alarming headlines to give the numbers time to shake out.
For the Wuhan coronavirus (also known as 2019-nCoV), headlines remained unnecessarily alarming in almost all media reports until last Thursday when the impeachment acquittal took over. In Tuesday’s Science Times, “Deadly New Contagion” was the six-column, front-page headline, and the words “experts…fear” appeared in the first sentence.
To assess new bug risks, keep track of statistics on numbers of cases, hospitalizations and deaths that work together to create risk: For example, as numbers of cases rise, the death rate can become much lower—while rates of hospitalization indicate virulence. Also relevant is the period when an infected person can spread the disease, more worrisome if before symptoms appear.
Another NYT story on February 4, buried deep in the paper version and difficult to locate online, offered the most useful information, such as the crucial context of the behavior of similar new viruses: “The highly transmissible H1N1 ‘swine flu’ pandemic of 2009 [around the world] killed about 285,000, fewer than seasonal flu normally does, and had a relatively low fatality rate, estimated at .02%.”
For anyone unsure of the definitions, however, the article’s headline made 2019-nCoV sound like the plague: “Rise in Cases Suggests Epidemic is Pandemic.”
In general, epidemic refers to rapid spread; and pandemic, to cases over a wide geographic region of one or more countries. For the Centers for Disease Control, pandemic indicates that an illness has caused death and has spread person-to-person beyond its original source—live animals in the case of the Wuhan virus.
But rates of spreading through a population can be unreliable. What at first looks rapid can turn out to be problems of poor early reporting compounded by underreporting of mild cases—especially from China, which earned a reputation for delayed response with another coronavirus, Severe Acute Respiratory Syndrome (SARS).
Because the median age of 2019-nCoV sufferers to date is 49-56, total case counts likely miss many children because they develop milder and often symptom-free illness. “Cases among children have been rare,” according to the NYT report from The Journal of the American Medical Association.
For the Wuhan virus, one concern has been the risk of similarity to SARS and Middle East Respiratory Syndrome (MERS), its “slow-moving viral cousins.” As numbers of 2019-nCoV cases increased, however, the numbers of deaths created a much lower rate than that for the cousins: 10% for SARS (9,893 cases) and more than 30% for MERS (2,500 cases).
As of last week, the 2019-nCoV fatality rate hovered around 2% (about 800 deaths in 37,500 people infected, with 99% occurring in China), though if true infection numbers are closer to 100,000 as suspected, the rate would plunge. However low the death rate, though, rising numbers of cases means higher total numbers of deaths: in some years, seasonal flu has killed tens of thousands (61,000 in the 2017-18 season) in the U.S. alone.
Comparing coronaviruses brings up the best if remote possibility that ongoing measures to isolate sufferers such as quarantines and travel bans could consign 2019-nCoV to the same fate as SARS, its outbreak halted and microbes eradicated, never to be seen again.
A more likely alternative is that 2019-nCoV will join four currently circulating (endemic) coronaviruses that cause about one-fourth of all colds. “We don’t pay much attention to them because they’re so mundane, especially compared to seasonal flu,” Columbia University epidemiologist Stephen Morse told Statnews.
During some winters, however, these four have caused serious symptoms, creating the possibility that if the Wuhan coronavirus infects enough people regularly, it might boost incentives to develop good treatments and even vaccines.
Among official warnings, the World Health Organization declared the Wuhan virus a “public health emergency of international concern”— a designation designed simply to mobilize international resources for containing the virus—on January 30 after the first reported person-to-person transmission of the virus.
For similar reasons, on January 31, the CDC, which is “closely monitoring” the situation, posted the statement by Health and Human Services Secretary Alex M. Azar II’s of a “public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to 2019-nCoV.”
Prompted by the WHO announcement, the U.S. State Department issued a “do not travel” warning for China, the highest-level travel alert that applies also to Afghanistan and Syria.
The WHO “dashboard” offers easy-access, up-to-date statistics with useful charts—revealing last week at least a temporary leveling off of new cases.
Immunity is a final important variable for assessing dangers from new viruses. ”Exposure to the four endemic coronaviruses produces immunity that lasts longer than that to influenza,” said flu expert Richard Webby at St. Jude Children’s Research Hospital. But coronavirus immunity wanes with age, so that risk of reinfection can be higher in older people.
Crying wolf, in the proverbial sense, is the biggest danger of media over-hype—alarming people too early or unnecessarily, which makes it harder to get their attention when threats get worse or more serious emergencies arise in the future. If this is happening with the Wuhan virus and the loudest alarms have already sounded, people could miss worse news or new precautionary advice when it comes.
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
OUT WITH supplements containing vitamins and minerals; in with the ingestible nutraceuticals or “functional foods” maca, moringa and collagen—usually consumed as powders added to coffee or smoothies, or capsules.
Maca and moringa have been popular for years in the U.S. and centuries elsewhere —maca from the mountains of Peru; and moringa from East Asian countries like India and Pakistan. Made from plants known as “adaptogens”—meaning they help the body adapt to fatigue or stress —both may boost energy and, taken together, may amplify each other’s effects.
Moringa is dubbed the “tree of life” in Belize; maca is high in iron and iodine, and purports to heighten sex drive in men. For both powders, as with most supplements, official regulation of the quality and quantity of active ingredients is weak, and reliable research minimal.
More convincing is recent evidence for collagen powder, that it improves skin health —elasticity and hydration, as well as wound healing and protection against aging. While topical collagen formulations boast similar benefits, most have difficulty penetrating to the skin’s middle layer, the dermis, where real changes occur, says New York dermatologist Whitney Bowe.
“I believe it does hold promise,” reports Mark Moyad, complementary and alternative medicine director at the University of Michigan Medical Center, comparing collagen with other powdered supplements. “It’s also one of the most wacky and controversial.”
The body’s production of collagen, long amino acid chains that form the scaffolding and comprise 80% of skin, decreases with age—with about 1% lost every year starting in the mid-20s and as much as 30% during the first five years of menopause, according to Bowe.
Collagen peptides in powdered supplements are shorter chains of amino acids than those produced by the body and touted to improve absorption into the bloodstream. But “how much [collagen] is absorbed and whether those amino acids make it to their target organs—i.e. skin—is still up for debate,” notes New York-based dermatologist Shari Marchbein.
In a recent Journal of Drugs in Dermatology review of 11 studies, with a total of 805 patients that tested three collagen formulations, collagen hydrolysate worked well for skin aging, wound healing and other issues, while the others showed good results for increasing skin elasticity and hydration.
Collagen powders are made from ground-up animal, fowl and fish parts —those marketed as “plant-based” do not contain collagen. Hydrolyzed bovine collagen is the most “potent and effective,” according to Smarter Reviews, where the number-one rated product is Lifewell brand “Collagen Peptides.” Bovine collagen, however, comes with a potential if very small risk of mad cow disease. Also, the parts ground for collagen—which can include bones, skin, nerve tissues, hooves—can be sponges for contaminants and heavy metals, like cadmium and mercury, according to Georgia dermatologist Lauren Ploch.
A Consumerlab review found that products contained the quantity of collagen reported on the label but very high levels of cadmium.
Most experts, however, say that ingesting supplemental collagen can do no harm. For consumers, the biggest concern may be that collagen powders require daily use —forever—to maintain effects.
To determine dosage, dermatologists advise following directions on the bottle because individual products differ greatly. On Amazon, among dozens of products costing under $3/ounce, recommended daily dosages range from five to ten grams. “Readers’ comments” for some of these, however, include complaints of skin breaking out and headaches, as well as different side effects from the same product depending on where it was purchased.
A popular collagen formulation, Peptan, is the main ingredient in products made by Rousselot, including those labeled “fish” or “marine” collagen that contain only fish products but cost more than $5/ounce.
Compared to other supplements, the almost-universal reports of moister, plumper— less wrinkled—skin make it tempting even for usually supplement-resistant consumers.
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
Note: This post is part of Mary Carpenter’s “winter series,” updates of her earlier stories on cold-weather well-being.
THE 2019-2020 FLU season to date is “particularly unusual” because influenza, B which usually circulates toward the end of the flu season, was the first to emerge this year—perhaps due to a vaccine mismatch and general reduced immunity to influenza B, according to Time magazine.
The good news: older adults, who account for most flu deaths each year, are less likely to get influenza B than children and younger adults. Compared to the 2017-18 flu season, considered the worst of the decade with 61,000 deaths, by early January this year fewer than 5,000 people had died.
At the same time, on the other hand, the CDC reported 32 flu-related pediatric deaths —double compared to that date last year—and the highest number for this time in the flu season for the last 17 years. Of those, 21 were linked to influenza B and five to the B/Victoria strain for which components were poorly matched in this year’s vaccine.
Compared to a cold, the clearest indicator of flu is symptoms that hit the whole body—chills, fever, aches and respiratory issues—all at once and usually hard. By contrast, most colds start with a runny nose and sneezing that get slowly worse.
“The Big Number” headline in the Washington Post Health Section appearing this fall was “6 to 8 feet”—referring to the average uncovered sneeze sending droplets about six feet; and smaller size particles traveling “closer to eight feet or farther because of a gaslike cloud that keeps them airborne,” according to videos of sneezes from M.I.T.
Other than missing on the B/Victoria strain, this year’s flu shot is well matched to circulating H1N1 and B/Yamagata viruses. H1N1, which first appeared in March, 2009, is the most rapidly changing of the strains and thus the most worrisome because of its potential for causing a pandemic. H1N1 primarily affects children as does B/Victoria. But the latter may be causing more early infections this year because it has been scarce in recent years, which means diminished immunity in the population.
Peak flu season occurs in either January or February. This year, the share of doctor visits related to flu dropped slightly during the week ending January 4, as did lab samples testing positive for flu. On the other hand, flu can last into April and even May—the reason it’s not too late to get the vaccine now.
In the event of a long season, getting the vaccine after late October should offer sufficient protection for six months (through April), while a shot in July or August might not last the season. (Travelers to the Southern Hemisphere between April and September should check on the need for renewed flu protection.)
In the past, most flu shots were trivalent—protecting against three flu strains, two A and one B. Starting this year all are quadrivalent with the addition of B/Victoria. What changes each year are the genetic profiles of each component, with the A (H1N1), for example, getting an update this year from A/Michigan to A/Brisbane—named for the originating location of each component. In this year’s quadrivalent, the B components are the same as last year, with B/Victoria missing the mark.
The CDC advises everyone to get the same standard-dose vaccination, although recommendations can be different for very young children. But for older adults, many doctors prefer one of two other options licensed only for those age 65 and over. High-dose Fluzone contains four times the amount of antigen, which provokes a stronger immune response than the standard dose. The other option, FLUAD, is trivalent plus an adjuvant, which also creates a stronger response. No research has yet compared these two.
While some people blame the flu shot for giving them the flu, the truth is generally one of three possibilities: side effects from the vaccine can cause mild flu-like symptoms, but not the flu itself, and affect fewer than 1% of people who receive the vaccine; exposure to the flu has occurred before the end of the one-to-two-week period it takes for the vaccine to begin working; or symptoms that sufferers call the flu are actually something different.
Gastroenteritis usually comes from to one of two viruses. Noroviruses, most likely to spread among people in confined spaces like cruise ships, are often traced to contaminated food or water, although person-to-person infection is possible. Sickness after eating shellfish, dubbed “winter vomiting virus,” most often comes from norovirus, although the cause can also be bacterial—usually E.coli.
The other, rotoviruses, are most common and most severe in young children who put their fingers or other contaminated objects into their mouths, and spreads easily in institutional settings. Adults, who often have no symptoms, can unknowingly spread the virus.
Advice for those wishing to emerge unscathed from flu season, besides getting the shot, includes washing hands and avoiding people who might be sick. But because the incubation period for flu can last as long as four days, it’s hard to know when someone close to you might already be spreading it. Staying at home is therefore the most common recommendation—but one that’s impossible for almost everyone to follow.
Mary Carpenter
Every Tuesday, count on well-being editor Mary Carpenter to deliver health news you can use.
CREATING GOOD habits, such as eating fresh fruit for dessert instead of ice cream and cookies, can build new neuronal pathways in the brain that eventually make new resolutions easier to keep. Firmly establishing new habitual behaviors, however, requires motivation, attention and time—at least several months.
The word “habit” encompasses everything from unhealthy sugar consumption and excessive clutter to nail-biting, OCD and drug addiction. What most have in common is behavior that is generally ill-advised, most often unhealthy, and difficult to change.
In Good Habits, Bad Habits: The Science of Making Positive Changes That Stick, University of Southern California psychology and business professor Wendy Wood argues against the idea that self-control and willpower are the cornerstones of converting bad habits to good ones.
People who score high on self-control are successful, Wood contends, not because of their self-control but because they have better skills for forming new habits that meet their goals. As a result, learning the mechanics of forming new habits is key for anyone wishing to get rid of the old, bad ones.
People act on automatic pilot about 40% of the time because learned behaviors are a sort of mental shortcut, according to the lytx blog. “If your brain had to decide muscle by muscle how to complete each task anew each morning, you’d be exhausted before breakfast.”
“The brain’s circuits for habitual and goal-directed action compete for control,” according to UC San Diego psychologist Christina Gremel. Goal-directed actions begin in the orbitofrontal cortex: when this area is quieted—at least in Gremel’s research on mice—habit takes over.
“We need a balance,” writes Gremel. Habits enable us “to make routine actions quickly and efficiently…but we need the capacity to break habits and perform a goal-directed action based on updated information.” Interfering with habit-directing areas in the brain by way of drugs or behavior therapy can help someone rid themselves of undesirable habits.
Once formed, good new habits can become the default behavior, Wood contends. In the M&M-and-carrot study Wood conducted with colleagues, participants who were hungry and also fond of both carrots and chocolate played a screen game at which they became accustomed to receiving carrots as rewards. Even when later offered the choice of M&M rewards, 60% continued choosing carrots.
But when the screen changed, many more chose M&Ms, because “they stopped to think,” explained Wood. “We formed beneficial habits to choose healthy food”— which people will fall back on even when distracted, tired or overwhelmed. But given time to think about their preference, people tend to opt out and return to the unhealthy food.
“Habit replacement looping” is the method of creating better habits described in The Power of Habit by New York Times journalist Charles Duhigg, according to Bernard Luskin in Psychology Today. Duhigg describes the “habit loop” at the core of every habit: a cue acts as a trigger for a routine, and performing the routine produces reward signals in the brain.
Changing a habit involves keeping the cue and reward the same but inserting a new routine, although the replacement must elicit an equivalent reward. Repetition of new behavior embeds it in “habit memory” —similar to muscle memory that develops with practicing skills like bicycle riding or juggling, according to Duhigg.
While cognitive behavior therapy (CBT) that employs habit replacement looping might be most helpful for some, Duhigg believe his methods work well for individuals doing it on their own. Techniques and responses, such as writing reinforcements to yourself about your progress, support efforts to change an ingrained habit. And psycho-visualization—“creating visualized scenarios that are memorably vivid and unique”— can reinforce “habit memory.”
Tapping into all five senses creates a “stickiness” that helps form new neural pathways by connecting a new behavior to as many areas of the brain as possible, according to diabetes educator Julie Hani.
Sixty-six days was the average amount of time required to reach “automaticity,” according to a study at the University College London—research used by Duhigg to support the effectiveness of habit-formation techniques. Occasionally missing a day didn’t interfere with new habit formation, which is dependent on “irregular but consistent conscious repetition.”
But even scientists disagree on the topic of habits. “Excessive and overly fixed behavioral routines are symptoms in many disorders,” according to Kyle Smith and Ann Graybiel, brain researchers at Dartmouth and M.I.T. respectively. But about the role of habits, they caution “there is little consensus.”
Some also question brain-based explanations for forming new habits. About the involvement of muscle memory, for example, eating habits are not skills and not related to the muscles; and habits and skills involve distinct systems in different areas of the brain.
And the Stanford University marshmallow experiment, often cited to show the importance of self-control in forming good habits and “one of the most famous pieces of social-science research,” according to the Atlantic, has recently been challenged.
In the experiment, those children able to delay eating a marshmallow when they knew they would receive a better treat later had more “measurable willpower” — the ability to maintain focus on future rewards—according to the researchers, and that accounted for their eventual greater success as adults.
Using a much larger sample and assessing variables such as race, ethnicity and parents’ education, however, a new study found that the capacity to hold out for a second marshmallow may come mostly from a child’s social and economic background: poorer kids might be less motivated to wait for the second marshmallow because, for them, daily life holds fewer guarantees.
Learning habit-changing techniques is certainly worth a try—and habit changing might work best for garden-variety ones like substituting fruit for ice cream, compared to disorders like OCD and addiction—but remember to keep working on that new behavior for at least 66 days.
—Mary Carpenter
Every Tuesday, count on well-being editor Mary Carpenter to deliver health news you can use.
U.S.–ACCREDITED hospitals in countries, such as Mexico and Costa Rica, offer medical care at much lower prices than at home.
If the total cost of getting medical care plus travel abroad can be lower than that of the same treatment alone in the U.S., why not take a vacation?
“Medical tourism” from the U.S.—Americans seeking medical care in foreign countries—doubled between 2007 and 2017 and may grow as much as 25% every year for the next decade, write University of Arizona physicians James Dalen and Joseph Alpert. The reason: comparably lower price tags on almost all medical treatment outside of the U.S.
Incoming medical tourism continues to exceed income lost by outgoing U.S. medical tourism, according to Dalen and Alpert, but at least one economist has warned about the comparison to Japanese carmakers’ effect on the American market as their products developed reputations for value and reliability.
Beginning in 1998, the Joint Commission that evaluates, inspects and accredits U.S. hospitals had by 2017 accredited 800 foreign hospitals—and expects to increase that number by 20% each year. Physicians and other health professionals, trained in the U.S., staff many of these hospitals.
While Brazil has long been the go-to country for cosmetic and plastic surgery, both Mexico and Costa Rica have gained reputations for these—and Mexico has seven Joint Commission-accredited hospitals—while Taiwan and South Korea specialize in orthopedic and cardiac conditions.
Surgery in India using “cutting edge technology” saves patients between 65% and 90% compared to costs in the U.S. Some hospitals offer health care packages for foreign patients that include private chefs; and one Indian hospital has 200 U.S. trained board-certified surgeons.
Dental surgery, most often not covered at all by U.S. insurance, can cost half as much in Mexico. Towns along the U.S.-Mexican border have intense concentrations of dentists due to the “dental crisis in the United States.”
Taiwan also offers low-cost dental procedures. And dental care lures many to Costa Rica, where the CheTica Ranch in San Jose provides “exotic recovery retreats.”
The Netherlands, “constantly ranked as one of the best health care systems in the world by advanced metrics,” spends a quarter of the cost to American insurers for hip and knee replacements. And a CT scan costing $140 in Holland can cost $1,000 in the U.S. —or, depending on the U.S. location, anywhere from $250 to $1,500.
While there may be good arguments for some higher prices in the U.S.—for example, paying more for drugs in the U.S. to cover pharmaceutical companies’ expenses for bringing new drugs to market—for exams like CT scans, the only explanation for both higher costs and costs that vary by region is the lack of price regulation.
Prescription medications, especially those essential to protect from life-threatening conditions, are notoriously expensive in the U.S. compared to foreign countries. Factor VIII, the clotting agent on which hemophiliacs with the most common form and in the most severe cases cannot live, costs half the U.S. price or less in “every single country.”
Another drug, Humira—offering incomparable relief from the pain and inflammation associated with autoimmune diseases, notably rheumatoid arthritis—can cost less than half of the U.S. price if bought elsewhere. And for Harvoni, one of the new breakthrough cures for hepatitis C, the most common 12-week regimen costs $94,500 in the U.S. and less than one-fifth that price in South Africa.
For medical tourists who might worry about the quality of care in foreign countries, a good option is U.S. medical centers— including Harvard, Boston University, Johns Hopkins and the Cleveland Clinic—that work directly with hospitals and clinics outside of the U.S.
Among its “global collaborations,” Johns Hopkins works with hospitals in Brazil, China and Columbia. Johns Hopkins also provides a “special concierge” to individuals wishing to arrange medical treatment abroad.
If choosing foreign facilities on your own, the most common advice is to look for accreditation by Joint Commission International, the division of the U.S. organization that certifies hospitals outside of the U.S.
While U.S.-based health care brokers can help arrange travel, accommodations and access to various hospitals and physicians around the world, warnings abound to watch out for the hard sell and for those selling packages that include a holiday, according to the Scottish National Health service.
Among general warnings for medical tourists, communication is number one. “Receiving treatment in a facility where you do not speak the language fluently may increase the risk of misunderstandings about your care,” as the Scottish site puts it.
Related warnings advise speaking directly with the healthcare provider and/or having a consultation before treatment. Before leaving home, a written agreement with the health care facility should list what treatments, supplies and care are covered by the costs of the trip.
Blood products can be an issue because many countries don’t screen as carefully as the U.S. for infections. And the third big concern is the risk of flying within the week after surgery, which can increase the risk of blood clots.
Other advice includes consulting your doctor or dentist and arranging for follow-up care before you leave; taking with you copies of all medical records and a list of all current medications; and making sure to get copies of all medical records in the foreign facility before returning home.
But there’s always a worst-case scenario, such as an accidental nick during surgery that results in infection that’s difficult to control with antibiotics and then requires additional surgery to repair the error —care that is covered in U.S. hospitals but foreign facilities may not have the capability to deal with, and the fees already paid may not cover.
For expensive dental surgery like a root canal —with a local price tag of $3,000 to $5,000 paid out of pocket on the first visit— a Mexican vacation sounds tempting. On the other hand, the need is often sudden and immediate following a scan; the root canal is best done in several visits at least several days apart; and there is the risk of needing repairs or a re-do down the line, all of which increase the challenges of getting the procedure in Mexico.
Mary Carpenter
Every Tuesday, count on well-being editor Mary Carpenter to deliver health news you can use.
IN2012 when M.I.T. microbiologist Mark Smith was pitching fecal transplants to a pharmaceutical group, one asked if the meeting was a prank. In the years since, fecal transplants have moved from an alternative treatment to standard care.
Fecal transplants, also called fecal microbiota for transplantation (FMT), are now available at more than 1,000 U.S. medical centers for sufferers of debilitating— as in “tethered to a toilet”—infections with Clostridioides difficile, known as C.diff.
“Over the past decade tens of thousands of Americans with C.diff have been cured through fecal transplants, often with a single dose that can bring patients back from the brink of death,” Andrew Jacobs wrote in the New York Times, March, 2019.
FMT has had an 80-90% success rate in preventing recurring infections in patients with C.diff. that has become resistant to antibiotics. FMT has also helped with intestinal symptoms of ulcerative colitis (UC), irritable bowel disease (IBS), Crohn’s disease and autism, and has shown promise in combating obesity.
When C.diff resides in the intestines of healthy people, other bacteria keep it in check. But antibiotic treatment for common infections—notably with the class of fluoroquinolones, which includes Cipro—can kill healthy bacteria, making way for overgrowth, and often drug-resistant, infection by C.diff.
In cases of drug-resistant C.diff, FMT not only adds healthy bacteria to the gut but sets off its regrowth and repopulation to conquer C.diff and prevent future recurrence. To be eligible for FMT, most patients have had at least one recurrence of C.diff following antibiotic treatment.
Later in 2012, Smith founded the non-profit stool bank OpenBiome, which guarantees the cleanest samples based on an intense evaluation protocol for donations.
Donors to OpenBiome must have taken no trips to developing countries and no antibiotics for the previous three to six months— after which each patient’s donation undergoes a 60-day examination before becoming available for transplantation. Of more than 15,000 donor candidates considered by OpenBiome between 2014 and 2018, only 3% passed the health screening to be permitted to make donations.
In June, 2019, at Mass General Hospital, two patients who had received FMT died. They developed an infection from a rare E.coli-related bacteria later detected in fecal samples from the same healthy donor, which had not undergone OpenBiome’s intensive screening. Because the human microbiome contains thousands of microorganisms, some worry that it’s impossible to test for everything to ensure that samples are 100% safe.
The FDA categorizes FMT as “investigational new drug” (IND) but gives physicians “enforcement discretion” to use it in the treatment of recurring C.diff without filing applications for each patient.
To transplant fecal material, physicians use a colonoscope, with the patient under sedation as in a colonoscopy exam, or an enema. An alternative delivery method is a tube extending from the nose to the intestine.
Newer methods involve pills containing stool samples, which have proven in at least one study of patients with recurrent C.Diff to be no less effective than colonoscopy delivery in preventing recurring C.diff infection for up to 12 weeks. YouTube videos showing DIY fecal transplants have racked up tens of thousands of views—but medical professionals warn against using samples that are not thoroughly vetted.
In research on fecal transplantation for conditions other than C.diff, FMT improved symptoms of IBS in 58% of patients, and remission of UC in 25% of patients compared to 5% for placebo.
In children with autism spectrum disorder, an “extended fecal transplant regimen” lasting seven to eight weeks lowered digestive symptoms and in some cases improved behavioral symptoms, with both effects enduring at least two months after treatment. And in obesity studies on mice, those on a high-fat diet that received fecal transplants from healthy mice—eating a normal fat diet and exercising—showed reduced inflammation and improved metabolism.
“Inspired by the success of fecal transplants for C diff., scientists are racing to develop similar treatments for an array of ailments and disorders,” writes Andrew Jacobs. Mentioning obesity and Alzheimer’s and Parkinson’s diseases, Jacobs notes that “investors are pouring tens of millions of dollars into start-ups chasing the next microbiota breakthrough.”
—Mary Carpenter
Every Tuesday, count on well-being editor Mary Carpenter to deliver health news you can use.
ALTHOUGH IT offers hope for treatment-resistant depression, the first experience of Transcranial Magnetic Stimulation (TMS) for D.C. personal trainer L.M. was so unpleasant that he never returned. As for Electrical Muscle Stimulation (EMS), the advantages of muscle building may be more than offset by workouts that feel like double the usual slog—even if joints are spared.
Stimulators for brain and body are popping up everywhere: those for the body offer muscle building and pain reduction, while options for the brain promise a host of benefits from treating depression and addiction to enhancing cognitive abilities in healthy adults and in those experiencing early dementia.
Such stimulators get their power from either electricity or electromagnetism. For the body, the two options for neuromodulation—that is, altering nerve function—are electrical. For building muscle, EMS targets motor nerves to cause rapid muscle contractions that feel like twitches and spasms.
While the most significant gains occur for post-op patients dealing with muscle atrophy, EMS can enhance muscle size and strength for anyone, including trained athletes—with less stress on joints and tendons. At physical therapy or the gym, clients run or bike on machines, lift weights and perform exercises like squats with electrodes attached to their limbs. While some complain of unpleasant vibrating or burning sensations, Florida lawyer L.K. said using EMS removed ripples from her thighs, leaving them smoothly muscled.
The other body stimulator is Transcutaneous Electrical Nerve Stimulation (TENS), which uses electrodes placed close to areas of pain to create uncomfortable vibrations that interrupt—and thus distract from—pain signals. Based on the gate theory of pain, TENS “provides a competing stimulus,” explains New York City physical therapist C. Shante Cofield. Although TENS helps with symptoms, Cofield warns, “a distraction is not a cure.”
For the brain, the most commonly used neuromodulator is TMS, most often given to those with severe, treatment-resistant depression. Large magnetic coils positioned above the scalp change polarity to produce short magnetic pulses that in turn create an electric current in nearby neurons.
For rTMS —r for repetitive—the coils change polarity at a rapidly increased speed to produce longer-lasting changes in the brain. Patients must remain immobile throughout the half hour or so of treatment —usually five days/week for four to six weeks. Current research aims to understand whether rTMS works better alone or with antidepressants.
But L.M., who stopped after one session, described the sensation as unbearably loud, hard knocking on the skull every three seconds —“painful scalp sensations” that occur for about one-third of patients.
The exact positioning of the electrodes, called the montage, depends on treatment goals. For depression, the best montage places one electrode on the left temple and the other above the right eye. Pulses from tDCS modulate the varying cortical excitability that commonly affects those suffering major depression disorder.
In the past decade tDCS treatment has exploded —with 650 studies in 2016—used also for chronic pain, addiction, schizophrenia and epilepsy. In a Chinese study of healthy college students, tDCS in conjunction with cognitive training improved working memory for specific tasks, and that improvement was transferrable to similar untrained working-memory tasks.
In an analysis of 12 studies on dementia patients, tDCS improved memory for a short period; and in one study, had a positive improvement on both memory and language. Personal brain stimulation devices make it possible to do tDCS at home.
(Other electrical options for the brain are more invasive and reserved for severe conditions: Deep Brain Stimulation (DBS), which requires surgery, is a last resort treatment, for example, for Parkinson’s Disease; and ECT, for Electroconvulsive Shock Treatment, requires anesthesia and risks short-term memory loss, and is most given for intractable depression.)
Finally, a new electromagnetic brain option, Transcranial Electromagnetic Treatment (TEMT), appears to directly affect the Alzheimer’s Disease (AD) process by breaking up aggregates of two toxic proteins, A-beta and tau. A TEMT device worn at home enhanced cognitive performance—that is, reversed deficits —in seven of eight patients with mild to moderate AD after two months of twice-daily treatment.
These patients showed changes in AD markers in the blood and spinal fluid, as well as improvements in MRI images of their brains. They had such positive experiences that they asked to keep their devices and remained in an extension study for an average of 17 months.
Because even TENS used for chronic pain can be unpleasant enough to discourage repeated use, the best motivation for using brain and body stimulators may be debilitating issues like dementia or long-lasting depression, or serious muscle atrophy—although smooth thighs are tempting.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
PHYSICAL THERAPISTS’ toolboxes these days sport such brands as Storz (Medical Master Pulse); Delfi (Personalized Tourniquet System); and Graston (Technique, facia manipulators), along with an array of similar devices produced under other names.
Of the three, the best results for general pain reduction come from “pulse” ESWT, for extracorporeal shock wave therapy. Although the exact mechanisms of action are unclear, high-energy sound waves from the device, which looks like an ultrasound wand, may increase pain tolerance by altering the transmission of pain stimuli.
First appearing in 1980 as a treatment to dissolve kidney stones called lithotripsy, ESWT seems to improve blood supply and spur tissue regeneration by stimulating an inflammatory response similar to the body healing itself. The waves have proved helpful for tendon pain—in the hamstring, knees, Achilles tendon and plantar fascia.
Of 384 tendinopathy patients in a Greek study, those receiving shockwave treatment reported improved functionality and quality of life as well as pain reduction immediately post-treatment and at a four- week follow-up compared to controls.
At the Mayo clinic, a once-weekly series of ESWT, lasting four to five minutes each, helped athletes “whose injuries are not responding to first-line treatments” including therapeutic exercise, explained Sports Medicine Director Jonathan Finnoff.
One drawback may be the sensation, which is described as “mild discomfort” by doctors and physical therapists but has been compared to hitting the funny bone—although that came from a veterinarian and applied to horses.
The second tool, the Delfi “tourniquet system,” creates blood flow restriction (BFR), long familiar among muscle-builders and “on the verge of becoming the next big thing in fitness,” according to Forbes.
BFR cuffs or wraps placed around a limb during exercise restricts venous blood flow to the muscles. Depriving muscle tissues of oxygen increases metabolic stress that mimics the effects of lifting heavy weights in a high-intensity workout —but occurs in BFR with lighter weights that create less strain on the joints.
By restricting blood flow—as much as 50% into an arm, 80% into a leg—BFR spurs growth in the size of muscle cells to reduce atrophy or stimulate hypertrophy in patients with osteoarthritis and osteoporosis, as well as helping those who are post-op or otherwise “deconditioned.”
For one patient with a two-inch difference in lower-thigh circumference following knee surgery, six weeks of BFR therapy shrank the difference to .75 inches— improvement that would take three to four times longer with traditional rehab, according to his Colorado physical therapist Brad Grgurich.
In a German review of more than 2,500 studies, BFR stimulated muscle growth and increased strength during both low-load training and walking for “older individuals in comparison with conventional resistance training programmes.”
Because limb occlusion varies among individuals and depends on hydration and time of day, a Doppler ultrasound assessment of limb’s occlusion pressure before applying the tourniquets can help determine how much to restrict without occluding blood flow.
Although less onerous on the joints themselves, the simulation of heavy lifting can still feel like very hard work. And unsupervised use of BFR can lead to muscle, nerve and cardiovascular damage in addition to issues like blood clots, which led a 2017 study to recommend additional research on BFR before widespread application.
Finally, the set of six stainless steel instruments employed in the Graston Technique may provide their principal advantage to physical therapists, as admitted by some, of saving their fingers —while not offering clearly proven benefits to patients.
In specialized training, PTs learn to use the Graston instruments for a “specialized form of massage/scraping the skin gently.”
Called IASTM, for instrument-assisted soft tissue mobilization, this kind of myofascial therapy may provide “a mechanical advantage for the clinician by allowing deeper penetration and more specific treatment, while also reducing stress on the hands,” according to researchers at California State University and the University of Idaho.
Neurological benefits of IASTM may result from the activation of nerve fibers and position sense organs and may include reducing pain and increasing function following soft tissue injuries.
IASTM may “stimulate connective tissue remodeling,” induce “repair and regeneration of collagen,” and result in the “release and breakdown of scar tissue, adhesions and fascial restrictions,” the researchers write. On the other hand, their review of five studies found “insignificant results and weak evidence” for IASTM.
In addition, many physical therapists and others who work on the body believe strongly in the advantages of using their fingers and hands—notably to sense when to push deeper and when resistance is too strong to ease tension as well as fibrosis.
And as tempting as any of these tool-assisted interventions might sound, the most commonly agreed-on advice for coping with pain and functional restriction linked to everything from recent injury to osteoarthritis involves regular, often uncomfortable, aerobic exercise.
“Today the more than 50 million adult Americans with arthritis are advised to seek the same 150 minutes a week of moderate exercise as everyone else,” writes Amby Burfoot in The Washington Post —with aquatic activity the least stressful for joints and muscles. Joints need movement to “swish around the fluids that deliver nutrients to the cartilage and other tissues,” Arthritis Foundation Health Director Marcy O’Koon told The Post. “Don’t push through pain. But don’t stop, either.”
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
THE NEED to eat more protein as we age is now a given. The current issues are optimal timing and finding good sources of protein other than animal products (eggs, dairy and fish as well as beef and chicken)—as concern rises about risks for health and, more urgently than ever, for the environment.
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Scientists’ “predictions turned out to be completely wrong,” wrote Eugene Linden in a recent New York Times. Compared to the “stately pace” previously envisioned, new estimates double the rates of climate change over the next 80 years—with the earth’s temperature rising 5.4 degrees F; sea levels rising by six feet; and up to 90% of the Northern Hemisphere’s permafrost melting to release dangerous carbon dioxide and methane into the atmosphere.
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Growing and producing livestock requires significant natural resources and creates about 14.5% of manmade greenhouse gas emissions.
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Health risks of consuming animal protein, depending on an individual’s genetic profile and particular diet, include diabetes, cardiovascular diseases and colorectal cancer, as well as lower life expectancy and disabilities that occur with aging.
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With age, protein needs increase because of physiological changes that alter protein utilization, including insulin resistance, impaired digestion and inflammation.
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Besides fueling organs and growing skin, protein builds muscles—by stimulating muscle protein synthesis (MPS)—which in turn helps to protect bone mineral content and density and prevent insulin resistance. After exercise, protein helps stimulate muscle recovery and decrease soreness, and alleviate fatigue.
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Of 6,800 Americans in a National Health Assessment Study (NHANESIII) who ate high-protein diets (20% of daily calorie intake from protein), those who were 65 and over had lower risk of dying from cancer or diabetes—while these risks increased for participants aged 50 to 64.
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Spreading daily protein consumption throughout the day improves absorption, with recommended intake for each meal 25 to 30 grams—about half the requirement for a woman weighing 140 pounds.
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Although the formula prescribes .36 to .90 grams of protein per pound of body weight, the amount varies widely among individuals and depends in particular on the quantity and intensity of exercise. Upping total protein consumption doesn’t make much difference because absorption plateaus after a certain point.
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To maximize muscle protein synthesis, eating most daily protein in one meal risks insufficient stimulation, but “overnight stimulation” gets a boost from eating a large high-protein meal before sleep.
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To benefit the body, dietary protein must be “complete,” containing all of the nine amino acids that are considered “essential” because the body cannot produce them—as opposed to the 11 other “nonessential” amino acids found in the body. Among essential amino acids, for example, tryptophan is vital to the production of serotonin, which helps with mood and sleep.
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Animal products all contain “complete protein,” but for plants, that’s only so in buckwheat, quinoa and whole soybeans, found in tofu, edamame and some other soy products.
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Among vegetables, fruits and legumes, many lack only one essential amino acid, but eating foods in combination during the same meal can create complete proteins. Perfect complements, for example, are beans, which lack methionine, and rice which, like many plant-based foods, is missing lysine.
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While most plants contain low levels of leucine —an important amino acid, along with isoleucine and valine, for maintaining and building muscle strength—the best options if eaten in sufficiently large quantities are dried seaweed, pumpkin seeds and cooked lentils.
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Consuming various forms of protein can be a better solution than eliminating animal-based foods entirely, because these provide other essential nutrients, notably B12—and vegetarians have a high risk of deficiency. To complement grains in cereals and breads, for example, add milk or yogurt.
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But combining and varying protein sources seems challenging to many, and decreasing the consumption of animal products has a long way to go. To improve health outcomes, according to Britain’s “Eatwell Guide,” consumption of beans and other legumes needs to increase by 85%, while that of red and processed meat needs to fall by 75%.
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Anyone needing extra motivation to change their diet might be spurred by daily news reports of worsening wildfires, storms and droughts, and rising oceans inundating coastline towns and cities—and by headlines like those from a recent article in The Guardian: “Animal agriculture is choking the earth and making us sick. We must act now!”
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—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
Note: This post is part of Mary Carpenter’s “winter series,” updates of her earlier stories on cold-weather well-being.
FOR DRY-SKIN sufferers, below-average temperatures predicted for the North and East this winter may present greater challenges.
While PhDs at cosmetics companies discuss at length the scientific principles behind their expensive potions, ever since a university-based dermatologist recommended the cheap and simple combination of mineral oil and lanolin, I’ve concocted my own brew.
Over more than 30 years, I’ve made only a few alterations—dropping in a little almond oil after friends described the odor as somewhere between sheep and urine; switching for a reason I can’t remember from mineral oil to petroleum jelly; and adding a few glops of some commercial preparation like Lubriderm or Eucerin to more easily mix in the heavy lanolin.
Although most friends brave enough to sample the brew find it too greasy, nothing has worked better for me, particularly when indulging in long, hot baths and showers (ill-advised for those with dry skin), but mostly because of dry air despite regular efforts to increase indoor humidity.
The best potions for very dry skin have the fewest ingredients—to reduce the likelihood of a sensitivity reaction. Hypersensitivity often accompanies dry skin, which is thinner and has lost some of the protection from lipids that act as mortar between skin cells, UCLA dermatologist Emily Newsom told SELF magazine.
Thinner skin creates a more permeable barrier for dry air to attack, makes the skin underneath more vulnerable—and makes it easier for moisture to escape. “You want to avoid what we call alligator skin,” Manhattan dermatologist Sapna Palep told New York Magazine. “Once it starts cracking like that…just using moisturizer isn’t going to cut it.”
Moisture is delivered to the skin via blood vessels that supply the skin’s middle layer, the dermis; from there it travels upward through the outer level, the epidermis, a bricks-and-mortar type membrane—before evaporating.
The drier the air due to low outdoor temperatures and overheated interiors, the more moisture it pulls from the skin—and the less water the epidermis can retain. (The third and lowest level of skin is the hypodermis or fatty layer.) Xerosis, or dry, flaky skin, is official when the skin’s moisture level dips below 10%.
To stay moist, what the skin needs is the unlikely sounding combination of oil and water: moisturizers work best when applied after bathing—when the water ingredient is already there —after the skin is blotted but not rubbed dry.
“Applying an oily substance to the skin without also resupplying it with water…is ineffective: you’d just end up with greasy skin that is still dry and cracked,” according to the Harvard Health Letter. “One reason for the proliferation of moisturizers is the continuing search for a mix of ingredients that holds in water like petrolatum but feels nicer on the skin.”
But there is no consensus regarding the definition of a moisturizer…a neologism coined by Madison Avenue,” according to dermatology researcher Anisha Sethi.
Traditionally, oily materials have been applied to the skin “to inhibit trans-epidermal water loss (TEWL)” by replacing the lost barrier.
Such oily materials, called occlusives—notably mineral oils and petrolatum—diffuse into the intercellular levels where they help bolster the bricks-and-mortar structure and form an evaporation-blocking barrier. Among occlusives, petroleum jelly has a “water vapor loss resistance” 170 times that of olive oil and reduces TEWL by more than 98%, compared to lanolin and mineral oils at 20-30%.
Humectants, another category, work by attracting moisture to the skin and keeping it there—“basically the opposite of occlusive and emollients which don’t like water,” writes Julia Calderone at Business Insider.
“But beware,” says Calderone. “In dry conditions, humectants can draw moisture from the younger, moist cells in the lower layers of the skin instead of pulling moisture from the air. Minimize this by pairing a humectant with an occlusive, which keeps the moisture in.”
The third category, emollients, include their own water and “penetrate the skin making it feel soft and flexible,” she explains. Depending on the amount of water added, emollients range from lotions to creams to ointments: for lotions, water is the base with oil added, advised for normal to slightly dry skin; creams contain about 50% of each, water and oil; and ointments start with oil, mixed with about 20% water— absorbed more slowly and staying on the surface longer for better protection, but often sticky and greasy.
Because adding water increases the likelihood of spoiling, some potions need more preservatives. And “since preservatives can stink, we add fragrances to mask the unpleasant smell…the more water content a product contains, the more likely it is for bacteria to form, so the higher the preservative and fragrance content,” according to Dermatology Alliance —which is why ointments can be easier on sensitive skin as well as less likely to go bad.
In one rating system assessing the 10 most popular lotions, the “hands-down” vote went to Aveeno Daily Moisturizing Lotion. The runner up was CeraVe Moisturizing Lotion, which is “even lighter than our pick…more expensive due to ‘healing’ ingredients even though research suggests they make little difference.”
For drier skin, dermatology sites recommend oils, including Neutrogena Light Sesame Oil and Alpha-Keri Oil. The most anecdotally well-liked and the one I use as backup is Aquaphor Advanced Therapy Healing Ointment—and for lips, the Repair and Protect Lip Balm—because the ingredient lists are shorter than most.
Specific ingredients that might affect those with sensitive skin include humectants like hyaluronic acid, which can burn; and lactic acid, an exfoliant—both found in different versions, for example, of Cetaphil, another anecdotally popular potion. For testing new potions, experiment with a little behind the ears several times and then alongside one eye before moving onto the rest of the face.
Also, keep indoor temperatures down, and use humidifiers to moisten the air. Believing that many people overdo their body-care routines, dermatologists suggest limiting the use of cleansers to private parts and underarms. Showers should last less than five minutes—in warm water. And take hot baths only when in dire need of comfort.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
IN VIRGINIA WOOLF’SMrs. Dalloway (1925), Septimus Smith jumps to his death rather than put himself in the hands of a one-diagnosis/treatment-fits-all psychiatrist, who plans on committing Smith, who has paranoid delusions, to an institution.
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Since the first DSM (Diagnostic and Statistical Manual) appeared in 1952, each subsequent edition has sprouted new diagnoses and sub-diagnoses—with the current DSM-V listing close to 200, compared with six disorders listed in the initial mid-19th-century census of mental patients.
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Binge eating, once considered a “sin,” appears in DSM-V, along with hoarding disorder, premenstrual dysphoric disorder, restless legs syndrome and REM sleep behavior disorder.
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Among those who blame “diagnostic inflation” for turning everyday emotions into medical problems in need of drug treatment is psychiatrist Allen Frances, emeritus professor at Duke University, who chaired the DSM-IV Task Force.
On the other hand, the more narrow and specific the diagnosis, the greater the relief for many sufferers and family members: If only Septimus and his wife had known about shell-shock.
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For Massachusetts science writer J.H., her son’s bipolar 2 diagnosis (BP-II) reassured them both that he was “less bipolar, with mania not over the top but depression that can be difficult,” she said. And that diagnosis led to a crucial treatment decision, because the medication typically prescribed for depression alone could send him into full-blown mania.
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“The main difference between bipolar 1 and bipolar 2 disorders,” according to a Healthline post, lies in the severity of the manic episodes . . . a person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode (a period that’s less severe than a full manic episode).
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What Frances calls “false epidemics of mental disorder” have led to “an excessive proportion of people” relying on drugs. When ADHD was added to the DSM-IV, he writes, the predicted increase in cases was 15%—but rates tripled once drug company ads began selling the diagnosis.
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The increasing popularity of diagnoses such as ADHD can also affect clinicians’ judgments, making them “quick to notice” difficulties associated with ADHD, writes New York City psychiatrist Grant H. Brenner. It also, he says, can cause clinicians to fail to recognize other issues, such as bipolar disorder, that are associated with many of the same symptoms as ADHD.
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Another epidemic, according to Frances, is social phobia, which “has turned everyday shyness into the third most common mental disorder with rates ranging from 7 to a ridiculous 13%” —making the diagnosis another prime target for drug advertising.
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Here too, though, personal experience undermines the criticisms. With her daughter’s diagnosis of social phobia, one Delaware mom could better accept her daughter’s depression, which began with an increasing inability to leave the house—as well as what she always viewed as debilitating shyness, which could be now be relieved with therapy and medication.
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Frances describes two conundrums: how to decide which disorders to include in the diagnostic manual; and how to decide whether a given individual has a mental disorder. In the past, too many sick people were being missed, which made increased sensitivity an early goal of the DSM—but the resulting proliferation in diagnoses now includes too many people.
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Another aspect of the controversy is increasing focus on the “biological model” of mental illness, which according to the past director of the National Institute of Mental Health (NIMH), Thomas Insel, makes these conditions no different from heart disease and diabetes and can be helpful for both clinicians and patients.
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“The only difference here is that the organ of interest is the brain instead of the heart or pancreas,” Insel said, noting that all chronic diseases have behavioral as well as biological components.
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To better predict medication response and illness course—but not to replace the DSM—NIMH has created its own classification system based on brain imaging, genetics, cognitive science and other research (called Research Domain Criteria, RDoC).
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For 13-year-old Sasha Egger, intense and sudden paranoia that was traced to an autoimmune attack, subsided immediately after an infusion of antibodies, writes Moises Velasquez-Manoff in the Atlantic. “Scientists have found that simply activating people’s immune systems as though they were fighting a viral infection can cause profound despair and suicidal thoughts.”
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But critics of the biological approach say too much attention on this model can overlook behavioral and emotional changes that occur with mental illness, according to New York psychiatrist Jerome Wakefield—and has led to the decline in patients’ receiving psychotherapy for depression while rates of antidepressant use have stayed the same.
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As for BP-II, the total number of bipolar diagnoses has doubled since its addition to the DSM, Frances notes, because “there is no clear boundary between hypomania and simply feeling good.” But he acknowledges that “perhaps the most important diagnosis [determining whether the patient has bipolar mood swings or “unipolar” depression] in all of psychiatry is unfortunately the most difficult.”
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Mood-stabilizing medications prescribed for bipolar disorder come with side effects that include “dangerous weight gain, diabetes and heart disease,” according to Frances. But anti-depressants can send BP-II patients into classic manic episodes that include “spending money like a drunken sailor and being intrusively sexual.”
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Awareness of hypomania could have saved Delaware theater director A.J., who was given Prozac for depression—and her subsequent mania when traveling in Israel led to involuntary hospitalization.
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In her case, though, an even narrower, more specific description was also helpful. Although never listed in the DSM, Jerusalem Syndrome describes a religious-themed psychotic break experienced by about 50 tourists a year: Believing she was pregnant with Baby Jesus (she was not pregnant), A.J. refused to budge from her place at a holy shrine.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
TINTED EYEGLASSES, in the past used mostly outdoors, are becoming more popular for everyday wear indoors—although the same pair is unlikely to work well for every occasion.
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WHILE EYEGLASS tints can reduce glare and the amount of light entering the eyes, they are generally not the best remedy for the separate problem of digital eye strain (DES), according to Mountain View, California, ophthalmologist Rahul Khurana, clinical spokesperson for the American Academy of Ophthalmology.
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“It’s not the blue light that’s making your eyes feel bad after a day of staring at the computer—it’s staring at a screen for hours without breaks,” Dr. Khurana told New York Magazine. For DES, the best relief is the age-old 20-20-20 formula: every 20 minutes, shift focus onto something at least 20 feet away for at least 20 seconds. Artificial tears to lubricate dry eyes can also help.
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On the other hand, because blue light scatters the most easily, it makes the eyes work harder to focus, and recent research shows that blue light from digital screens may add to eye strain. Also, because blue light penetrates to the retina in the back of the eye, the long-term added exposure from digital screens may over time contribute to macular degeneration.
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But it’s because clear lenses allow in the most blue light from both sunshine and indoor lighting that they are the best option for seeing well indoors. In addition, because blue light suppresses melatonin, it boosts attention, reaction time and mood —helping to counter depression in winter months, hence its use in “light therapy” —and to create healthy circadian rhythms.
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Clear glass provides the highest percentage of visible light transmitted (VLT) at 86% to 96% —while VLT for the darkest, densest tints that provide the best outdoor protection is 20% to 40%.
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Tints with VLT lower than 50% worn regularly indoors can “pose a significant risk” because the eyes adapt to the darker view, making subsequent light exposure feel brighter and sometimes painful.
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VLT is dependent on tint color, lens thickness and material, and the number of coatings applied. For sun protection, tint density should be at least 75%—and UV absorption 100%—though tints offer little protection from glare in most light conditions. In sunglasses, gray and brown tints create the least distortion in color perception.
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For an indoor/outdoor compromise, 50% to 60% VLT can make eyes more comfortable and improve accurate color perception, although both effects can take days or weeks. The advice is to try out different tint colors and densities when buying glasses even though simulating a variety of real-light situations in one indoor location would be challenging.
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To reduce strain during long hours of digital screen use, yellow-tinted lenses can increase contrast but block only ultraviolet light. Orange tints eliminate close to 100% of blue light, making them the best “blue-blockers” for late-evening screen activity, notably the $10 UVEX glasses used in most research.
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In studies at the University of Toledo, those subjects using digital screens during the three hours before bedtime who wore glasses tinted amber (between yellow and orange) reported “better sleep” as well as improved mood, compared with those using yellow tints.
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Blue-blockers can also protect those with strong light sensitivities, such as to fluorescent lighting—in particular, those suffering chronic migraine. Yellow and orange tints, while blocking blue light, can paradoxically brighten overcast, hazy, low-light conditions, as well as heighten contrast for athletic activities like skiing and cycling.
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While the idea of rose-colored glasses sounds appealing, they can make eyes look red and tired. Rose and red can also cause significant color imbalances, but these tints heighten contrast in both cloudy and sunny conditions and are often the best choice for fishing. And green tints heighten contrast but preserve color balance for sports like golf. (See this chart on tinted lenses.)
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Fishermen are also the best candidates for polarized lenses, which help deal with glare, although they can make it impossible to read digital screens as well as car dashboard lights. For the multi-sport aficionado, some sport sunglass frames have interchangeable lenses.
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In addition to altering eyewear, “reduced-blue” LEDs can be easier on the eyes than LEDs with cool, white light. Blue-light filters for digital screens can help block blue light without reducing visibility, and the “night shift” setting on some devices can alter display colors to the warmer end of the color spectrum.
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I usually sleep plenty of hours but plan to try UVEX blue-blockers when working on screens after dinner to see about improving sleep quality. On the other hand, I might worry what to do before naps—on trains and planes, and sometimes in the afternoons.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
OUR GENERATION got screwed, in the words of one 60s-something DC lawyer, referring to the panic among women and refusal by doctors to prescribe oral hormone replacement therapy (HRT) for menopause-related symptoms—from painful sex to brain fog— based on a 2002 study since shown to be flawed.
After publication of the study by the Women’s Health Initiative (WHI)—which followed 16,608 women ages 50 to 79 on HRT for more than five years but was stopped prematurely because of worrisome results—the number of women taking HRT fell by 66%.
Further analysis of the research revealed that many participants were overweight and already at risk for heart disease, as well as being in their mid-60s—while the best “window of opportunity” for starting HRT is during menopause, generally ages 45-55.
“There has been almost a generation of women who have mostly been denied the opportunity of improved quality of life during their menopausal years,” according to the “fact sheet” prepared by the Women’s Health Concern and reviewed by the British Menopause Society.
Dubbed the “menopausal vagina monologues” by the New York Times, genitourinary syndrome of menopause (GSM) continues to plague post-menopausal women, notably during vaginal sex—with pain that burns, stings or throbs as well as painful contractions during penetration.
Vaginal discomfort affects about 50% of postmenopausal women, and more than 50% of sufferers avoid intimacy as a result. GSM can affect quality of life, including self-esteem and relationships,
HRT is “the most effective solution for the relief of menopausal symptoms..also effective for the prevention of osteoporosis..may provide protection against heart disease,” the British fact sheet states. Research since the flawed WHI study has linked HRT to a reduced risk of heart disease and several cancers, including breast and colon, along with protection against osteoporosis.
From the Mayo Clinic: “systemic estrogen remains the most effective treatment for the relief of …vaginal symptoms of menopause such as dryness, itching, burning and discomfort with intercourse.”
During the decade following the onset of menopause, arteries often begin to narrow, and estrogen can cause the clumping of platelets that clog narrowed vessels. Women who wish to start HRT in the years after menopause can have a variety of tests to assess plaque buildup and risk of heart disease, such as ultrasound and CT calcium scans—also used to help determine the need for statins.
In 2016, MyLittleBird wrote about the then-latest vaginal rejuvenation treatment for post-menopausal issues—the MonaLisa Touch laser—for which DC women were storming the first local ob-gyn practice to offer it. But disappointment has for most women, including the DC lawyer, relegated lasers to the long list of treatments tried and failed —and for the MonaLisa, most spent thousands of dollars out of pocket.
In 2018, the FDA warned about the lack of evidence and reports of side effects for “energy-based devices used to treat vaginal conditions and symptoms related to menopause.” Treatments like the MonaLisa Touch, the agency said, could cause burns, scarring, and chronic pain.
And vaginal estrogen tablets were no more effective than vaginal moisturizers or placebo tablets or gel in a recent Mass General study of 302 postmenopausal women. Yet low-dose vaginal estrogen therapy—insertable tablets, creams and rings—is “currently considered the best treatment for GSM.”
“I’m heartsick at the costly, foolish, and sometimes dangerous alternatives to HRT that women resort to for vaginal pain and other symptoms,” wrote Carol Tavris, co-author with LA oncologist Avrum Bluming of the book Estrogen Matters, in an email to MyLittleBird.
Since the publication of their book, along with podcasts and talks, Bluming has received dozens of letters from women around the world “desperate for HRT, who were on it, taken off it by alarmed physicians and are now suffering the consequences—relentless night sweats, insomnia, brain fog, etc. as well as vaginal pain,” according to Tavris.
The WHI researchers have since backed down on their conclusions, at least for vaginal estrogen creams, although the package insert still has the FDA’s strongest boxed warning. But to date most clinicians remain unwilling to prescribe HRT or they prescribe it only as a last resort after patients have spent time and money on other treatments. Women who wish to try HRT are advised to contact the North American Menopause Society as a resource for the few ob-gyns willing to prescribe it.
(Similar to what happened with autism and vaccines, despite flaws in the original study and despite every study since that disproved the original results, it can take a long time to remove fears and change minds, even among doctors.)
Based on a University of Nottingham study that showed no effect on the risk for blood clots among those using patches, creams, gels and injections to administer HRT, lead researcher Yana Vinogradova advises women who wish to try HRT to start with the patch.
Meanwhile, popular alternative treatments for GSM range from marijuana douches and vaginal dilators to lidocaine ointment that numbs the vagina. New drugs include steroid vaginal inserts such as the DHEA-containing Intrarosa and injections of platelet-rich plasma. Many GMS specialists recommend trying everything until something works—though rarely does that everything include HRT.
Every married woman the DC lawyer knows who is not taking HRT complains of pain and/or burning, and none of them are having vaginal intercourse. And, she says, those taking HRT not only feel better but have better-looking skin: “You can see which women are taking it.”
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
THE NOBEL PRIZE in Physiology or Medicine—rarely interesting or comprehensible to most lay people—has been a hot topic around town this year, spilling into Starbucks wait lines and the early minutes of yoga class where talking is generally discouraged.
Although the prize goes to basic research and is often presented years after the first publication of results—so not breaking news—work by the 2019 winners offers new hope for the treatment of the most aggressive breast cancers.
In addition, the focus of this year’s research—decreased oxygen levels in cancer cells—may also lead to improved treatments for cervical cancer and other tumors induced by human papillomaviruses (HPV), blamed for 5% of all cancers worldwide, including those of the head, neck and reproductive tract.
Low oxygen levels transform some cancer cells so that they behave much like embryonic stem cells—immature cells known for their ability to multiply indefinitely and give rise to “progenitor cells,” which mature and populate the body’s tissues during embryonic development.
“Oxygen-poor environments like those often found in advanced human breast cancers serve as nurseries for the birth of cancer stem cells,” according to Johns Hopkins geneticist and Nobel Prize winner Gregg Semenza.
Contrary to the earlier view that cancer cells located deep in tumors and deprived of oxygen were dying, they turned out to be merely dormant, sleeper cells that in hypoxic conditions were in the process of acquiring new powers as stem cells.
The same low oxygen levels allow these cancer cells to evade treatment. Based on other research, Arizona pharmacology researchers noted that “tumor hypoxia is a prevalent and major obstacle to effective cancer treatment with radiotherapy, chemotherapy and immunotherapy.”
Once newly empowered, cancer stem cells travel to distant regions of the body where they create dangerous metastases. Investigations into what the cancer cells are searching for as they spread into surrounding tissues and then into blood cells spurred Semenza and colleagues to consider oxygen—and in turn to identify those cancer cells capable of thriving in low oxygen conditions as stem cells that can help tumors spread.
“The search has been intense to find these cells’ Achilles heel…so they would no longer have the power to keep repopulating tumors,” Semenza told Johns Hopkins News.
That Achilles heel may be the molecular on-off switch discovered by the prize winners, which controls the cancer cells’ response to low oxygen levels. Interfering with the genes involved in that switch could reduce the number of dangerous cancer stem cells that migrate and cause metastases.
At least two drugs now in clinical trials focus on reversing tumor hypoxia, one of which improves the permeability of oxygen into the tumor tissue.
Drugs currently on the market based on a similar understanding of oxygen-sensing pathways work to increase both red blood cell production in cases of anemia, and oxygen levels for patients with lung and heart disease.
In 2018, the Nobel Prize in Physiology or Medicine also went to cancer treatment researchers, and a documentary portraying the life and work of one—“Jim Allison: Breakthrough”—is currently playing in D.C. theaters.
Research by Allison, professor of immunology at the MD Anderson Cancer Center, and colleagues led to the first checkpoint inhibitor drug, a “breakthrough” in the treatment of advanced melanoma, which helped spawn recent advances in immunotherapy—that requires overriding inhibitor molecules on cancer cells to allow a patient’s own immune system to attack them.
Precision medicine, seen as the future of cancer treatment, will likely depend on assessments of multiple biomarkers, with an important one being the location of hypoxic microregions throughout tumors.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
PERSISTENT WARNINGS that cooking with olive oil releases dangerous chemicals perpetuate a myth, despite contradictions from research now dating back several years. The studies’ conclusions also upended age-old wisdom that cooking with oils rich in polyunsaturated fats, such as corn and sunflower, is better for the health than the saturated fats in animal products.
Heating an oil to the point of breakdown diminishes its healthful components and releases unhealthy ones into the environment. Two variables affect an oil that is being heated: smoke point, the temperature at which it begins to smoke and break down; and oxidative stability, its ability to resist that breakdown process.
Extra virgin olive oil, despite its comparatively low smoke point of 410 degrees Fahrenheit, has strong oxidative stability. Derived from the first pressing of olives, this “superfood” is the least processed and most healthy of oils for cooking and eating.
Cheaper, more refined oils —corn, safflower, sunflower—have higher smoke points because the refining process has removed ingredients that cause it to smoke. But as in the case of “light,” more refined, olive oil, most oils with higher smoke points have fewer nourishing ingredients. In addition, heating most of these oils releases into the air high concentrations of aldehydes that have been linked to illnesses including cancer, heart disease and dementia. Simply standing in a kitchen as these oils are used can cause harm.
Roasting, sautéing and frying —except deep-frying—are rarely done at temperatures above 400 degrees. But even at higher temperatures, the healthy advantages of olive oil diminish only to the starting levels for cheaper oils, including “light” olive oil, which has a smoke point of 468 degrees F.
Even under prolonged cooking, olive oil is usually equal or superior to more refined vegetable oils, according to researchers at the University of Porto. Prolonged heating at high temperatures can degrade its health benefits to the level of other oils that can sustain higher cooking temperatures but do not begin with the same benefits.
For economic reasons, many people choose to start with lower grade, less expensive oils and then add higher grade extra virgin olive oil later in the cooking process —or use it intermittently throughout cooking.
The oxidative stability of olive oil comes from its high proportion (73%) of monounsaturated fatty acid (MUFAs). At higher temperatures, MUFAs keep an oil from releasing harmful toxins and allow it to retain bioactive components such as phenolic acids, including flavonoids, and vitamin E that are associated with anti-oxidant and anti-inflammatory effects.
Most more refined oils are higher in polyunsaturated fatty acids (PUFAs), which have the advantage of higher smoke points. Many of these, including canola oil, which has a smoke point of 400 degrees F, are good sources of healthy Omega-3 fatty acids, although fatty fish like salmon have higher levels as well as the most effective (long-chain) type of Omega-3s.
Coconut oil falls into the third category—saturated fatty acids—present in high levels in animal fats including butter and at 14% of fat in extra virgin olive oil. These are the most heat-resistant, although many have unhealthy disadvantages such as elevating levels of LDL cholesterol. Despite its low smoke point of 350 degrees, coconut oil is considered “very resistant” to heat because of its high saturated fat content.
Combining its levels of saturated and monounsaturated fatty acids, extra virgin olive oil contains only 13% of the less stable polyunsaturated fatty acids. The Porto researchers found extra virgin olive oil “particularly resistant to oxidation even when used for deep frying.”
To produce extra virgin olive oil, expeller pressing removes oils using a mechanical press, generating a minimal amount of heat. Cold-pressed oils are extracted with an expeller press under carefully controlled temperatures, below 120 degrees F, which helps retain healthy phenols as well as vitamin E. Thus cold-pressed extra virgin olive oil is the healthiest of the oils, but also the most expensive—which is why many cooks prefer to add it during the cooking or after it’s done.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
IF YOUR doctor prescribes Cipro or another drug in the class of fluoroquinolones, you should ask why that drug – whether your bacterial infection is especially hard to treat or because allergies prevent you from taking other choices like penicillin. Otherwise, according to the FDA, the benefit of taking these drugs may not worth the risk of “disabling and potentially permanent side effects.”
While such side effects are deemed “rare,” three people in my immediate family (not blood relations of each other) who took these drugs suffered a ruptured Achilles tendon.
Since taking Levaquin, also in this class, a previously healthy North Carolina woman has suffered 25 tendon ruptures requiring surgery, as well as ongoing memory problems, seizures and sudden drops in blood pressure.
After reviewing more than 1,200 cases of disabling side effects, the FDA found 16% of patients had at least two different conditions, dubbed FQAD for fluoroquinolone-associated disability. Also, by clearing good, healthy bacteria along with the bad, these drugs have paved the way for potentially life-threatening and difficult- to-eradicate Clostridium difficile (C.diff) infections.
Last year, the FDA revised its strongest “black box” warning for fluoroquinolones to include mental health issues like depression and anxiety, as well as trouble paying attention, disorientation and memory loss. FDA warnings also address patient reports of ruptures or tears in the aorta, which can be fatal; dramatic drops in blood sugar levels; and neuropathy or nerve damage —all of which lasted longer than a year and could be permanent.
Fluoroquinolones—the third most commonly used antibiotics for adults—are “over-prescribed because they are so potent and easy to use,” Orlando Health infectious disease specialist Antonio Crespo told Web MD. For drugs in this class, a once-a-day pill can be as effective as intravenous treatment and can allow some patients to avoid hospitalization.
But about 5% of fluoroquinolone prescriptions are “completely unnecessary.” About 20% are wrongly employed—not adhering to black-box warnings —as the first round of treatment, according to CDC medical officer Sarah Kabbani.
One target of misuse is prevention of traveler’s diarrhea, for which Cipro has been a staple of vacationers’ medical kits for years. And in 2016, the FDA warned specifically against prescribing fluoroquinolones for sinus infections, bronchitis or uncomplicated urinary tract infections for which only about half of patients currently receive the recommended first-line antibiotic therapy.
Contrary to warnings issued by both the FDA and its European equivalent, the Infectious Diseases Society of America continues to suggest these drugs for treating community-acquired pneumonia—in “patients who frequently are elderly and have hypertension or vascular disease…precisely those for whom fluroquinolones are counter-indicated,” writes San Diego infectious disease specialist George Sakoulas.
Because fluoroquinolones interfere with production of the kind of collagen present in both the Achilles tendon and the aorta, collagen is one focus of likely mechanisms for adverse effects. Another is damage to the mitochondria that create energy needed for cellular function.
Patients at particular risk for FQAD include those with high blood pressure, peripheral artery disease and genetic conditions that affect collagen structure, such as Ehlers-Danlos and Marfan syndromes. Also at risk are patients on immune-suppressing glucocorticoid therapy to treat autoimmune diseases like these and to treat inflammation associated with allergies.
If your doctor prescribes a fluoroquinolone, first ask why that drug. Then, advises American Pharmacists Association consultant and infectious disease specialist Heather Free, make sure they know your health history and all the medications you are taking.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
EVEN AS uses—from bladder issues to severe underarm sweating (hyperhidrosis)—for Botox (botulinum toxin) treatments grow, women looking for a “more natural” approach are turning to platelet-rich plasma (PRP) therapy for some of the same conditions and for hair loss.
In 2014, seven million people sought treatment with Botox, the most common cosmetic procedure performed today. In the wild, infection with Clostridium botulinum causes botulism, which starts by paralyzing the muscles of the face, mouth, and throat, spreads to the rest of the body, and, when it affects the diaphragm muscles, causes death—with outbreaks as recently as May, 2017, in California.
Along with plumping facial lines and wrinkles, Botox injections can elevate the eyebrows; treat eye spasms or twitches (blepharospasm); and help relieve neck contracture, spasticity, migraines and chronic pain. Using Botox to smooth the glabella—the skin between the eyebrows that wrinkles with frowning —has aided in treatment of depression.
Botox injected into the affected organ—the salivary glands for excess drooling; the skin for sweating—blocks the release of acetylcholine necessary for muscle activity and can also interfere with mediators of pain and inflammation.
For “urgency urinary incontinency,” related to overactivity of the detrusor, the bladder wall muscle, Botox has proved more successful than the primary alternative, an implanted nerve-stimulation device called InterStim. So-called “urge incontinence” affects 17% of women over age 45 and 25% of women over 75.
In a Duke University study of 364 women followed for six months after receiving Botox injections into the bladder wall, daily episodes decreased by 3.9 in those receiving botulinum toxin versus 3.3 for neuromodulation, although the Botox group had three times the rate of urinary tract infections, and some required intermittent self-catheterization.
Most side effects of Botox occur close to the injection site, such as excessive shutting down of muscles when treating bladder problems as well as overactive sweating and drooling; and headaches when treating migraines and smoothing facial lines.
As a “more natural treatment,” the growing popularity of PRP–first used in orthopedics on painful joints—for aging facial skin is part of a larger medical trend of activating boosters from the patient’s own body, New York City plastic surgeon Robert Silich told The New York Post. Another example is stimulating patients’ immune systems to fight some cancers.
For PRP, a centrifuge spins the patient’s blood to separate out plasma containing a high concentration of platelets. With two means of transferring PRP to the skin —microneedling and injection —the FDA’s classification of PRP as a medical device has less exacting standards than those for new drugs.
The microneedling used in the “vampire facial” works by way of a cylinder (it looks like a lint roller), covered with tiny needles, which creates many tiny wounds that are subsequently soothed by applications of PRP. The skin can also be plumped with filler. The collagen production stimulated by PRP may produce longer-lasting effects than Botox treatment.
With PRP, there is no chance of an allergic reaction because the injections come from [patients’] own blood,” notes New York dermatologist Marina Peredo.
For hair growth, Peredo says, “This is the first procedure…that has dramatic results and doesn’t need daily upkeep.” In theory, PRP injections trigger and maintain growth by increasing blood supply to the hair follicles, though there is little scientific evidence documenting these effects.
Research support for facial treatment using PRP is also limited. Of 31 patients receiving PRP injections in a multi-center study, only one reported improvement on the Wrinkle Severity Rating Scale (WSRS) while 14 recorded positive results on the Global Aesthetic Improvement Scale (GAIS), though the FACE-Q (measuring satisfaction and quality of life) showed statistically significant increases.
Besides seeming more natural, PRP appeals to vegans because animal testing is not required. But treatment, which costs from $1,500 to $3,500 and requires a series of three injections four to six weeks apart, with boosters every four to six months, is not yet covered by insurance.
Unanswered questions about PRP include the possibility of long-term side-effects as well as how it works for some but not all patients; how many treatments provide the best results; and how much and where to inject PRP. According to the study report: “the quality of evidence supporting its use is poor due to the lack of consistent methods of is preparation and application.”
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
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