“THE GUT is now recognized as its own organ,” announced a young woman loudly to her pew as a recent local funeral was about to begin. (She whispered further explanation only to her seatmates.)
“Gut” has traditionally referred to all organs of the digestive tract, itself an “organ system” that includes “solid” organs” —liver, pancreas and gallbladder —as well as the GI tract. Alternatively, “gut” sometimes refers to just the GI tract, which is a series of hollow organs extending from the mouth to the anus and includes the esophagus, stomach, large and small intestines, colon and rectum. (Spread out, the entire GI tract is about the size of a tennis court.)
And these days, the “gut,” which often refers to the gut microbiome (the healthy bacteria living in the digestive tract that digests food) plays a role in the body’s immunity—which is especially important in the recent outbreak of E.coli infections—and has indirect effects on weight gain, fatigue, anxiety, depression and inflammation.
Most E. coli living in the gut qualifies as “good” bacteria and blocks colonization of pathogenic strains of microorganisms, including E.coli strains like the 0157:H7, involved in infections traced to romaine lettuce and meat products.
Diarrhea and stomach cramping are caused by the virulent Shiga toxin produced by this E.coli strain. More worrisome are kidney complications that can lead to long-term damage and failure, signaled by severe dehydration, a fast heart rate, pale skin and lightheadedness.
Why some people develop more severe, sometimes life-threatening symptoms can depend on which healthy microorganisms—specifically which strains of harmless E.coli —currently populating those individuals’ guts have the potential to increase or decrease how much toxin is produced by pathogenic E.coli. Assessing these organisms might someday help predict which individuals will become the sickest.
Women and girls make up about two-thirds of those affected in both recent E.Coli outbreaks linked to romaine lettuce this Thanksgiving and in late 2017. One explanation, according to a study of nearly 15,000 men and women, is that women eat more lettuce and other vegetables. Other possibilities: women report illness more often; and women’s microbiomes are more susceptible to this infection, whereas men have higher infection rates in E.coli outbreaks traced to meat products.
Because gut microbes have an average lifespan of about 20 minutes, the entire population of a person’s microbiome can be altered quickly by what they consume, along with the entirety of these microbes’ genes. Because of continuous regeneration, the gut lining is entirely replaced every two to three weeks—and a healthier diet can make for a healthier gut in anywhere from two to twelve weeks.
“Our diet programs our microbiome, and its genes,” writes New York internist Raphael Kellman, author of “The Microbiome Diet.” How the gut works also counters the assertion by Paleo diet enthusiasts that human genetic inheritance makes it impossible for our guts to digest grain. “Not only is that bad genetics, it’s bad nutrition,” according to Kellman.
In a 2011 study at Harvard and Duke University, over a 24-hour period, one group of volunteers ate a high-protein (meat, eggs, cheese) diet, while the other consumed a diet high in fiber (fruits, vegetables, grains). Bacterial analysis before, during and after that period showed that the microbiome responded quickly in both groups by increasing those bacteria that could metabolize their diet—even for the long-term vegetarian who agreed to eat meat for the study.
The gut microbiome benefits from specific diet components. Probiotics (food containing bacteria such as yogurt and kimchi) “help to maintain healthy levels of “good bacteria…support immune defenses…help break down foods we might otherwise find difficult to digest,” according to University of Newcastle molecular nutritionist Emma Beckett.
And “prebiotic” food —largely unaffected by digestion, including legumes, oats and beans —feed the good bacteria. (As for dietary supplements that purport to supply pre- or probiotics, nutritionists say these are unable to maintain a beneficial variety of bacteria.)
In yet one more definition, the “gut” refers to the mesentery, a “mighty membrane that twists and turns through the gut, first identified as a single structure by Leonardo da Vinci. For now, the mesentery, which connects the small and large intestines to the abdominal wall, is considered part of several organ systems: intestinal, vascular, endocrine, cardiovascular and immunological. Classifying it as an organ—meaning a group of tissues adapted to perform specific functions—is still in the proposal stage from surgeon Calvin Coffee at the University of Limerick.
Finally, there is the “gut feeling”—butterflies, queasiness—leading to the view of the gut as a “communication center for the brain,” according to NYU clinical medicine professor Lisa Ganjhu, who refers to the “brain as part of the gastrointestinal system.”
The gut and the brain communicate about mood, state of mind and stress level. Stress can cause chronic nausea or bloating, says Ganjhu. And, of course, about digestive matters: “first the gut provides information to the brain, while the brain helps us decide what, when, how much and how fast to eat and drink,” Ganjhu explains.
As we pay more attention to the gut, whatever the definition, it is increasingly clear that it requires attention to emotional well-being as well as careful feeding.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news that affects our everyday lives.
HYSTERIA—and its reputation for being the first mental disorder attributed to women alone—surfaces in contemporary news reports every decade or so. Now a company called Hysteria proposes to “change the term hysteria into a movement of positivity, taking back our sexuality” with a website offering resources for women “as well as reviewed products to fit their needs.”
Labeling women hysterical, meaning crazy, is “alive and well,” according to Huffington Post’s “tour of just seven of the weirdest things so-called ‘experts’ used to believe about female hysteria.”
Symptoms and Diagnoses
Among hysteria’s symptoms, accumulated over centuries of diagnosing the disease, are “nervousness, hallucinations, emotional outbursts and various urges of the sexual variety,” as well as sexy thoughts, sexual frustration and “excessive vaginal lubrication.” Also, the inclination of “lascivious females to venery,” attributed to the buildup of “sexual fluids.”
“Cheerleaders’ Disease” was hysteria’s most recent public iteration—though more aptly labeled “mass hysteria.” In 2002 North Carolina and then in 2011 near Buffalo, one cheerleader’s strange physical symptoms—Tourette’s-like tics and movements, voices breaking and warbling—were initially related to that girl’s emotional distress but soon “caught” by other girls.
Blame for hysteria’s symptoms went first to a wandering uterus—in Egyptian texts dating to the 19th century B.C.—although the term came from Hippocrates (founder of Western medicine in the 5th century B.C.). The condition was first deemed a physical disease traced to abnormal womb movements and later a psychosomatic condition in which physical symptoms reflected underlying psychological issues.
“Irregular motions of the animal spirits” was how these symptoms were described in the 1600s by British physician Thomas Sydenham. He reported hysteria as the second most common malady of the time, after fevers.
High-pressure hosing of the vagina with very cold water was said to help, as were the healing properties of semen —resulting in a prescription of marriage, because it was accompanied by regular sexual intercourse.
Treatments
Pelvic massage or physician-assisted paroxysm (orgasm) became the main cure starting in the Renaissance and was “firmly entrenched” in Europe and the U.S. by the early 19th century. Then came the vibrator, a welcome advance for doctors who “sought every opportunity to substitute other devices for their fingers”—as shown in the 2012 film “Hysteria,” which portrayed the “rampant hysteria affecting England’s sexually and socially repressed.”
In 19th-century France, adolescent girls considered excessively sexual, because of their behavior or because they became pregnant, were removed from society’s temptations to live in the walled city of Paris’s vast Salpetriere Hospital, often for the rest of their lives. Those women exhibiting extremely contorted physical poses were chosen by Jean-Martin Charcot and his student Sigmund Freud to show off in amphitheaters filled with curious medical observers.
The term “female hysteria” remained in use by the American Psychiatric Association until the early 1950s, and “hysterical neurosis” was not removed from the DSM, psychiatry’s diagnostic manual until 1980. Today, hysterical symptoms are considered manifestations of dissociative disorders, such as amnesia and identity disorder, although the decreasing diagnosis of hysteria has coincided with a rise in that of depression in Western societies.
A New Interpretation
Brain imaging on patients with hysterical paralysis, that is, those who have healthy nerves and muscles but a functional inability to initiate movement, has shown that attempts to move paralyzed limbs activate parts of the brain associated with action and emotion instead of the motor cortex. Those in turn inhibit normal function of the brain responsible for movement, sensation and sight. Even after brain scans and revised terminology, hysteria is still associated in many people’s minds to women behaving erratically and unpredictably—something Hysteria Wellness intends to change. Among the website’s useful information is a history of hysteria, ending with a 2000 Alabama state court ruling that deemed sexual health a serious “health concern in which sex tools are necessary.”
Hysteria Wellness promotes openness about issues of female health, notably urinary incontinence. Its related products come in prettier colors and more interesting shapes than those available from medical suppliers, albeit with higher price tags (slightly offset until December 5 by a site-launching promotion of free shipping with code FREESHIP).
Other featured products contain CBD oil; and the “Hysteria Accessory Set” (coconut oil and a Turkish towel) “accessorizes any of our products with a little extra comfort.” Despite the commercial angle—with or without accessories—the website may finally be heralding an era in which previously embarrassing and shunned aspects of hysteria are embraced and even celebrated.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
DENVER POLITICAL aide P.G. considers herself excessively jumpy, sometimes embarrassingly so. She once shrieked at a sudden noise during a duplicate bridge tournament at a country club. Heads turned.
The “startle easily symptom”—also called “a case of the nerves” or being “on edge” or “jumpy” —is a mostly unconscious motor response to sudden, unexpected sounds and sights. The response to loud noise, the most studied, is the acoustic startle reflex.
“Startle is a very interesting reflex,” explains psychology researcher Ottmar Lipp at Australia’s Curtin University— “a brainstem reflex… mediated by two to three synapses. In other words, it’s actually very simple.”
Emotional State Plays a Part
The startle response is more intense when you’re undistracted, trying to rest, relaxing or going to or waking up from sleep. But unlike the automatic reflex to a knee tap, this reflex is affected by your emotional state. If you’re already feeling anxious—while watching the movie “Psycho,” for example—a sudden door-slamming will make you jump, notes Lipp. But if you’re watching a comedy, the same slammed door will startle you less.
Jumpiness “can come and go rarely, occur frequently, or persist indefinitely,” according to anxietycentre.com, an international therapy group that offers counseling online and in person. It can range in intensity from slight to moderate to severe. It can also come in waves—strong one moment and easing off the next; and can change from day to day or moment to moment.
When the stress response occurs too frequently or too dramatically —called “stress response hyperstimulation” — the body has trouble recovering and remains hyper-vigilant, in semi-emergency readiness. The brain is continually flooded with stress signals, even in the absence of stimuli, including elevated levels of the “stress hormone” cortisol and a hyperactive amygdala, the brain structure most commonly involved in the stress response.
Lowering the Volume
Startling easily can occur when the brain has been conditioned to perceive the environment as dangerous or threatening—and is a physical indicator of PTSD. Even in veterans with mild symptoms, a heightened startle response can help with determining a diagnosis and treatment.
In adults, one study found the acoustic startle response to be an independent indicator of childhood abuse, even with no symptoms of PTSD or depression.
The startle response can also be more pronounced in people with a genetic variant that affects regulation of the neurotransmitter dopamine: those with more sensitive nervous systems have faster reactions but are more prone to anxiety disorders. Also having a suspected genetic link, behavioral and psychiatric symptoms can occur along with the startle response. The extreme startle that occurs with the “Jumping Frenchmen of Maine” disorder can include jumping, yelling, hitting, involuntarily repeating sentences and forced obedience to commands.
As with any reflex, intentional repetition of the startle stimuli can help diminish the response. You can slam your own doors, but having another person make noise adds the crucial variable of surprise. Cognitive behavior therapy, which also involves repeated exposure to offending stimuli, can counter increased fearfulness and a heightened response to fear.
In addition, regularly practicing self-calming techniques, such as meditation and breathing, can lower the brain’s background level of alertness. When Tibetan monks, known for their meditation practices, were tested in a lab with a gun fired close to their ears, they had no startle reflex at all. People generally figure out their preferred method for stress-reduction breathing. Most methods involve a combination of slow inhaling through the nose and slow exhaling through the mouth, sometimes counting to 5 or 6 for each. Some involve several seconds of breath-holding after the inhale.
Calming Effects of Lavender
Essential oils can also help—lavender, in particular. A recent Japanese study found that sniffing linalool, a component of lavender oil, affected mouse brains “like popping a Valium.” Signals went directly from the nose to the same brain areas as those affected by the drug but without entering the bloodstream. According to the New York Times, the findings add to a “growing body of research, demonstrating anxiety-reducing qualities of lavender odors.”
P.G. had tried everything from breathing and meditation to psychotherapy, but after hearing about the duplicate bridge incident, her therapist recommended a local naturopath. In a regimen intended to balance the organs and treat a host of minor complaints that included difficulty sleeping, the naturopath advised weekly enemas, dietary changes, digestive enzymes and supplements.
After a few months, P.G. still jumped at noises. But she had a small victory when a trip to the basement led to a surprise encounter with a snake caught in a glue trap designed for mice and then a second snake in another glue trap. Neither made her jump or shriek. For now, P.G. will continue the regimen, hoping for further benefits.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
SUDDENLY BURSTING into tears can be “inappropriate”: from puzzling (crying at movie previews) to embarrassing and even job-threatening (tears when your boss criticizes your writing—or, worse, you),
You can stop unwanted tears by pressing your tongue against the soft palate (located behind the teeth at the roof of the mouth), either alone or as part of swallowing, according to Paul Wilson in his book “Instant Calm.” Swallowing naturally pushes the tongue against the soft palate.
As part of the autonomic response of crying, throat muscles open the glottis, which controls the opening between the back of the throat (pharynx) and the voice box (larynx). (The autonomic nervous system operates bodily functions, like digesting food and sometimes crying, that you don’t control.)
To prevent food from getting into the larynx while swallowing, the glottis closes—even while it strains to open to allow crying. According to a Quora article, trying to swallow and cry at the same time creates muscle tension in the back of the throat—what feels like a lump, called the globus sensation—and makes it difficult to do either.
Clearing the throat prior to swallowing starts the interruption of the crying mechanism by briefly closing the glottal opening.
Emotions such as sorrow, fear and anger cause several autonomic nervous system responses to stress, all aiming to increase flow of oxygen to the muscles. The heart beats harder and faster to increase blood to the muscles; the lungs breath faster to increase absorption of oxygen into the blood; and the throat and mouth open to increase air intake into the lungs.
The results—panting and heart pounding, and sometimes nausea—are stress reactions that often accompany crying. Also, sadness increases the brain’s secretion of the hormone cortisol to provoke the stress reaction, and cortisol in turn makes the mouth drier and prompts the swallowing reflex to moisten it.
Alternatives for stanching tears include distraction, such as pinching your skin between the thumb and index finger or biting your tongue hard; capturing tears before they fall by tilting your head up slightly to collect tears in the bottom of the eyelids or blinking rapidly to clear tears away; and slowing the breath, which can reduce feelings of stress and control crying.
Psychotherapists suggest that different parts of our bodies hold sadness—flippantly referred to as “issues in the tissues.” The throat, for example, can be a repository of shame about unacceptable tears or of the helplessness and fear of childhood. Dealing with these issues with emotional and physical therapies can reduce inappropriate crying.
One commenter on the Quora article, for example, found respite by practicing believing that crying is important and helpful, rather than shameful, and that others’ negative judgements should be seen instead as reflecting their own issues.
For some people, the trickier challenge may be, not stopping tears at inappropriate moments, but figuring out how to cry when it’s useful—when a family member you disliked dies, or when you are finally breaking up with someone, and you’re already over it but they are hurt and shocked. You need to cry.
Besides the predictable suggestion to think of something sad—death of a pet, someone you miss—what can work is rubbing a menthol product (a vapor rub or “tear stick”) underneath your eyes. The chemicals will slightly irritate the eyes, causing tears to form and making them look red and puffy. Be careful not to get menthol in your eyes.
What’s safer is plain petroleum jelly applied under the eyes and high on the cheeks, making it look as if you have been crying on and off. Other solutions for producing tears involve drying the eyes: for example, holding the eyes wide open by pretending you’re in a staring contest with someone. Hair dryers directed at the eyes can help, as can “tear blowers” that contain menthol, although using drying machines may make fake tears less convincing.
In addition to knowing how to stop inappropriate tears and fake them when necessary, don’t forget about “good” tears—when happy feelings provoke tears of joy.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
MANY BEHAVIORS considered strange or inappropriate, such as hysterical crying, overwrought anger, obsessions, depression and mania, can sometimes be traced to frontal lobe damage, degeneration or disease. But because brain cells cannot be examined directly—and brain imaging is rarely able to detect problems—frontal lobe diagnoses are very susceptible to error.
Such behaviors can be either wrongly attributed to mental illness (and thus inadequately treated) or traced incorrectly to frontal lobe impairment, leading to severe consequences for the sufferer.
“Executive functions”—planning, motivation, inhibition, emotions, and creativity—are behaviors controlled by the frontal lobe. Say, for example, a dental patient, at the first twinge of pain, slugs the dentist. It may be because of an impairment in the part of the brain that would ordinarily inhibit such a reaction, based on the patient’s knowledge that treatment is necessary.
Head trauma, including post-concussive syndrome and traumatic brain injury, is the most familiar cause of frontal lobe dysfunction. In what are known as “deceleration” injuries, sudden impact causes the brain to be knocked powerfully back and forth inside the hard skull. The result, a sort of bruising, can cause brain swelling and bleeding and lead to lasting damage. It can either heal with intense therapy over time—more slowly depending on the victim’s age—or can be irreversible.
Frontal lobe degeneration and disease make for trickier diagnoses. Frontotemporal dementias (FTDs) are the most common forms of dementia in people under 60; and FTDs affect as many people in the 45-64 age group as Alzheimer’s Disease (AD). Early symptoms include “a disregard for social conventions, impulsivity, apathy, loss of sympathy or empathy…poor insight, planning and assessment,” according to the University of California at San Francisco Memory and Aging Center.
Estimates of false positive FTD misdiagnoses range between 50-69%, usually by general practitioners and most often in younger patients who are in fact suffering from depression or alcohol abuse. Average life expectancy is 7-13 years after the first FTD symptoms, so that an individual’s ongoing survival can be the only indication of incorrect diagnosis. Moreover, an FTD diagnosis can make patients vulnerable to others taking control of their care and in some cases obtaining court-ordered guardianships that can be difficult to reverse.
Missed cases—false negatives—of FTD are most often incorrectly labeled AD, Parkinson’s or Huntington’s Disease, or progressive aphasia—the loss of ability to express or understand speech.
Frontal-lobe epilepsy, the second most common form of epilepsy, can also cause emotional symptoms, from sudden fear or a sense that something terrible is about to happen to feelings of anger, range, sudden joy or happiness. Although seizures commonly include movements—grimacing, flailing, bicycling legs—these can occur while the sufferer is completely unaware (called “complex partial seizures”) or aware but unable to move or speak.
A syndrome known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), in which the body’s immune reaction to strep—and possibly other infections like Lyme Disease—attacks frontal lobe brain cells. PANDAS occurs most often in children, but a Beverly Hills psychiatrist reports diagnosing one to two adult cases each week.
The syndrome can cause obsessive-compulsive behaviors, known as immune-mediated OCD, as well as tic disorders (Tourette’s syndrome), which can appear suddenly, sometimes overnight, during or after the infection. Also “children may also become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones,” according to the National Institutes of Mental Health PANDAS fact sheet.
Frontal lobe disorders can be focal, affecting a small area, and can include stroke, Huntington’s Disease, infection and PANDAS. But most are diffuse, creating different clusters of symptoms in individual patients.
The unpredictability and sometimes unknowability of which regions are affected can make impairment difficult to assess and treat. On the other hand, in some cases, deficient executive functions—particularly inhibition—have led to a blossoming of previously unknown artistic talent.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
GENETIC PROFILING can now help select the most effective medications or rule out the riskiest ones for certain conditions—similar to how some use it to select the best diet for weight loss or general health. It may be most worthwhile for people looking for a drug that works well without debilitating side effects.
Pharmacogenetic or pharmacogenomic (PGx) testing exists for some 200 medications to date, including 40 neuropsychiatric medications, with findings often included in FDA labeling. But PGx testing is currently considered essential—reimbursable—for only a handful of drugs.
Unlike genetic testing to help diagnose disease or potential risk of disease, PGx testing can find responses to particular medications. It falls under the umbrella of precision medicine.
Why PGx Testing
Pharmacogenetic testing is standard of care, for example, in the treatment of inflammatory bowel disease. For patients who are “slow metabolizers” (specific IBD drugs stay in their bloodstream longer), prescribing these drugs can have side effects of a “severely depressed immune system and life-threatening infections,” writes Shannon Manzi, director of pharmacogenomic services at Boston Children’s Hospital.
Codeine, on the other hand, is dangerous for fast metabolizers because its effects depend on the body turning the drug into a morphine derivative. For fast metabolizers, that allows morphine metabolites to reach dangerously high levels in the bloodstream. After causing the deaths of four children, the FDA warned physicians to prescribe alternative medications.
“The ultimate goal is to really take out the guesswork,” writes Andrea Gaediqk, head of the PGx Lab at Children’s Mercy Hospital in Kansas City. Determining whether an individual falls at either extreme of the spectrum on the speed of metabolizing a certain drug can guide prescriptions of different dosages or different drugs altogether. “It is mostly patients with these extreme metabolizer phenotypes that benefit from drug dosing that is different than usual.”
At Children’s Mercy Hospital, PGx testing is usually done in retrospect —in the GOLDILOKS clinic—when patients have tried a long list of drugs without success or with challenging side effects.
Codeine, however, is also a prime example of the limitations of PGx testing. Because of the drug’s potential dangers and also because alternative drugs exist for the same applications, large-scale, expensive experiments assessing its effects on different genotypes are considered more difficult and less worthwhile.
What seems like the biggest hurdle to widespread use of PGx testing, though, is the large number of variables that affect an individual’s response to a particular medication, including age, gender, diet, environment, whether someone is a smoker or is pregnant, other medical problems and “most importantly the other medications you are taking (including over-the counter medications and herbal supplements),” writes Manzi.
Some genes strongly affect how medication works, while in other cases, different variables are more influential. Using the analogy of a pie to demonstrate the influences of genetics on a specific drug’s metabolism, Manzi estimates that PGx makes up to 90% of the pie for some medications, while for others it’s “only a tiny sliver.”
Gene Testing and Antidepressants
Treating mental illness in particular relies on a combination of medication, psychotherapy and self-care activities (diet, sleep and exercise) that play a role in mood and how the body responds to medication. Still, psychiatry is an area with “many current applications for pharmacogenetics,” write University of Cincinnati psychiatry professor Melissa Delbello and PGx specialist Olivia Bentley in Pharmacy Times.
“We are tantalizingly close to being able to [use PGx testing] to determine whether patients are more or less likely to respond to a specific antidepressant class,” according to Delbello and Bentley. Fluoxetine was one of the first individual drugs found to be affected by PGx variants. And tricyclic antidepressants, prescribed less often since the development of SSRIs —because the latter generally have fewer side effects—can work well for certain patients with certain conditions, and that can be determined using PGx testing.
Yet another problem with PGx testing is that most genes influence how the body metabolizes not just one class of medications, but many others as well—with different and sometimes opposing effects. For the future, the goal might be preemptive testing of an array of different drugs, so that when a medical condition arises, the risks and benefits are already known. But for aspirin and many OTC paint relievers, PGx testing has not yet been developed.
The Problems
A related downside of PGx occurs when the same genetic variant is related to more than just drug effects. For some cholesterol-lowering statins, genetic variants of the ApoE gene affect the drug response but also influence the risk for Alzheimer’s Disease. In this case, the effect of the variant on the drug response is minimal compared to potential problems for patients who learn their ApoE profile.
Turnaround time for testing is an obstacle in cases where medication is required quickly. Also, most tests are given for only one drug at a time, so that more testing is necessary to add other medications at the same time or in the future. When medical centers and others offer PGx profiling (the price ranges from $250 to $500), it is reimbursed only for specific drugs when the FDA “requires” testing.
An alternative is pre-emptive testing, either for one drug or to provide individual profiles covering many drugs. The Inova MediMap Plus analyzes 25 genes that influence responses to medications in 13 drug categories, including anesthesia, cardiovascular, infection, pain, gastrointestinal and psychotropic. The price depends on how many are tested.
For pre-emptive profiling of either one drug or many, as well as for genetic profiling for disease prediction or diagnosis, a major problem is that ongoing research into different effects of genetic variants means that the profiles can change over time. However, there is currently no efficient way to communicate updates to doctors or patients. “The system is completely chaotic,” Baylor clinical geneticist Sharon Plon told the New York Times.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
AFTER A year-long search for pain relief, DC writer W.C. remembered that TENS (Transcutaneous Electronic Nerve Stimulation), which uses electrical current to treat pain, had been popular in pain treatment and research since the 1970s.
Until about ten years ago, the devices cost thousands of dollars. Most pain sufferers rented them at $200 to $400, sometimes per month, from physicians and physical therapy practices, and there was often a waiting list.
Today, people can buy their own TENS devices for under $100 on Amazon; one of the most highly recommended is the Santamedical PM-470, at $29.95. The devices come with four or more electrodes on small sticky “gel pads,” connected by wires to a TV-remote size controller, with a power source of replaceable or rechargeable batteries.
Based on long-term research, TENS is now viewed less as a cure for pain and more as a useful distraction: the vibrations can interrupt brain signals that are responsible for chronic pain long after the original source or injury has healed.
“TENS is what I call sensation-enhanced placebo,” writes Paul Ingraham on PainScience, “belief [that can be] greatly enhanced by novel sensations.”
(TENS should not be confused with EMS, the placement of electrodes to stimulate muscles, rather than nerves, to contract, which is used both in rehabilitation to prevent muscle atrophy from disuse after trauma, and with the hope of performance enhancement. “EMS feels like doing light isometric muscle contraction exercises,” writes Ingraham.)
For her chronic leg pain with no clear cause, W.C. splurged on the Easy@Home EHE012PRO model ($89.95)— after asking for a recommendation from her physical therapist, who admitted she’d almost forgotten about TENS and that “it might help, temporarily, and couldn’t hurt.”
During sessions on her device that run for 20 minutes, W.C. is distracted by TENS vibrations—at the intensity level commonly recommended, unpleasantly strong but as high as she can bear—a welcome relief when trying to relax, which is when her pain is at its worst.
“Using the strongest intensity that remains comfortable [reduces pain] in healthy subjects; lower intensities are ineffective,” writes University of Iowa physical therapist Carol Vance. “Higher pulse amplitudes are proposed to activate deeper tissue afferents allowing for greater analgesia.” Vance noted that pain relief may be limited by the development of tolerance, as with drugs, to the point of no longer helping at all.
To date, W.C.’s relief has never lasted after the vibrations end. Researchers are currently studying the use of TENS during activity, but W.C. is waiting for the results before trying to cope, even while standing, with the unwieldiness of sticky electrodes that fall off easily and the tangled mass of wires.
Another problem is that her greatest pain occurs on trains and planes, where she can’t imagine rearranging her clothes to apply the electrodes on her upper thighs, much less coping with seatmates’ reactions to the spectacle of the dangling wires attached to a brightly lit controller.
TENS reduces pain by activating opioid receptors in the brain to block pain signals traveling through the central nervous system, explains Vance. On functional MRIs, TENS lowered brain activity in patients with carpal tunnel syndrome and modulated pain-induced activation in the brains of patients with shoulder impingement pain.
Vance describes ongoing research to study TENS when electrodes are placed at acupressure points, and using TENS in conjunction with acupuncture. In a study of post-operative hysterectomy patients, TENS applied at acupoint sites reduced opioid intake, nausea and dizziness compared with using it at non-acupoint sites, Vance reports.
But in Ingraham’s view, pain “is completely controlled by an overprotective brain that likes to sound the alarm too loudly…most kinds of chronic pain are partially and briefly treatable with tricks and hacks and virtually any novel stimulation…[and] anesthesia is the only truly effective analgesia.”
A TENS-related newcomer used to treat migraine headaches is Cefaly, an external trigeminal nerve stimulation (eTNS) unit worn on the forehead (experts caution that regular TENS units should not be used in this way), which offers hope but little evidence to date.
Another tissue-stimulating therapy, with effectiveness also unconfirmed by scientific studies, uses ultrasound, sound waves above the range of human hearing—in other words, vibrations, according to Ingraham.
Ingraham also mentions the option—“if you are eccentric”—of an electric bath, created by running direct or galvanic electric current into the bathtub, which produces smooth sustained muscle contractions but not the more effective vibrations of TENS.
Some TENS devices boast of positive effects beyond easing pain: the Santamedical PM-470 “helps with tiredness, promotes blood circulation, recuperates spleen and stomach, enhances immunity, improves sleep quality and activate circulation for pain relief,” according to the manufacturer.
A worrisome issue with TENS is the tolerance likely to develop over time after repeated application. The hope for users is to have more lasting effects—pain reduction that continues after the vibrations stop—before it becomes too well-tolerated to work at all.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
Holotropic Breathwork: The Latest Wellness Craze?,
iStock
I AM LYING on a foam mattress, wearing an eye mask, with a pillow and blanket, water and tissues by my side. I have a “sitter” to hand me whatever I need, lead me to the bathroom (still blinded by the eye mask) and call for help if I want or appear to need it from one of six trained facilitators. My sitter is Rosie, my good childhood friend who is also a massage therapist and yoga teacher—without whom I probably would never have undertaken such a thing.
For three hours, I work on breathing in the unusual, difficult way that I’ve practiced (at an earlier one-hour session), taking very deep gulps of air into the abdomen, then pushing the air out with strong, loud exhales, and immediately inhaling again—similar to hyperventilating. Inside my mask, I see only darkness and am engulfed by very loud music, moving from fast, intense primitive ritual sounds to slower and quieter, sometimes with lovely women’s voices, sometimes punctuated by groaning, crying and screaming from other breathers.
In the California desert, I am attending a weekend of Holotropic Breathwork, touted to provide relief from anxiety, depression and PTSD as well as psychedelic hallucinations and enlightenment. The remote possibility of achieving these by breathing is an appealing alternative to ingesting anything —LSD, ayahuasca—with the similar goal of “psychedelic therapy.”
While I’m open to ideas about mind-body connections and have dabbled in gentle adventures like flotation tanks, I am too skeptical to try most New Age practices like consuming smelly herbs or doing whatever with crystals.
What helped get me to this breathing weekend was its location in Joshua Tree, where I’d long yearned to go because a favorite musician, Gram Parsons, loved it and died there. I’d had trouble justifying such a long trip and been reluctant to do it alone until Rosie wanted to come, too.
Workshops in Holotropic—from the Greek, growing towards wholeness—Breathwork, also called neurodynamic breathing, were created by Stanislav Grof, one of the 1960s researchers looking into LSD as a therapeutic tool. By 2009, more than 100,000 Americans had participated in these workshops. Decades earlier, Rosie had done Holotropic Breathwork with Grof, which reassured me. Our weekend took place at the Joshua Tree Retreat Center, a collection of aging buildings with a pool, oleander bushes in bloom and one shop that sold crystals and smelly herbs but no snacks to relieve hunger or fatigue.
Among 60 attendees, most were friendly but not insistently so. Some said they hadn’t done “other woo-woo things,” while others had done Holotropic Breathwork several times. Having both groups there comforted me, although I remained wary. Rosie is my only friend who’d ever heard of such a thing. Also, the lingo—“visuals” for hallucinations, “dropping in” for moving away from reality—made me feel as if I’d entered an alternate universe.
Some attendees had brightly colored hair and flowy robes; most were from California. One brought his own bathtub in the back of a truck, which he filled with huge buckets of ice cubes each morning for 10 minutes of cryotherapy (healing with cold) by the pool, after which others jumped in to see how long they could last.
There are several explanations for the effects of deep, fast breathing accompanied by music of specific vibrations. Directing blood flow away from brain structures responsible for rigid thinking and background chatter can allow for the greater “connectivity and ego-dissolution” associated with long-term improvement in well-being.
Reduced carbon dioxide in the blood (caused either by hyperventilation itself or by the brain stem response) has been shown to “modify emotional states,” UCLA neurobiology professor Jack Feldman told Cosmopolitan.
And lower carbon dioxide levels spur a rise in blood pH that can cause dizziness, tingling and “carpopedal spasms, which is basically flapping your arms and legs,” writes Conor Creighton on Vice. “Breathwork adds…after-care and some therapeutic suggestions. Plus, there’s someone to catch you before you fall over.”
Besides feeling skeptical, wary and faintly hopeful, I was a little worried: three hours sounded very long, especially if nothing happened, which was my biggest fear. In my first role as sitter for Rosie, I watched the room full of breathers crying, yelling, flailing, making me both more unsure of my ability to do any of these but also better prepared to try when the time came.
Taking my turn as the breather, I focused on doing it correctly, continuously searching for a better position to allow deeper breathing—on my back on the mattress, then arched over a pillow, then on my hands and knees; then forgot about breathing altogether as I moved around; then remembered to start the breathing again.
What kept coming into my mind was anger and sadness for all the women affected by sexual abuse and for my own difficult experiences—and for the courage it took those women who spoke publicly, which I had never done. These thoughts got me to some mattress pounding and kicking, and then to longing for greater physical strength to fight back, to protect myself, to hurt men who hurt women. At first I punched upwards, which didn’t feel very powerful; then I tried knee pushups into the mattress, strenuously pushing and pulling with my arms.
I liked reacting physically to the horrible trauma affecting women, also to move freely—without the prescribed poses of yoga or Pilates, and with the eye mask to keep me from seeing myself look silly or from watching anyone else for comparison. Another physical effort was trying to warm my toes, which became so cold in the chilly room that I felt sorry for them. But I couldn’t bring myself to make any noise at all.
What brought me to tears was Rosie leading the way to the bathroom as I followed blindly, my hands on her shoulders, feeling the power of friendships, of trust, of touch—of someone taking care of me.
Toward the end of my session, visuals emerged—at first very exciting. With my eyes open but encased in the mask, I looked down from a mountain ledge, surrounded by dark granite rocks, into a valley with lots of little twinkling lights that looked like a town at night—like a 3-D movie. The rocks below me morphed into a monster shape, more exciting, but quickly morphed back into the cliff. I heard bird singing, but despite knowing it came from the recorded play tape, was slightly disappointed to look around and find no bird flying around over my head.
While thrilled to be capable of such a hallucination, after the session I couldn’t extract any meaning from the dark landscape, except maybe death. From the entire experience I wasn’t sure anything significant had happened, though the three hours sped past without me once wondering about the time.
Leaving the room, I felt relaxed and “floaty” (a popular Breathwork adjective), especially in the swimming pool. The desert landscape, the blue sky and the moon and stars all looked sharper and brighter.
Rosie had some helpful thoughts, for example that looking down from a high perch might mean I was getting a new perspective, although I wasn’t sure of what. She had noticed my difficulty breathing and suggested that my general well-being might benefit from a breathing coach. She wondered if that difficulty might be linked to my silence and if both might be holding me back from a fuller experience: “getting unstuck” depends on a combination of breath, movement and sound, Rosie said.
Before the weekend, we spent a few days in Joshua Tree. It was my first trip to the American desert and first view of Joshua trees, unimaginable to me before seeing them. We visited the motel where Gram Parsons stayed and the room where he died, the walls covered with Parsons memorabilia—and heard locals bursting into Parsons’s songs. In Joshua Tree National Park, we took long hikes, which I usually consider arduous and boring but I loved spending time among the Joshua trees and the park’s towering boulder formations. Listening to Parsons after I returned home, the songs sounded better than ever and kept me reflecting on my Breathwork experience.
For now, I am not eager to sign up for more Breathwork sessions, concerned that no location could lure me like Joshua Tree and that I could never match the experience of having my first Breathwork there. Despite being slightly disappointed that my three hours weren’t more dramatic, I also emerged with more trust in my ability to survive such experiences and with more interest in trying what is increasingly popular and available: psychedelic drugs in a therapeutic setting.
On the other hand, maybe I’m “still processing,” which is what many Breathwork participants said. Maybe I’ll crack the puzzle of the granite valley as representing something other than death, or get better at breathing and finding my voice. One- and two-day sessions are offered around the country, mostly on the west coast but also by one of our Joshua Tree facilitators, Sharanya Naik, in New Jersey.
Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter reports on health news we can use.
AT HER once-every-several-years eye exam, Paris journalist C.N. learned she had elevated intraocular pressure (IOP), called intraocular hypertension, although she had no symptoms—like red eyes —and no new difficulties with vision.
Anyone with a diagnosis of elevated pressure – 21 mm Hg. or higher— gets the label “glaucoma suspect” after two findings of IOP and no evidence of optic nerve damage or vision loss.
Of every 100 people older than 40, about 10 will have pressures higher than 21 mm Hg,. but only one of those will develop glaucoma. Both elevated IOP and glaucoma become more prevalent with age. The recommendation is for those over age 65 who have intraocular hypertension to keep pressures below 25 mm Hg.
Intraocular pressure can also be elevated in individuals with low blood pressure, or pressure lowered by taking medication for hypertension (high blood pressure), which can make it more difficult for blood to reach the eyes to supply oxygen and nutrients, and to remove waste.
What’s confusing is that as many of 40% of those who develop glaucoma have eye pressures in the normal range. And even patients who have glaucoma along with elevated eye pressure have readings in the normal range about one-third of the time. “Clearly while eye pressure is important in glaucoma, it does not explain why glaucoma develops in all patients,” according to the Glaucoma Research Foundation.
Glaucoma is diagnosed after examining the optic nerve with pupils dilated; and after assessing peripheral vision—usually using the Humphrey visual field test, which consists of a center fixation light and blinking test lights off to the side.
Intraocular hypertension can also indicate problems in the eye’s drainage system—an imbalance in the production and subsequent draining of fluid in the eye’s aqueous humor. Drainage problems are detected using a special contact lens and a technique called gonioscopy to examine the drainage angles (or channels) in the eyes.
Compared to adding water to a water balloon, increases in intraocular fluid—especially if the channels are obstructed—causes pressure inside the eye to rise, and that can damage the optic nerve. In a small percent of people with ocular hypertension, veins in the retina become blocked, leading to vision loss.
Elevated IOP without detectable signs of glaucomatous damage occurs in 4 to 10% of the U.S. population, but these individuals have only a 10% risk of developing glaucoma over five years. This risk can decrease by 5-50% with medication, usually eye drops—and is expected to go down below 1% with improved techniques to detect damage before vision loss occurs.
Besides those with higher risk of glaucoma because of family history, studies disagree on who is at greatest risk: some say women, some say women after menopause, and some say men. Glaucoma in African Americans occurs earlier and progresses faster than in the rest of the U.S. population.
Risk of glaucoma also changes depending on the specific level of intraocular pressure —from as low as 2.6% for those with pressures 21-25, to above 10% for those with pressures 26 to 30, and about 40% for those with pressures over 30 mm Hg.
Pressure is assessed using “tonometry,” based on measurements taken for both eyes more than once because pressures vary from hour to hour and at different times of day. A difference in pressure between the two eyes of 3 mm H. or more can suggest glaucoma.
While some ophthalmologists prescribe eye drops when the IOP is higher than 21 mm Hg., most wait until pressures are consistently higher than 28-30; or in cases where there is optic nerve damage or symptoms like halos, blurred vision or pain. For eyes that cannot tolerate medications, laser surgery is an option but usually not recommended because its risks are higher than those of developing glaucoma from IOP.
Having thin corneas increases the risk of glaucoma due to IOP. But while those with thicker corneas, including C.N., may be at lower risk, they are also more likely to get falsely high IOC readings—when their pressures are in fact lower and normal. C.N. has the added problem of being “so myopic,” which her doctor said makes it more difficult to assess her optic nerve.
With a reading of 23 mm Hg, C.N.’s doctor started her on eye drops. Afterwards, on her own, C.N. went to an osteopath to “loosen up her neck, head and maybe eyes,” and took a few drops of cannabis tincture to help sleep. After a week of these measures, her pressure dropped to 17. She continues to use the eye drops, awaiting further results.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.
WHEN SOMEONE says they’re having a panic attack, a bystander’s first response must be to believe them —that they are not feeling anxious in ways a typical person can relate to, but in serious trouble and in need of the right help.
Most important for the bystander: remain low-key and don’t go away, because most panic attacks ease up in 20 to 30 minutes. Says DC school aide and artist A.M. “You feel so vulnerable and so embarrassed that you don’t want to be around other people, but it’s not good to be alone either.”
During a panic attack, the body “prepares for the pseudo-emergency…eyes may dilate to improve vision, heart rate quickens to circulate blood faster to vital organs, breathing increases to get more oxygen to the circulating blood, and your muscles tense in case you have to move quickly.” Hyperventilating can lead to dizziness and heart palpitations, which in turn cause some to panic more.
What’s known as “5-4-3-2-1” is a tool that bystanders can use to ratchet down the panic, a series of prompts for the sufferer to focus on and name out loud nearby sensory stimuli: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and one thing you can taste. “These five steps are a way to ground yourself in the NOW…take you out of your head.”
Use specific examples: 5 things you see might include something blue, or something huge; for things you can touch, try your feet in your shoes or the ring on your finger, according to The Independent, which calls the sequence a “mindfulness hack [that] helps bring us back to the present.” The thing you taste can be your tongue.
For A.M., 5-4-3-2-1 required “lots of practice— for months to be able to step out of my body.” When practicing, she went first to touch, such as rough surfaces, and then smell. But in real situations, she likes to start with sight, especially numbers, like apartment numbers, or letters. Touch is still #2, and then hearing: “because everything is super loud: breath, heartbeat…”
The right help for sufferers does not include rational explanations for their feelings of fear: in their minds, they are threatened, and sometimes they are dying. Also unhelpful: telling them to “calm down.” Both responses invalidate the experience, said A.M. And suggesting calm breathing is usually a bad idea, “because panic attacks mean you are struggling to breathe at all.”
You’re stuck in your head, as A.M. describes it, so what helps is connecting to reality, or at least being distracted. After 5-4-3-2-1, talk about anything that might interest the sufferer, like a TV show they’re watching.
For her boyfriend, O.D., who also has panic attacks, meditation—focusing on breath, sound and then touch—works well. “It’s important not to move, just sit there,” he says. For those who prefer this option, practice is also advised—daily for 10 minutes or so—both to help reduce frequency of panic attacks and make them easier to conquer.
A.M. compares her panic attacks to being on a roller coaster: you can see you’re heading for the top, but when you get there you stop. You’re stuck. For her, the anticipation is terrible—”feeling the dread of it coming—even if the waiting only lasts 30 seconds: I can’t talk, I feel like I’m drowning.” She worries about going to the Giant—and used to avoid taking subways—fearing a panic attack would start and she wouldn’t be able to get out in time.
Fear induced by phobias is similar to that with panic attacks; the difference is those with phobias can see their specific trigger (spiders, vomit, open spaces or airplanes, for example), while people who have panic attacks cannot. Although both groups live with ongoing anxiety about having the next attack, those with phobias are on the lookout for their triggers. For panic attack sufferers, symptoms can spring up with no warning and sometimes no apparent reason.
Both groups, however, can find relief in having another person present to help with grounding and distraction, to accompany them through 5-4-3-2-1 when it helps, and to wait with them until symptoms subside.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.
“HI, GUYS, welcome back,” whispers a young blonde woman in an extremely close-up video shot on the first episode—”The Internet Whisperers”—of Netflix’s documentary series, “Follow This.” She swishes her tongue back and forth, then rubs, licks and sucks what look like white ceramic ears, creating an effect somewhere between seductive and disgusting.
But susceptible aficionados feel something different: a tingling sensation that begins on the scalp and moves down the spine and sometimes through the arms and legs. It’s called ASMR, which stands for Autonomous Sensory Meridian Response. ASMR has helped people with sleep, stress, anxiety and depression.
“The Internet Whisperers” reports on a genre of online streaming videos that has exploded in recent years, with viewers over the past year up from 5 to 11 million, and hundreds of ASMR videos posted every hour. In this first episode, Buzzfeed News culture reporter Scaachi Koul investigates ASMR, both on videos and in person, and has what she ultimately concludes was “the most complicated experience I’ve ever had…I don’t know if that was the worst thing I’ve ever done or the best, it could have been both.”
ASMR is elicited by watching or hearing other people whisper, tap, brush hair, brush other surfaces, close and open boxes, turn pages, crinkle paper, even eat —with a recent surge in ASMR food shows highlighting sounds over recipes. One video of a woman eating pickles has attracted more than 5 million viewers.
The doyenne and maybe most-watched Internet ASMRtist, Maria, has garnered half a billion views on her YouTube channel GentleWhispering since she started in 2011 role-playing soothing cosmetologists, librarians and flight attendants, but mostly appears as herself.
“I try to be nurturing, almost a motherly figure,” Maria told “Follow This.” Tracing ASMR’s popularity to increased stress and insomnia in today’s culture, she says: “Our main concern is a viewer’s sleep.”
“People who have insomnia are in a hyper state of arousal,” Columbia University sleep disorders expert Carl Bazil told the New York Times. Grouping ASMR with other behavioral treatments for insomnia such as progressive relaxation, Bazil suggests ASMR videos might be another way “to shut your brain down.”
ASMR has been compared to a sensation called musical frisson, a ripple of chills or goosebumps in response to music, studied by Montreal neuroscientist Robert Zatorre, who found a corresponding increase in the brain’s dopamine activity.
On functional MRIs of 22 relaxed subjects, those who reported experiencing ASMR showed differences in their brain networks compared to typical controls, in studies by University of Winnipeg psychologist Stephen Smith and colleagues.
In the first group, unusual areas of the brain, specifically those related to vision, were activated as part of what’s called the brain’s “default mode network”—structures along the brain’s midline that fluctuate together when people are daydreaming, and during altered states of consciousness, such as psychedelic experiences. In the first group, too, there was more blending of different brain networks compared to the controls.
Personality studies of the two groups found those with ASMR “more open to new experience, also more neurotic with a greater level of emotional instability and less agreeable,” said Smith, noting that “at this point it’s a lot of speculation.”
Of 475 self-reported “tingleheads,” 75% said whispering was an effective trigger and a “sizeable majority” of these said they watched ASMR videos to help them sleep and cope with stress, according to University of Wales psychologists. Despite the reputation of ASMR videos being used for “braingasms” and “whisper porn,” only about 5% of subjects said they chose ASMRotica with sex as their goal.
Early reports of ASMR surfaced around 2007. While considered the first psychological phenomenon discovered by internet users, ASMR also appears in audio recordings, such as the episode “A Tribe Called Rest” in the 2013 “Tribes” series on NPR’s “This American Life.” By 2014, nearly 2.6 million YouTube videos depicted ASMR.
In addition to earlier books on the topic—including an Idiot’s Guide to ASMR published in 2015—Brain Tingles by ASMR guru Craig Richard, professor of biopharmaceutical sciences at Shenandoah University in Virginia, came out in September, 2018. Richard, founder of ASMR University, a clearinghouse website with interviews and blogs related to ASMR, has been conducting an online survey with tens of thousands of responses so far and one early conclusion: the intimate experiences offered by ASMR may trigger feelings of being loved.
Richard addresses the possible connection of the tinglehead to what is often called the Highly Sensitive Person—individuals in the 15 or 20% of the population with different atypical sensory sensitivities, called “sensory processing sensitivity” or “sensory integration disorder.” In fact, this group might have the most negative reactions to ASMR stimuli, including misophonia, a strong dislike of one or more particular sounds, which can provoke anything from mild anxiety to rage.
Many ASMR enthusiasts like the anonymity of viewing or listening to stimuli—characterized as “intimacy without vulnerability” by the creators of the Brooklyn N.Y. Whisperlodge, which offers a “sensory journey of live ASMR.” During her visit, Buzzfeed’s Koul watches the two Whisperlodge creators together brushing a client’s naked back in synchronized movements. Afterwards, Koul is given a short simulated clinical exam, as if she’s at a doctor’s office. Watching such an exam (probably mostly because of the touching) is the subject of many ASMR videos.
To critics, the very close-up face shots of these videos create artificial intimacy. While Maria (of GentleWhispering) believes that artificial intimacy is not better, she believes, “if it helps someone, it helps someone, that’s the bottom line.”
Koul’s conclusion after her Whisperlodge experience: “Everyone is entitled to a little one-sided intimacy once in a while.” She suggests, in a soft voice, “The Internet may be introducing intimacy back into our lives one gentle whisper at a time.”
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.
PHILADELPHIA PAINTER J.C. had a minor cut that never “scabbed over completely” until a dermatologist diagnosed eczema as the underlying reason for delayed healing. Another wound remained open eight weeks after laser surgery to remove a small, potentially cancerous bump on his ankle, despite using mupirocin and a “cohesive” bandage, and staying out of the water as prescribed.
DC writer M.W. had a small cut on the bottom of her foot that wasn’t healing but didn’t hurt, although when she admitted to some loss of feeling in her feet, the doctor reacted quickly with a tetanus booster, prescriptions for Bactrim and mupirocin ointment, and instructions to swim only in salty or chlorinated water—no ponds or lakes.
You have a cut or a burn or a sore—or in rare cases, an injection site—that isn’t healing, and the weeks pass. You started off doing all the right things: cleaning it with soap and running water—not peroxide or iodine because these can irritate the wound and delay healing; applying antibiotic ointment; and covering with a bandage. And to stop bleeding, applying pressure.
For a wound that is large, deep, won’t stop bleeding, or is on your face or over a joint, stitches can help speed healing but must usually be done in the first eight hours after the injury before bacteria has a chance to enter the skin and before the body’s own healing response begins.
Common signs that a wound is becoming infected are the skin becoming redder or more painful, or the sore becoming warm, swollen or oozing. More serious indicators are chills or fever over 100 degrees and red streaks near the wound.
Infections occur more often in people over 60 and more often in men due to their lower estrogen levels. Besides hormones, other factors are reduced immunity, use of many medications, inadequate nutrition and general stress. Non-healing wounds affect between 3 and 6 million people in the U.S.; those 65 and older account for 85% of them.
The most common cause of infection is healthy bacteria living on the skin’s surface—notably staphylococcus, present on the skin of 90% of the population—that enters the body. Even for wounds that start as small cuts, healing can be too slow to keep bacteria out.
Recent cases of infections following intramuscular injections of vitamins, non-steroidal anti-inflammatory drugs and other pain-killers have been traced to staphylococcus, atypical mycobacteria, E. coli and Clostridium species (like C. diff). These are deep-muscle infections that can be notoriously resistant to treatment. Causes are inadequate cleaning of the skin with alcohol prior to an injection; also alcohol doesn’t remove all forms of bacteria.
Atypical bacterial infections are also associated with cosmetic and plastic surgery and also occur more often in older populations, with South Florida identified as a high-risk area.
For slow-healing wounds, the main worry is MRSA, methicillin-resistant Staphylococcus aureus bacteria, which can invade even minor skin problems such as insect bites, but more often arises as painful skin boils and spreads via skin-to-skin contact. In addition, for mupirocin, the antibiotic ointment most often prescribed to protect against MRSA, resistance can develop after about 10 days.
The most dangerous outcome of infection is sepsis, most common in those over age 65 though it can occur at any age. It is often undiagnosed because of general unfamiliarity with the symptoms: chills or fever, extreme pain, clammy or sweaty skin, shortness of breath and a high heart rate. Sepsis develops when the body mounts a response to infection that overwhelms the organs, impedes blood flow and lowers blood pressure. It is the contributing factor in up to half of all hospital deaths.
Chronic wounds—those failing to heal after three months—are more common over age 60 for the same reasons that infections more often afflict older adults. Among nutrition issues, low-carbohydrate diets can include too little vitamin C.
Allergic reactions, such as contact dermatitis, are another cause of delayed wound healing. Set off by topical medications such as antibacterials and antiseptics, it is common with advancing age due simply to more years of exposure to multiple allergens. “Atopic”—meaning allergic —dermatitis such as eczema can increase the likelihood of skin infections; in turn, treating the eczema can also heal the wound.
Slow healing can also be traced to systemic problems, most often diabetes and heart disease; also to peripheral neuropathy, in which impaired functioning of sensory nerves reduces the immune defense mechanisms.
Treatment for non-healing wounds usually includes a broad-spectrum antibiotic such as Bactrim and a topical ointment like mupirocin, as well as an updated tetanus shot. For severe skin lesions, especially among diabetics, a newer option is the allograft – a graft from a non-identical donor — created using placentas donated after women give birth, which is injected or surgically transplanted.
For stubborn non-healing wounds, the general advice includes heat and elevation three to four times a day. The main lesson, though, is to pay attention and don’t hesitate to seek medical attention for suspicious signs and wounds that simply last too long.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.
A NEW YORK art curator in her 60s was a runner until numbness in her feet and legs caused her to stumble and fall. DC writer M.W. began experiencing similar numbness following a short but intense bout of Lyme disease, which led to her stumbling and falling, as well as causing her not to feel pain from a injury or notice a foot infection.
Most people learn about peripheral neuropathy (PN), a neurological condition that affects 25 to 30% of Americans —some 20 million—only when they, or a friend, experience symptoms including numbness, tingling, pain burning sensations, loss of coordination or reflexes and the feeling of wearing socks and gloves when you are not.
“Idiopathic peripheral neuropathy” accounts for about 25% of the conditions. Idiopathic indicates that the cause is unknown, particularly to distinguish these from the 30% or so of neuropathies caused by diabetes and affecting almost 70% of diabetics.
Peripheral nerves include both sensory nerves, which carry messages about perception—for example, of touch, heat or pain—from the extremities up the nervous system to the brain; and motor nerves which send signals in the opposite direction telling muscles to move.
Sensory neurons in the skin respond to pain and temperature changes while those in the muscles respond to pressure, but these nerves and their functions are intricately intertwined, which is why sensory loss can disturb motor performance. Problems with these receptors can cause neuropathic pain from damaged nerves; hyperalgesia, heightened sensitivity to pain; and phantom limb syndrome. More than 100 different types of peripheral neuropathy are classified based on variables like cause and type of nerve damage.
Risk of PN increases with age, most commonly after age 60, and the condition is more common among Caucasians and men, as well as among people working in professions that require repetitive motions.
Carpal tunnel syndrome (CTS) is unusual among neuropathies because it affects only one nerve. Considered a “compression neuropathy,” CTS results from pressure on the nerve due to repeated stress or narrowing of the nerve space. Especially if identified early, CTS often responds to treatment.
Longer-lasting neuropathies can be caused by infections: viruses such as herpes, and bacteria such as that responsible for Lyme disease. In one study, after an average of six years following treatment for Lyme, 34% of patients had symptoms that included neuropathy. Linked to Lyme disease, Bell’s palsy results when a facial nerve becomes swollen or inflamed, although it has also been linked to upper respiratory infections as well as diabetes and pregnancy.
Spinal stenosis, or narrowing of the spine, especially in the lower back or lumbar region, can put pressure on the spinal cord and nerve roots to cause neuropathy, most commonly in the sciatic nerve.
Neuropathy can also be hereditary—most commonly as a symptom of Charcot-Marie-Tooth disease—which causes weakness in the foot and lower leg muscles, and related to autoimmune disorders such as Guillain-Barre syndrome. Also linked to PN are medications, including chemotherapy drugs and statins, used to lower cholesterol; alcoholism; and exposure to toxic substances such as heavy metals.
Treatment for PN usually starts with neurologic tests, mainly to rule out a brain tumor, such as the electromyogram and nerve conduction tests —both to assess nerve and muscle function, and to measure electrical properties of the nerves to pinpoint which ones are involved. A spinal tap or lumbar puncture can help identify infection that might be associated with neuropathy.
Early treatment is important because peripheral nerves have a limited capacity to regenerate and can at least stop progression of the condition. Conservative measures include hot/cold therapy (alternating cold packs and hot pads), physical therapy, low-impact activities and OTC medication like aspirin or ibuprofen to relieve pain and inflammation.
Medication, such as steroids, local anesthetics and opioids, can also be given via injection into the area near a nerve. Reducing irritation can help the nerves heal enough for the patient to take on more active physical therapy and higher-impact physical activity.
For the art curator, after surgery to relieve compression on the nerves in her spine, numbness was replaced by tingling, which her doctor considered a sign of improving nerve function and gave her hope, if not for running, then for playing tennis again soon.
While tingling sensations usually indicate pressure on a damaged nerve, doctors believe these can also be a sign of regeneration, suggesting the presence of young axons in the process of growing.
M.W. felt lucky her neuropathy was limited to numbness, without the tingling or pain that plagued others. And there was one benefit—a clearly sprained toe didn’t hurt. On the other hand, she was unhappy to hear her son’s recommendation as she wobbled near the end of a long walk on uneven terrain, “Mom, have you thought of using a cane?” But when a small cut on the bottom of her foot became infected without her knowing—because there was no pain—she began to worry.
After trying acupuncture and several physical therapy practices, M.W. moved to a physical therapy practice based in Pilates theory and movement, which seemed to help. She still hopes the cane is a long way off, although “walking sticks” have started to look more appealing.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.
BY SUMMER’S END, even with the best protection, your skin may have simply had too much sun. Sunscreens aren’t always up to snuff, mostly because people generally put on one-third to one-half of the very thick application used for establishing SPF and then fail to reapply as often as advised.
Hovering in the shade is unreliable, because UV light reflects off surfaces and sunlight is more scattered on cloudy days. And those nasty UV rays can reach below the water’s surface and even penetrate glass windows.
Short of staying indoors for the prime sun hours between 10am and 4pm, the right clothes can help—and they can’t be applied incorrectly: compared to sunscreen, a shirt is either on or off. But while dark-colored jeans offer excellent protection, a white T-shirt falls near the bottom of the list —even lower when wet or worn.
The most important variable is coverage: the more skin covered, the better—long sleeves, long pants, wide-brimmed hat and wrap-around sunglasses, according to the Skin Cancer Foundation (SCF).
UPF (ultraviolet protection factor) is like SPF but for clothes; it measures the amount of UV radiation that penetrates fabric and reaches the skin. While UPF refers to the burning ultraviolet B rays, a shirt that blocks UVB will also block most UVA, while a high-SPF sunscreen filters only UVB, unless labeled broad-spectrum. (UVA rays are linked to skin cancers.)
A UPF rating of 50 means 1/50th or 2% of the sun’s UV rays get through to the skin. Most cotton T-shirts have a UPF of 7 for white—down to 3 when wet—and 10 for darker colors. Indigo denim jeans clock in at 1,700—a complete block.
To win the SCF’s Seal of Recommendation, fabric must have a minimum UPF of 30. While a UPF of 30-49 offers “very good protection,” 50+ is “excellent.” Fabrics that are light colored, lightweight and loosely woven give the worst protection, and sun protection is reduced when clothing is tight or stretched out, if it becomes damp or wet, or after it’s been worn and washed too many times.
For fabric choices, the “most important single protective factor of fabrics is…weave density – i.e., how much of the fabric is actually fiber and how much is open space, through which UVR can pass,” according to the SCF. The tighter the knit or weave, the smaller the holes and the less UVR can get through.
Studies done in Australia found lycra/elastane fabrics were the most likely to have UPFs of 50 or higher, followed by plastic, nylon and polyester. And REI’s Expert Advice page advises that “Cotton, rayon, flax and hemp fabrics often score low without added treatments.”
On the other hand, unbleached cotton and linens can act as “high absorbers.” And even thin satiny silks can be highly protective, like high-luster polyesters, because they reflect radiation, according to the SCF.
Protective design features include high neck coverage; longer sleeves; and a double layer of fabric at the shoulders, a high UVR exposure area. Hats made of tightly woven fabric are better than canvas or straw, and a brim wider than 2-3 inches is advised—especially compared to the narrow protection afforded from baseball caps.
Darker colors are more protective because they absorb more UV rays. Dark blues are best, reds are good and yellows the worst, leading to the advice: go for loud. Experts suggest darker-colored clothing as a significant factor in protection, also as lower-priced options compared to specially labeled sun-protective fabrics.
“Clothing should be your first choice for reducing UV exposure,” states the Environmental working Group. “For everyday use, most clothing without a UPF label can provide adequate sun protection.”
New Jersey dermatologist Naomi Lawrence agrees, telling the New York Times: “When it comes to sun protection, you really can’t beat a dark shirt with a tight weave and a good hat.”
Clothing can also be made sun-protective by adding sunscreen chemicals, such as tinosorb, titanium dioxide and zinc oxide. An alternative is “washing” similar chemicals into clothing. SunGuard contains tinosorb, which lasts through dozens of washings. The Environmental Working Group advises against wearing chemically treated clothes.
High-tech clothing offers sun protection up to 50+, but it can be impossible to find out whether an item has been treated with chemical sunscreens or if it instead relies on fabrics of protective weave and colors and/or designs offering good coverage. (Investigating one REI item with a high sun-protection rating failed to turn up any relevant information.) Meanwhile, options are proliferating: Amazon’s sun-protective products number close to 25,000 and include a wide assortment of clothes.
For swimmers, rashguards improve every day, with the full-zip models easiest to put on and take off. To be reliably protective, the UPF for these should be 50+ because UPF decreases when wet.
As with sunscreens, though, experts worry about high-UPF attire creating a false sense of security. The best advice—even when applying sunscreen and wearing protective clothing: keep an eye on the clock to minimize exposure during the hours of strong sunlight.
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on the latest health news.
THINK THE acronym FAST to identify the most common symptoms of a TIA (transient ischemic attack). Although the risk of having a stroke more than doubles each decade after age 55, nearly one-fourth of strokes occurs in those under 65.
Each letter of FAST (remember face, arm, speech and time) stands for a warning sign or course of action. F is for drooping face (check the smile); A for arm weakness (raise both arms and compare); and S for speech difficulty (repeat a simple sentence like “the sky is blue”).
The best outcome of such signs is the diagnosis of a TIA, sometimes called a mini-stroke or warning stroke. In the case of a TIA, blood clots that block arteries are naturally dislodged or dissolved, leaving no injury to the brain. But anyone with these signs, however brief or minor, should go directly to the ER.
T is for time, because the 911 call should be made immediately and include both the words “I think…stroke” and the time of the first symptoms. TIAs can last less than an hour and sometimes as little as one minute, though symptoms can endure for up to 24 hours.
Time is crucial because, if the incident is in fact a stroke—meaning that blood flow is not restored quickly enough to avoid injuring brain cells—the best treatment is the extremely time-sensitive TPA (tissue plasminogen activator) to dissolve clots.
TPA, known as a thrombolytic agent, must be given within three hours—in some eligible patients up to four and a half hours—to minimize damage. Before TPA can be given, intravenously, for most patients a non-contrast CT head scan and glucose test are required.
Other important sudden signs are weakness or numbness especially on one side of the body; trouble walking, dizziness, fainting or loss of balance; severe headache; and abnormal sense of taste or smell.
Problems with speech, called dysphasia, include difficulty recalling words, saying words or understanding words. They are often the only symptoms of a TIA and indicate that the blockage has occurred in the dominant brain hemisphere.
Visual disturbances, called transient monocular blindness or amaurosis fugax, cause the vision in one eye to become suddenly dim or obscured, and things can look gray or blurry. Exposure to bright light can make symptoms worse, and reading words on a white page can be impossible.
Anyone (no matter the age) with any of these signs should be evaluated for a possible stroke. Of the 10 or 15% of strokes occurring in people age 45 and younger, one in seven was misdiagnosed as vertigo, migraine, alcohol intoxication, inner ear disorder or other problems—and the patient was sent home without proper treatment, writes Jane Brody in the New York Times.
Of all strokes, 85% are traced to a blood clot and labeled “ischemic”— caused by an inadequate supply of the arterial blood responsible for transporting oxygen, vital to cellular survival, to organs like the heart and brain. Obstruction of arterial blood flow can also be created by diseases such as hypertension; atherosclerosis, narrowed arteries caused by the buildup of fatty deposits called plaque (carotid artery disease occurs when arteries in the neck are blocked by plaque); and diabetes.
Although TIAs cause no damage, they are most aptly called “warning” strokes because about one-third of people who experience a TIA have a more severe stroke within a year. DC-area residents can breathe more easily than some: the highest rates of death from stroke occur in the “Stroke Belt,” in the southeastern U.S. and Mississippi Valley.
When TIA or stroke is suspected, initial tests check for risk factors: high blood pressure—the most important one for stroke; high cholesterol levels; diabetes; and high levels of the amino acid homocysteine, which can increase odds of a blood clot.
Further assessments are made using ultrasound on the carotid arteries to show narrowing or clotting; MRI and CT scans as well as arteriography, with or without contrast, to look at the brain and to evaluate the arteries; and one kind of echocardiogram for clearer, more detailed images.
For both TIA and stroke, the most common prescription is anti-platelet drugs, most often aspirin or preparations containing aspirin. Anticoagulants like heparin can affect clotting-system proteins but require careful monitoring. (Confusingly, anti-platelet drugs like aspirin are often referred to as anticoagulants.) Surgery to clear fatty deposits or widen narrow arteries can help prevent future attacks.
But the best prevention, besides not smoking, is to keep blood pressure down. A recent study of almost 1,000 adults, average age 68, was stopped early because of such clear benefits of a target pressure of 120 mm systolic (the top number) or less.
In the brain portion of the study, called SPRINT-MIND, the group receiving this intensive approach also had a 19% lower rate of new cases of MCI (mild cognitive impairment) and a subgroup had significantly less increase in white brain matter lesions—an increase associated with normal aging and with a higher risk of stroke, dementia and higher mortality.
According to the American Heart Association, every rise of 20/10 mmHg above 115/75 mmHg doubles the risk of cardiovascular disease —and the recommendation is to treat pressure at and above 130/80 mmHg.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on the latest health news.
RAISING TEACUPS from saucers or spoonfuls of soup or cereal from bowls are challenging for hands that shake as they move, most likely caused by Essential Tremor (ET)—not Parkinson’s Disease (PD), which shares the rhythmic trembling but usually occurs in the body at rest.
Essential Tremor—previously called familial tremor, benign essential tremor and hereditary tremor—is the most common movement disorder, affecting an estimated 10 million Americans. Katharine Hepburn was a famous sufferer.
“To drink without using both hands” was the greatest wish of Tim Dobbyn, a 60-year old writer who lived with ET since age 9 before trying an experimental surgery for ET, he told NBC news.
Handwriting by someone with ET tends to be large and tremulous—rather than slow and very small as in PD. While dopamine is depleted in Parkinson’s —it’s visible on brain scans—that is not so with ET. For sufferers of both, though, tremors can be made worse by anxiety, stress, fatigue, physical exertion and fever.
Essential Tremor is often associated with a family history, most commonly begins after age 40 and can range from mild to disabling. It can interfere with eating and drinking as well as activities like writing and shaving; and cause dangerous behaviors for sufferers such as throwing objects or hitting themselves or others very hard. Head, voice, face, tongue and other body parts can be affected by the tremors.
Even for those whose worst moments occur with jiggly teacups and wobbly spoonfuls, ET sufferers live with an ever-present risk of difficulty and embarrassment, along with stress that comes with knowing such “action tremors” might occur —stress that can make the tremors worse.
(Tremors can also be caused by neurological disorders, such as MS and other movement disorders such as dystonia; or as a side effect of drugs, such as asthma medication, amphetamines, corticosteroids, and drugs used for psychiatric and neurological disorders like Thorazine and Mellaril.)
The most common treatments for ET are drugs such as propranolol, a beta blocker and the only FDA approved drug for ET; and primidone, an anti-convulsant, but these don’t work effectively for many patients. Another treatment is deep-brain stimulation, which requires brain surgery to implant a battery-powered device that delivers electrical stimulation to parts of the brain controlling movement.
The newer method tried by Tim Dobbyn focuses some 1,000 ultrasound beams, guided by magnetic resonance imaging, to heat—from 98 to 130-140 degrees—and destroy a very small section of brain tissue in the thalamus. Weill Cornell neurosurgeon Michael Kaplitt compares the effect to using a magnifying glass to focus sunbeams that can heat and even burn leaves or paper—similar to what the boys did with Piggy’s thick eyeglasses in Lord of the Flies.
During surgery, the patient remains awake and is checked regularly, for example, given handwriting samples, to assess progress. Although the procedure is still performed on only one side, in experimental cases, patients who received bilateral treatments had significant improvement with no significant adverse effects.
Since its FDA approval in 2016, focused ultrasound has provided significant lasting improvement in most patients but is still not reimbursed and can cost around $25,000 for each side of the body. Eleven days after the surgery, Dobbyn held a wine glass by the stem and drank with confidence, and he moved around his house much more easily.
But most ET sufferers simply live with their tremors, and many suffer alone. “Other than my mother, I thought I was the only person with this condition. It was confusing, embarrassing and frustrating,” one sufferer wrote anonymously to the International Essential Tremor Foundation.
Another ET support organization is the Diann Shaddox Foundation for Essential Tremor. Both foundations raise money for ET awareness, anti-bullying programs and suicide prevention as well as for research grants.
—Mary Carpenter
Every Tuesday Mary Carpenter reports on the state of our well-being, giving us the download about new shingle shots, lyme disease, chemical additives in food, psychedelic therapy and strength training.
YOU HAVE a cold, the flu, or anything that leaves you with a cough, but the cough keeps going, week after week. You cough, pop cough drops, blow your nose, cough, try Mucinex or Claritin, even the 24-hour Claritin that usually dries you right up, and you still cough.
You can hear noises coming from your chest or feel something down there, suggesting that whatever you had is lingering. The common villain is swollen and oversensitive airways—nose and throat—caused by the cold virus and by the body’s attack on the virus. Usually called postnasal drip or mucus cough, the cough can take weeks to clear up.
Another category of lingering coughs is post-inflammatory bronchospasm—caused by tightened airways that restrict air flow—which resembles asthma, George Washington medical faculty internist Matthew Mintz told the Washington Post. This cough is often worse at night and can cause shortness of breath, especially during exercise. Although it’s not asthma, bronchodilators and/or steroids can help.
With airways raw and irritated following a cold, bacteria can invade more easily, causing sinus infections and bronchitis as well as pneumonia—mainly signaled by fever and pain along with the cough.
For detecting pneumonia, sputum color turns out to be unreliable. But two medical devices that can help, if you happen to have one on hand, are the “pulse-ox” and the stethoscope. The definitive test is a chest x-ray.
The pulse-ox (short for pulse oximeter) is a little finger clip that tests the percent of oxygen in red blood cells. With healthy oxygen levels starting around 95%, anything lower can suggest pneumonia, but the pulse-ox shouldn’t be used alone to rule it out. According to a British study led by Michael Moore, primary care researcher at the University of Southampton, nothing replaces clinical judgment, but the pulse-ox can “help pick up pneumonia” when clinical signs are unclear.
In the study of 28,883 patients with signs of infection in the lungs, such as a cough, of 720 who went on to receive chest x-rays, 115 had pneumonia. Of the 115, 86.1% had exhibited at least one of these signs: a temperature higher than normal, pulse rate over 100 beats/minute and oxygen saturation in the blood less than 95%.
The fourth sign is crackling sounds in the lungs—at one time the cornerstone of clinical diagnosis —which can be detected using a stethoscope, and sometimes by having someone lean their ear against your back.
Symptoms of pneumonia include fatigue, sweating or chills, lower-than-normal body temperature, chest pain and shortness of breath. Most pneumonia can be spread easily by coughing and sneezing, and by just breathing. Community-acquired pneumonia refers to that affecting people who have little contact with healthcare—who have not been in hospitals, clinics, etc.
Pneumonia can be mild to life-threatening, depending on age and general health and also on the type of germ—the complicating factor. Pneumonia most often is caused by a virus, which can be treated with antiviral medication, but often improves in one to three weeks with no treatment at all.
Pneumonia that can be treated with antibiotics include cases caused by bacteria, including strep, staph and legionella, and by bacteria-like organisms such as mycoplasma pneumonia—sometimes called “walking pneumonia.” A rarer cause is fungi.
A different cause of persistent cough, which even doctors rarely consider, is pertussis. Symptoms include the familiar “whoop” sounds as well as paroxysms of coughing and vomiting. For adults, most of whom have been vaccinated (though a booster is recommended), it is not considered dangerous; and it can be treated with antibiotics but only in the early, acute stage. So, getting this diagnosis after weeks of coughing is useful only to stop using cough and cold remedies. Pertussis in adults usually runs its course by six weeks, although coughing can persist up to ten.
Most lingering coughs can be attacked with an array of OTC medications. Steroid nasal sprays like Flonase will calm inflammation in the nasal passages, making it easier to clear the mucus. But the number-one remedy among healthcare providers is “nasal irrigation twice a day with warm saltwater,” using a neti pot with a saline solution, for example, the NeilMed Sinus Rinse.
To reduce post nasal drip—and in turn lessen throat irritation—two medicines that work well together are the decongestant pseudoephedrine (the one that must be requested with I.D. from the pharmacist, not its less effective substitute phenylephrine); and antihistamines, like Claritin and especially the old-fashioned, drowsy options like Benadryl.
Antihistamines dry up secretions and indirectly decrease congestion, pharmacist Paul O’Reilly writes on Quora. As for taking Mucinex to loosen chest congestion, writes O’Reilly: “Mucinex is just guaifenesin… also the generic name for plain Robitussin”—while studies show that “drinking lots of fluid loosens chest congestion just as much if not more than Mucinex or Robitussin.”
Because stress can make colds last longer, relaxation, like sleeping 7 to 8 hours a night or longer, is advised. While most fluids help loosen mucus in the airways which can then be cleared by coughing, alcohol and any drink with caffeine can be dehydrating. Also, avoid using nasal decongestants for more than three days, which can cause nasal membranes to swell, triggering more congestion, postnasal drip and coughing.
After all possible weapons have been deployed, coughing that continues past eight weeks is considered “chronic”—with a host of other treatments recommended. Or you could be in the final weeks of pertussis, in which case waiting is the only option.
—Mary Carpenter
Every Tuesday Mary Carpenter reports on the state of our well-being, with her download on topics like new shingle shots, preventing lyme disease and the benefits of strength training.
IF THERE WERE EVER a reason to switch to eating organic, a compelling one would be avoiding foods associated with weight gain or that contribute to skin problems (including acne and aging skin).
Obesogens are a subset of endocrine-disrupting chemicals (EDCs), which mimic, block or interfere with the body’s natural hormones; they include any chemical introduced into food with the potential to predispose people to gain weight and have a hard time taking it off. They have “emerged as one of the most urgent threats to global public health,” according to the Endocrine Society.
“Even those at the lower end of the BMI [body mass index] curve are gaining weight,” notes UCSF clinical pediatrics professor Robert Lustig. “Whatever is happening is happening to everyone, suggesting an environmental trigger.” And while most research on obesogens has been done on animals, and mostly in the pre- and peri-natal periods, the National institutes of Health Strategic Plan for Obesity Research has acknowledged the “role of environmental chemicals in obesity.”
Food-additive obesogens include artificial sweeteners, preservatives and added sugars. Other common obseogens show up in food from chemicals like bisphenol A (BPA) used in packaging—especially plastic wrappings and can linings—as well as from pesticides and fungicides sprayed on conventionally grown fruit and vegetables.
For the past three years, strawberries topped the “Dirty Dozen” list of foods most affected by obesogens, created annually by the Environmental Working Group—with one strawberry sample containing as many as 20 different pesticides. Next on the list: spinach, nectarines, apples, grapes, peaches, cherries, pears, celery, potatoes and sweet bell peppers.
Other foods with high pesticide content include lettuce, cucumbers and even kale. In addition, growth hormones and steroids, as well as antibiotics, accumulate in the fat of conventionally raised animals and farm-raised salmon. And one study traced high levels of urinary EDCs to ground cinnamon and cayenne pepper.
Obesogens interfere with the hormone estrogen, which in adults protects against abdominal obesity. The most serious effects are in adipose tissue, which releases hormones related to appetite and metabolism. While some obesogens might increase the number of fat cells, others affect the fat cells’ size, and still others alter hormones related to appetite, satiety, food preferences and energy metabolism.
“Obese humans have more fat cells…We theorize that [obesogen exposure] received perinatally or during adolescence permanently increases fat cell number, thereby creating an altered set-point,” write Amanda Janesick and Bruce Blumberg, cell biologists at the University of California, Irvine, in the American Journal of Obstetric Gynecology.
The “vicious spiral” of obesogenic activity begins with increasing body fat, and as the amount of body fat increases, more EDCs will be stored along with other environmentally polluting chemicals, according to biologist Philippa Darbre at the University of Reading.
The term “obesogen” was coined in 2006 by Blumberg, author of “The Obesogen Effect,” which details changes in American eating habits that increased the consumption of obesogens. In one example, banning cane sugar from Cuba led to an explosion in the use of “corn sugar,” most often as high-fructose corn syrup.
Doctors tell us all calories are the same. And it’s not true,” said Blumberg, whose book’s subtitle is: “Why We Eat Less and Exercise More But Still Struggle to Lose Weight.”
According to Blumberg’s research, altered hormone activity can be inherited: pregnant mice exposed to tributylin (TBT), found in seafood from contaminated waterways, had offspring with physiological changes so that “even if they eat normal food, they get slightly fatter.”
Among endocrine disruptors, an early example was DES. Given to pregnant women for nausea, it caused missing limbs and long-term ill effects in these women’s children. Another, triclosan—used in antibacterial soaps, toothpaste and acne cream—interferes with the regulation of thyroid hormones and is associated with obesity and cancer.
Eating organic, whenever you start, may cleanse the body of early, less healthy choices. “Avoiding the most obesogen-laden foods for just five days can reduce the contaminants in your body by 80%,” according to Stephen Perrine, food and fitness expert, and author of “The New American Diet: How Secret Obesogens are Making Us Fat.” If that estimate is overly optimistic, any effort in this direction should help.
—Mary Carpenter
Every Tuesday Mary Carpenter reports on the state of our well-being, giving us the download about new shingle shots, lyme disease, longevity, psychedelic therapy and strength training.
