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WHILE ADULTS should keep up to date on relevant vaccines such as tetanus, they have a new one to put on top of the list: the new Shingrix vaccine for shingles, available only since fall 2017. People who received the older shingles vaccine are advised to get the new one—although recent promotions have created a supply shortage and long waiting lists at local pharmacies.

The new shingles vaccine “really looks to be a breakthrough in vaccinating older adults,” physician and NIH researcher Jeffrey Cohen told the New York Times.

The risk of developing shingles rises dramatically beginning at age 50 until, by age 80, there’s close to a one-in-two chance of getting the disease. More than a million shingles cases are reported in the U.S. each year. Shingles causes a rash, sometimes with thousands of blisters, that can be excruciatingly painful—with the risk of nerve pain, called postherpetic neuralgia, that can linger for months or years.

While the old vaccine, Zostavax, recommended for those 60 and older, protected only about 50% of those vaccinated, the new Shingrix—given in two injections two to six months apart and recommended for those 50 and older —provides up to 97% protection. In a study of those age 70 and older, Shingrix protected 90% of the time, while Zostavax offered only 38% protection for this age group, and its effectiveness waned to about zero in 11 years. The long-term effectiveness of Shingrix beyond four years is still under investigation.

Contrary to myth, those who remember having chicken pox as a child are not the only ones at risk—because it’s possible to have chickenpox without knowing it. Most Americans born before 1995, when the chickenpox vaccine became available, have dormant varicella zoster virus, which can erupt years after exposure to chickenpox to cause shingles. (Adults who have no memory of having chickenpox are advised either to get tested for immunity or to go ahead and get the two-dose chickenpox vaccine.)

Shingrix has the downside of mild side effects lasting a day or two for as many as 50% of those receiving the injections, which include fatigue, fever, chills and and aching joints. People are advised to get the vaccine when they have a day or two available in case of difficulties.

“I rarely get headaches and I had a headache that night until the next morning. That happened both times,” said Nutley, New Jersey, allergist Alan Goodman. “ I’m never cold [but] I was chilled during sleep after the second vaccine. I was back to normal in two days. The first dose I took on a Friday, which is what I would recommend, not on a Monday.”

The cost of Shingrix is covered for those with work health plans and those with Medicare Part D—though the latter group can get coverage at a pharmacy more easily than in the doctor’s office. In both cases, patients may be asked to contribute to the cost.

Among regular vaccines recommended for adults are flu shots every year; also, every 10 years, the tetanus vaccination, which can be had in combination with diphtheria protection or as a tetanus-diphtheria-pertussis combo. To protect against the dozen or so kinds of bacteria that most commonly cause serious infections, including pneumonia and ear infections, the two-shot Pneumococcal vaccine should be given on varying schedules depending on which one is given first.

For measles, adults born before 1957 are considered immune, but anyone born afterward should get the two-dose MMR (measles, mumps, rubella) vaccine even if they had this vaccination as a child. Measles, with its risk of severe complications including pneumonia and deafness, has been spreading in the US as well as most of continental Europe, especially France, mostly among people who were not vaccinated.

People with a chance of exposure to Hepatitis A or Hepatitis B—working in health care, having sex with more than one partner, or when traveling to certain countries—should get those vaccines as well.

Vaccination records are best kept by the primary-care physician, but a personal record can be helpful—especially for tetanus, because it’s hard to know where you might be if protection is needed suddenly for a cut or scrape.

Meanwhile, CVS pharmacies report delays of weeks, even months to get Shingrix. The waiting lists are long and, due to shortages from the manufacturer, shipments are limited to 10 doses. The order limits and shipping delays will continue through 2018, according to the CDC, which began reporting shortages in early May. For now, people are joining ever-lengthening lists for the next shipment.

Bottom line, get on a list.

—Mary Carpenter

This is the tick-bite rash to look for, signaling the probable presence of Lyme disease. / iStock photo.

THOSE NASTY Lyme disease–carrying blacklegged ticks can crawl up the inside of pant legs, or up the outside and then in via the waistband; can be carried indoors on clothing; and appear to be increasing in the DMV area.

Although more than 30,000 cases of Lyme disease are reported annually nationwide, studies suggest the number might be closer to 300,000, according to the national  Centers for Disease Control.

Locally, Maryland has the highest infection rate of Lyme, about 20 per 100,000 people, followed by Virginia at 13.1 and DC at 11.6—compared with the hardest-hit state, Pennsylvania, with 57.4 infections per 100,000—according to the most recent confirmed data from 2015.

(In estimates for 2016, rates for Virginia and DC went down slightly, while those for Maryland rose slightly, to 21.2, and for Pennsylvania, to 70.3.  Tick-borne illness accounted for more than 75% of vector-borne disease reports in the U.S. in 2016.)

So this may be the summer to begin taking more anti-tick measures. Spray the insecticide (as opposed to insect repellent) permethrin on clothing, and repeat after every one or two washes.  A local tree expert gives Repel to his crew but warns that “a little does not go a long way”—so spray heavily.

What might be easier over time is purchasing pants pre-treated with permethrin, on which effects last through dozens of washings.

In conjunction with insecticides, apply Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin and lemon eucalyptus oil directly on the body.

After walking in grass or any vegetation not closely trimmed, take a hot shower within two hours of being outdoors. Although the nymph or juvenile tick that most often transmits Lyme disease can be hard to spot “with bodies as small as a freckle or the tip of a pencil,” check your clothes and body. Wash clothes in hot water; before or instead of washing, dry for 10 minutes in a hot dryer. On the body, ticks love warm, moist areas like armpits, hair and especially groin areas.

Outdoors, remove brush and woodpiles, trim low-hanging vegetation, cut grass to the edge of wooded areas, and set up play areas on lawns rather than in wooded areas. And because dogs can bring Lyme-infected ticks indoors, collars or anti-tick chemicals are recommended for then as well.

If you see a mouse or signs of mice indoors, take immediate action. An individual mouse can carry up to 100 ticks at a time and infect up to 95% of them with Lyme.

And protect predators of the white-footed mice, crucial to the larval stage of the life cycle of Lyme-carrying ticks and considered primary vectors of Lyme disease. As many as 90% of white-footed mice carry the Lyme bacterium, and an individual mouse can carry up to 100 ticks at a time.  At the next stage, the nymphs are most dangerous to humans, and adult ticks live and mate on deer, which are responsible for spreading the larvae.

Be especially kind to neighborhood foxes. When predatory animals such as red foxes proliferate, prey animals like mice show decreased movement and increased hiding behavior: “The mice are too busy hiding from foxes to end up as tick food,” according to Arlington Patch.

People should feel especially responsible for protecting predatory animals because human impact on the environment has caused rising temperatures and earlier springs, providing more time for ticks to become active and boosting tick populations. Ticks do well in temperatures 40 degrees and above, and with moisture, from both rainy weather and standing water.

If you find a tick attached to your skin, remove it as soon as possible—within 24 to 36 hours, before the tick has the time to inject the Lyme bacteria—and save the tick. If you experience Lyme symptoms, such as fever and muscles aches, without the characteristic bull’s-eye shaped rash, showing the tick to medical professionals can help persuade them to begin antibiotic treatment.

Because blood tests to detect Lyme disease rely on the development of a measurable immune response, it can take 10 to 30 days before tests show a positive response. But sometimes symptoms alone are clear—and often severe—enough that doctors will begin treating right away.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on the state of our well-being, taking on topics like medical marijuana, longevity, psychedelic therapy and strength training. 

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PAIN IS such a different experience for each person—different bodies, different brains—that effective treatment is frequently elusive.  Many sufferers search over many years—and if they find relief, often have trouble determining which treatment did the trick.

Efforts to deal with pain—other than that with a clear cause, such as shingles, that can be treated directly—go in different directions depending on the methods as well as the medical professionals engaged: orthopedists, who focus on specific body parts, like knees; alternative and integrative medicine practitioners, who work on something besides the painful area, like trigger points; and pain specialists.

For DC resident W.C., pain that persisted for more than a year in her thigh and sometimes lower leg—especially in most seated positions—was determined by an orthopedist specializing in hips to require a hip replacement.  The back specialist prescribed physical therapy for her back, as did the foot specialist for her feet and “gait.”  On MRIs and X-rays, each area looked like a potential source of terrible pain.

Although pain is often broken down into different kinds, most could be used to describe W.C.’s pain, for example: arthritis pain, nerve pain, referred pain (coming from one place but felt in another) and chronic pain (when signals continue moving along pain pathways to the brain after the original injury has been resolved).

A different way of thinking about pain—commonly referred to as “Explain Pain” – is based on the idea that pain is an output of the brain—rather than a signal from the body to the brain; and, based on recent understanding of neuroplasticity, that “the nervous system moves and stretches as we move,” from Australian practitioners David Butler and Lorimer Moseley in books including the most accessible for patients, “The Explain Pain Handbook Protectometer.”

Explain Pain is a “biopsychosocial” approach that uses a curriculum for “teaching people that pain can be over-protective” and “that the brain can turn down the danger message at the spinal cord…it is always the brain that decides whether or not to produce pain,” writes Butler, founder of the Neuro Orthopaedic Institute, which organizes dozens of international seminars each year.

Among support for this concept, scans showing damage are notoriously unreliable—with the worst arthritis and degeneration showing up in areas that cause no pain at all and vice versa.  Years ago, W.C.’s shooting leg pain was first explained by a “terrible” MRI of her back, for which she was prescribed physical therapy—until that therapist diagnosed a torn meniscus in her knee. When that was repaired surgically, the pain disappeared.

Also, people have vastly different responses to potentially painful stimuli, such as “fire-walking,” based on both scientific knowledge and personal experience of the levels of stimuli that cause actual physical damage to the tissues, muscles or joints.

Early on in her painful year, W.C. tried the non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen) and Alleve (naproxen) without success, in the process learning about gastritis (dubbed the “N-sad stomach”), provoked by taking NSAIDs.  She also tried topical anti-inflammatories: Voltaren (the NSAID diclofenac); and “Ted’s pain cream” containing resveratrol (found in red wine) after it was touted in an NPR broadcast —to no avail.

She tried marijuana-based preparations purchased at a DC dispensary, both tinctures placed under the tongue and topicals.  And she sampled several “alternative” treatments, including acupuncture and myofascial massage; also Pilates and Yoga—carefully.  Over the years, she’d had a lot of physical therapy for gait as well as for problems in her knees and back, and had kept up most recommended exercises.

Then she went to a pain clinic physiatrist—a physician with a specialty in physical medicine and rehabilitation—who had three recommendations: stronger (prescription) naproxen; physical therapy from a practice reputed to have a more personalized approach than most; and an epidural injection of cortisone.  Cortisone injections have not stood up well to long-term research: a 2017 study on knee pain showed a loss of cartilage over a two-year period—but years of anecdotal support convinced W.C. to try.

Only after the first injection offered no relief was she told it often takes two or three, and then she learned that the injections often need to be repeated several times a year to keep pain at bay.  She said no to more for the time being.

The pain clinic also suggested other treatments supported by anecdotes but inconclusive evidence, such as dry-needling.  Needles (called dry because they contain no medication) are inserted to relax overstimulated muscles— in contrast to needles used for acupuncture that are inserted more deeply and intended to affect energy pathways.

Meanwhile, friendly recommendations kept coming, such as lasers —the higher dosage and power the better, with up to five treatments usually needed—touted to release endorphins, decrease nerve sensitivity and have a pain-blocking effect on nerve fibers, though these are often most effective immediately following an injury.

Or, seeing an osteopath. Trained to look more at the whole body, doctors of osteopathy (DOs) specialize in “hands-on” diagnosis and treatment using osteopathic manipulation—the goal being to help the body heal itself by relieving impediments to correct structure and function.

Other treatments, focused on treating the injury, involve re-implanting or re-injecting the patient’s own stem cells or plasma, both offered by the pain clinic—costing thousands of dollars per procedure, usually requiring more than one treatment and not covered by insurance.

Although pain can drive patients to try unproven treatments until something works, that something can be time. Sufferers joke that particular kinds of pain, such as “frozen shoulder,” get better in six months or one year no matter what treatments are tried.

The problem is not knowing.  DC lawyer J.F. had less pain after about two years spent trying first stem cell injections and then cortisone shots, but he wasn’t sure what made the difference.

For as long as WC’s pain persists, depending on insurance coverage, she plans to keep progressing through possible treatments and to keep hoping for relief—not a particularly medical approach.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on the state of our well-being, taking on topics like medical marijuana, living longer and psychedelic therapy.

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ACHING, THROBBING, pulling, itching, crawling, and creeping, with an irresistible urge to move the legs—ranging in severity from uncomfortable to irritating to painful —are among the experiences of people with Restless Legs Syndrome (RLS), “unlike normal sensations” of those without the disorder, according to the “Restless Legs Syndrome Fact Sheet” from the National Institute of Neurological Disorders and Stroke.

Recent research at Penn State University links RLS to cardiovascular disease in women—independent of obesity and high blood pressure, though both are also risks for those living with RLS.

With RLS, legs feel like they are jumping around or wracked by spasms that grow worse at rest in movie theaters and cars, trains and airplanes; and at night, often followed by a distinct symptom-free period in the early morning.  Immediate relief can come from moving the legs or walking, but sensations often recur when movement stops.

RLS affects from 7 to 10% of the U.S. population and is one of the most prevalent neurological disorders in North America and Europe.  It can occur at any age in both men and women, but women are affected up to twice as often as men, and the condition is more severe in those middle-aged or older, with symptoms becoming more frequent and long-lasting with age.

RLS—also called Willis-Ekbom Disease, referred to as RLS/WED—is classified as a neurologic disorder because it originates in the brain; a sleep disorder because it causes exhaustion and daytime sleepiness; and a movement disorder because moving the legs can provide temporary relief.  Symptoms of “primary RLS” usually begin before age 40 and become worse over time. Nearly half of sufferers have a family member with the condition, which has been linked to genetic variants.

“Secondary RLS” usually has a specific cause, such as iron deficiency, neuropathy (nerve damage), diabetes and pregnancy (around 20% of women experience RLS during the last trimester). Anesthesia directed to the spinal cord, such as a spinal block, can also trigger symptoms. RLS can be relieved by alleviating or removing the cause.

More than 80% of RLS sufferers also experience the more common condition, called “periodic limb movement of sleep” (PLMS), with twitching or jerking movements that occur every 15 to 45 seconds sometimes throughout the night.

RLS has been linked to dysfunction in dopamine pathways involved in producing smooth, purposeful muscle activity and movement—in the same part of the brain affected by Parkinson’s disease— and can be triggered by medications like SSRI (selective serotonin reuptake inhibitor) antidepressants that affect the activity of dopamine.

Symptoms have also been traced to medications such as treatments for nausea and some antihistamines; to alcohol, nicotine and caffeine; and to sleep deprivation and other sleep problems such as apnea, which are in turn blamed for mood swings, irritability, depression and weakened immunity.

Linked to sleep problems as both a cause and an effect —it causes fatigue, and tiredness makes symptoms worse—RLS is blamed for up to a 20% decrease in work productivity.  “Lifestyle” treatment recommendations include warm baths and relaxation techniques for their direct effects as well as for improving the quality of sleep.

Insomnia connected to RLS can also be alleviated by increasing magnesium from whole grains, nuts and green leafy vegetables, and from supplements; also by staying hydrated—drinking more water, especially in hot weather, and less caffeine and alcohol.

Anti-seizure drugs such as gabapentin can decrease symptoms as can dopamine-related medications and benzodiazepines, although all have side-effects, which range from fatigue to obsessive behaviors such as gambling or shopping.

Because many RLS sufferers have low levels of iron in the brain, iron supplements can help, especially for people with low blood ferritin levels, though some need intravenous iron.

Various devices have relieved RLS symptoms: the “restific” foot wrap, available by prescription, puts pressure on specific points on the bottom of the foot; the pneumatic compression device (PCD), available to rent, OTC or by prescription, used for an hour daily, improves circulation; and a vibrating pad called Relaxis, available by prescription, used at night to help with sleep, provides “counter-stimulation” that may relieve RLS.

Yoga and stretching exercises, specifically, have been shown to improve RLS symptoms. Increasing exercise and physical activity can also help, though exercising too strenuously particularly later in the evening can makes symptoms worse.

—Mary Carpenter

Every Tuesday Mary Carpenter lets us in on the latest news about our well-being.

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STRENGTH TRAINING— an umbrella term for exercises that work against resistance, and are neither aerobic like jump roping nor for flexibility like stretching—offers lots of pros, along with its share of cons. Once you’ve decided to give strength training a try, choosing a specific reason such as to counter aging, weight gain or depression can provide the motivation to keep going.

“One of the most important things when you kick-start your [strength exercise] journey is to know your ‘why,’” Mayo clinic health and wellness coach Lynne Johnson told Anahad O’Connor in the New York Times.

Adding muscle can slow and even reverse the fat-gain/muscle-loss that occurs with age, which in turn can up physical work capacity and ability to perform activities of daily living (ADLs), increase bone density, improve coordination and balance and lower the general risk of injury.

But the most oft-cited, research-supported benefit is slowing the aging process at the cellular level—by increasing the number and health of mitochondria, the source of energy in the body’s cells, writes O’Connor.   Metabolism-boosting also burns calories: according to one formula, each pound of muscle gained burns an average 7-15 extra calories/day.

Coping with anxiety as well as depression can be another motivator.  While most research on depression has focused on aerobic exercise, a recent analysis showed that strength training can reduce people’s “gloom—no matter how melancholy they feel at first, or how often —or seldom —they actually get to the gym and lift,” writes Gretchen Reynolds in the New York Times.

Positive effects on mood also occurred regardless of the numbers of repetitions of each exercise performed.  On the other hand, the general recommendation is at least two to three strength-training sessions per week, and at least eight repetitions of eight different exercises.

After motivation, another key to success is setting goals that are short-term and realistic—such as in the first month increasing the number of pushups by 10, rather than aiming to go from zero to 50.  Up to 65% of people who begin an exercise program drop out in three to six months, but smart goal-setting has reduced the likelihood of dropout by more than 50%.

Finally, have a plan: don’t head into the gym looking for a good place to start.  Successful plans to kick off strength training range from those created by a personal trainer—useful especially for those choosing weight machines, and on offer at most gyms at introductory discount rates—to sequences available online like the “9-minute strength workout.”

Popular plans such as the 9-minute workout and programs at Cross-fit gyms include exercises in “sets”—for example, doing three different exercises 10 times each in a row, then repeating that sequence over and over for a 10-12 minute period before moving onto a new set.

Disagreement about strength training arises most over the particular choice of exercises, generally divided between those that rely on equipment—machines, free weights and resistance bands —and those that rely on body weight, including Pilates, Yoga and exercises like push-ups and lunges.

Resistance machines have the advantage of isolating one body part or region, of making it easier to adjust the weight load and of enhancing spinal stability – all of which makes it safer to exercise alone.

On the other hand, using machines in a busy gym can make it hard to do exercise sets because you usually need to finish with one machine entirely and then move on.  Also, machines can encourage overconfidence, accompanied by the temptation to increase weight-load to the point of injury.  And providing spinal stability can prevent strengthening the exact muscles needed when moving to heavier weights.

A final issue with machines: movements that are “forced” or constrained to specific paths, and thus unnatural, risk causing joint injuries as well as expending less energy than free-range exercises in which more body parts work together.

Using free weights has the drawback of requiring careful attention to form in order to avoid injury.  Even under the guidance of a personal trainer, it’s easy to use the wrong muscles.  Lifting light arm weights, for example, can incorrectly engage shoulder and neck muscles, risking migraine headaches as well as rotator cuff tears and shoulder bursitis.

But compared to machines, free weights provide three-dimensional training closer to real-life movement.  Also, free weights and most other strength training works not just on muscles but also on the fascia—connective tissue that envelopes and connects muscles, tendons, ligaments and bones—increasingly viewed as crucial for both strength and coordination.

Resistance training—either using machines such as the elliptical where it’s possible to adjust the load, or one’s own body weight as in Pilates—may be safest on joints.   Using body weight alone merges exercises that are isokinetic, involving muscle lengthening and shortening, such as lunges—and isometric, with no change in muscle, such as planks.

Among the risks of all strength training, accumulating muscle mass too rapidly is associated with stress fractures in women.  Also, muscle damage that is the basis for building muscle mass can result in tears as well as damage to the ligaments and tendons—the reason strength training days should be done on alternate days to give muscles a day off in between for repair.

Despite distinctions between strength training and aerobic exercise—strength training works the outside (arms and legs) of the body while aerobics work the insides (heart and lungs)—most aerobic exercises also provide some resistance.  Jogging offers the most strenuous resistance, but swimming exercises the entire body, as well as improves flexibility and muscle function. Water helps protects against muscle and bone problems, according to Kenneth Cooper, medical expert on exercise who originated the aerobics concept in the late 1960s.

Finding the best exercise combination for personal motivation and goals, as well as those that can make up a doable plan, can take trial and error, with progress and slippage and hopefully more progress.  Regular repetition can, however, produce visible improvement fairly quickly in both physical and emotional well-being.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on the state of our well-being, taking on topics like medical marijuana, living longer and psychedelic therapy.

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“IT’S REALLY the wild west,” said Penn psychologist Marcel Bonn-Miller–referring to medical marijuana, both to its use for treating everything from cancer to chronic pain, insomnia, anxiety and depression, and to the unregulated production of hundreds of marijuana formulations.

(Medical marijuana is legal and available in more than half of US states and DC, but all marijuana use remains illegal under federal law.)

Experts lament the dearth of research on medical effects of marijuana.  Speaking about its best-documented health benefit—treating childhood epilepsy—Iowa clinical pharmacist Timothy Welty said, “This is really the only area where the evidence has risen to the point where the FDA has said this is acceptable to approve a new drug.”

Meanwhile, physicians are prescribing marijuana for everything from nausea to Parkinson’s Disease.  And anecdotes abound—most about pain-reduction and a few very dramatic, such as the guy who takes one day off every spring to imbibe “a lot” of marijuana, which he credits for bringing his otherwise-unbearable springtime allergies to a full-stop.

Medical marijuana use among Americans age 50 and older increases every year.  In states where marijuana is legal for medicinal or recreational use, 12 percent of those 50 and over have used it in the past six months, with 19% of these citing pain relief as their primary reason and 16% citing relaxation.

One AARP survey found 6% using it for medical reasons, a percentage considered by the study’s researchers to be “relatively high,” compared with prior studies and a “tipping point for medical marijuana.”

Among the concerns of poll director, University of Michigan professor Preeti Malani is the lack of standardized doses for medical marijuana. Also, more than half the respondents using it did not tell their primary care physician—a risk because at least one marijuana ingredient, CBD, can make a patient’s other medications more or less effective.

“We already worry about memory loss with this population,” Malani said: “Is it accelerated in older adults who use medical marijuana?”

The existence of a system of endocannabinoid receptors in the body appears to indicate a natural pathway for cannabinoids found in marijuana (including THC and CBD) to affect the body.  But as most people who have tried marijuana know, personal reactions can fall anywhere between two extremes: exhilaration, relaxation, amusement and pleasurable munchies—and depression, fatigue and over-eating.

Such a range is similar to the way different drugs—in particular, anti-depressants—and different diets work well or not so well for different individuals.  In addition, the effects of marijuana vary widely depending on different strains and formulations.

CBD, for example—one of dozens of cannabinoids that does not produce a psychoactive response and has been used for “thousands of years” to treat pain and insomnia—varies in effect by levels of the compound found in different plants, which depends in turn on how the plant is bred; by different methods used to extract the compound; and by different formulations.

CBD content—in edibles, like chocolates or gummies; tinctures, placed under the tongue using droppers; and topicals—is unreliable.  In a 2017 study of CBD products led by Bonn-Miller, 43% contained less CBD than labeled while 26% contained more. In earlier testing by the FDA, some products contained no CBD at all.

(Another complicating factor: while CBD can be extracted both from hemp plants, which are legal, and marijuana plants, which are illegal under federal law, medical marijuana cardholders can typically access CBD products containing much higher concentrations of cannabidiol than hemp-derived CBD products.)

While CBD is popular because of its lack of psychoactive properties, what’s known as the “entourage effect” means that an array of compounds from the plant can have a more beneficial effect than CBD alone —and products with the best-reported benefits contain THC, the ingredient that can cause both euphoria and depression.

After childhood epilepsy, the next most promising application for CBD is countering inflammation, but good research results come from animal studies: the most-often cited, using a topical CBD gel, showed “significant drop in inflammation and signs of pain”—when applied to rats.  And pain is both notoriously difficult to measure objectively and susceptible to the placebo effect.

What appeals to many people about medical marijuana is the purported absence of side-effects and development of tolerance, although reviews have noted the risk of tiredness, diarrhea and weight gain or loss, as well as increased liver enzymes suggesting possible liver damage.  Furthermore, “cannabis-dependent” is listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM IV).

Getting a “medical marijuana card” in DC is an ever-changing process with many steps, which can be facilitated by a local dispensary. You must visit a “marijuana doctor,” who provides a “marijuana recommendation”—in my case, for arthritis pain.  That costs around $50.  Then you fill out forms, provide identification and proof of residency and mail everything to the DC Department of Health.

The dispensary, Takoma Wellness, helped me do all this—for which I paid $100 that could be used as credit for purchasing products once the card was obtained (although that is no longer true).  The entire process must be repeated every year.  After a year sampling recommended products, most making me too tired to judge pain reduction or to continue taking them, I don’t plan to renew my card.

But I’m hopeful marijuana won’t disappear from my life entirely.  When I purchased gummies and sampled them during a visit to Denver, my iTunes music collection sounded better than ever before and led to an unusually deep and refreshing sleep.  Because marijuana products are illegal to transport out of state and gummies are not offered in DC dispensaries, any future use must await changes in federal law.

Until then, marijuana-infused Epsom salts make a hot bath feel both relaxing and pain-relieving. Although originally purchased at the DC pharmacy, these are easy to prepare from marijuana plants growing (legally) in our DC garden.

—Mary Carpenter

Every Tuesday in this space Mary Carpenter reports on well-being, taking on topics like living longer, the dangers of  homeopathy and psychedelic therapy.

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AN ADULT who mentions night terrors usually gets the same two questions: You mean, like nightmares? Or, aren’t children the only ones who have those?  For adults, the same questions lead to general confusion and often to misdiagnosis.  Other misconceptions trace the terrors to Satan and other demons; and, especially among veterans, to post-traumatic stress disorder (PTSD).

Compared to nightmares, night terrors usually have no content and can be dangerous.  They can include sudden nighttime awakening, screaming, sweating and flailing, along with persistent fear, terror and confusion. Sufferers may hit or throw objects and can also sleepwalk, with inherent dangers such as walking into things and “using kitchen appliances.”

Night terrors can last from a few seconds to 20 minutes, and can occur at any age from an hour after birth to death.  Prevalence is estimated at 1-6% in children, although recurrent episodes are less common; and less than 1% for adults, according to the DSM IV.

Sleepers remain asleep, although their eyes may be open.  Once semi-awake, some people see frightening images like spiders and snakes in the room.  But they are unable to wake up fully and are difficult to comfort. On awakening, sleepers have no memory of the terrors.

Night terrors occur during deep, Stage 4, non-REM sleep, which begins close to an hour after falling asleep.  In contrast, nightmares occur during REM sleep, the dream phase—which begins later in the sleep cycle, usually about 90 minutes after falling asleep—during which most body muscles are paralyzed.  When nightmares occur in clusters, called nightmare disorder or dream-anxiety disorder, “there is complete alertness and recall of dreams on waking.”  These nightmares are associated with extreme anxiety and often related to previous trauma that is relived in the dreams, and are a major symptom of PTSD.

Night terrors are one of many non-REM parasomnias, also called disrupted sleep-related events, “undesired occurrences during sleep,” and “disorders of arousal,” which occur when the person is in a mixed state of being both asleep and awake—awake enough to act out complex behaviors but asleep, and unaware of and unable to remember their actions.

The timing of night terrors in Stage 4 differentiates them from the parasomnia common sleep paralysis —waking without being able to move or speak —which occurs during Stage 1.  (The related hallucinatory, or hypnagogic, sleep paralysis has also been traced to evil spirits.)

Another parasomnia is nocturnal seizures, causing the sleeper to cry, scream, move about or curse.  And sleep starts, like the sudden jerk that can occur while falling asleep, are visual or auditory sensations that seem to come from inside the head.

Included among “confusional arousal disorders” (in which the higher reasoning centers of the cortex are deactivated while more primitive activities like sex and eating are disinhibited) are variations of sleepwalking, such as sleep-related eating disorders. Another somnambulistic sexual behavior —also called sexsomnia or sleep sex —is an automatic behavior, in contrast to motor activity during a dream.  Episodes of sleep-related eating and sexsomnia may affect up to 5% of adults.

Night terrors are more common among family members, suggesting a genetic component.  In sleep lab research, they are linked to increased brain activity or “misfiring.”  Adults suffering from any of the arousal disorders should seek evaluation, because these could be triggered by heartburn, limb movements during sleep and sleep apnea, all of which affect quality of sleep and often cause daytime drowsiness.

The best research-based treatment for night terrors, found to cure 9 out of 10 children, is “scheduled awakening therapy”—interrupting the sleep cycle every 15-30 minutes.  Created using research from Stanford University, a device called the Lully Sleep Guardian monitors individual sleep patterns and emits gentle vibrations when night terrors are most likely to occur—and then turns them off when the sleeper stirs.

Because night terrors are often related to increased stress and fatigue, more and better sleep (longer hours and regular wake times) can be the best cure for children, but also for adults.

—Mary Carpenter

 Every Tuesday in this space, Mary Carpenter reports on the state of our well-being. 

Ester Perel / TED Talks

ESTHER PEREL suddenly seems to be everywhere.  Friends are listening to her podcast series “Where Should We Begin?” with episode titles like “You Can Be Right or You Can Be Married.” More than 17 million people have watched her two TED talks—“Rethinking Infidelity” and “The Secret to Desire in a Long-Term Relationship.”  Stories about her have appeared both in The Atlantic and The New Yorker —in each more than once.

Recently, Perel was a featured speaker at the Psychotherapy Networker Conference in DC, where a dominant theme was listening as a way to help bridge the great divides in contemporary life, such as between red and blue perspectives, and for increasingly isolated individuals, especially those in couples.

During a panel, Perel said, “Isolation, not obesity, is a public health crisis.”  She sees this as the reason for her podcasts’ popularity. Because couples don’t have enough opportunities to listen to other couples, they lack the vocabulary to conduct productive conversations themselves.

Although she was born in Belgium, educated in Israel and speaks nine languages,  Perel is “fundamentally American,” writes Cristina Nehring in The Atlantic —in her “can-do conviction that people will live happily ever after” and in her self-promotion.

When Perel, who has more than 30 years of experience as a couples therapist, put out the word that she was offering a therapy session to couples willing to be recorded for podcasts, thousands volunteered.  Each session, edited down from three hours to about 45 minutes, focuses on a different problem: cheating, addiction, children. With two seasons recorded to date and a third in the works, the podcasts are available on Amazon via an Audible account, on the Podcast app and elsewhere.

“The show’s drama lies not so much in the details of each couple’s situation as in their struggle to communicate about it, to get their two ‘I’s’ to equal a ‘we,’” writes Alexandra Schwartz in the The New Yorker.  “Perel is a master at what she does.  She is preternaturally incisive and humane.”

“Truth.  People are hungry for truth…the antithesis to the jolly faces that are promenading on social media,” Perel told Schwartz.  By listening to another couple, “you very quickly realize that you are standing in front of the mirror, and that the people you are listening to are going to give you the words and the language for the conversations you want to have.”

In an introductory note to “Where Should We Begin?” on Amazon (Perel made her original podcast deal with Amazon and Audible), she says, “There is no school for relationships, no place for us to learn the tools for rebuilding and repair, to learn to straddle the many contradictions that roil in all of us. [This podcast] is a way for me to create meaningful, deep and open conversations.”

Perel said she starts her therapy sessions with a couple’s “longings and desires.”  In follow-up surveys, participating couples said the therapy “gave them a meaningful vision of the future” and “was harnessing their resources.”

For “I’ve Had Better” (the first episode of “Where Should We Begin?”), Amazon listener comments range from “This was a brutal podcast to hear…they are horrible communicators” to “the couple’s story was a powerful reminder of my own… I am keen to learn more from her.”

“Being privy to these conversations is like sitting in on somebody else’s therapy session and taking notes, but without the hefty bill,” another wrote. “I still learn something profound about the art of communication. Every. Single. Time.”

On a Recode Decode podcast, Perel said that phone addictions are creating a “new definition of loneliness,[ a kind of] ‘ambiguous loss:’ a loved one is physically present but in all other ways absent from a relationship.”

“Some couples are cheating on each other constantly—with their phones,” said Perel, who described one patient saying, “Every night, I go to bed and she’s on Instagram, in the bed.  And it’s like, I’m lonely!”

Loneliness is widespread in America, according to a recent survey of 20,000 adults using the UCLA Loneliness Scale.  The survey was done by the health insurer Cigna because loneliness has been linked to immune system function, higher risk of coronary artery disease and premature death, according to Brigham Young University social psychologist Julianne Holt-Lunstad. A score of 43 out of possible scores from 20 (most isolated) to 80 (least isolated) was considered “lonely.”  The average loneliness score in America was 44.  With 54% of survey respondents saying they always or sometimes feel that no one knows them well, Cigna CEO David Cordani said he was surprised about the finding that “half of Americans view themselves as lonely.”

Baby boomers had an overall score of 42.4; people ages 72 and older, the Greatest Generation, scored 38.6; and members of Generation Z—born between the mid-1990s and the early 2000s—scored 48.3.

Whether social media is a culprit depends on how it’s used—either passively, “just scrolling feeds,” which is associated with negative effects, or “to reach out and connect to people to facilitate other kinds of [in-person] interactions,” said Holt-Lunstad.

Women across all ages report higher levels of loneliness than men—with married women slightly lonelier than married men.  But among single people, single men “vastly outweigh single women as the lonelier bunch,” according to Psychology Today blogger Kira Asatryan.  One explanation: women may maintain more close friendships outside of a primary romantic relationship.

When it comes to romance, though, Perel advocates creating more distance with the goal of upping desire: stop cuddling. “Sexuality is all about bridging distances—but to bridge distances, you must have distances,” Perel is quoted in the Atlantic blog. “Treat each other like trash, and you might notice a discreet rise in sexual tension.”

In her TED talk, Perel posed the question, “why does good sex so often fade, even for couples who continue to love each other?”  Her advice for rekindling desire, such as “committed sex is premeditated sex,”writes Schwartz, is “counterintuitive yet reassuringly practicable.”

“In our age of serialized, bingeable entertainment…there’s something refreshingly bold and optimistic about a show made up only of beginnings,” Schwartz concludes.  Also,“Everyone wants to be heard.  Perel’s show is a reminder of how good it is to listen.”

—Mary Carpenter

Every Tuesday in this space, Mary Carpenter reports on our well-being. 

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R.C., AGE 25, felt lethargic and bloated.  When her skin erupted in a red, itchy rash, she headed for the ER where she was told she could be experiencing a kind of anaphylactic shock.  The most likely cause: the food additive almost no one has heard of, although it’s found in some of the healthiest vegan and vegetarian foods.

Carrageenan is used as a thickener or emulsifier—a stabilizer, to keep ingredients from separating unappealingly— in processed foods like some ice creams, cheeses, meats, high-protein beverages and diet soft drinks, as well as in some toothpastes.

Among healthy brands, it is found in Stonyfield products, such as some Greek yogurts and organic heavy whipping cream; and in Applegate Naturals products like turkey breast.  But it is most prevalent in vegetable-based milk substitutes, including some soy and almond milk—notably Almond Dream and SO Almond Plus —which R.C. drank often, and in some used by Starbucks.

Extracted from red seaweed, carrageenan is a type of Chondrus crispus, also called Irish moss and used in Ireland to make a panna cotta-like jelly. Researchers studying carrageenan since the 1960s have seen no conclusive evidence of harm to humans but have found links in lab animals and human cells to gastrointestinal disease, including ulcerative colitis, intestinal lesions and colon cancer.

“As with magnesium stearate and soy lecithin, carrageenan has been frequently portrayed as significantly more harmful than is supported by available evidence,” according to Berkeley, California, functional medicine practitioner Chris Kresser, author of The Paleo Cure. But Kresser considers carrageenan slightly “more concerning than the other two “because of its association with gut issues.”

“There is evidence that [carrageenans] can be harmful, especially if consumed regularly,” said Kresser: “Many people report reacting negatively with symptoms like digestive troubles, skin rashes and other health problems.”

Personally, Kresser “adheres to the ‘precautionary principle’ for anything I eat,” staying away from foods that have not been proven safe and have questionable adverse effects.” And he recommends “avoiding carrageenan especially [for those with] a history of digestive problems.”

In April 2018, the USDA renewed carrageenan on the National List of allowable food products—a decision made on the grounds that “carrageenan continues to be necessary for handling agricultural products because of the unavailability of wholly natural substitutes,” according to NPR.

On the other hand, in 2016, the National Organic Standards Board voted to drop carrageenan from the list of approved organic ingredients based on evidence that it could be replaced by other ingredients.  In the EU, carrageenan is banned for use in infant formula for “precautionary reasons,” but is permitted in other food items.

Carrageenan “activates an immune response that dials up inflammation” in lab animals and cultures of human cells, explains Joanne Tobacman, associate professor of clinical medicine at the University of Illinois, Chicago.  “Although derived from a natural source, it appears to be particularly destructive to the digestive system.”

In fact, drug investigators have used carrageenan to cause inflammation when testing anti-inflammatory properties of new drugs, Tobacman points out.  Also, mice exposed to carrageenans have developed glucose intolerance and impaired insulin action, possible precursors of diabetes.  (The plural “carrageenans” refers to different forms of the additive.)

Carrageenan triggers “an immune response similar to that [caused by] pathogens like Salmonella…inflammation which can lead to ulcerations and bleeding,” said Tobacman. Her 2008 petition to the FDA cited decades of peer-reviewed research—to which the FDA responded with a letter of denial.

The FDA cited as “the gold standard” a 2006 rat study, despite its funding by a carrageenan manufacturer. Challenging the FDA denial, the organic industry watchdog group Cornucopia Institute asked why the FDA didn’t consider more recent studies.

Cornucopia Institute publishes a “shopping guide to avoiding organic foods with carrageenans,” although sufferers like R.C. have found that the “bad” list omits many carrageenan-containing almond milks.

Vegetable-based milk substitutes are especially popular among those on Paleo diets and for those seeking relief from GERD (gastro-esophageal reflux disorder), but for the latter group, if symptoms persist, carrageenans may be another culprit to consider.

—Mary Carpenter

Every Tuesday in this space Mary Carpenter reports on well-being, taking on topics like living longer, the dangers of  homeopathy and psychedelic therapy.

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ANSWER THESE two questions quickly: In the biblical story, what swallowed Jonah?  And how many animals of each kind did Moses take on the Ark?

People often answer “whale” to the first question and “two” to the second—even when they know that Noah built the Ark.  What’s called the Moses Illusion demonstrates “knowledge neglect,” that people have relevant knowledge but fail to use it, according to Vanderbilt psychology professor Lisa Fazio.

People are very bad at picking up on factual errors in the world around them even when they know the correct information, and they will go on to use that incorrect information in other situations—one reason “fake news” is so dangerous, Fazio points out.

Vision in particular can be erroneous when the brain’s selective screener makes some things much more visible than others—the brain’s “selective selectivity,” writes Keith Payne in Scientific American.  “The unconscious screener shapes what the conscious ‘you’ gets to see but the conscious ‘you’ doesn’t have veto power over that decision.

Recent research documents show how our personal screeners’ preference for seeing people similar to us actually blocks our ability to see those of other races.  The tragedy: Personal contact is a powerful way to reduce prejudice, but “we cannot get to know or learn from people if we look right through them,” writes Payne.

The Cultural Cognition Project based at Yale strives to understand how people acquire and then stick to false information, as well as what strategies could help them accept accurate—if unappealing—information.

Asking “why doesn’t the mounting proof that climate change is a real threat persuade more skeptics,” Yale law professor Dan Kahan and his colleagues describe the wrong-headedness of the leading theory, the Scientific Comprehension Thesis (a version of the More Information Hypothesis) that the public needs more information and better explanations to arrive at accurate conclusions, Ezra Klein writes on Vox.

There are “some kinds of debates where people don’t want to find the right answer as much as they want to win the argument,” explains Klein. Humans “may reason for purposes other than finding the truth.”  Among those purposes: increasing their status in the community and “ensuring that they don’t piss off leaders of their tribe.”

People aren’t reasoning to get the right answer, but to get the answers they want to be right, Klein writes.  In one of Kahan’s studies on attitudes to climate change, for those people already skeptical, improving their scientific literacy made them even more skeptical.

When statistics are involved, the people who most accurately evaluate most statements of fact are those who are good at math—but only until the issue becomes politicized.  At that point, mathematically skilled people not only come to conclusions based on ideology, but are more likely to do so than those with weak math skills.

Personal biases can be confirmed, even bolstered, by very small numbers of doubting “experts.”  The book and film Merchants of Doubt show how even a single scientist—such as one well funded by the cigarette companies—can rally doubters against an enormous preponderance of scientific evidence, in this case proving that cigarettes cause lung cancer.

In the case of climate change, although some 99% of scientists have found evidence substantiating devastating effects as well as the human role, a handful of experts —including the same scientist who questioned the cigarette-cancer link— provide sufficient, if few, seeds of doubt for deniers to feel comfortable holding onto their incorrect convictions.

Attacking weak links is one weapon used by doubt merchants: find a mistake, exaggerate it and condemn the entire proposition.  Scientists throughout history have made some whoppers. In The Truth About Animals: Stoned Sloths, Lovelorn Hippos, and Other Tales From the Wild Side of Wildlife, Lucy Cooke describes early scientific explanations of what happens to birds that disappear in wintertime, which scientists stood by adamantly. Birds hibernate—underwater; and birds fly away—to the moon.  (They migrate.)

Such erroneous views could prevail, however, only as long as there were too few scientists and resources to test hypotheses—centuries ago, before long-distance travel was possible—compared to today when hundreds, often thousands, of research studies support scientific conclusions.

Another weapon is false statistics. The work of serious climate deniers is “filled with fact and figures, graphs and charts…much of the data is wrong or irrelevant,” writes Klein.  “But it feels convincing.”

Maybe the biggest reason why deniers are unmoved by science is that people innately resist change, more so when urged by voices they consider to be fighting for the other team; and most importantly, when changing their minds could mean distancing themselves from their “tribe.”

An example of someone who risked alienation from an enormous tribe, Mark Lynas wrote two books about the risks of GMOs, but when he re-examined the data and found that he’d come to the wrong conclusions, he went public with his about face. “For a lot of people, it was an ‘Oh fuck’ moment,” Lynas told The Guardian. “They realised they’d been lied to, at a very profound level, by the very people they’d trusted.”

“And what of his worst fear, that he wouldn’t have any friends left at all?  ‘Well,’ he smiles sadly. ‘That’s probably what happened.’”

Even today when 90% of scientists say GMOs are safe, only about one-third of consumers agree. As with the childhood vaccine debate, the origin of the GMO scare was a scientific paper later retracted by the journal that published it due to flaws in method.

Contemporary media fan the flames.  “The rage-fueled tribalism of social media, especially Twitter, has infected the op-ed pages and, to some extent, the rest of journalism. Twitter is about offering markers of affiliation or markers of disaffiliation,” according to journalist Kevin Williamson, recently at The Atlantic.

Kahan is hopeful that, “if researchers can just develop a more evidence-based model of how people treat questions of science as questions of identity, we can use reason to identify the sources of threats to our reason and…devise methods to manage and control those processes,” Klein writes.

For each of us, better understanding our brains’ selective selectivity can spur us to seek what we might have missed, look beyond news reports and check facts.  “One thing that does seem to help us [see errors and falsehoods] is to act like a professional fact-checker,” writes Lisa Fazio.  Professional fact-checkers are, she believes, “one of our best hopes for zeroing in on errors and correcting them, before the rest of us read or hear the false information and incorporate it into what we know of the world.”

—Mary Carpenter

Every Tuesday Mary Carpenter reports on well-being, taking on topics like the pros and cons of homeopathy and the benefits of psychedelic therapy. 

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ESTHER WILLIAMS, Cary Grant and LSD is the title of the opening chapter in “aqua-musical star” Williams’s autobiography The Million Dollar Mermaid. It describes an event in the late 1950s when LSD gave her startling and life-changing insights.

The potential of psychedelics drugs for insight and other positive effects are spurring studies on LSD, psilocybin, ketamine (“special K”) and MDMA (“ecstasy”) as treatments for depression, anxiety, addiction and PTSD.  Although these drugs have different effects, all work via the serotonin system—receptors, circulation, re-uptake—the same system used by many antidepressants; except ketamine, which affects the neurotransmitter glutamate.

(LSD used for “psychedelic therapy” or “trip treatment” is given in a single dose of around 75 micrograms, while psychedelic “micro-dosers,” who are aiming for greater focus and clarity, take about 10 micrograms every four days.)

During treatment, patients don headphones for music and eyeshades, and are “encouraged to go as ‘deep’ as possible into the experience,” explained UCLA psychiatrist Charles Grob, who has studied MDMA and psilocybin as well as ayahuasca.  After the hallucinogenic effects wear off, patients discuss the experience with their therapist and “follow-up psychotherapy sessions facilitate lasting results,” Grob said.

After the 1960s’ surge of interest in LSD for both recreation and research, the drug became illegal, bringing most investigations to a halt. But research starting in 2011 has used advanced imaging techniques—specifically fMRI and magnetocephalography—to track blood flow and electrical activity in the brains of participants after taking LSD, ketamine and psilocybin.

During a psychedelic trip, “the normal hubs which control and regulate brain function become disrupted.  There’s much greater connectivity—parts of the brain that rarely talk to each other…talk to each other,” London Imperial College psychopharmacologist David Nutt told Business Insider.

As we grow from infancy to adulthood, our brains become “more consistent and compartmentalized,” said Robin Carhart-Harris, neuroscientist at Imperial College.  “Independent networks perform separate specialized functions…We may become more focused and rigid in our thinking as we mature.”

Brain activity under the influence of psychedelics is more diverse, and the brain experiences greater “connectivity and ego-dissolution, meaning the normal sense of self breaks down and is replaced by a sense of reconnection with themselves, others and the world,” Carhart-Harris said.  “This experience seems to be associated with improvements in well-being after the drug’s effects have subsided.”

In one study, 20 healthy volunteers (who had all previously taken some type of psychedelic drug) each took a placebo and LSD.  Under LSD, explained Carhart-Harris, “Many additional brain areas—not just the visual cortex—contributed to visual processing…suggested our volunteers were seeing things from their imagination rather than from the outside world.”

Earlier psilocybin studies at Johns Hopkins found a single session gave people a “more open personality as well as a greater appreciation of new experiences and enhanced curiosity and imagination,” according to psychiatrist Matthew Johnson, head of the Hopkins Psilocybin Research Project.

Psychedelics put “the ego out of commission by dissolving boundaries between self and the world,” according to Johnson.  What he calls a “primary mystical experience” includes “a transcendence of time and space, a sense of unity and sacredness and a deeply felt positive mood” that is highly correlated with successful therapeutic outcomes.

Studies on depression in cancer patients at Johns Hopkins and New York University found 80% of patients showed clinically significant decreases in depressed mood and anxiety for as long as six months after one or two treatments involving psilocybin.

Ketamine works much more quickly and often effectively to treat chronic depression. Dr. Thomas Insel, past director of the National Institute of Mental Health, called ketamine “the most important breakthrough in antidepressant treatment in decades.”

While other psychedelics are illegal and thus difficult to obtain, ketamine is approved as an anesthesia and can be prescribed off-label for depression.  Potomac Actify Neurotherapies offers series of ketamine infusions—most patients have three to five to start, with regular boosters—which take about an hour and a half and cost around $500 each, not covered by insurance.

MDMA has reduced the symptoms for sufferers of PTSD.  Previously when a patient with PTSD was asked to “relive the traumatic experience they would be overwhelmed with fear, anxiety and despair,” Grob told NBC. But under MDMA, “It’s as if they can navigate the experience more safely.”

Because the drug “doesn’t encourage deep introspection,” therapy sessions “often involve much more discussion” between doctor and patient than other psychedelics, which is especially important for those suffering PTSD.  With around 50% of participants in recent clinical trials PTSD-free a year after MDMA-assisted therapy, the drug is now on the fast track for FDA approval.

Esther Williams’s LSD trip at age 37 began with a call to Cary Grant after she read in Life magazine about his “psychic energizer” experience on the drug. “Cary, I’m at the end of my rope,” she told him when they met.  Taking the drug under the supervision of Grant’s doctor, Williams went through peak moments of her life and understood ways in which her problems developed after the death of her older brother when she was eight, when she became determined to take on “the role of the firstborn son,” she writes. “LSD seemed like instant psychoanalysis.”

—Mary Carpenter

Every Tuesday Mary Carpenter reports on well-being, taking on topics like living longer, the dangers of heavy metals and homeopathy.

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NOTE TO SELF: “In order to protect yourself from stress, to enhance your relationships…develop some flexibility. Make a list of things you would like to have happen.”  Finally, “to relax your mind, occasionally practice not thinking

Suggestions like these come from my results on the “New Personality Self-Portrait,” a personality assessment updated and made available to the public online for the first time in early 2018. The cost is $18, and in return you get many layers of results.

For each NPSP25 test-taker, a personalized graph is created to show the relative importance of how each of 14 personality styles affects personal behavior, relationships, etc.

“The high scores/peaks/dominant styles are determined by looking at the graph and noting the peaks. Some people may have two, many people more,” explains Lois Morris, co-author with psychiatrist John Oldham of “The New Personality Self-Portrait” (Bantam, 1995).

“Generally, what is the tallest of these, if there is one definitely so, it is the so-called dominant,” Morris wrote in an email after viewing my results.  “But as in your case (and many others), Serious, Self-sacrificing, Conscientious, Idiosyncratic, Devoted, Vigilant and Dramatic all have a major effect.  Nobody is just one personality style.  Everyone has a different Personality Self-Portrait.”

In addition, the NPSP25 provides a second “normative” assessment showing where each person’s results fall among those 12,000 or so people who have taken the test, previously given exclusively by professionals and usually in mental health and human resources settings.

The NPSP25 goes beyond most online tests by offering not just evaluations but also ideas for moving forward according to personality type.  Also compared to other personality assessments, more information is available online about the complexity of the results.

Taking the NPSP25 and becoming “aware of your style’s characteristic trouble spots, you may now be able to learn better habits…a big part of personality styles and, fortunately with sufficient motivation, habits can be changed,” Oldham and Morris write.

Those like me who score high on Devoted, for example, should “express your anger directly,” “practice decision-making,” “experience yourself as independent” and “try to resist throwing yourself into a new relationship when one ends.”  The encouragement to develop flexibility and relax comes from my highest-scoring Serious style.

Also directing attention to my lower scores, Morris wrote: “Low scores can give you a clue to traits that may need some bolstering. In your case, these are Self-Confident and Aggressive.  Read descriptions of the positive trait associated with these styles and see what might apply to you.”

In 1984, Oldham, specializing in personality disorders at Baylor College of Medicine in Houston, had the idea of creating a system and test for normal personality styles based on categories of personality disorder listed in the DSM-III (Diagnostic and Statistical Manual of Mental Disorders, third edition), subsequently updated to the DSM-IV in 1994 and then to the DSM-V in 2013.

For the online version, Houston psychologist Alok Madan, contributed expertise in personality styles and disorders along with Internet savvy.

The NPSP25 reveals “normal” or healthy styles, defined as being able to cope with one’s environment in a flexible manner and typically having perceptions and behaviors that foster personal satisfaction, Oldham and Morris write. In their book they also describe extensions of each style into disorder: for example, Devoted at an extreme becomes Dependent, Serious becomes Depressive and Self-Confident becomes Narcissistic.

“Our approach is that styles range on a continuum and that disorders reflect ‘too much of a good thing,’” Morris wrote in an email.

Another layer of NPSP25 results involves six Domains, in which different personality styles dominate.  For Carolyn (the book’s example), scoring high on Conscientious makes Work her ruling Domain.  Work dominates her emotional life, and she is miserable if her work isn’t going well.

In contrast, for Jonathan who scored high on Leisurely, the Domain of Self rules, which makes his need for independence and pursuit of his own meaning in life not just essential but “more important than his relationships, should he be forced to choose.”

Before going online for the general public, the test was frequently used in couples counseling to “reveal predictable problems, which can be worked with or resolved,” Morris writes.  Sample couples’ personality profiles online include Self-Confident Henry with Devoted/Sensitive Sofia, and Dramatic Kirsten with Conscientious Jonah.

While my NPSP25 results were not surprising, their presentation and the in-depth discussion of styles gave me a different perspective and more resolve—in particular, to be more flexible.  They also provided greater justification for a regular mid-afternoon break—or not thinking, along with back-stretching and mindful breathing. Which sounds much like a nap.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on well-being, answering questions about longevity, homeopathy and solutions for dry skin.

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HOMEOPATHY GETS more popular every year in the United States, growing by 15% between 2010 and 2016.  It’s currently a $3 billion industry.

Homeopathy purports to be a single system—albeit one not yet established scientifically—in which “like cures like.”  For example, a poison like snake venom that causes swelling or itching can be used to treat those same symptoms whenever they arise.

Harvard Medical School researcher Ted Kaptchuk and others at the Program in Placebo Studies (PiPS) enthuse about homeopathic treatment as a powerful placebo—especially compared to antibiotics.  (A 2008 study found that 13% of doctors prescribed antibiotics as placebos, because patients believe the drugs will treat their condition, even if what they have is viral and cannot be affected by antibiotics).

According to PiPS research, even clearly labeled, “honest” or “open label” placebos are effective when given to patients along with explanations about the role of the mind in recovery, especially from chronic pain.

Alternative-medicine guru Andrew Weil, director of Arizona’s Center for Integrative Medicine, believes homeopathy has “value even if it merely evokes a placebo response.  If that response does heal…physicians should exploit is as a safe, effective way to treat disease.”

On the other hand, an assessment of more than 1,800 studies on homeopathy by Australia’s National Health Council found only 225 scientifically rigorous enough to analyze—and from these, “no good quality evidence to support the claim that homeopathy is effective in treating health conditions.”

Even the National Center for Complementary and Integrative Health (NCCIH), the division of NIH responsible for studying alternative health options, considers homeopathy “controversial” and “a number of the key concepts of homeopathy…not consistent with fundamental concepts of chemistry and physics.”

Supporters of homeopathy tout its “law of minimum dose”—the notion that the lower the dose…the greater its effectiveness—and the corresponding harmlessness of its preparations. Homeopathic drugs are produced by diluting active substances to such a degree that most analyses detect no remaining trace.

But, concludes NCCIH: “It is not possible to explain in scientific terms how a remedy containing little or no active ingredient can have any effect.” Georgetown University pharmacology professor Adriane Fugh-Berman described evidence for homeopathy’s effectiveness as “between scant and nil.”

And in 2016 the FDA issued new “risk-based enforcement priorities to protect consumers from “potentially harmful, unproven homeopathic drugs.”  (Before that, although homeopathic preparations were officially subject to the same requirements as any other drugs, the FDA was not monitoring them—under enforcement policies in effect since 1988.)

“Homeopathic products have not been approved by the FDA for any use and may not meet modern standards for safety,” stated FDA Director of Drug Evaluation and Research Janet Woodcock.

From 2006 to 2016, as the U.S. homeopathic drug market grew “exponentially,” the FDA saw “a corresponding increase in safety concerns, including serious adverse events…also an increasing number of poorly manufactured products that contain potentially dangerous amounts of active ingredients,” according to its statement.

The FDA has warned against substantial risks of specific homeopathic drugs, for example, ordering Zicam to stop marketing three nasal products containing zinc gluconate after more than 100 users reported losing their sense of smell.  The FDA also found strychnine, used to poison rodents, in the homeopathic nux vomica.

Besides potential dangers of the preparations, problems arise when homeopathy is used for serious illnesses that could be effectively treated by “allopathic”— traditional or western—medicine. The FDA warns consumers not to rely on homeopathic asthma products or immunizations promoted as substitutes for conventional treatments.

Although patients are advised to tell physicians if they are taking homeopathic preparations, many medical practitioners either have a poor understanding of homeopathy or they confuse or lump it together with herbal, naturopathic, complementary or alternative medicines, according to professors teaching the subject.

Arnica, among the most popular homeopathic preparations, received National Standard (now called Natural Medicines) ratings of “C” (unclear or conflicting evidence) for treating arthritis, pain after surgery, bruising and trauma; and “D” (fair negative evidence) for muscle soreness.  Arnica taken by mouth has been linked to stomach irritation as well and breathing and heart problems.

One study comparing arnica gel to a well-regarded ibuprofen gel found each had positive effects on about half the patients.  Both preparations could work by way of a placebo effect—created in part by rubbing the skin of painful areas during application, the researchers concluded.

If all pain gels work via the placebo effect, arnica is the better choice: It’s cheaper than other options and available OTC— compared to ibuprofen gel, which is available in the U.S. only by prescription or mail order from Canadian pharmacies.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on well-being, answering questions about living longer, the dangers of heavy metals and solutions for dry skin.

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THE PhDS at cosmetics companies will discuss at length the scientific principles behind their expensive potions for dry skin.  But ever since a university-based dermatologist recommended the cheap and simple combination of mineral oil and lanolin, I’ve concocted my own brew.

More than 30 years later, I’ve made only a few alterations—dropping in a little almond oil after friends described the odor as somewhere between sheep and urine; switching for a reason I can’t remember from mineral oil to vaseline petroleum jelly; and adding a few glops of some commercial preparation like Lubriderm or Eucerin to more easily mix in the heavy lanolin.

Although most friends brave enough to sample the brew find it too greasy, nothing has worked better for me, particularly after a long winter of long, hot baths and showers (ill-advised for those with dry skin) but mostly dry air, despite regular efforts to increase indoor humidity.

Still, I continue to experiment with alternatives—for the hoped-for ease of ordering online as well as for saving tired hands.  With their temptingly natural nickname, “barnyard balms,” used to prevent cows’ udders from chapping, turned out to moisten and soften farmers’ hands.  But because most people find Bag Balm greasy and smelly and Udder Cream unappealing because it contains urea, I tried the more popular Udderly Smooth, with instructions to “wash udder and teat parts” and the warning, “Do not use on parts affected with cow pox.”  It failed to restore my skin’s moisture.

Moisture is delivered to the skin via blood vessels that supply the skin’s middle layer, the dermis; from there it travels upward through the outer level, the epidermis, a bricks-and-mortar type membrane that acts as a hydrophobic barrier— before evaporating.  The dryer the air due to low outdoor temperatures and overheated interiors, the more moisture it pulls from the skin. (The third and lowest level of skin is the hypodermis or fatty layer.)

Dry, flaky skin or xerosis (officially when the skin’s moisture level is less than 10%) occurs when the water-retaining abilities of the top layer of skin are lost.  To stay moist, what the skin needs is the unlikely sounding combination of oil and water: moisturizers work best when applied after bathing —when the water ingredient is already there —after the skin is blotted but not rubbed dry.

“Applying an oily substance to the skin without also resupplying it with water…is ineffective: you’d just end up with greasy skin that is still dry and cracked,” according to the Harvard Health Letter. “One reason for the proliferations of moisturizers is the continuing search for a mix of ingredients that holds in water like petrolatum but feels nicer on the skin.”

But there is no consensus regarding the definition of a moisturizer…a neologism coined by Madison Avenue,” according to  dermatology researcher Anishi Sethi.

Traditionally, oily materials were applied to the skin “to inhibit trans-epidermal water loss (TEWL)” by replacing the lost barrier.

Such oily materials—notably mineral oils and petrolatum—diffuse into the intercellular levels where they help bolster the bricks-and-mortar structure and form an evaporation-blocking barrier.  Within this category of moisturizers called occlusives, petroleum jelly has a “water vapor loss resistance” 170 times that of olive oil and reduces TEWL by more than 98%, compared to lanolin and mineral oils at 20-30%.

Humectants, another category, work by attracting moisture to the skin and keeping it there—“basically the opposite of occlusive and emollients which don’t like water” from outside sources,” writes Julia Calderone at Business Insider.

“But beware,” says Calderone. “In dry conditions, humectants can draw moisture from the younger, moist cells in the lower layers of the skin instead of pulling moisture from the air.  Minimize this by pairing a humectant with an occlusive, which keeps the moisture in.”

The third category, emollients, include their own water and “penetrate the skin making it feel soft and flexible,” she explains.   Depending on the amount of water added, emollients range from lotions to creams to ointments: for lotions, water is the base with Vaseline added; creams contain a little more added Vaseline; and ointments start with Vaseline mixed with a little mineral oil to lessen the stickiness.

Adding water, however, increases the likelihood of spoiling, requiring the addition of preservatives.  And “since preservatives can stink, we add fragrances to mask the unpleasant smell…the more water content a product contains, the more likely it is for bacteria to form, so the higher the preservative and fragrance content,” according to Dermatology Alliance —which is why ointments can be easier on sensitive skin as well as less likely to go bad.

In addition to udder creams, home remedies include the familiar pairing of vinegar and olive oil, usually one or the other.  In “The People’s Pharmacy,” by Joe and Terry Graedon, one contributor dips her hands in a solution of two-thirds white vinegar and one-third water for two minutes and then rinses.  Noting the lack of supporting science, “The People’s Pharmacy” authors suggest “vinegar restores balance to dry skin caused by too much hand washing.”

Olive oil rubbed on skin, as well as hair, is also considered an “effective moisturizer,” by “The People’s Pharmacy,”although “it may be a little greasy.”  And it can appeal to dogs who like licking oily skin.

In one rating system assessing the 10 most popular lotions, the “hands-down” vote went to Aveeno Daily Moisturizing Lotion.  The runner up was CeraVe Moisturizing Lotion, which is “even lighter than our pick…more expensive due to ‘healing’ ingredients even though research suggests they make little difference.”

For drier skin, dermatology sites recommend oils, including Neutrogena Light Sesame Oil and Alpha-Keri Oil.  The most anecdotally well liked, however, and the one I use as a backup is Aquaphor Advanced Therapy Healing Ointment; and for lips, the Repair and Protect Lip Balm.

—Mary Carpenter

Every Tuesday Mary Carpenter reports on well-being, answering questions about living longer, the dangers of heavy metals and solutions for dry skin.

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FLORIDA MIGHT yet boast a fountain of youth—according to a presentation last month in West Palm Beach.

People hoping to increase their longevity have many options: injections of young blood (in Florida), post-partum placentas and stem cells; eons-old bacteria from Arctic permafrost; and pills, such as the diabetes-drug metformin and formulations containing various forms of nicotinamide.  Despite the fact that most of these are not yet supported by gold-standard clinical studies, they’re expensive— thousands of dollars or more.

Demanding more effort and will power and backed by better or at least longer term research are choices like calorie restriction and exercise, especially with added intervals of fasting and intense exercise. They’re also usually cheaper, although many dietary regimens offer costly options, including one with “teeny-weeny meals,” according to editorial writer Pagan Kennedy.

The best life-extenders of all, however, may be reducing air and water pollution,  which require both money and effort, though less from the individual and more from the community. “It’s the decisions that we make as a collective that matter more than any choice we make on our own,” Kennedy points out.

“The greatest gains in longevity have occurred not because of personal choices but because of public sanitation, clean water and the control of infectious diseases,” former CDC Director Thomas Frieden told Kennedy.  A recent study found that babies exposed to high levels of air pollution in the womb may be at risk for premature aging.

It is interesting to note, as Kennedy points out, that pioneers of drastic diet recommendations for better health, including Roy Walford, of the calorie-restricted diet, as well as Nathan Pritikin and Robert Atkins, proposers of diametrically opposed low- and high-fat diets, died in their 70s.

Among the newer options, infusions of young blood—specifically a trial with an enrollment cost of $285,000—was described to a West Palm Beach roomful of “mostly baby boomers.”  Independent experts, however, are critical: “It just reeks of snake oil,” said Michael Conboy, cell and molecular biologist at UC Berkeley.  “There’s no evidence in my mind that it’s going to work.

The infusions contain plasma (proteins and other molecules but no red or white cells) from young people who’ve taken a drug to activate their immune systems.  Earlier plasma transfusions have been offered by a Stanford University lab spin-off as well as by a company called Ambrosia (price tag $8,000), but the Florida group is the first to add immune-system stimulators to increase the plasma’s “restorative” effect.

So-called “biohacking” has also focused on nicotinamide (niacinamide)—part of the Vitamin B3 complex and found in cow’s milk and brewer’s yeast—which appears to boost both physical and cognitive functions and is marketed OTC as a cognitive enhancer.

NAD+ (nicotinamide adenine dinucleotide), a related molecule that regulates cellular aging and diminishes over time, is “the closest we’ve gotten to a fountain of youth,” according to Harvard Medical School Aging Center Co-Director David Sinclair, who plans to submit NAD+ research for FDA approval.

Another NAD+ product, called Basis and sold by Elysium Health, was developed at an MIT lab and is marketed as a supplement that helps people stay healthier longer —rather than as a life-extending drug—thus bypassing the FDA approval process.

Calorie restriction, touted for life-extension and an increasing common recommendation for brain health, refers to consuming about 75% of daily calorie needs (between 1,600 to 2,000 calories/day). For “alternate-day fasting,” days spent consuming 25% of calorie needs are alternated with “feast days,” consuming 125%.  In recent studies, the long-term effects of the two had similar effects on risk factors for cardiovascular disease.

“Fasting” also refers to intervals, in this case, the increasingly well-regarded 12-hour fast between dinner and breakfast—to give the body time to finish digesting and sufficient additional time to clear the brain of debris (especially amyloid-beta plaque) accumulated during daytime activities.

Intervals of high intensity are also the latest enthusiasm in exercising.  Mayo Clinic researcher Sreekumaran Nair noted that high-intensity interval training (HIIT), in particular, is “highly efficient” when it comes to reversing many age-related changes.

The weekly exercise recommendation from the Department of Health and Human Services calls for at least 150 minutes of moderate, or 75 minutes of intense, aerobic activity; plus strength training for all major muscle groups on at least two days.  But the Mayo Clinic website suggests as “a general goal, aim for at least 30 minutes of physical activity every day, and 300 minutes of aerobics for “more health benefits.” (On the site, “moderate aerobic” refers to “brisk walking,” and “vigorous” to running.)

—Mary Carpenter
Check out this space every Tuesday for Mary Carpenter’s posts on health issues for grown-up girls.

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SOME PEOPLE worry about what, quite literally, they’re going to leave behind—and how they can help the environment with their final decision. They ask, What are the greenest options for the body after death?

Creative solutions—especially some recent ones such as body farms—decrease burdens on the environment that are imposed by the traditional options of embalming and burial, even cremation, while sometimes contributing to scientific research.

Among the drawbacks of traditional methods: embalming fluids contain formaldehyde, a potential carcinogen, with some 800,000 gallons buried each year in the US. And burial usually involves wood and other casket materials, as well as real estate—maintaining cemetery lawns usually requires chemical fertilizers and pesticides, as well as vast quantities of water.

Cremation may be the first step in many greener options, but it has environmental drawbacks. For incineration, using combinations of natural gas and electricity, fuel consumption is estimated at around 20 gallons to create sufficiently high temperatures (1600 to 1800 degrees Fahrenheit) for the two to four hours per body. Cremation also releases chemicals—carbon and sulfur—and fine soot, as well as heavy metals such as mercury from dental fillings, into the environment. Indeed, the most environmentally sound cremation might be an open-air pyre using a wood casket, which is carbon-neutral and is the most-requested “fantasy funeral” at The Green Funeral Company in England.

(For those choosing cremation, there are many rules on scattering ashes: For example, controlled public lands such as city parks, as well as inland waters, require permits. Cremation Solutions advises, “Don’t ask, don’t tell” because “there are no ‘scattering ashes police’ in any state . . . no health, safety or environmental issues to be concerned about.”)

Resomation (also known as green cremation, bio-cremation, flameless cremation, dissolution and “the fire-to-water method) uses water and potassium hydroxide to liquefy the body, called liquefaction or alkaline hydrolysis. Water heated to around 350 degrees makes resomation less energy intensive than traditional cremation, and teeth fillings can be removed before the remaining sterile liquid is dumped into local wastewater systems.

Alternative disposition of ashes focusing more on sentiment than environment include “memorial diamonds,” made by pressurizing ashes or hair to create a “forever keepsake,” and ashes used in vinyl compression to create an LP of a favorite song.

For a final underwater solution, Georgia-based Eternal Reefs combines human cremains—crushed bone—with concrete to make heavy orbs that help support and rebuild reefs. Back on land, there are also biodegradable urns, known as “bio urns” or “living urns,” made of coconuts and other soil nutrients, that break down in months compared with conventional containers that take years to deteriorate. And burlap sacks containing ashes can be interred almost anywhere—woods, fields and, recently, specially designated urban locations.

Ashes can also be mixed with seeds or be buried close to a tree to spur healthy growth and development. To avoid incineration entirely, whole bodies buried in sacks or “pods” alongside trees provide more nourishment than ashes.

Freeze-drying, using a process called promession, immerses the body in liquid nitrogen to make it brittle, followed by vibrations that shake it apart, after which fillings can be removed. The powdered remains are buried in a shallow grave where, mixed with oxygen and water, they form what the inventors call “perfect compost.” Ashes can also be shot into space by companies like Celetis Memorial Spaceflights.

A post-life choice that preserves the body is mummification, offered by religious organizations such as  Summum. And plastination, developed to preserve organ specimens for education purposes, can now be done on whole bodies “posed as if frozen in the midst of their everyday activities,” according to LiveScience.  “Body Worlds” exhibits plastinated bodies, and thousands have signed up to donate their bodies to The Institute for Plastination.

Greener alternatives for traditional burials include embalming fluids made of essential oils, and caskets made of biodegradable materials such as bamboo, paper, cardboard, wool, banana leaf, willow and cedar.

To monitor the “death care” market and keep up with green solutions, Joe Sehee founded the Green Burial Council “to prevent meaningless greenwashing in the green burial world.”

The most completely natural options are tree burial and sky burial. Tree burial involves placing bodies high in a tree or entombed in the trunk to keep them away from animals. Sky burial, also known as “exposure” and practiced in countries such as Tibet, relies on vultures to take care of the remains, based on the spiritual belief that bodies should serve a useful purpose after death.

“Body farms” in the US, while very green, are created for research on body decomposition and other forensic issues by anthropologists, law enforcement and others. The Freeman Ranch in Texas has 16 acres of land with cages where dead people are laid out naked to decompose—70 bodies at a recent count.

The latest “body farm,” opening near Tampa, Florida, includes a “training ground for K9, ballistics and remote sensing, among other cutting-edge forensic techniques,” according to Forbes Magazine.

Recent innovations in body donation make it possible to arrange for a combination of options—such as donation of organs followed by that of the cadaver, along with final disposition—through organizations like Science Care. Coordination can be important because less than 1 percent of hospital deaths meet the criteria for organ donation, and because some whole-body researchers don’t accept bodies that have already been used for organ donation.

Science Care will redirect bodies initially offered for organ donation to medical schools and scientists and others in “desperate need of whole-body donations to further their research, training and development.”  In the DMV (the DC/Maryland/Virginia metropolitan area), Science Care’s final disposition of the body can be arranged via pre-registration only in Virginia, but not in Maryland, DC, Pennsylvania or Delaware, where each step (donation of organs, donation of whole body and choice of final disposition) must be arranged independently by your survivors.

(But bodies donated to medicine—both organs for transplant and whole bodies for research—must also be assigned a disposal option following medical use.)

People are encouraged to discuss body disposal preferences in advance with those who will survive them, although some may not be eager or even willing to listen.  Many survivors, too, will have trouble accepting choices such as sky burial and open pyres.

Written requests can also be helpful. But in the end there’s only so much one can ask of loved ones—at least until the environment becomes more fragile, or researchers more demanding, to provide clearer reasons for accepting what once appeared distasteful.

—Mary Carpenter

Every Tuesday in this space, Mary Carpenter reports on health issues of interest to 21st-century women. 

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AN INCREASINGLY popular “alternative” therapy, chelation (pronounced key-LAY-shun) is used to remove heavy metals from the body through a slow intravenous infusion that takes several hours and must be repeated every few weeks for up to six months.

Enthusiasts believe chelation can alleviate everything from depression, fatigue and brain fog to Alzheimer’s, autism and multiple sclerosis, as well as stave off cardiovascular disease.

Mercury is the main concern, with increasing environmental levels linked to global air-pollution. An estimated 40% of mercury in U.S. water and soil comes from the global reservoir,  which ends up in the ocean.  In the northern Pacific, for example, mercury levels increased by almost 30% in the last two decades.  That mercury, in turn, shows up in fish with especially high concentrations in large-prey fish like tuna and swordfish.

In addition to mercury, the most worrisome heavy metals  (for which occupational exposure causes the most serious problems) include lead (from industrial processes, gasoline, old plumbing pipes and house paint), arsenic (from paint manufacturing and ingestion of pesticides) and cadmium (from discarded cell phones and batteries).

In 2012, a large multi-center study on people who’d already had a heart attack found that chelation therapy reduced the risk of stroke, heart attack, other cardiovascular problems and death by 18%.

Orlando Florida cardiologist Kirti Kalidas believes chelation should be part of regular routine care for heart patients.  For one round of chelation—which takes from six weeks to six months–Kalidas charges $3,000 to $4,000, which she considers “considerably less than bypass surgery…well over $40,000,”although generally it’s not covered by insurance.

Immediate warnings about the multi-center research came from the study’s lead author, Cleveland Clinic cardiologist Steven Nissen, who called it a dangerous failure. Critics of the study noted an unusually high number of people dropping out, as well as little regulation at many of the “alternative medicine” clinics involved.

The results “should not be interpreted as an indication to adopt chelation therapy into clinical practice,” said one American Heart Association physician.

Even the godfather of “alternative” or “integrative medicine,” Harvard M.D. Andrew Weil, is “skeptical of claims that chelation therapy is an effective treatment for cardiovascular disease and the many other conditions…”

Along with most in the medical profession, Weil supports “conventional medical usage” of chelation to remove toxic levels of heavy metals from the body.  Lead poisoning most often affects children between one and three years old, although with growing awareness has been occurring less often.  In one of the few recent outbreaks of heavy metal poisoning in the U.S., the culprit was imported plates and cookware insufficiently coated to prevent metals from contaminating food.

In chelation therapy, a medication, or “chelating agent,” is delivered intravenously into the bloodstream, where it binds with and carries minerals out of the body, including the calcium contained in fatty deposits in the arteries.  Removing calcium can sweep away this “plaque” but can also lead to deadly low calcium levels in the blood, described in a 2006 CDC report on the death of three people.

A very slow rate of infusion enables constant monitoring to help avoid excessively removing minerals essential to bodily function, but is the reason that each session takes so long —more than three hours or more are required by the NIH, and multiple sessions over time are needed.  Side-effects of the therapy include diarrhea, nausea, vomiting and skin rash.

“Before scientists became aware of the toxic effects of mercury—it poisons the kidneys and nervous system—this seemingly magical metal was widely used in medicine, cosmetics and industries like hatmaking (an explanation for the term “mad hatters”), according to the Mercury Guide of the National Resources Defense Council (NRDC).

An ongoing worry is the mercury used in amalgam fillings, which some people have extracted and replaced.  The current advice, though, is against removal because the process releases more mercury than that emanating from the fillings.

Mercury is also found in compact fluorescent lights (CFLs), those twisted spirals labeled “lamp contains mercury,” although the NRDC traced the highest levels of lightbulb-related mercury to conventional incandescent bulbs.  For comparison, old mercury thermometers contain 100 to 200 times more mercury than today’s CFLs.

On the other hand, new efficiency standards are met by both halogen incandescent and LED bulbs, which contain no mercury.  For light bulbs, thermometers, and anything else containing mercury, the important concern is proper disposal.

The number one cause of mercury exposure in America, however, is “eating contaminated fish,” according to the NRDC. In addition to swordfish and tuna, the highest concentrations are found in tile fish, shark, orange roughy, and king mackerel.  Current advice on canned tuna is to consume no more than three cans of “light” tuna per week, and no more than one can of “white” (albacore).

Avoiding risky fish may be sufficient for maintaining safe heavy metals levels in the body—at least until further research more clearly establishes the benefits of chelation therapy, filling removal and other medical interventions.

—Mary Carpenter

Mary Carpenter writes in this space every Tuesday on matters of health. 

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HOT OR cold? The debate continues about which temperature works better—outside and inside the body. It’s all about the circulation of the blood—how to get it to the right place at the right time.

Cryotherapy, which uses cold packs to reduce swelling and discomfort for both injuries and chronic pain, has been standard practice for decades. The idea is that constricting blood vessels prevents inflammation-causing cells from reaching the problem areas.  Now “whole body cryotherapy,” which originated in Japan 50 years ago, is catching on across the country, most notably in warm-weather states.

Once in favor of cold treatment, however, sports medicine and pediatric specialist Gabe Merkin, who in the 1970s coined the acronym RICE (Rest, Ice, Compression, Elevation) for treating injury, recently reversed his advice.  He now prescribes heat to make the best “use of your immunity.”

Based on a summary of 22 research studies, Merkin concluded that in the process of preventing swelling, ice “shuts off the blood flow that brings in the healing cells of inflammation” crucial to recovery.  Delaying inflammation can “cause the tissue to die from decreased blood flow and even cause permanent nerve damage.”

Heat, on the other hand, dilates blood vessels to increase the flow of healing cells, as well as oxygen and nutrients, to the muscles. Warming also helps relax muscles and lubricate joints, and can relieve muscle and joint stiffness —especially important before activity and especially for anyone with degenerating cartilage due to injury or osteoarthritis.

For those who prefer the cold approach, area locations, such as Capitol Cryo, offer $60 cryotherapy sessions lasting around two minutes in a “cryosauna.” In a narrow metal cylinder enclosing the entire body except for the head, liquid nitrogen cools the surrounding air to temperatures as low as minus 200 degrees Fahrenheit.  (Cryotherapy is not recommended for anyone with Raynaud’s syndrome, fever, urinary tract disease, open wounds, high blood pressure and heart disease.)

Although the absence of any moisture or air current keeps the cold from being intolerable or dangerous, skin temperatures can drop to around 55 degrees Fahrenheit.  When extreme cold forces blood away from the extremities and toward the core to protect vital organs, that blood collects increased oxygen and nutrients and then streams back to the extremities where it flushes out toxins and boosts circulation, according to promoters.

Many opt for cryotherapy to promote healing after injuries or surgery, or to relieve chronic pain and inflammation-related skin conditions.  Others seek the “rejuvenation” touted to result from a flood of endorphins that can numb pain and improve mood, as well as from an uptick in the body’s metabolic rate that raises energy levels.

Poor circulation of blood can be a reason why some people always feel cold. One cause is anemia (too few healthy red blood cells to carry oxygen throughout the body), which can be alleviated by changes in diet or with supplements, notably vitamin B12. Another is Raynaud’s syndrome, when blood vessels in the hands and feet overreact to temperature or stress by narrowing, which limits blood flow to the extremities and causes discoloration, pain and more dangerous risks.

As for the debate on what temperature your beverage should be, practitioners of Chinese and Ayurvedic medicine advise against cold drinks, saying these cause muscles to contract.  Especially before meals—starting first thing in the morning—warm drinks are thought to aid digestion.  In contrast, cold liquid imbibed during or immediately after meals causes energy to be diverted toward increasing body temperature, thus interfering with digestion.

Warm drinks can increase blood circulation to relieve pain and protect internal organs. Even when the body is overheated from exercise and in hot weather, heated drinks help increase the evaporation of sweat, a process that cools the body and “more than compensates” for any heat added to the body from the drink, according to Canadian researcher Ollie Jay.

Tea, in particular, is best imbibed hot, as soon as possible after brewing to get the greatest benefit from antioxidants—credited with linking green tea to lower risk of colon cancer—which dissipate quickly from a beverage left cooling in an open container.

But even for otherwise-healthy teas, drinks hotter than 149 degrees Fahrenheit, such as an “extra hot” request at Starbuck’s, have been linked to increased risk of esophageal cancer.  In a recent study, drinking hot tea was associated with a five-times higher risk of esophageal cancer, though only in those who also smoked cigarettes and consumed at least one alcoholic drink/day.

So, what to do?  Outside the body, combining hot and cold is a common strategy: apply a cold pack (or bag of frozen peas), alternating with a heating pad or a warm bath (epsom salts can increase the healing effects). For residents of states with a “marijuana card,” marijuana-infused epsom salts may amplify the relief.

Cold drinks are definitely the better bet if the body gets so hot that sweat increases to the point of dripping or when excess clothes prevent perspiration from dissipating. But for most other times, heat is the way to go.

—Mary Carpenter

Mary Carpenter writes about healthy living in this space every Tuesday.