BABY BOOMERS have watched aging relatives and friends who have no terminal disease but suffer increasingly debilitating dementia. Some are exploring alternatives for a better and peaceful death that give them some control over the process; others are horrified by the notion.
When KD,* a woman in her mid-eighties, legally blind from macular degeneration and having increasingly upsetting nightmares, broke her pelvis, she couldn’t bear being carried around. She’d had enough. Along with her family, she chose VSED —voluntary stopping of eating and drinking—set a date, and arranged for a “comfort pack” from a local hospice. These generally include medications for anxiety, nausea and pain, to be kept in the fridge just in case.
After two weeks, KD died of dehydration, with her family gathered around and everyone agreeing it was a “good death.” The average time for death via VSED is 10 days—the time it took the husband of DC-based radio host Diane Rehm to die using this method. Severely crippled by Parkinson’s disease, John Rehm was considered “terminally ill”—having an illness predicted to cause death within six months—for which a host of states and recently DC (but not Maryland where Rehm lived) have passed “aid in dying” bills. Dementia is rarely considered “terminal.”
A 2015 New York Times magazine article widely discussed among boomers described plans for death made by retired Cornell professor Sandy Bem after experiencing several years of what she called “cognitive oddities.” Diagnosed with a precursor to Alzheimer’s Disease at age 65, Bem told a neurologist, “I want to live only for as long as I continue to be myself.”
Reading “The Peaceful Pill Handbook” by Philip Nitschke, Bem learned about phentobarbital, a barbiturate used in veterinarian euthanasia and state-sanctioned physician-assisted suicides. She ordered two 100-milliliter bottles from an address in Mexico provided by the book.
When Bem lost her ability to play the piano, read novels or follow movie plots, she chose a date. When she could no longer remember who was related to whom among her immediate family members, she moved the date up— to May, 2014, five years after her diagnosis. At that point, she completed a document she’d started earlier titled “Ending” that made it clear no one helped her either with making the decision or with killing herself.
Another widely discussed article appeared in The Atlantic in 2012, by University of Pennsylvania oncologist and bioethicist Ezekial Emanuel titled “Why I Hope to Die at 75.” Emanuel writes, “We wish our children to remember us in our prime. Active, vigorous, engaged, animated, astute, enthusiastic, funny, warm, loving. Not stooped and sluggish, forgetful and repetitive, constantly asking ‘What did she say?’ We want to be remembered as independent, not experienced as burdens.”
“At 75 and beyond, I will stop getting any regular preventive tests, screenings or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability…65 will be my last colonoscopy…flu shots are out.”
Emanuel quotes Sir William Osler, author of a classic turn-of-the-century medical textbook, The Principles and Practice of Medicine: “Pneumonia may well be called the friend of the aged. Taken off by it in an acute, short, not often painful illness, the old man escapes those ‘cold gradations of decay’ so distressing to himself and to his friends.”
Some applauded Emanuel’s position, with reasons ranging from how they want to be remembered to concerns about draining their children’s bank accounts with the high costs of health care for dementia patients. But others expressed some version of: “We took care of our kids—let them take care of us.” Because Emanuel was 57 at the time of writing, most readers hoped he might move the timeline ahead by at least five or ten years as he got older.
The Alzheimer’s Association, responding to a sufferer’s suicide, included in its statement: “…we must also affirm the right to dignity and life for every Alzheimer patient and cannot condone suicide.” The association, at the same time, takes the position that “no person with Alzheimer’s will be made to endure unwelcome efforts to prolong dying in the advanced state of the disease or discomfort due to the lack of treatment for pain.”
“Death with dignity” is one of the preferred umbrella terms for an individual’s ability to choose the timing and means of their death—as opposed to using the word “suicide”—and is the name of an organization that provides information for terminally ill patients, in particular about VSED.
The Hemlock Society—started in 1980 by Derek Humphry, a co-author of the 1991 book Final Exit— has over time morphed into two groups. (While hemlock and other poisonous plants can be deadly, the death is not a peaceful one and thus isn’t mentioned in the context of orchestrating one’s own death.) One, Compassion and Choices, focuses on legislative change.
The other, Final Exit Network, addresses “the current needs of those who are suffering now in a very real and personal way”—by providing “Exit Guide” services to members who are “suffering from intolerable medical circumstances, are mentally competent, want to end their lives and meet our official written criteria.” What exactly those services include depends on individual preferences and needs needs, but the “intolerable medical circumstances” include Alzheimer’s Disease and other conditions that affect mental as well as physical functioning.
While the right to “death with dignity” for terminal illnesses is predicted to become legal in more states, strong opposition remains from institutions like the Catholic church as well as from medical professionals, ethicists and others who worry about abuse and about the conflict with physicians’ prescribed roles as healers.
When dementia is the issue, however, opposition is exponentially more pronounced—placing greater burden on the individual to make their own way: those wanting professional support can turn to Final Exit Network; and those who prefer to plan farther ahead can obtain a “peaceful pill.” Finally, there is VSED, with the possibility of “comfort” care from hospice.
*the author’s godmother
—Mary Carpenter Want to read more of Mary Carpenter’s posts? Click here.
YOU HAVE a small kitchen disaster with a sharp knife and you might need stitches. Or you fall on your ankle and may have broken a bone. But it’s Friday night—of course —long after doctors have turned out the lights for a long weekend ahead.
You should not wait. Broken bones shouldn’t wait to be set. And wounds requiring “closure” must be medically closed—stitched, stapled, etc.—within 6-8 hours to avoid infection, though some can wait longer. When too much time has elapsed for closure, a deep wound can only be dressed with bandages, will take much longer to heal and must be treated with extreme care. A cut on the bottom of the foot can mean more than a week of no weight on that foot at all.
Walk-in clinics—known as “urgent care” or “retail clinics”—in contrast to Emergency Rooms, usually have the advantage of much less wait time, on average 30 minutes compared to two and a half hours for the ER. Urgent care clinics are usually run and staffed by hospitals or doctors, while retail usually refers to clinics located inside a big box store or pharmacy. But how to choose?
As with any medical recommendation, friends are usually the best source of advice, although late Friday night might not be the best time to do a survey.
Deciding among many local walk-in options depends on several variables, number one being hours—i.e, is it open at the moment you need it? Next comes the level of medical practitioners on staff: urgent-care clinics usually have physicians, who can perform a higher level of care than nurse practitioners, who often staff retail clinics.
The counterpart of that variable is the selection of medical procedures that can be performed. Minute Clinics in CVS pharmacies are generally staffed nurse practitioners who can write prescriptions, but the absence of a doctor means no stitches or x-rays.
Then there’s the question of cost, along with how much your insurance will cover the bill. It can help to ascertain whether the clinic is officially an urgent care facility or an emergency room. Basic care at urgent care clinics costs on average $70-$125 compared to ER visits at around $1,500, with added costs for x-rays, labs and sometimes for specific treatments. But sometimes going to an ER can result in less money out of pocket— especially if an ER visit is required in the end anyway.
(Yelp star ratings can be useful but they rarely include these variables, and can be confusing: for example, in DC there are two MedStar clinics next door to each other providing different levels of care.)
A favorite local clinic for DC and MD residents is MedOne on Old Georgetown Road because people like the doctor; open 9am to 9pm seven days/week. Patient First on 16th Street in Silver Spring is also recommended, open 8am to 10pm every day including Sundays and holidays.
Prompt Care in Friendship Heights is considered “trustworthy” because it belongs to MedStar, open 8am to 8pm seven days a week. Also popular is Bethesda Immediate Care on Wisconsin Ave (formerly on Montgomery Avenue) where a team of doctors can do everything from physical exams to urgent care, but hours are limited to 9am until 7pm on weekdays and until 5pm on weekends. In addition, some hospitals have “fast-track emergency room” systems for patients with problems less serious than a true emergency.
For a true emergency, call 911: if an ambulance takes you to the ER, you are evaluated and often started on treatment before reaching the hospital, usually much more quickly than if you arrive on your own.
Once in the ER, a triage/intake nurse will place you in line according to your needs; from the end of the line, the wait in DMV-area hospitals can go on and on, hour after hour, depending on when you arrive. Friday nights are reputedly the worst.
A final option is Doctors to You, a service offering doctors who make house calls 6am to 12pm. Founder Ernest Brown drives around the DC area in blue scrubs on a red E-bike (electric bike). The organization “does not participate with insurance plans,” although some insurers reimburse a percentage of the cost; the site suggests calling your insurer to check.
—Mary Carpenter Well-Being Editor Mary Carpenter understands the value of being prepared. Look for more of her posts here.
HUMID DAYS of summer can be deceptive. You feel puffed up with fluids but your clothes are damp with sweat. Since water comprises up to 75% of our body weight, it’s important to pay attention to hydration—but drinking more water is not always the answer.
In fact, even mild dehydration—also known as “heat illness” —can cause water retention, often noticeably in the legs, as well as feeling faint and cramping muscles. Although the body usually can reabsorb fluid from the blood as needed, when you’re dehydrated, the blood becomes more concentrated, which causes water retention in the kidneys as well as in tissues throughout the body.
Thicker blood makes the heart work harder to pump the blood, which can cause a rise in heart rate to maintain blood pressure. In addition, one of the body’s first cooling actions is increasing the heart rate to move blood and heat outward to the skin. An elevated heart rate can increase the risk of fainting, often accompanied by dizziness and nausea.
Sweating is another of the body’s cooling responses designed to prevent elevations in core temperature. But with age, the sweat glands respond more slowly, allowing core temperatures to rise and increasing recovery time. Also the body’s water concentration decreases with age, and the thirst response takes longer to activate.
Early signs of dehydration include dryer mouth and eyes, darker urine and feeling more tired and irritable. Bad breath can be a clue because dehydration reduces saliva, along with its bacteria-fighting abilities. Dehydration interferes with the body’s ability to regulate temperature, causing body temperature to rise or sometimes, paradoxically, to fall—causing chills. Quick tests include pushing one finger into skin on the arm or using two fingers to pull up skin on the hand—in both cases, skin should resume its original appearance in a few seconds.
When severe dehydration reduces fluid in the blood to the point where blood can no longer circulate to the organs, the most serious result is life-threatening shock —which requires medical attention. While shock usually occurs only in cases of severe diarrhea, it’s a reason to pay attention to the body in extreme heat.
Sweat contains more sodium than other electrolytes. Both dehydration and drinking too much plain water when dehydrated can cause hyponatremia—insufficient salt in the blood—which can trigger muscle cramping. Cramping is also caused by becoming overheated while exercising, as well as by overexertion of the calf muscles, insufficient warming up and magnesium and/or potassium deficiency.
In cases of severe dehydration risk, UNICEF and commercial rehydration packages include salt and carbohydrates—sometimes simply sugar—to mimic the normal composition of fluid in blood, which improves absorption.
To stave off dehydration ahead of time, alternatives include pre-cooling and heat acclimation. In a Scandinavian study of different cooling methods, 12 experienced male runners were tested on three separate occasions: first after drinking a room-temperature sweetened beverage, then after a sweetened “slushy” (icy) drink and finally after cooling their skin by draping cold towels around their necks, immersing their arms in cold water and wearing underwear filled with ice packs. (The French brand Yokool freezer packs are designed to be worn inside women’s underwear—Marion Cotillard is a reported fan.) The athletes performed better after both the slushy drinks and skin cooling than after a room-temperature drink—but the effects of core cooling with the slushy drink wore off faster than the effects of skin cooling.
A different study, at the Environmental Extremes Laboratory in Brighton, England, tested nine recreational runners doing a simulated 5K race four times at top speed in a 90-degree heated room: first with no preparation; then after pre-cooling with frozen underwear and a chilling arm plunge, plus a cooling vest; next, after formal acclimation—cycling for 90 minutes in 99-degree heat for five consecutive days; and finally, after both pre-cooling and acclimation. Acclimation made the biggest difference in subsequent running times; adding pre-cooling provided little additional gain.
Because overheating alters many bodily functions, including efficient production and use of energy, many athletes use cooling vests to reduce excess heat while exercising. In one study, however, core cooling did not increase any more for the group wearing a cooling vest than it did for those who simply sat in the shade ahead of time—the only difference for the former was cooler skin and a feeling of coolness. Also, cooling vests and underwear come with the risk that reducing perceptions of body heat can mask rising core temperatures—making heat-induced illness more likely.
But for most people, overheating occurs without warning (and preparation). In that case an easy option is salt pills or salty chews (though people with high blood pressure should be careful). “Saltstick Fastchews,” tasting something like sweet tarts, include four electrolytes and promise to “reduce heat stress and muscle cramping.” Whatever the individual response to a hot day—sweating profusely, experiencing leg cramping or feeling a little nauseated—these chewy treats, along with cool, watery drinks, seem to help many people feel a little better.
—Mary Carpenter Well-Being Editor Mary Carpenter writes about how to stay healthy both physically and mentally.
RE-IMPLANTATION of one’s own stem cells has proliferated over the past two decade. As many as 600 stem cell clinics in the U.S. treat more than 100,000 patients for relief of persistent orthopedic pain, especially for sufferers frustrated by long journeys fraught with unsuccessful treatments. This growth continues despite still-inconclusive data, according to the latest research summary published in December, 2016 and despite lack of reimbursement for stem cell procedures costing from about $4,000 to $12,000 per procedure.
Transplanted stem cells can secrete proteins that improve blood flow, decrease inflammation, help regenerate cartilage and spur recovery; using one’s own cells avoids the risk of an immune system attack on implanted cells. Injected into the bloodstream or into an arthritic joint, these “autologous” transplants are thought to respond to signals from injured and inflamed cells and move through the body in that direction to begin healing the area of pain.
Also published in December, 2016, “the world’s first prospective, blinded and placebo-controlled clinical study” at Florida’s Mayo Clinic examined the benefits of using bone marrow stem cells. When 25 patients, each with two painfully arthritic knees, had one injected with stem cells and the other with a placebo solution, “dramatic improvement” occurred not just in the knee that received stem cells, but also in the other knee.
One conclusion: the re-implanted stem cells “homed” to areas of injury —that is, moved from one knee to the other. Another possibility, that simply injecting anything into knees can provide relief, is unlikely, as orthopedist Shane Shapiro told Mayo Clinic News Network, because “some patients are still doing well years after their study treatment ended.”
Stem cell therapy remains a promising option for treating orthopedic pain because the alternatives are often ineffective. DC lawyer J.F. went down this path for pain—in two small joints at the meeting of the ankle and mid-foot—that made walking very difficult, both for just getting around and as J.F.’s preferred and primary form of exercise.
Of his first treatment, three cortisone injections, the first and third did nothing, and the second helped a little. Afterwards, his orthopedist said: no more shots, “nothing more to do, come back when you’re ready for surgery”—with no time for discussion or questions.
Surgery to fuse J.F.’s foot/ankle joints—where arthritis had destroyed all the cartilage—would involve “six weeks recuperation, off your feet completely,” he was told, followed by weeks or months of rehab. He later learned that it could take more than a year before he walked without pain; even then, permanent loss of some lateral movement could displace everyday stress and shock absorption and cause pain in other joints.
J.F. made the surgery appointment. Then sufficient misgivings drove him on a “campaign to try everything” else. First: acupuncture, which he found calming, but didn’t relieve the pain. Then: a therapy program, Egoscue, which had the wrong focus of improving posture, and also failed to relieve his pain.
The Egoscue therapist, however, told J.F. about StemCell Arts in Fairfax, where pain specialist Mayo Friedlis uses a method called Regenexx to re-implant one’s own stem cells. Over three visits, costing J.F. $7,000, bone marrow was extracted, very uncomfortably, from the hip joint; and stem cells were then isolated and returned to the body —by way of injections into both the joints and other joints as well—along with platelets containing growth factors to augment the effect.
Although the Regenexx procedure allegedly leads to regrowth of cartilage, when J.F. asked if he could look at an x-ray and see more cartilage, Friedlis “did not say yes.”
After the procedure, J.F. stayed off his feet for one day and took it easy for a few more—“nothing” compared to the recovery time required for surgery. Also, he ate a high-protein, low-carb diet, with protein shakes provided by StemArts, to encourage stem cell growth.
At the first follow-up visit at six weeks, he felt “no relief”— and was told only about 50% do better during that period. After 12 weeks, still no results—but one or two weeks later, he started feeling better and walking with less pain.
At that point, however, an alternative emerged that helped J.F. most of all: New York City orthopedist David Weiss, who is “very knowledgeable” about all the alternatives to surgery, according to J.F., because he treats dancers for whom surgery is usually not a good option. Also very important to J.F., Weiss willingly answered questions and talked at length about the options, an experience surprisingly uncommon among orthopedists.
The first treatment Weiss offered was cortisone shots, though not in the painful joints. After the first shot, into the side of his foot: “immediate relief!” said J.F. After the second shot, more “good relief.” Weiss told J.F. he could have these shots every six months as needed —which the D.C. orthopedist had refused because of a slight risk of soft-tissue damage. But Weiss weighed that risk against the long-term effects of inflammation and debilitating chronic pain. Weiss also recommended a DC-based physical therapy group for follow-up treatment that continued to help.
For treating back pain caused by degenerative disc disease, just-in research on stem cell therapy shows “growing evidence of safety and efficacy.” Another analysis of 14 studies involving a total of 533 patients treated with spinal fusion surgery showed that adding stem cell injections led to fewer complications and improved function.
As with many who’ve gone on lengthy quests for relief from orthopedic pain, J.F. doesn’t know for sure what helped when. Maybe the stem cells were starting to work when Weiss added the cortisone shots; maybe both spurred long-term recovery after physical therapy began changing movement patterns; maybe all these treatments bolstered each other; and maybe their ultimate effectiveness was aided by the passage of a frustratingly long period of time.
—Mary Carpenter Read more of our well-being editor’s posts right here.
ARTIFICIAL SCENTS ARE popping up everywhere—in taxis and Ubers, in hotel rooms and lobbies, in new cars, and even at the gym. In humid workout rooms and indoor pools, one person’s fragrant spritz can be overpowering.
Scents often drive DC resident B.N. to switch hotel rooms. Most hotels save a few odor-free rooms, B.N. says—though she once had to try four rooms before finding one that was okay. For B.N., a sore throat and headache can be set off by scented environments, by highly perfumed dinner guests and Amtrak riders—and recently by the glove compartment scent-disperser in her 2017 car.
Starting with perfumed clothing, the company ScentAir makes Bloomingdales smell like Baby Powder, Lilac and Coconut—except at Christmas when the scent switches to Sugar Cookie, Chocolate and Evergreen. These are a few of ScentAir’s “over four billion ‘enduring impressions’…Other stinkers include the Westin Hotel and Resorts, Anytime Fitness, Jimmy Choo Shoes, Saks…” according to the blogger Multiple Chemical Survivor.
Many people are not so happy about all these scents. In surveys by University of Melbourne environmental pollutant expert Anne Steinemann, 50% of American respondents preferred workplaces, healthcare facilities and professionals to be fragrance-free; more than one-third were irritated by perfumed products worn by others; and about 20% reported ill-health effects including headaches and breathing difficulties. “Lawsuits under the Americans with Disabilities Act concern involuntary and disabling exposure to fragranced products,” according to Science Daily.
Among all those with chronic health issues, 22% suffer from some degree of chemical intolerance—and more than 6% are “greatly affected,” Claudia Miller, an environmental health doctor at the University of Texas, San Antonio, told Jill Neimark of Discover Magazine.
People who object to being forcibly immersed in strong artificial odors—as well as flowers in especially aromatic arrangements —may be afflicted with “hyperosmia,” increased olfactory acuity or heightened sense of smell.
Steinemann receives hundreds of letters, phone calls and emails from people who report respiratory, dermatological and neurological problems that they attribute to scented products. “Adults pass out around air fresheners,” she says. “Children have seizures after exposure to dryer sheets.”
About 2.5 million Americans have “fragrance allergies,” according to the American Academy of Dermatology -– although doctors disagree about whether the reaction is truly allergic or rather sensitivity to an irritant, which causes headaches, sore throats, etc. Scented skincare products are the main cause of “cosmetic contact dermatitis,” with symptoms that range from skin itching and redness to blisters and swelling.
Sufferers of Multi-Chemical Sensitivity (MCS; also called Environmental Illness, and IEI for Idiopathic Environmental Intolerance) can have devastating reactions to environmental toxins—although the American Medical Association, many medical professionals and others don’t recognize MCS as a true medical condition. Not until B.N.’s sister broke out in large red welts over her whole body after visiting a scented ladies’ room were friends and colleagues convinced that she had a serious problem. (Some experts trace chemical sensitivity to a genetic component.)
“Odor cues,” i.e. telltale odors, make chemical sensitivity difficult to document. In “studies where the chemical odor was masked or suppressed by menthol,” according to British allergist Adrian Morris, both study and control groups had similar symptoms.
MCS skeptics charge that the impact on health maybe due more to perception than to actual toxic effects– in which case smell alone would influence the perceived IAQ (indoor air quality) strongly enough to spur physiological responses. Even when four commonly studied “abundant indoor fragrances”—pinene (pine), limonene (citrus), linalool (floral, sometimes spicy) and eugenol (clove)—are present at two- to three-fold below their thresholds for sensory irritation in the eyes and airways, they might be close to or above thresholds for odor detection. In that case, smell alone could influence the perceived IAQ (indoor air quality) enough to spur physiological responses, according to Danish researchers Peder Wolkoff and Gunnar Nielsen.
Skeptics also point out that the pinene blamed for negative health effects is the same odor inhaled from pine trees during “forest walking”—a pleasant experience for almost everyone.
Also affecting the perception of toxicity are psychological conditions, like anxiety, which are capable of inciting physical reactions. On the other hand, the mind is increasingly acknowledged by the medical community to play a valid role in chronic health complaints, such as pain. (In studies where placebos are clearly labeled as such, if doctors explain the important role of the mind in causing symptoms, patients often improve—sometimes even more than they do with mainstream medical treatments.
A single fragrance can contain hundreds of chemicals, some of which react with ozone in ambient air to form dangerous secondary pollutants, including formaldehyde. Testing 25 top-selling products including air fresheners, laundry detergents and lotions, Steinemann and colleagues detected 133 VOCs (volatile organic compounds) including ethanol and acetone, which are often used as carriers for fragrance chemicals.
An initial extreme exposure can cause the “neurological setpoint for sensitivity” to fall —an actual change in brain processing which has become evident only with the latest imagining techniques, according to Claudia Miller. The change sets off what she calls TILT—toxicant-induced loss of tolerance, with toxicant referring to man-made poisons versus toxins, which are naturally occurring poisons such as spider venom. TILT is a “genuinely new class of diseases unique to our toxic, modern times,” according to Miller.
A man whose office had been sprayed with a potent pesticide (an organophosphate now banned for indoor use) first developed what felt like a bad flu and afterwards each encounter with fresh paint, gasoline odors and other chemicals provoked symptoms. Following many moves, he finally settled in a renovated travel trailer with porcelain (inert and non-reactive) tile floors, but still often needs to sleep outdoors. Chemical-free housing exists in various forms around the country—such as Seagoville Ecology Housing near Dallas—but can be impractically remote and expensive.
Dallas’s Environmental Health Center, founded by controversial cardiovascular surgeon and “clinical ecologist” William Rea, attracts patients from around the world with complaints Rea traces to environmental sensitivities. Although charged in 2007 by the Texas Medical Board for using pseudoscientific test methods, failing to make accurate diagnoses and providing “nonsensical” treatments,” Rea continues to be a popular lecturer and was keynote speaker at last year’s Environmental Health Symposium in San Diego.
Ann Lloyd, a 70-something socialite, was sleeping on the beach to avoid toxins until Rea diagnosed her as a “universal reactor” (to almost everything) and suggested she move to Seagoville. She lived there for 10 years, afterwards moving to a secluded island in the Bahamas, and credited MCS for causing her to lead a simpler life—one that kept her young.
IN THE 1970s, Rolfing® had a heyday—after gaining traction at California’s Esalen Institute during the previous decade—for treating body and mind.
Needing help with both at the time, I signed up for the standard “10-series,” which involved 10 hour-long sessions. My Rolfer’s™ every move caused intense and unremitting pain, only interrupted when he took annoying day-trading phone calls. Not a positive experience for body or mind.
Fast forward more than 30 years. After decades of regular injuries and subsequent orthopedic surgeries—traced mostly to hypermobility in my joints—I began going several times a year to local bodyworker Rebecca Carli, based on friends’ recommendations. Each time, Carli got my body feeling better balanced and ended every session with blissful cranial-sacral (head and spine) massage.
Immediately following the injuries and surgeries—and recently noticing a slight but worrisome new scoliosis—I went more frequently. But until friends began asking me about Rolfing®, I was only vaguely aware of Carli’s training as a Certified Advanced Rolfer™ and Rolf Movement® Instructor.
Turns out that 21st-century Rolfing® “is experiencing a resurgence,” according to Austin Considine’s 2010 story in the New York Times —among people “for whom the novelty of yoga has worn off, and who are now seeking more intense ways to relieve the stresses of modern life.” Rolfing® is now recommended for athletes, particularly runners, swimmers and golfers.
Rolfing® has also become less painful, said Carli, starting in the 1980s and less with every passing decade. Considine’s contention that Rolfers “gouge with knuckles and knead with fists, contort limbs and lean into elbows”—exactly my experience with the day trader’s 10-series—is thus outdated. (Despite the passage of time, randomized controlled studies to compare Rolfing® with other physical therapies are difficult to do because patients feel whatever body work they are getting—and Rolfing® feels different from everything else.)
Rolfing® was developed by Ida Rolf, a biochemical researcher at New York’s Rockefeller Institute for Medical Research, during the middle of the last century. Observing bodies that seemed “at war with gravity,” Rolf came to believe that “human bodies are shaped by gravity, physical structure, past injury or illness and our daily habits.”
Exploring ways to get bodies back into alignment, Rolf focused on fascia, the connective tissue composed of collagen and elastin that forms a “body stocking”—continuous layers of webbing connecting muscles to muscles and muscles to bones that extends throughout the entire body from toes to head.
When fascia is treated carelessly—as it was originally by surgeons who considered it mere packing material—the tissue can become bunched or tangled, or even wrapped the wrong way around organs like the colon. Rolf observed that, among our “organs of structure”—tendons, muscles, bones—fascia is the most elastic of the tissues and, in contrast to the others, can be changed immediately and extensively, for better or worse.
Over time, with repetitive, unbalanced movements, the body rearranges itself to support those movements: using a computer mouse with one hand, day after day, for example, can cause that side of the body to contract. Then the slightest movement, such as simply reaching for a book or bar of soap, can send the back into excruciating spasm. The spine should be able to turn and reach for something, Carli explains, “but if you’re overusing one side for so long, the spine gets stuck.”
“For mobility to happen, you must have stability first,” explains Carli. “You need to coach the body so it’s more at ease in gravity.” During each session, Carli’s manipulations, often starting with the feet, lengthen, realign and organize the fascia where needed.
Carli also makes suggestions—gently but repeatedly—on what to do between sessions, such as standing on and rolling a slightly squishy ball around under one foot and then the other every day, as a way of keeping the fascia pliable and the feet “fully awake and functional,” as she puts it. Using that ball was something Carli mentioned to me over the years, but not until a serious injury forced me to focus on and better understand about the fascia did I manage to do it regularly, almost daily.
The amount of pain in early Rolfing® techniques came from the flawed idea that fascia is stubborn and can change only in response to painful manipulation, Carli explained. But “if the body is resisting because of pain (caused by the Rolfer™), changes to the tissue can’t be integrated, because we are one nervous system.” She compares the process to titration: “if you drop a chemical in too quickly, the mixture explodes.” Instead, she “listens” with her hands to changes in the connective tissue to “figure out the right depth and direction” of her manipulations.
Less pain is one variable that differentiates Rolfing® from other treatments involving fascia, like myofascial release. Also, those usually work with troublesome body parts in isolation—which Carli calls “sacrilege to Rolfers™, because if you injure your foot, that affects fascia throughout the body.” Some bodyworkers, including Rolfers™, are more structure-based, for example, relying on photos of the body’s misalignment to determine goals for what Ida Rolf preferred calling “education”—rather than therapy.
In contrast, Carli considers herself “movement-based” and starts sessions by watching the client walk around the room. She looks at body structure in relationship to coordinated patterns of movement—“patterns that may have developed badly and can be relearned to promote ease.”
Part of the challenge, she says, is getting an individual to be aware of how they are moving and of how they can change that—which, depending on that person’s kinesthetic awareness, can take a long time: “People can’t just be told to sit differently at the table or walk differently, because such movements are deeply patterned in the nervous system. They have become deeply ingrained patterns or reflexes that can’t be changed quickly.”
As with rolling the ball underfoot, over the years I heard Carli’s suggestions and sometimes practiced standing and walking with better alignment—but my body took a long time to catch up, to incorporate her advice into my spontaneous movements. On the other hand, since my first day-trading Rolfer™, I have tried many body-improvement methods, but none of them stuck in the way that Carli’s Rolfing Movement® work has.
About the reputed psychological effects of Rolfing®, Carli explains: “change must happen on all levels—physical, mental, emotional, spiritual.” Rolfing® views the body holistically, so for example, if a person’s underlying perception is that the world is not safe or the world demands a lot from them—or the world loves them— that perception will affect how they move. Changes in movement patterns may create changes at a deeper, more psychological, level—which in turn can lead to more lasting change.
When a Rolfer™ works on a tight diaphragm, for example, that might lead to the client talking about fears at the root of their breathing difficulties. “Over time, you are building a sense of safety,” said Carli. “Too often people don’t trust their bodies, so initially part of my work is about building their respect for whatever their body is trying to tell them.”
While Carli’s practice used to be made up of almost half her clients doing the 10-series, the current schedule is usually too full to take on many of these. Now she has many weekly clients, including actors, dancers and those with severe ongoing problems —severe scoliosis, severe hypermobility, severe arthritis—who come on a regular schedule, she says, “because they function better when their relation to gravity is being tended—like a garden.”
In addition to the basic Rolf training—usually one year or 18 months of classes on an intense schedule—Carli has had many additional years of training. Also, several times a year, she teaches at The Rolf Institute in Boulder, Colorado, as a Rolf Movement® Instructor. Despite what might seem like worldwide waxing and waning interest in Rolfing®, depending on health trends, she says the total number of Rolfers™ at any one time rarely varies: about 2,500 altogether.
That Rolfing® has continued to evolve since the death of Ida Rolf in 1979 was Rolf’s intention, Carli says. “She never kept things the same…was more interested in evolving the work.” Ida Rolf describes her thinking about change:
“Rolfing is a process of change. If we resist change, we experience pain. The goal of Rolfing is a more resilient, higher-energy system. The organism then is itself better able to defend against illness and overcome stress, and the greater energy does its own beneficial work in healing and relaxing.”
Recently, two friends I hadn’t seen for a while, separately and out of the blue, said I seemed to be “standing straighter.” By that point I understood better what had been happening over those years of Carli’s slow and repeated manipulation while she encouraged “movement awareness.” I also realized that, along with body improvements, I might have gained some confidence and courage as well.
—Mary Carpenter Read more of Mary’s well-being posts.
MODAFINIL, BIOHACKING, nootropics, racetams, eugeroics—if you haven’t heard these words, you might be missing the biggest news in brain boosters since Adderall came on the market in 2002.
Modafinil, a drug launched in the late 1990s to treat sleep disorders, such as excessive daytime somnolence, appears to have performance-enhancing effects comparable to those of Adderall. But, unlike other “smart drugs,” modafinil is not an amphetamine and, instead of stimulating all psychomotor activity, it specifically improves alertness with fewer side effects and lower potential for abuse or addiction.
In a 2008 survey by the journal Nature, one in five of its readers had taken brain-boosting drugs, and half of those had used modafinil, according to Scientific American MIND’s 2016 article “A Safe Drug to Boost Brainpower.”
The percentage of adults ages 26 to 34 taking all “ADHD medications”—modafinil, as well as Adderall, Ritalin and Concerta, when prescribed off-label as cognitive enhancers—almost doubled, from 1.5% to 2.8%, between 2008 and 2013.
Doctors prescribe modafinil (Provigil) for sleep dysfunction, although many also prescribe it off-label as a smart drug. And it can also be ordered from online pharmacies, albeit a potentially illegal and unreliable route —with pricey delivery fees and many weeks en route.
Modafinil is the best known of the eugeroics—from the Greek for “good” and “awaken,” applied to drugs that reduce the need for sleep—as distinguished from psychostimulants. And it’s considered a nootropic—from the Greek for “mind” and “to bend or turn”—along with caffeine, nicotine and the racetams (OTC stimulants). Some of these drugs, including modafinil, appear on the World Anti-Doping Agency’s list of prohibited substances and are banned by sports organizations for athletes without an ADHD diagnosis.
Biohacking involves using drugs—as well as non-pharmaceutical alternatives such as neurofeedback—to enhance cognitive function. Considered a “lifestyle drug,” modafinil is used by those coping with busy lives as well as flight crews and soldiers who must stay alert during long work hours. The film “Limitless” with Bradley Cooper is based on the effects of modafinil.
Among biohacks, modafinil stands out: it’s not a stimulant and so doesn’t risk causing jittery feelings or after-effects such as crash or withdrawal; and it can increase resistance to fatigue, improve mood and reduce “impulse response,” that is, making bad decisions.
On the other hand, it’s too early yet to know about long-term effectiveness or safety. And possible side effects include insomnia, headaches and stomach aches.
An analysis of 24 studies done between 1990 and 2014 to evaluate modafinil’s effect on cognition found that for simple tasks, those taking the drug experienced few benefits compared to those taking a placebo. But for participants doing more complex and difficult tasks, modafinil most often improved decision-making and planning, and some studies showed gains in flexible thinking, combining information, and coping with novelty, according to an Atlantic story,“The Rise of Work Doping,” which quotes Oxford University neuropsychologist Anna-Katharine Brem: “What emerged was that the longer and more complex the task…the more consistently modafinil showed cognitive benefits.”
Scientists aren’t yet sure how modafinil affects cognitive function. Among a range of possibilities, it stimulates the release of histamine —with the opposite effect of antihistamines like Benadryl, which can cause drowsiness. Also, it triggers the release of other neurotransmitters, such as adrenaline —which boosts energy, creating the fight-or-flight response—and increases dopamine and norepinephrine, both related to wakefulness and energy levels.
Taking modafinil has also increased the effectiveness of antidepressants for the one-third of depressed patients who are not helped by antidepressants alone, even in conjunction with psychological counselling.
As to concerns about its effects on brain health, there is some indication that modafinil works as an antioxidant to reduce free radicals that can damage the brain. On the other hand, research has found its effects on cognitive functions decreased among older participants.
For this group, the appeals of biohacking may be offset by both the risk of side effects—especially insomnia, which can increase with age—along with the challenges of getting an off-label prescription or dealing with the vagaries of online pharmacies.
NEED ANOTHER reason to take up yoga or try a bodywork program like Feldenkrais (an exercise therapy that uses gentle movements to reorient mind-body connections)?
Turns out that, besides working on the physical body, movement programs can also balance and strengthen one’s mental state.
Brain imaging in recent years has discovered that trauma, including that from childhood, is lodged in primitive parts of the brain—brainstem, hypothalamus and limbic systems. A deeply distressing or disturbing experience might be beyond the scope of traditional treatments like psychotherapy or Cognitive Behavioral Therapy (see MyLittleBird post Confronting Anxiety) because these address higher-level brain functions, such as language.
“When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it,” writes Boston psychiatrist Bessel van der Kolk, author of the 2014 book The Body Keeps Score. That’s also the name of his all-day workshop, subtitled “When Talk Isn’t Enough,” at the recent Psychotherapy Networker Symposium.
“All trauma is pre-verbal,” van der Kolk writes. “When something reminds traumatized people of the past, the right brain reacts as if trauma is happening in the present…they are just furious, terrified, enraged, ashamed or frozen.”
One recent imaging technique—the “functional MRI” (fMRI), which traces changes in blood flow—shows decreased neural activity in almost every area of trauma sufferers’ brains. The fMRI also shows neuroplasticity—ongoing changes that occur in response to the environment or therapy—in “lower” parts of the brain, previously believed to be impossible.
At Boston’s Trauma Center, founded by van der Kolk, therapeutic yoga positively affected both arousal levels and PTSD symptoms in a small group of subjects, while those in a program of Dialectical Behavior Therapy (incorporating mindfulness) did not improve. Van der Kolk cites evidence that yoga’s combination of breathing practices with postures and meditation helps balance the central nervous system.
Also recent is the understanding that trauma can occur even in childhoods where basic needs—food, clothing and shelter—are met. In How Children Succeed, Paul Tough describes categories of “adverse childhood experiences” (ACEs) that can be chronic and ongoing. Besides abuse, ACEs include growing up in a “seriously dysfunctional household,” which extends to parents with substance-abuse problems, often with underlying mental illnesses, and those who divorce. The third category is “neglect,” which can occur when parents are present but disengaged, creating what’s called “chronic understimulation.”
Mild, early trauma can cause a lifetime of physical ills: heart disease, liver disease, emphysema or chronic bronchitis and many symptoms of immune system dysfunction such as chronic fatigue. (Van der Kolk talks about the effect on the immune system of incest, which can provoke an immune reaction to the person’s own body as if faced with ongoing danger.) Early trauma has also been linked to difficulties in learning and behavior that include attention regulation, cognition and language development.
“We found that lots of clients who usually intellectualized their way through talk therapy responded well to guided imagery, sensate body focusing…” writes UCLA psychiatrist Daniel Siegal (author of the recent Mind: A Journey to the Heart of Being Human) in a blog for Psychotherapy Networker.
During the 1990s—named the “Decade of the Brain” by President George Bush—Siegal writes, “We began to look at how therapy can catalyze neural growth to create long-lasting change…to optimize self-regulation, the coordinated flow of energy and information through the major systems of the brain—brain stem, limbic circuits…”
Van der Kolk believes the essence of trauma is dissociation—a feeling of numbness or a lack of connection to the body, or self-numbing with food, work, drugs, alcohol. For many people, ongoing stress makes them feel stuck and unable to trust others.
To help overcome trauma, van der Kolk uses a kind of role-playing therapy that involves both the physical body and other people—whenever he has a “small group and a willing volunteer,” according to Jeneen Interlandi in the New York Times. Interlandi describes van der Kolk’s “four decades studying and trying to treat the effects of the worst atrocities we inflict on each other: war, rape, incest, torture and physical and mental abuse,” and writing some 100 peer-reviewed papers on psychological trauma.
“In so many cases, it was patients’ bodies that had been grossly violated, and it was their bodies that had failed them—legs had not run quickly enough…voices had not screamed loudly enough to evade disaster,” Interlandi explains. She quotes van der Kolk: “The single most important issue for traumatized people is to find a sense of safety in their own bodies.”
Van der Kolk’s therapy exercise, called a “structure,” is based on psychomotor therapy developed by a dancer. One of van der Kolk’s therapy groups focused on a soldier suffering from PTSD after shooting a man who appeared threatening but turned out to be unarmed, and then watching the man’s mother discover his body. As different group members were assigned roles of people involved in the incident, they moved to sit very close to the soldier and, as he told the story, to touch and hold him. Van der Kolk considers touch a source of physical comfort that’s “about how we collectively care for each other.”
Van der Kolk’s critics, such as New York neuroscientist Joseph Le Doux, contend that the rational and emotional brains are already well integrated and communicate regularly, and that van der Kolk’s scans showing otherwise are not reliable. Critics also point to the dearth of controlled studies supporting the use of psychomotor therapy, yoga, massage or acupuncture for trauma.
Data on more than 10,000 September 11survivors, however, show that the most popular therapy requested was acupuncture, along with massage and yoga. Yoga is about regulating the body, says van der Kolk, and therapies such as craniosacral and Feldenkrais involve touch.
He also points out that there was very little PTSD as a result of 9/11 because no one blamed New Yorkers and—in contrast to the child who has no one coming to their aid—the world “poured caring and love into New York City.”
IN THE BAD OLD DAYS, there was only Dramamine or, in a pinch, Scotch. One or the other —Scotch tried only once in desperation—got me through long hours on rocking boats, sort of. Because most motion-sickness remedies cause such drowsiness—you’re in a daze or asleep—or require staring at the horizon non-stop, any pleasure to be gained, along with pleasurable memories, are reduced so much you might as well have skipped the trip.
A more recent option, scopolamine patches, also risks drowsiness—and such dry mouth that people tear off the patches and then must wait hours for the effect to wear off. As for pleasant memories, scopolamine has the specific side effect of anterograde amnesia—blocking the first stage of memory coding, which disrupts the formation of short- term memories. Other side effects include dry, itchy eyes and disorientation; and, if taken for more than three days, withdrawal symptoms of nausea and vomiting.
Better relief came for me at a corporate dinner held on a boat tied up at a dock. A fellow guest suggested using the thumb of one hand to press a point near the wrist bone of the other hand and hold it there, creating a sort of acupressure or maybe just a distraction. The nausea abated to the point where I might have sampled the food, except that both hands were occupied. (The Greek word for seasickness, nausia, is derived from naus, meaning ship.)
The best solution for me is the “relief band,” which operates on a similar principle. Borrowed first from a friend, the battery-operated device looks like a wristwatch. It vibrates gently against the inside of the wrist—with five levels of intensity that can be increased as needed—creating what’s called electrical acustimulation. Most bands come with a gel that improves contact and increases the sensation.
Ecstatic at my success, I forked over what seemed like a hefty amount (at Sharper Image, about $90 at the time, now $119.99) for my own band. With that band, I managed to enjoy, first a bumpy car ride in the morning—when motion sickness is usually worse—then a ferry boat ride in rough seas, and I felt ready for anything.
Less expensive bands, from around $5 to around $20, come in sets of two for wearing on both wrists and provide static pressure without vibrations. While these can work well, some people need to ramp up the intensity with extra help from the thumbs.
Motion sickness, also called kinetosis and travel sickness, occurs in susceptible people when motion is felt but not seen, as in a ship without windows or if you’re not paying attention to your surroundings—for example, because you’re reading or chatting, both ill-advised for those at risk. The same result comes from motion that is seen but not felt, as with jerky film images from a handheld camera or with video games.
The one-third of the population considered “highly susceptible” includes those who get migraines, those taking medications—some antibiotics and antidepressants along with OTC drugs like ibuprofen and naproxen—children ages 2-12, and women, especially when menstruating or on hormone therapy. Susceptibility can increase with age.
The symptoms of motion sickness occur when sensory information received by the eyes doesn’t match that received by the vestibular system, based in the inner ear —which interprets balance and spatial orientation in order to coordinate movement with balance. Symptoms include nausea, headaches, cold sweats, irritability and dizziness as well as the same fatigue that comes with many remedies.
The oldest and most common explanation for motion sickness is the body defending itself against poisoning. With a sensory information mismatch, the brain’s interpretation is that the individual must be hallucinating, which is caused by poison, including food poisoning. In response, the brain signals the stomach to rid the body of poison by vomiting, or emesis.
The movement of such messages within the brain is facilitated by the neurotransmitter acetylcholine. Both classes of medication that can counter symptoms of motion sickness—antihistamines (Dramamine) and scopolamine—are thought to interfere with acetylcholine receptors to interrupt the poisoning message.
Neuromodulation—from relief bands, both vibrating and non-vibrating—is believed to interrupt signaling later in the process, from the brain to the gastric system by way of the vagal nerve. The brain senses a problem but is blocked from communicating with the stomach, which in turn prevents nausea and vomiting. The makers of the vibrating relief bands credit an algorithm that triggers electric pulses to come frequently enough to block nausea but not so frequently that the nerve stops responding.
Among other remedies, chewing anything, especially gum, works via a similar mechanism of interrupting signals that result in vomiting. For many, ginger works by relaxing specific stomach muscles. Closing the eyes can resolve the “input conflict” but risks leading to sleep. And then there’s cannabis, which can help with all kinds of nausea, along with its added pleasures—though for some, marijuana causes the drowsiness they are trying to avoid.
In clinical studies on relief bands, however, no changes in “symptoms and gastric myoelectric activity” were observed—leading to a more psychogenic or psychosomatic explanation, such as one’s attention directed to the bands’ uncomfortable, even annoying, vibrations —or to pressure from the non-mechanized model—distracts the brain sufficiently to interfere with or replace neural messages that concern poisoning. While the bands’ effect could thus be described as a placebo—so could the action of remedies like ginger and cannabis.
Just working on this post, I began to feel queasy almost immediately, as my apparently overly suggestible brain experienced motion merely from thinking about it—until I donned my relief band set at its car/boat intensity of 3 to 4.
True relief of motion sickness makes way for better experiences and increased mindfulness, for the ability to say truthfully: “It’s not the destination but the journey that matters.”
Note: Battery-powered bands from other companies, like Reliefband, start at $89.99.)
—Mary Carpenter Armed with her relief band, Mary Carpenter is ready for rough seas. Read more of her posts here.
PROPONENTS RAVE about the nourishing and healing properties of bone broth. But it is a concoction fraught with confusion. First, the names and definitions: most “bone broth” looks more like what was traditionally called “stock,” viscous with collagen-rich gelatin that seeps out of bones, which have been pre-cooked or -roasted anywhere from 18-48 hours.
“Broth,” in contrast, has always been thinner and made using more actual meat. (While most commercially available gelatin in the past came in powdered form, bone broth offers it in liquid straight from the bones.)
Along with cooking times, widely varying recipes—different animal bones, some with fatty marrow—affect nutritional properties, along with the smell, which can be unpleasantly strong like a barnyard, and taste. There’s also the question of marrow, by reputation packed with health-giving nutrients but in fact “pure fat” and to be avoided, as Marco Canora, chef at NYC’s Brodo Broth Company, told Bon Appetit magazine. Brodo was the first to sell cups of “bone broth, priced at $5 and up, with 30- ounce containers currently available online at three for $51 and up.
Recently and more confusingly, many “bone broth” formulations appear to be evolving, or reverting to the original “broth” definition. Packaged “bone broth,” now widely available—sold at local Whole Foods stores in 8-ounce portions with 9 grams of protein for $2.99, with choices like chicken with lemongrass, is not only thinner than “stock” but has a more delicate flavor and scent.
Similarly less viscous and more savory, locally produced Brainy Belly bone broth is closer to the Asian pho, according to founder Janalee Redmond. Cooked quickly under pressure and frozen, Brainy Belly’s broth is sold wholesale to chefs, caterers and markets, such as the local Yes! Organic Market chain. A recent demo at Yes! drew loyal customers who “buy it by the case,” according to Redmond.
Brainy Belly makes broth from “good bones filled with trace nutrients and collagen-packed gelatin” that come from “passionate farmers who proudly present their flavorful beef as “grassfed, grass finished, no grain ever!” according to the company’s site. One indication of the burgeoning interest in what Redmond refers to as “a dressed-up version of stock:” she raised thousands of dollars on Kiva to fund the USDA-approval process, which was successful.
Redmond started her bone broth biz after coping with serious stomach issues, which she traced to an overabundance of “bad” bacteria in the gut. Among the touted healing powers of broth, the collagen is said to act as an intestinal Band-Aid that heals damaged lining of the digestive tract and in turn improves absorption of nutrients.
Enthusiasts also praise bone broth as an anti-inflammatory, further healing and soothing the gut to create a better environment for “good” bacteria. They also claim its anti-inflammatory powers can decrease pain and dysfunction throughout the body, especially in aging joints. Kobe Bryant famously took up a regimen of bone broth to ease his swollen joints.
Of two bone-broth health claims best supported by clinical evidence, one applies to endurance athletes replacing electrolytes, especially sodium, after exercise. The other, familiar to believers in the healing powers of chicken soup, is the effect of its amino acids in combating flu and cold symptoms. The most widely embraced use of bone broth is supplying collagen to bones, hair and nails to strengthen and replace loss due to aging. Gelatin is also recommended for everything from treating osteoporosis to losing weight, but its health benefits have not been supported by respected clinical evidence. Side-effects include bloating and heartburn.
The book “Nourishing Broth,” by Sally Fallon Morell and Kaayla T. Daniel, credits bone broth’s “unique combination of amino acids, minerals and cartilage compounds” for quelling inflammation, speeding healing, calming allergies and combating fatigue. But a Time Healthstory points out that there “isn’t much research on both broth to support—or refute—these health claims.”
“The idea that because bone broth or stock contains collagen it somehow translates to collagen in the human body is nonsensical,” University of South Dakota biomedical scientist William H. Percy told Time magazine. In the same way eating fatty foods doesn’t directly add to body fat. Instead, the digestive system breaks collagen down into its component amino acids.
While these amino acids may contribute to bone building, broth may be a poorer source than leafy green vegetables, critics contend. And as with vegetables, long cooking times may denature vitamins and minerals, making them less accessible to the body. For people who are deficient in amino acids from protein sources, bone broth could supply some of what’s missing, but some say there’s a greater benefit from eating eggs.
The loose basis in nutrition science, however, doesn’t sway bone broth’s many true believers, like Redmond, who drinks bone broth every day. Chef Nathan Anda at DC’s Red Apron—which has sold cups of 36-to-48 hour simmered bone broth—tried that regimen for about two weeks. When asked about the results, he admitted he found it hard to stay with “dietary trends” because he continually encounters new and delicious gourmet options.
—Mary Carpenter Read more of Mary’s well-being posts right here.
JENNIFER ANNISTON has it, and she talks about it on TV. She’s not alone; everyone is talking about it. Dry Eye Syndrome (DES), it turns out, is one of the most common eye problems affecting Americans—up to 15% of those over age 65 (compared to 5% among ages 30 to 40); and one in five women (versus one in 10 men).
DES, also called keratoconjunctivitis, includes decreased tear secretion, production of poor-quality tears and/or accelerated evaporation of tears—associated with swelling around and on the surface of the eye. If left untreated, DES can lead to abnormalities in vision.
Dry eyes can be part of an allergic reaction—with complaints rising highest alongside pollen counts in April, and falling to the lowest levels in midsummer. Teasing out the cause, however, can be difficult, and allergy treatments like antihistamines and decongestants can make dry eyes worse.
J.B., a woman in her mid-60s, uses a combination of remedies that target both possibilities: for allergies, Alaway drops along with Zyrtec in the morning; and for symptoms of DES, Systane Ultra drops at other times of day.
Among the causes of DES: medications that have the side effect of reducing tear secretion—anxiety and pain relievers, as well as antihistamines and decongestants; and air—dry and windy air; high altitude and desert air; airplane cabin air and air-conditioning.
The prevalence is increasing as Americans age and spend more time on video display terminals (VDT) like computers and phones. Normal tear flow adjusts to changes in both environmental conditions and blinking rate—typically about 12 blinks per minute. Blinks decline during VDT use.
Another common cause, the immune disorder Sjogren’s syndrome, occurs most often in women over 40 and is identified by its most prominent symptoms: dry eyes and mouth. Dry eyes can result from other immune-related conditions like rheumatoid arthritis, as well as from deficiencies in vitamin A and thyroid.
Three layers of the eye’s “tear film”—fatty oils, water, and mucus—protect eyes from infection and smooth their surface. Watery eyes, caused by both allergies and DES, can mean poor-quality tears that are blinked away so quickly they don’t remain in the eyes long enough to keep them moist. The same sequence occurs when eye irritants produce tears that overflow and look like crying—but fail to soothe the eyes—as do actual crying tears.
Eyelid inflammation, which can keep glands from secreting sufficient oil, has one of the easiest fixes: frequent and gentle washing with a warm, wet washcloth, or adding a mild soap or baby shampoo. Antibiotics can also help—either pills or in eyedrops or ointments.
Tear “supplements” or artificial tears like Systane can be applied several times a day as needed. When these don’t help, a tiny rice-sized insert placed under the lower eyelid releases the same ingredients used in eyedrops. Alternatively, to reduce tear loss, tiny silicone plugs can be used to block tear ducts.
A quick remedy for persistent inflammation causing dry eyes is steroid drugs, but these can’t be taken over a long period without side effects. NSAIDs can also reduce inflammation and discomfort. Until recently, the only prescription drug given over long periods was the immune-suppressant cyclosporine (Restasis), which decreases swelling to allow for increased tear production. (Remember those ads from 2013?) Because Restasis can take several months to begin working and has side effects like burning and stinging, only around 15% of patients report “significant relief.” A second drug that was approved in 2016, Xiidra, can improve symptoms in around two weeks and has been “well-tolerated,” meaning side effects are less cumbersome. The short time since its approval, however, means long-term assessments are not yet available.
Meanwhile, J.B. is trying another option, supported by little research but by many personal anecdotes: a break from alcohol. In a small Korean study of 20 men with healthy eyes, half drank about two beers over a two-hour period—considered a “small” amount—after which alcohol was detected in the tears of all ten. By the next morning, although all traces of alcohol were gone from the tears, they remained altered in various ways—such as shortened tear break-up time—that could result in drier eyes.
Red wine is blamed for the worst effects—which may be assuaged by matching one glass of water for every one of wine. Coffee, on the other hand, has been linked to improvement of dry eye symptoms as have rich-in-vitamin-A foods like sweet potatoes and carrots.
Among practical steps: direct hair dryers, car heaters and fans away from the eyes; wear goggles to protect the eyes when working outdoors, especially during high winds or allergy season; use humidifiers to help moisten the air indoors. Computer screens should be placed below eye level, so eyes don’t need to be opened wide for reading.
To keep tears spread over the eyes, take periodic breaks by closing the eyes for a few minutes or blink repeatedly for a few seconds. Or there’s always the brief nap.
IT ALL BEGAN with my search for a plastic-free toothbrush,inspired by Catherine Clifford’s “plastic purgery“story. That quest led me to bamboo toothbrushes and then to bamboo brushes with black bristles “infused” with charcoal, which sounded appealing because black wouldn’t look dull or dirty.
From there, I found charcoal products for personal use popping up all over the place: charcoal-whitening toothpastes, black-charcoal lemonade at juice bars, charcoal capsules to treat stomach bugs in addition to detoxing and calming gas, charcoal skin cleansers and charcoal air fresheners and shoe deodorizers.
Most of these products use “activated” charcoal, made from various materials—coal, peat, petroleum, coconut shells and wood (bamboo or oak)—that are exposed to intense heat or steam along with chemicals to remove non-carbon materials. What remains looks like black dust, with many nooks and crannies that greatly expand the surface area compared to ordinary coal and make activated charcoal powerfully absorbent.
“In theory, the black sludge binds to everything in its path–stains, tartar, bacteria, viruses (and maybe even your tonsils),” New York area cosmetic dentist Peter Auster told Harper’s Bazaar. “As it takes tartar off the teeth, your teeth will get whiter, which is a positive, of course, but it may also bind to medications that the body needs to absorb and even bacteria that you need for digestion. And additionally, it just might not work.”
Besides removing medications and “good” bacteria, charcoal can bind to and absorb essential nutrients from the gut, and it can permanently destroy tooth enamel. Side effects of ingesting charcoal include constipation and dehydration.
Use of activated charcoal is evidence-based and approved only for Emergency Room treatment of poisonings and drug and alcohol overdoses. Some doctors recommend keeping over-the-counter charcoal capsules on hand for emergencies, and some users claim it helps with hangovers. But because most charcoal-containing products are regulated as “foods”—rather than “drugs”—they are not required to be proven safe or effective before being sold, and ingredients can be unreliable. (Ingesting non-activated charcoal can be dangerous though it has proved helpful in emergency situations.)
At Baltimore’s Pure Raw Juice, black lemonade is in great demand. General Manager Adam Armstrong calls it a “super scrub for the digestive tract” and recommends it to customers with digestive ills, according to InStyle. “Activated Charcoal Elixir,” sold online by Luli Tonix, claims to cleanse the body, help with stomach issues and cure hangovers.
Biore Deep Pore Charcoal Cleanser—which looks foamy white–is said to draw out twice the dirt of a regular cleanser. And the Binchotan Charcoal Eye Mask promises to mitigate fatigue and emit infrared rays that improve blood circulation and quell headaches.
Back to teeth. My Magic Mud toothpaste, touted to whiten teeth and reduce tooth sensitivity, is used by holistic dentists and sold on Amazon in flavors like cinnamon clove. And a 2016 YouTube video showing a black charcoal mixture being smeared on teeth, posted by Mama Natural, attracted millions of viewers.
But Michigan dentist Susan Maples points to insufficient evidence of benefits, while the risks include stained, blotched teeth and enamel susceptible to erosion— which can make the teeth more sensitive as well as darker. Malaysians who applied charcoal and salt with their forefingers to clean their teeth had “distinct forms of abrasion” on the teeth, according to the journal Nature.
Incorporating binchotan—white charcoal made from special oak trees, used by Japanese chefs because it burns for longer periods without unpleasant odors—into black toothbrush bristles can prevent the growth of harmful bacteria and viruses, fend off halitosis and reduce plaque, according to enthusiasts. Like most toothbrusth bristles, however, these are made of plastic.
High-end black-brush bristles used on the Japanese company Morihata’s binchotan toothbrush claim specifically to draw out tannin (from coffee, tea, etc.) stains from the teeth—along with their antibacterial, antifungal and antiviral properties. For a glimpse of proliferating charcoal-based dental products, check out this site.
The only completely plastic-free brushes I found (such as those from Life without Plastic) use bristles made from Chinese pig hairs, which sounds very unappealing, especially for vegetarians. And wooden toothbrushes in general have the downsides of susceptibility to mold and handles that can splinter.
But as long as massive piles of plastic that will never biodegrade continue accumulating on the earth and there are islands of plastic floating on ocean currents, search for replacements must go on.
—Mary Carpenter MyLittleBird’s well-being editor continues her search for non-plastic products. Read more of her posts right here.
“I WANT YOU to take this placebo,” says the white-coated medic to her bemused patient. “If your condition doesn’t improve, I’ll give you a stronger one.”
This exchange is from a cartoon shown at a medical conference by Harvard Medical School researcher Ted Kaptchuk, founder of the Harvard-based Program in Placebo Studies (PiPS) and the Therapeutic Encounter. Kaptchuk was only partly joking.
Turns out strong placebo effects can occur even when patients know what they’re getting—hence, the new terms “open-label” and “honest” placebo. As such, they can be especially powerful tools in treating chronic pain—for which traditional medicine has been notoriously unsuccessful.
Honest placebos reduced chronic back pain in a recent trial (co-authored by Kaptchuk) of 97 patients, who had not responded to previous therapies. The group receiving twice-daily, clearly labeled sugar pills over a three-week period—along with explanations of research showing how and why these might help—reported “sometimes modest, sometimes, dramatic improvements in pain and disability that had major impacts on people’s lives,” according to lead researcher Lisbon ISPA-University Institute psychologist Claudia Carvalho.
Cavalho speculates that knowingly taking placebos may have helped patients become more aware of the role of the mind in controlling pain—as it has for patients who experienced less pain when allowed to control dosages of their medication.
In dozens of brain-imaging studies, placebos have been shown to affect the same biochemical pathways as the neurotransmitters that activate endorphins, endocannabinoids and dopamine, as well as those that reduce levels of prostaglandins, which dilate blood vessels and thus increase sensitivity to pain.
Placebos may be better understood as filling a need—instead of provoking a response—comparable to thirst or hunger, and giving patients knowledge about the placebos they’re taking harnesses the power of that need. Patients are told specifically that such knowledge puts them in charge of their healing process. “A placebo’s active ingredient is a person’s psychological response to being treated,” says Kaptchuk.
New research also shows that placebo responses can be learned, in the same way Pavlov’s dogs learned to salivate in response to a buzzer associated with food, according to Tor Wager at the University of Colorado at Boulder. After four episodes of “pre-conditioning”—using actual pain medication to modulate experimentally induced pain—study volunteers felt less pain with an inert cream despite knowing it was a placebo. What their brains had learned (about easing pain) was stronger than their previous mistrust of placebos.
After pre-conditioning, the neurochemical pathways triggered by each placebo match those of the original drug being replaced. When two groups of volunteers —one treated with morphine and the other with a non-opioid painkiller—subsequently received placebos, those in the morphine group had increased endorphin release, while relief for those in the other group was mediated by endocannabinoids.
Combining placebos with the actual drugs can reduce drug dependency, toxicity and tolerance—and thus lower total treatment costs. Parkinson’s disease patients, especially at risk for tolerance, who first received the active drug, later responded strongly to a placebo. And pills in blister packs containing both real painkillers and placebos—with the patient unaware which pills were which, but knowing some were placebos—all worked well. Similar techniques have been successful in treatments for insomnia and autoimmune diseases.
Such combinations could also reduce side effects, although placebos have been known to produce the same side effects as those caused by the actual treatment —called the nocebo effect. In every trial of migraine drugs, patients receiving placebos have reported side effects, specifically the same side effects produced by the particular drug being studied. Patients who thought they were taking anticonvulsants felt drowsy and less hungry; those believing they took painkillers experienced the digestive problems commonly caused by these drugs.
(In other studies, decaf coffee produced tremors in those told they were drinking caffeinated coffee, and almost 30% of subjects showed evidence of intoxication after drinking flavored water.)
“Surgery has the most potent placebo effect that can be exercised in medicine,” according to British physiologist Patrick Wall, considered a father of pain research. Angina patients told they’d had a shunt surgically implanted experienced improvements in angina symptoms, exercise tolerance and the shapes of their echocardiograms. Following wisdom tooth extraction, patients felt less pain when they believed they were receiving ultrasound therapy, which was in fact a sham substitute.
Merely changing the labels on envelopes containing the treatment can alter the results. In one of Kaptchuk’s studies, groups of migraine sufferers received either the drug Maxalt or a placebo, according to a BBC report. Each group was further divided into three, with each of these receiving drugs in envelopes labeled “Maxalt,” “Placebo,” or “Maxalt or Placebo.”
The response was the same for two groups—those given Maxalt who were told it was a placebo, and those given the placebo in an envelope labeled Maxalt. Said Kaptchuk: the question now is whether doctors prescribing a medication should say “This is going to help you…because of extensive trials” or “Shall we try and see if this works?”
Americans might be particularly susceptible to the placebo effect based on data from 80 trials of drugs for neuropathic (nerve) pain, Jeffrey Mogil at Montreal’s McGill University told the BBC. A possible explanation: the U.S. permits direct consumer advertising of drugs— in contrast to every other country except New Zealand. Because patient expectations are linked to stronger placebo effects, “maybe all those adverts showing virile middle-aged men shooting hoops…” has a widespread effect on patients in trials of those drugs, according to the BBC report.
A LARGE GIFT CARTON from a favorite friend arrived with 24 bags of Skinny Pop popcorn. What a treat! So many bags, ready to eat and only 100 calories each.
Around the same time came great news —that popcorn qualifies as a healthy whole grain, in fact one of the healthiest, in part due to high levels of polyphenols that help neutralize free radicals blamed for damaging cells and contributing to aging. Three cups of popcorn count as one of three whole-grain servings recommended daily for the MIND and other diets.
Replacing refined grains with whole grains, in new study data from Tufts University, led to an extra 100 calories per day weight loss—probably due to increased fiber, which reduced calories retained during digestion (“increased fecal energy losses”) and speeded up metabolism—compared to a control group, according to researchers. Health benefits of whole grains and fiber— improving glycemic control and insulin sensitivity—have been suggested in many studies, but effects on weight loss hadn’t been clearly documented. In addition, while the study used whole-grain flour, researchers suspect that whole-grain kernels—such as corn—might have a more significant benefit.
Because the 100-calorie Skinny Pop bag has some downsides—not much popcorn (about two cups) and the negative environmental impact of so many metallic-lined bags—a survey found an array of enticing popped options, with “enticing” defined as the largest quantity of popcorn for the fewest calories and correspondingly low amounts of unhealthy fats. (This survey does not cover all available options, nor does it include popcorn flavored with anything other than butter, for example: black pepper, kale, cheddar cheese.)
The least labor-intensive—and for some the most pleasurable—is movie-theater popcorn. The Regal theaters’ popcorn is rated the least healthy: their published calorie count for the 20-cup “medium” is 720, but other testers put it as high as 1,200 calories. The “small” comes in at 670 calories—about the same as a Pizza Hut Personal Pepperoni Pan Pizza. At AMC theaters, the nine-cup “medium” comes to 590 calories.
Slightly more labor-intensive is bagged corn like Skinny Pop, because those who want larger portions with less environmental impact should buy bigger bags than the 100-calorie snack size (commonly found packaged as six bags inside yet another metallic-lined bag). Then, to be sure of the upper limit consumed —always a risk when reaching into big bags— the contents should be distributed into smaller containers. For example, the 4.4-ounce Skinny Pop bag containing about 14 cups of popped corn (although the label says five 4-cup servings) can be divided into four quart-sized baggies of 3 to 5 cups, at 175 calories each. The similar size 4.8-ounce bag of Angie’s Boom Chicka Pop contains 16 cups of popped corn, which, divided in four, comes to 4 cups at 160 calories each.
Microwaved popcorn is a little trickier—requiring careful listening for the popping to slow down, then quickly removing the bag before the corn burns (creating a terrible odor and flavor), followed by carefully opening the bag to avoid burning yourself. This option became healthier after the FDA’s 2015 ban on perfluorooctyanoic acid— the cancer-causing substance previously used in microwave bags. (PFOA substitutes, however, have not been tested for long-term health consequences.)
Even before that, most major brands removed the intensely buttery-tasting chemical diacetyl used to flavor both microwave popcorn and E-cigarette vapor, which has been linked to “popcorn lung syndrome” and Alzheimer’s. (For brands using diacetyl substitutes, the warning persists to wait up to 10 minutes post popping.)
In several microwave rankings, the healthiest was “Whole Foods Organic Light Butter,” at 130 calories for 3.5 cups. Preferable, however, are brands that list only one ingredient: corn. Paul Newman’s “Own Organic Pop’s Corn” provides about six cups for 100 calories and tastes surprisingly good. Black Jewell’s “No Salt, No Oil” has black kernels, which produce bright white popped corn and contain healthy antioxidants called anthocyanins, found in dark-colored fruits like cherries and blueberries.
The healthiest option is the most labor-intensive and least reliable: popping your own kernels—either on the stove or in an air-popper or microwave (but not pre-packaged). Inexperienced poppers are likely to end up with kernels either unpopped or burned, as well as pans, bowls and other containers to clean. One DIY advantage is choosing the healthiest oils, with canola recommended for its high levels of omega-3 healthy fats. The bagged options mentioned above use sunflower oil; and most pre-packaged microwave popcorn uses palm oil—with the Whole Foods brands emphasizing “responsibly sourced,” but others may be less so.
For super-healthy popcorn—if your taste buds are willing—the advice is to sprinkle on a little flax seed or yeast powder. Also, not to overdo the fiber: those 100 calories of “Pop’s Corn” contain eight grams, the most fiber/calories of any sampled. Sudden over-consumption of fiber can result in abdominal pain, bloating, diarrhea and constipation.
After all the sampling and comparing—and the as-yet-unknown risks of the substitutes for outlawed chemicals in pre-packaged microwave popcorn—Skinny Pop begins to look like a healthier option. And it might have a slightly richer flavor than other bagged options. Skinny Pop’s perceived delectability may be affected by loyalty to the aforementioned multiple-bag gift—and in fact the “case” available on Amazon contains 30 bags, not 24, which could explain why that gift seemed especially endlessly delightful.
—Mary Carpenter MyLittleBird’s well-being editor loves popcorn almost as much as the movies. Read more of her posts right here.
NARCISSISM, INCREASINGLY hostile partisan politics, mass shootings—all have been blamed on what President Obama called the “empathy deficit.” But while researchers are exploring ways to increase an individual’s empathy, some point to its downsides.
Yale researcher Paul Bloom—in a debate entitled “Empathy, is it all it’s cracked up to be?” at the 2015 Aspen Ideas Festival —focused first on misguided empathy. For example, giving money to child beggars in India in fact supports “a huge network of child abuse” (parents maiming their children to become more successful beggars).
But gifts to Oxfam, which help those children more, don’t provide the warm feelings engendered by performing empathetic acts, said Bloom. In fact, having greater empathy has no correlation with how generous you are, as defined by charitable giving.
There’s also the familiar observation that empathy among “helping professionals,” such as doctors who put themselves in their patients’ shoes, can make them bad at what they do. If I’m anxious, I don’t want the doctor feeling anxious, too, because empathy can impair the ability to act, he said.
And, empathy can be exploited. “When I think about empathy, I think of war,” said Bloom, such as the tales of Iraqis suffering under Saddam Hussein that swayed Americans to support the U.S. invasion and ongoing war.
Empathy can provoke reactions of anger and rage, even violence, he noted but these emotions can have a positive role in motivating leaders, like Martin Luther King and Nelson Mandela, to fight injustice and to sustain high levels of commitment over long, difficult years.
University of Wisconsin psychologist Richard Davidson, Bloom’s debate opponent, agreed. Davidson, creator of the Center for Investigating Healthy Minds and co-author of The Kindness Curriculum for use in early education, spent years studying meditation with the Dalai Lama with whom he became close friends. Davidson has documented changes in brain waves that occur with practicing compassion and kindness, which in turn contribute to general feelings of well-being.
Davidson discussed the lifetime of practice that has led the Dalai Lama to love everyone —which Bloom countered with his preference for more rationally based behavior. For example, to the question “who would you die for?” he would choose his own children first, and at the same time acknowledge that other children matter, too.
Empathy is “a parochial, narrow-minded” emotion, Bloom said. Putting oneself in another’s shoes activates mirror neurons: watching someone burn their finger makes the observer feel actual pain—albeit less pain if the hand is a different color from theirs or belongs to a soccer player for the opposing team.
Bigoted empathy comes from entrenched beliefs, for example, that black people feel less pain than others—an assumption shared even by many black people—related to beliefs about social status and hardship. People considered more privileged are widely perceived to feel greater pain. As a result, minorities, primarily blacks and Hispanics, receive inadequate pain medication, writes Jason Silverstein on Slate.com.
Also, people avoid situations that might cost them significant time or money, according to Daryl Cameron and others at the University of Iowa. Subjects who were told they would be asked to make a donation felt more empathy for a single child; conversely, when there was no financial cost, subjects could feel more empathy for larger numbers of children.
Motivation is another variable. People in more powerful positions have less incentive to interact with other people and thus less empathy. And when researchers told people that empathy was a skill that could be improved—rather than a fixed personality trait—they made a greater effort to feel empathy for racial groups other than their own.
Empathy begins at birth with “attunement” of the mother and infant: lacking this early emotional connection can lead to narcissism or psychopathy—considered “empathy deficit disorders.”
Psychopaths “tend to be very good at reading other people’s emotions while remaining emotionally unmoved themselves,” according to a Guardian article on the definitions of empathy. In contrast, many on the autism spectrum are poor at reading nonverbal emotions but, once made aware of these, can share them intensely.
Even for narcissists, though, empathy can be restrained or expanded by choice. In research by psychologist Erica Hepper at the University of Surrey, those “high narcissists” told to put themselves “in another person’s shoes”—called cognitive perspective taking—reported more empathy than others for a domestic violence victim portrayed in a video. When asked to take the perspective of a woman describing her recent breakup on tape, the heart rates of the high narcissists increased to match those in the control (low-narcissism) group.
“Our findings are promising in suggesting that even relatively anti-social members of society can be empathic,” said Hepper, who believes in the importance of empathy for everyone in helping to “form and maintain close relationships.”
Perspective-taking can reduce bigotry in empathy. Silverstein refers to a study on participants who were told, “try to imagine how your patient feels about his or her pain and how this pain is affecting his or her life,” which reduced treatment bias by 55%.
An “empathy gap” can exist when one or more people are believed to be “the other” or worse, “the enemy”—an explanation for the actions of mass shooters, suicide bombers and those who engage in political violence, some of whom are empathetic in other aspects of their lives.
Psychologists have developed ways to assess such prejudices, for example, the “implicit association test”—sometimes referred to as the “racist test.” “The idea is to intervene at the psychological level,” says M.I.T. cognitive neuroscientist and conflict specialist Emile Bruneau, to “see if doing that improves the success rate of various integration programs.”
With the number of flotation centers surging nationwide—149 opening since 2011 and more than 200 planned over the next two years—we are republishing Mary Carpenter’s story on sensory-deprivation tanks. Beyond relieving stress, depression and anxiety, the tanks now appear also to help children diagnosed with autism and veterans struggling with PTSD. While such clinical changes have been ascribed generally to the combination of sensory deprivation and magnesium sulfate (Epsom salt), researchers are currently focusing on how exactly these effects occur.
AT BETHESDA’S HOPE Floats, hallways painted in lovely watery aqua shades lead to private rooms spacious enough for a shower with sumptuous towels, shampoos and candles, as well as the flotation tank that looks like a giant coffin with a front door that, once closed, leaves you in total darkness. Inside, salty water about a foot deep is kept at average skin temperature, around 94 degrees.
Also new is the vocabulary: Reduced Environmental Stimulus Therapy (Flotation REST) has replaced “sensory-deprivation,” although credit is given on Hope Floats brochures for “work done at the National Institutes of Health in the 1950s” on “flotation therapy” and “sensory reduction to promote relaxation and healing.” That work was spearheaded by John Lilly and focused on psychedelic experiences and other mental effects of sensory deprivation as depicted in the 1980 film “Altered States.” (“Chamber REST” refers to similar complete sensory deprivation without water.)
The clients are new as well. Instead of “aging hippies,” they are “stressed-out city dwellers seeking to get away from their devices while perhaps approaching the theta brainwave state, usually only achievable after years of deep meditation practice,” according to Phyllis Fong in Men’s Journal.
Researchers in Texas and Colorado found that floating increases the brain’s production of theta waves, creating feelings of “conscious drowsiness” usually experienced in the twilight state between waking and sleep. Theta waves keep the mind open, or uncritically accepting, to verbal material or to learning almost anything that the brain can process. “Theta offers access to unconscious material, reverie, free association, sudden insight, creative inspiration,” writes Michael Hutchison in “The Book of Floating.” Swedish researchers found the theta waves of “floating” helped patients cope with depression and anxiety.
Dr. Peter Suedfeld, in research done at Princeton and the University of British Columbia in Vancouver, found an array of REST benefits: cognitive effects including “an openness of mind” that led to improved performance on tests of creativity, as well as a reduction in memory loss; behavioral modification that helped people quit smoking, curb over-eating and “partially overcome a powerful fear of snakes;” and health benefits including reduction of chronic pain, insomnia and the effects of stress.
Also new since the 1950s is an abundance of research on magnesium, in which most Americans today are reportedly deficient. The best way to up levels is bathing in Epsom salts, or hydrated magnesium sulfate, of which each Hope Floats tank contains 850 pounds, enough to keep you afloat like the Dead Sea. Nothing touches your body except warm salty water, with “no distractions for the senses of touch, sound or sight,” according to the brochure.
Magnesium levels of most Americans have dropped by half in the last century, which may contribute to heart disease, arthritis, digestive maladies and chronic fatigue, according to the National Academy of Sciences. Reasons include industrial farming that depletes magnesium in the soil and thus in our bodies, as well as salt and fats in the American diet itself. In addition, taking supplements of calcium can deplete magnesium, although calcium’s effectiveness relies on the presence of sufficient magnesium, explains Melissa Breyer on the Care2 website.
Magnesium is best absorbed through the skin, as is sulfate, which plays a role in digestion and ridding the body of toxins. Magnesium supplements do not always increase levels and can create other problems. Magnelevure, a popular powder taken for its calming effect as well as for improving dry skin and hair, can cause restless legs, muscle aches and a strong laxative effect.
When I first tried a flotation tank in Manhattan in the early 1980s, my work was so stressful that I barely got myself and a friend to the downtown location. Afterwards we emerged into a sparkling New York evening, feeling like we’d taken a marvelous drug. I didn’t have quite the same sensation emerging into midday downtown Bethesda, maybe because I am generally less stressed, but the same marvelous relaxation endured for hours. At Hope Floats, you are told that chimes will ring softly when it’s time to get out. Once you close the tank door, quiet music is played to start you off. “Twilight state” and “unconscious drowsiness” are apt descriptions of how I felt, although that drowsiness morphed into unconscious as I slipped into a nap that seemed a waste of floating. Although I had worried about how to spend 60 minutes doing nothing, the chimes seemed to ring much too soon. With every additional float, people report more health benefits as well as staying awake more easily and for more interesting experiences—ever deepening emotions and ever more psychedelic hallucinations. If only I’d known: I would have kept my eyes open instead of squeezing them shut against the stinging salts.
At Hope Floats, one hour costs $75; 90 minutes, $95; and a package of three 60-minute sessions is $175 for first time floaters, otherwise $195, with larger packages available. Another option is the 60-minute flotation-plus 30 minutes in an infrared sauna for $95. Make sure you have no cuts and do not shave that day. One hour might be best to start, although buying a package should improve the chances of healthful, emotional and psychedelic experiences.
—Mary Carpenter See more of Mary Carpenter ‘s well-being posts.
Hardly a day goes by without news that some celebrity or another has entered alcohol rehab or is back home after treatment (the latest is Ben Aflleck). In light of that and the spike in drunk-driving crashes that this past weekend’s St. Patrick’s Day inevitably brings, we’re reprinting Mary Carpenter’s Nov. 21, 2016, post with the latest info on help for those struggling with alcohol dependency. For anyone confronting the disease for the first time in a friend or family member, she recommends: Drinking: a Love Story, by Caroline Knapp; Dry: A Memoir, by Augusten Burroughs; and Co-Dependent No More, by Melody Beattie.
ANTIGUA, MALIBU, Tucson, anyone? The attraction of a four-week stay at an upscale resort with the likelihood of a celebrity or two is undeniable—even if the days are packed with therapy based on the 12 steps of Alcoholics Anonymous (AA), the monthly price tag over $50,000, and the likelihood of success very low, at least on the first go-round, and sometimes after dozens of tries.
Long-term success rates of AA-based-treatment—including resort rehab and regular 12-step meetings—may be as low as 5%, according to retired Harvard psychiatrist Lance Dodes in his book, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Furthermore, low-cost publicly funded clinics often have better-qualified therapists and better outcomes than high-end residential centers, according to Anne Fletcher in her book, “Inside Rehab.”
A key reason for the low success rates: most people with what’s now called Alcohol-Use Disorder (AUD) do better when aided by medication, which requires an MD to prescribe. Drugs are used both for blocking the addiction and for treating underlying, “co-occurring” conditions like depression, for which alcohol can act like anesthesia or help numb. Of more than 13,000 rehab facilities in the U.S., as many as 80% follow the drug-free Alcoholics Anonymous model and recommend AA follow-up 90 meetings in 90 days is the mantra.
Common “dual diagnoses”—depression, anxiety, and the more serious bipolar disorder and schizophrenia—affect approximately 37% of those with AUD and 53% with drug addictions, according to the National Alliance of Mental Illness. Treatment for these conditions alone, using medication and/or therapy can reduce cravings for alcohol. Most experts agree that about half of a person’s vulnerability to alcohol-use disorder is hereditary and that co-occurring conditions play a role.
While the AA approach advises against taking both anti-abuse medication and potentially “mood-altering” drugs, many AA participants believe they should refuse all medicine—even aspirin for headaches. Medication-assisted-treatment (MAT) “has never been quite as controversial a subject as it is today,” according to the Substance Abuse and Mental Health Services Administration website. Despite increasing evidence of MAT’s effectiveness, only 1 to 2% of people treated for alcohol-use disorder receive anti-craving medication.
About 18 million adults in the U.S.—as many as 20% of patients seen in primary care of hospital settings—abuse alcohol, and the numbers are rising, according to the National Institute for Alcohol Abuse and Alcoholism (NIAAA). One definition of AUD: having developed a high tolerance for alcohol and experiencing withdrawal symptoms if its use is suddenly stopped.
The current state of addiction treatment is like “general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools,” concluded a 2012 report from Columbia University’s National Center on Addiction and Substance Abuse, as described in a 2015 Atlantic Monthly article by Gabrielle Glaser. The report noted, “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” Glaser also cites “The Handbook of Alcoholism Treatment Approaches,” published more than ten years ago, that ranks AA 38th out of 48 methods.
Many people have been helped by AA and by the ready solace of its ongoing groups. AA keeps no records of participants but claims to have more than two million members worldwide. According to the “Big Book,” AA’s bible, the program works for 75% of those who go to meetings. Critics deem this claim a tautology since most of those who go to meetings have already stopped drinking and attend to maintain rather than achieve sobriety—but in fact all that’s usually required of attendees is the intention to stop drinking, and the willingness to join in the group’s serenity prayer is considered a personal pledge.
AA’s blame-the-victim ethos considers alcohol abuse a personal failure of will. According to the Big Book, “Those who do not recover are people who cannot or will not completely give themselves to this simple program…who are constitutionally incapable of being honest with themselves.”
This morality stigmatizes people who fail to overcome addiction—as it does with obesity. Fear of the stigma as well as the abstinence-only goal of AA keep people from asking for help until their problems become so serious that treatment is more challenging. Only about 10% with alcohol and substance-use disorders ever seek treatment.
Research-based conclusions about AUD that run counter to the AA model are ignored by most practitioners, says addiction psychiatrist Mark Willenbring, director of treatment research at NIAAA from 2004 to 2009 and founder of the Minnesota outpatient clinic Alltyr. “When the facts change—and they’ve changed a lot—the minds have not,” he told the New York Times.
Approaches more successful than AA, according to hard research, have been available since the early 2000s. These are individualized; involve medical professionals — who can treat co-occurring disorders such as depression as well as prescribe anti-abuse medication; and offer help for as long as necessary — usually a lot longer than 28 days.
The drug Antabuse, which causes nausea when combined with alcohol, can be given only to patients who have completed withdrawal from alcohol and are committed to abstinence. In contrast, Naltrexone, which blocks the opiate receptors involved in the pleasurable effects of drinking as well as in cravings for alcohol, is considered a “treatment” drug and can be offered to those struggling to recover.
Over time, constant consumption of alcohol changes the brain, in particular altering the release of chemicals such as GABA and dopamine that create the feelings of warmth, contentment and good humor associated with alcohol; and strengthening the synaptic connections that increase the likelihood of thinking about and eventually craving alcohol, until drinking becomes compulsive.
Naltrexone has been shown to reduce drinking and increase abstinence in more than a dozen clinical trials, including one large scale NIAAA-funded trial published ten years ago. Because it’s available in an inexpensive generic form, however, drug companies are not promoting it. Still, AUD experts are baffled by its limited use.
For her article, Glaser tried Naltrexone (ordered online with no RX) and, sipping her evening glass of wine, “felt almost nothing—no calming effect, none of the warm contentment that usually signals the end of my workday … I had never found wine so uninteresting.” After taking the drug for several more nights, she wrote, “I no longer looked forward to a glass of wine with dinner.” She also lost several pounds, noting that an opioid antagonist is being tested on binge eaters in Europe.
Resort rehab also runs up against research indicating that most individuals need at least three months of treatment to significantly reduce or stop their addictions. Those with co-occurring or long-standing addictions can require 12 months or longer. Which is why the most successful rehab programs are local and available as long as and whenever needed.
At Alltyr, Willenbring’s Minnesota clinic, addiction is considered a chronic medical condition, and treatments include antidepressants, anti-relapse medications and psychotherapy—for as long as needed. “You don’t treat a chronic illness for four weeks and then send the patient to a support group,” Willenbring said. These individuals need treatment “that is individualized and offered continuously or intermittently for as long as they need it.”
Among patients who were helped at Alltyr, one woman had been in and out of rehab 42 times, and one young man had tried more than 20 abstinence-based programs, attempted suicide and overdosed on heroin.
AA’s one-size fits all approach “was originally intended for chronic, severe drinkers —who may, indeed, be powerless over alcohol,” notes Glaser. But only about 15% of those with alcohol-use disorder are at the severe end of the spectrum. And whereas AA considers alcoholism a progressive disease that can only get worse, in fact as many as 20% may go on to drink at low risk of becoming more dependent, she wrote.
Any changes in this picture make news, such as when the Hazelden Betty Ford Foundation, previously an AA-only model, announced it would offer Naltrexone. But that was in 2006— and there has been little movement since.
NEED ANOTHER reason to take up yoga or try a bodywork program like 
