photo by Duncan Moody / iStock

MY FRIEND SAM,  who is tiny and exercises several times a day, recently learned that she was pre-diabetic and was advised to eat less sugar.  She had, admittedly, been consuming mostly lattes and cookies until dinnertime, when she usually ate a healthy meal.

(Disclosure: I like sugar and sugary foods, am hounded by the food police when I add an extra packet to my tea, and read with special interest medical reports on sugar and disease.)

Type 2 diabetes (T2DM) is generally thought to occur in people with weight problems, especially those with sedentary lifestyles, but thinner people are not exempt.

In both Type 1 and Type 2 diabetes, though for different reasons, insulin is no longer doing its job of processing sugar (glucose), which then circulates at high levels in the bloodstream.  High blood sugar can cause connective-tissue damage and chronic inflammation, leading to long-term effects, especially on the nerves, the retina and the kidneys.  With T2DM, high blood sugar measurements can precede the development of full-blown diabetes by ten years or so, during which time circulating glucose may have begun causing complications.

The reasons for high blood sugar and eventually for T2DM in thinner people include some disease conditions (autoimmunity and “fatty liver”) along with genetics, inflammation and stress.  In the past, autoimmunity was believed to cause only Type 1 diabetes, in which the body’s immune system destroys the pancreatic cells that produce insulin, usually at a young age, after which sufferers are dependent on insulin from outside sources.

Recently, lines between the two types of diabetes have blurred.  Now Type 1 diabetes is also seen occurring later in life, when it looks more like Type 2.  In the past, T2DM was the result of insulin resistance, when the body continues to produce insulin but the cells can’t use it efficiently to process glucose.  Being over age 45 is now considered a risk factor in itself for diabetes, along with excess weight, high blood pressure, family history, etc.

In stressful situations, high levels of the “stress hormone” cortisol raise blood sugar levels to deal with the crisis.  But chronic stress, from hours spent in rush-hour traffic or long-term anxiety about jobs or health, causes chronically elevated cortisol and thus chronically high blood-sugar levels, even with a perfect diet and regular exercise.

Lack of sleep can provoke a reaction similar to insulin resistance, and high sugar levels remain circulating in the blood.  Getting enough sleep, however, measured by the ability to wake up without the help of an alarm clock, can be a challenge.

On the subject of sugar alone, most of the health news is bad.  Besides diabetes, there are wrinkles — as many as from sun exposure and smoking – caused by a process called glycation that causes sugars to attach to the proteins in collagen and elastin.  The same mechanisms by which high blood-sugar levels cause tissue damage and inflammation spur aging effects on the skin.

Sugar-curbing advice has even spread to wine. Wines with less sugar, such as Pinot Grigio and Cabernet Sauvignon, called “bone dry,” have less than one gram of sugar in a 5-ounce glass compared to about 12 grams of sugar in a 4-ounce glass of vintage port.

Low blood sugar can also create problems. Low glucose levels have been shown to make married people angrier at their spouses and more likely to lash out aggressively, according to research at Ohio State University, in which participants were given voodoo dolls representing their spouses along with 51 pins.  To control anger and aggressive impulses, along with all other mental activity, the brain consumes about 20 percent of our calories, explains Ohio State psychology professor Brad Bushman.  To raise blood glucose when needed, however, complex carbohydrates are, of course, preferable to candy bars.

Early symptoms of diabetes can include increased thirst, hunger and urination, especially at night, as well as fatigue and unexplained weight loss.  More serious indicators are blurred vision, numb or tingling hands or feet and sores that don’t heal quickly.

To reduce the risk of diabetes, olive oil helps boost insulin sensitivity, while vegetables, whole grains and nuts lower blood sugar. Because fiber slows sugar absorption, whole foods like oranges are a better choice than the juice.

Most of the other risk-lowering tactics involve movement.  An easy one is light exercise after each meal, like a stroll around the block, but it must be done 30 minutes after eating.  The resulting muscle contractions continue to clear sugar from the blood for about three hours afterwards.

Moving for a few minutes every half-hour throughout the day keeps the metabolism working better to maintain low glucose levels.  Recent research in New Zealand on people whose blood sugar levels remained severely elevated for hours after eating showed that three 10- to 12-minute periods of exercise worked better than one 30-minute period. And within the short sessions, blood sugar stayed low over a 24-hour period when high-intensity intervals — one minute walking as fast as possible, or one minute of high-intensity upper-body resistance training with exercise bands – were alternated with minutes of regular exercise.

But keep the risks of long-term stress in mind.  Don’t worry too much about pre-diabetes.  And take heart from the axiom: Pre-anything means you have nothing.

— Mary Carpenter

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WARM WEATHER brings the sweet fragrance of flowering trees and the mouth-watering smells of barbecue along with the less-appealing scents of sweaty body odor.  Sweat is the body’s response to excess heat, whether from the sun, exercise, fever, menopause or some combination of these.  Of the 2- million-plus sweat glands right under most people’s skin, women have more, but men’s sweat smells worse.  How to deal with it depends on whether you want to combat the odor, skip the wet altogether or prefer doing nothing at all.

Animals pant to rid their bodies of excess heat by way of their mouths.  But humans sweat from glands, transferring heat from our entire body surface. Of the two kinds of human sweat glands, eccrine glands are spread over the body, and they produce a mixture of minerals that differ depending on the person.  If your sweat stings your eyes, you are a salty sweater.

But the strongest smells come from sweat produced by apocrine glands, located under the arms, around the breasts and in the groin.  Some of these odors are pheromones, the “personal scent” that attracts the opposite sex, which many people find unpleasant.  Even worse are odors from the sweat that’s caused by stress, which is chemically different from sweat from heat or exercise.

Sweat from the apocrine glands contains small amounts of fatty acids, which are very tasty to the main culprit of bad odors: the bacteria that live on your skin.  Bacteria gobble up sweat and then you stink. Diet also plays a role: After a night of too much pasta aglio e olio and red wine, excess morning-after sweat comes with strong eau de garlic.  Red meat, curry and onions also make the odor worse.

Many deodorants simply cover up bad odors with good scents, such as tuberoses or even bacon: “Power Bacon” comes with the label, “for those with active lifestyles–or people who just sweat like pigs.”  Most deodorants are labeled for either men or women, and although manufacturers often use exactly the same ingredients for both, unisex deodorants make up as little as 10 percent of the market.

Some deodorants also disinfect the armpit with an alcohol base that makes the skin slightly acidic and thus less attractive to bacteria.  Others contain a specific ingredient, most often triclosan, that inhibits the growth of bacteria and other microbes on the skin.  (Deodorant soaps often contain triclosan, but studies have found no benefits from antibacterial soaps, either for preventing infection or for reducing bacteria.)

To combat the drip, antiperspirants have a different function: to stop sweat and thus odor by clogging the pores or ducts through which sweat pours.  Most antiperspirants use some version of aluminum–lately, aluminum zirconium compounds that are less likely to cause irritation than earlier forms.  Because antiperspirants alter a bodily function, unlike deodorants, they are subject to FDA regulations.  To boast “all day protection” requires only that the brand reduce sweat by 20 percent; and for “extra strength,” only by 30 percent.  Many antiperspirants contain deodorants.

You might be one of the lucky people whose sweat doesn’t smell at all, which you can determine by simply sniffing.  Or you can use the “ear wax” test: If your ear wax is white and flaky, you are missing a chemical that odor-causing bacteria feed on, according to LiveScience, leaving you odor-free.  Alternatively, you could suffer from hyperhidrosis, excessive sweating and find antiperspirants a necessity.

While the aluminum in antiperspirants was once suspected of contributing to risks for breast cancer and Alzheimer’s disease, studies have failed to support both hypotheses.  Research, however, has not solved the problem of why one person’s antiperspirant seems to lose its effectiveness after about six months, at which point brands must be switched.  Neither does anyone understand what causes the yellow staining on clothes, but manufacturers are studying the “yellowing phenomenon.”

To avoid the side-effects of commercial antiperspirants, from skin irritation to yellowing, “natural” alternatives can be made using various plant oils and extracts that have antibacterial powers, including white thyme essential oil, rosemary essential oil, lavender essential oil and castor oil.

Also low-tech, wearing natural fabrics, which breathe more easily, reduces sweating.  Wicking fabrics may soak up some of the sweat, but the remaining moisture and its accompanying bacteria always seem to smell worse.  Try wearing several light natural-fabric layers instead.

In extreme cases, there is Botox, which paralyzes and shrinks the sweat glands by blocking a neurotransmitter that stimulates them.  Most often used for those with hyperhidrosis, Botox is also popular with brides, grooms and prom-goers who want to avoid embarrassment as well as ruining expensive clothes.  Several injections in the armpits can last up to eight months.

So you can join the Americans who spend $18 billion per year on deodorants and antiperspirants.  Or head in the other direction, toward saunas and sweat lodges, and enjoy a good sweat–even if the overpowering smell is garlic.

— Mary Carpenter 

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THERE IS NOTHING either good or bad, but thinking makes it so. That’s a line from Act II of “Hamlet,” but it could apply to recent research on placebos.

Among the surprising findings are that both personalities and genetic differences appear to explain individuals’ varying reactions to placebos. In addition, the effectiveness of placebos now makes it clear that our bodies do not distinguish between a chemical process and the thought of a chemical process.

Also surprising: as many as 80 percent of all doctors say they have prescribed placebos – which include saline (salt water) injections along with familiar “impure” placebos, such as prescribing an antibiotic for a viral illness.  In a Swiss study, of the doctors who admitted to using a placebo, more than half told patients they were getting “a drug or therapy.”

Nicer patients respond best to placebos.  In a multi-university study, people with traits like resiliency, straightforwardness and altruism experienced a greater reduction in pain after taking a placebo than did those with an “angry hostility personality trait.”  The brains of those with “more agreeable” personalities released more mu-opoids – the brain’s own pain-killers, according to Jon-Kar Zubieta, M.D., of the University of Michigan.

The more agreeable traits “are part of an overall capacity to be open to new experiences and integrate that information in a positive fashion,” Zubieta told Scientific American Mind magazine.  “That’s probably what drives the placebo effect.”

Ted Kaptchuk, Harvard Medical School professor who studied Chinese medicine but never got an M.D. degree, was determined to find out not if but how the body responds to placebos.  With colleagues, he founded the Program in Placebo Studies and the Therapeutic Encounter (PiPS) at several Harvard-affiliated hospitals.   A recent PiPS study found that patients with a variation of one gene linked to dopamine production were more likely to respond to sham acupuncture than those with a different variation.

Early PiPs research on patients with irritable bowel syndrome (IBS) was the first to show a dose-dependent placebo response: the more fake care patients received, including “very schmaltzy” attention from doctors for one of the study groups, the better the patients did medically.

Because deceiving patients goes against the ethics of doctoring, Kaptchuk’s next experiment compared a control group who received no treatment with a group told they were getting placebos, from bottles clearly labeled “placebo pills.”  The placebo group had twice the improvement in symptoms – in fact, as much improvement as seen with “the best real IBS drugs,” according to Kaptchuk.

Imaging studies support these findings, showing that placebos affect the same areas of the brain that modulate pain reception. According to Italian neuroscientist Fabrizio Benedetti, what “placebo neuroscientists” have learned is that therapeutic rituals move the same molecules in the brain – use the same biochemical pathways – as drugs.

Anticipation plays a role in the placebo effect. Our “forward-thinking brain” shapes our actions, personality and health, explains Chris Berdik in his book “Mind over Mind” (Current/Penguin, 2012).  For the same reason that wearing all black can make you a more aggressive competitor and striking a pose can make you act authoritative, believing that a treatment will work can cause a patient’s body to mimic the effects of medication and even of surgery.  Fulfilling expectations is what our brain does best, and most convincingly in the work of placebos, says Berdik.  And a placebo’s effects can increase with time as confidence in the treatment grows.

Placebos work via the same physical pathways as the body’s active healing mechanisms, by stimulating real physiological responses that range from changes in heart rate and blood pressure to chemical activity in the brain.  They work best for pain, allergies, insomnia, fatigue, nausea and disturbances of bowel, urinary and general functioning – and least well for broken bones.  In an analysis of 46,000 heart patients, the half taking a placebo did as well as those taking the heart drug, as long as all believed they could be getting the drug.

In the early 1970s, researchers demonstrated that brains of patients given placebos for depression show increases in dopamine as well as in electrical and chemical activity in several regions of the brain.  Conversely, they also showed that chemicals blocking the release of endorphins – the brain’s natural pain-relievers – also blocked the placebo effect.

Maybe genetic differences help explain my own skepticism.  Assigned years ago to report on homeopathy, I realized that, even after speaking to many medical doctors, patients and personal friends among its adherents, I could never believe in medication so diluted that no trace of an active ingredient could be found using existing technology.  Enthusiasts argue efficacy can be traced to the “memory of a molecule.”  Believing that a pill can remember an active but invisible ingredient was too much for me.  While the research on homeopathy doesn’t always meet the highest standards of controlled studies, the anecdotal evidence is overwhelming: homeopathy can work wonders – but perhaps only on believers.

— Mary Carpenter

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Photo by Joe Elbert

A FEW YEARS AGO I unwittingly scheduled my annual checkup with my internist and my gynecologist within a few weeks of one another.  During those two appointments I heard surprisingly contradictory advice on supplements.

At the first, with my internist, I heard about new research on calcium and vitamin D.  With my blood levels, I was advised to stop taking both. Two weeks later, my gynecologist reminded me that, because of my mother’s severe osteoporosis, I should be taking the maximum doses of calcium and vitamin D.

Over the years, people learn which diet works best for them and that similar dietary advice rarely helps everyone. With low blood pressure, for example, I have learned to consume salt, especially after intense exercise in warm weather, to allay weak or shaky feelings.  But that is bad advice for people with higher blood pressure.

For some, drinking a regulated amount of water – the old eight glasses a day – can be terrific for the skin and help digestion and kidney function. But for most people, the body is good at judging when it has had enough: drinking when you’re not thirsty causes the brain to switch off the swallowing reflex, and the motor cortex must work harder to swallow each sip. Over-hydrating risks debilitating weakness and even death.

Supplements are trickier, because their effects are more subtle. First, some statistics.  In 2010 Americans spent $28.1 billion on dietary supplements, and 49 percent of adults used at least one supplement, according to the U.S. Preventive Services Task Force report published in 2014.  The task force found no benefits in the use of multivitamins for the prevention of cardiovascular disease or cancer.

In what has come to be called The Great Vitamin Controversy, the task force also recommended “against daily supplementation with 400 IU or less of vitamin D and 1,000 mg or less of calcium for the primary prevention of fractures in…postmenopausal women.” Countering this advice, Diane L. Schneider, M.D., author of The Complete Book of Bone Health, wrote, “The news headlines are conveying the wrong message.”

Both conclusions are based on the seven-year Women’s Health Initiative study that included more than 36,000 women ages 50 to 79 and found no difference in the number of fractures between women taking supplements and those taking placebos. Dr. Schneider, however, says that on closer inspection, that the women who actually took the pills 80 percent or more of the time had a 29 percent lower rate of hip fractures. Later, the Women’s Health Initiative researchers wrote: “Long-term use of calcium and vitamin D appears to confer a reduction that may be substantial in the risk of hip fracture.”

All experts agree that it’s better to get calcium from food and vitamin D from the sun, but when those don’t fulfill the daily recommended amounts, supplements can help. In a recent article on the Smithsonian magazine website, “Five Vitamins and Supplements That are Actually Worth Taking,” vitamin D tops the list. The other four are: probiotics, zinc, niacin and garlic. Although this list is based on several studies published in the Annals of Internal Medicine, the accompanying editorial in the journal declares: “Enough is enough: stop wasting money on vitamin and mineral supplements” – because, these expert authors believe, results are not good enough to say that people NEED or even BENEFIT from any of these.

Advice on diet also remains murky, but there is increasing evidence to support tailoring advice to an individual’s genetic make-up and to their specific risks for obesity, heart disease and cancer.

Unsurprisingly, some of the variability is in our genes. In a recent study published in Nature Genetics, people with a fewer copies of the AMY1 gene, which affects the saliva’s capacity for initiating digestion of starchy foods, were at greater risk for obesity; people with fewer than four copies had an eight times higher chance of being obese than people with more than nine copies. Esoteric, yes, but proof that while some people can enjoy guilt-free pasta, others should investigate the Paleo diet.

The U.S. News & World Report’s “Best Diets 2014” ranked the high-protein diets Paleo and Dukan (named for its French creator) least successful for weight loss on a scale of five, while the DASH diet for hypertension, full of good advice like avoiding calorie- and fat-laden sweets, was number one. But subjects were not grouped in ways that could help individuals make the best dietary choices.  And the DASH diet could be risky for people with low blood pressure.  Also, when assessing a diet for healthiness rather than weight loss, most now agree that the Mediterranean diet is the best.

In addition, Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health,  told the New York Times that looking at individual “nutrient groups” – such as fats — in isolation could be “misleading.”  Dr. Hu was responding to research showing that consumption of saturated fats might have no role in increasing heart attacks, and conversely that eating higher amounts of unsaturated fat does not lead to fewer signs of heart disease.  Dr. Hu pointed out that when people cut down on fats, they tend to eat more refined carbohydrates that can also be bad for the heart.  “The single macronutrient approach is outdated,” said Dr. Hu.

And what about the single-item approach for supplements – which is the content of most news reports?  For example, from the same Women’s Health Initiative, an article earlier this month reported that “Calcium and vitamin D supplements after menopause can improve women’s cholesterol profiles.”  But the article concludes by admitting that there is no information on whether the higher levels of calcium and vitamin D translate into lower rates of cardiovascular disease.  The only certain result applies to women at risk for vitamin D deficiency – i.e., not Everywoman!

Personally, I choose a doctor and then go with their advice.  In the case of my two doctors, I compromise.  Every other day, I take one pill of 500 mg. calcium with 200 IU Vitamin D; on the off days, I skip these supplements entirely.

 — Mary Carpenter

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JUICING A POUND of kale for your daily breakfast may not be a good idea.  Kale and other cruciferous vegetables (broccoli, brussel sprouts, cabbage, bok choy, turnips, arucola) when eaten raw in very large amounts can interfere with thyroid functioning and, in the worst case, lead to an enlarged thyroid, called a goiter.  To decrease the risks, cook your cruciferae, or vary your greens with non-cruciferous veggies like cucumbers, tomoatoes, zucchini and carrots.

Spinach, too, can interfere with thyroid function.  Also it contains purine, a substance occurring in most living cells, which in excess can lead to the accumulation of uric acid, causing gout and kidney stones.  To benefit from spinach’s healthy vitamins, it must be ingested with a “good fat” such as olive oil – along with jokes about how Popeye really did need Olive Oyl…

For both spinach and kale, only organic veggies avoid the pesticides that can accumulate excessively on dark leafy vegetables.

To digest asparagus, because humans do not have the right enzymes to break down its complex carbohydrates, bacteria in the intestines must ferment the stalks – leading to the formation of gases that must then be released from the body.  For most people, asparagusic acid is excreted in urine, causing the characteristic odor of “asparagus pee” and changing its color.  But for some people who have not inherited the right enzyme for doing this, eating too many asparagus at once can cause severe pain and digestive problems.

–Mary Carpenter

To clear your mind, focus on just one thing–cooking for example. / photo by Darren Baker, iStock

DO SUDOKO, play bridge or learn a new language are just a few of the prescriptions we hear about to keep an aging brain agile.  Among oft-mentioned solutions, the most appealing to me is mindfulness: Keep doing the things you’re doing, but do only one activity – washing dishes, walking – at a time, with greater awareness and attention.  While cooking dinner, focus on the smells and sounds; don’t read the newspaper or answer the phone.  Try eating one almond: Concentrate on how it feels in your hand, then on your tongue – the texture, the saltiness.

If your mind keeps wandering back to the to-do list, follow your breath slowly in and slowly out, until you feel calm enough to remember which ingredients you’ve added, how many almonds you’ve eaten, where you put your phone.  Or use STOP: Stop, Take a breath, Observe (thoughts and feelings) and Proceed.  For example, on arriving at home, STOP before entering your house to think about one positive thing you’ve done that day.

The advantage: lasting improvement of “working memory,” which keeps track of what you’ve recently said, done or heard.  Working memory is directly impacted by stress, including: ongoing daily stress; prolonged effects of childhood stress from abuse or neglect; depression and anxiety disorders.  With recent research showing that stress is increased by feelings of helplessness, the sense of control and calm gained through mindfulness makes a good antidote. Mindfulness training has helped soldiers withstand high-stress deployments, according to research by Georgetown University Professor Elizabeth Stanley and others.

Mindfulness studies by Harvard psychologist Ellen Langer gave a group of men the chance to turn their body clocks back two decades.  In a New England hotel redone to resemble the late 1980s, the men were told not to reminisce about the past but to pretend they had traveled back in time.  After one week, compared with a control group, these men had more joint flexibility, increased dexterity, improved gait and posture and improved mental acuity.  And they were judged by outside observers to look younger. According to Langer in her book “Counterclockwise,” by resisting mindless acceptance of negative cultural cues about old age that shape our self-concepts and behavior, we can “mindfully” open ourselves to possibilities for more productive lives.

“Aging” thoughts or feelings, which can arise when you can’t touch your toes or you forget a recipe, are targets for mindfulness because they evoke regret and comparisons to our younger selves, “two patterns that take us away from our present situation,” according to Lewis Richmond, in his online “Mindfulness of Aging” lectures.  So if you can’t believe you are 20 years younger, as in the hotel experiment, avoid negative thoughts by staying in the present.

If regret and comparisons are impossible to escape, if mindfulness cannot be employed to feel and look younger, you can always chant the slogan: 60 is the new 40.

Local mindfulness guru Jonathan Foust, senior teacher at the Insight Meditation Community of Washington (IMCW), recommends three routes to mindfulness: some kind of daily practice, even lasting just a few minutes; occasional intensive practice – half- or whole-day retreats; and finding a group involved with spiritual or mindful practices that meets regularly. Many options for learning and practicing mindfulness can be found at IMCW.  If you prefer working on your own, workbooks and CDs are available online from IMCW and from Jon Kabat-Zinn, founder of the “Mindfulness-based Stress Reduction” (MBSR) program and others.

–Mary Carpenter

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LATELY EVERYWHERE I go, I am offered nuts in bowls, bags and oversized plastic containers.  If  I demur, I’m told I should eat them.

A Harvard study of 119,000 men and women found that, over the study period of 30 years, those who ate nuts almost every day, compared to those who never ate nuts were:

*20 percent less likely to die

*29 percent less likely to die from heart disease

*11 percent less likely to die of cancer

Study participants who “often ate nuts” weighed less, exercised more and were less likely to smoke than nut-abstainers, but even accounting for these variables, nuts provided strong health benefits.

Those who ate nuts less often than once a week still reduced their risk of death by 7 percent; those who ate nuts once a week, by 11 percent; and two to four times a week, by 13 percent.  The benefits occurred with peanuts as well as with tree nuts such as almonds and walnuts.

Nuts contain “good” unsaturated fats, fiber and omega-3 fatty acids – which have been touted to help with everything from depression to the effects of aging on the brain.  During times of acute stress, walnuts appear to protect the heart, and almonds boost immune functioning.  Walnuts may also help reduce “bad” LDL cholesterol. And pistachios may provide protection from lung cancer.

–Mary Carpenter

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WHAT’S GOOD FOR THE GUT might also be good for reducing stress, anxiety and anger.  So-called probiotics — good bacteria — might also improve problem-solving abilities as well as mood and might help with weight loss.

While these possibilities are enticing, the evidence is not yet completely in for good microbes doing much more than their traditional uses: to offset the side-effects of taking antibiotics or “for symptoms that are digestive in nature or urinary tract-based,” says local clinical nutritionist Kelly Dorfman, who works with other medical professionals to help people cope with complex symptoms.

Based on studies (mostly at Yale) that suggest probiotics boost immune function and help prevent illness, Dorfman says, “I often use probiotics when people get sick frequently.”

The digestive tract can be viewed as a second or small brain. Along the walls of the 30-or-so-foot tube — composed of the stomach and small and large intestines — are trillions of microbes, including many good bacteria that control the smaller amounts of bad bacteria, which in large numbers can make you sick. The best good gut bacteria are probably specific strains of Lactobacillus and Bifidobacterium, according to Shekhar Challa, a Topeka, Kansas, gastroenterologist and author of “Probiotics for Dummies.”  When taking antibiotics knocks out these good bacteria, nasty bugs can cause digestive problems, and a particularly nasty one called Clostridium difficile can cause potentially serious diarrhea and fever, explains Joel Mason, nutrition scientist at Tufts School of Medicine.

While it has been known for years that hormones related to high stress can increase the virulence of bad gut bacteria, leading to stomach pains and diarrhea, recent evidence suggests the reverse might also be true: A rise in good bacteria can, for example, raise the levels of tryptophan, a precursor of the feel-good neurotransmitters serotonin and dopamine. Also in a French study of moderately anxious people, taking a daily probiotic supplement decreased anger and depression. And an Irish study on stressed mice showed that daily doses of good bacteria changed the way the mice reacted to a maze, which typically causes high anxiety.

In addition, studies on overweight mice found that there was a higher percentage of one type of the bad bacteria in their guts, and when those bacteria were put into germ-free thinner mice, they became fat. too. Research on the Old Order Amish sect (whose members eat similar diets and are genetically similar) found 26 species of bacteria present in different amounts in obese people compared with thinner family members and neighbors, according to researchers at the University of Maryland Medical School in Baltimore. Jane Foster, PhD, an associate professor in psychiatry and behavioral neurosciences at McMaster University in Ontario, suggests that “people struggling with weight try a probiotic supplement.”

On the other hand, there is a story with the opposite outcome: A chemist took antibiotics for travelers’ diarrhea and suddenly began began losing the weight he’d struggled with for a long time. The theory is that some “good” gut bacteria are more efficient at breaking down food, which enables the body to absorb more calories — so after the chemist began taking antibiotics, he wiped out some “good” bacteria so his body absorbed fewer calories and he lost weight. In that case, forget the probiotics: Reducing “good” bacteria would be the key to weight loss.

Determining the best levels of good and bad bacteria, however, is not simple.

According to Dorfman, the prescription depends on an individual’s symptoms, sensitivities and diet, but exactly how this works is not well understood. The National Institutes of Health is now compiling information for its “Human Microbiome Project,” which hopefully will clarify these issues.  Although Dorfman sometimes takes a stool sample to assess an individual’s situation, she says that “for many situations, you throw in a bunch of species [of bacteria] and hope one sticks.”

Among foods that contain probiotics are kefir and cheese; fermented foods such as sauerkraut and kimchi (Korean fermented cabbage); and pickles fermented in briny water, not vinegar.  Local classes in “Fermenting Fundamentals” or “Crazy for Kefir and Kombucha” are taught by Gina Rieg, certified Health Coach at Holistic Maryland in Columbia.

Also yogurt, if it has been refrigerated and the label says “live” or “active.” In a study comparing Dannon’s Activia, which contains a strain of bifidobacterium, with yogurt that does not, food passed more quickly through subjects who ate Activia — which may reduce the discomfort of constipation, according to Robynne Chutkan, founder of the Digestive Center for Women in Chevy Chase and Associate Professor of Medicine at Georgetown University Medical Center.

Foods that operate as prebiotics, to stimulate the growth and activity of good bacteria already living in the intesting, include oats, chicory, bananas, wheat, garlic and onions, flaxseed, artichokes, barley, legumes and raw dandelion greens, and honey, contain prebiotics that stimulate the growth and activity of good bacteria already living in the intestine.

If you don’t love yogurt, kimchi and pickles, improving your store of the good bacteria could be as easy as taking one pill a day –- but do not drink anything hot for an hour afterward because heat destroys bacteria en route to the stomach.

More magazine author of “A Surprising Way to Beat Stress” Dianne Lange suggests Align. (My totally unscientific sampling of Align saw a decline in post-meal symptoms, including occasional stomach pains and gas.) But Joel Mason at Tufts warns that the “good” bacteria you’re swallowing can lead to infections, albeit in rare situations. And Dorfman cautions that unrefrigerated supplements can be ineffective; she recommends checking Consumer Lab for product evaluations.

 Finally, a related treatment involves “fecal transplants” — from a healthy person into someone who is sick, specifically with C. diff., usually caused by antibiotics and often found in hospitals.  A recent study conducted in the Netherlands supports the experience of gastroenterologists around the United States that fecal transplants have saved the lives of patients with C.diff.  Use of these transplants will hopefully be obviated as the Human Microbiome Project pinpoints which bacteria work best in different situations.

–Mary Carpenter

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MOST OF US GREW up sleeping on one pillow. Unaware that there were different kinds of pillows, we wouldn’t have considered complaining. Now pillows with names such as Chiroflow and MyPillow are everywhere, but how do you decide which one is right for you?

In recent years, hotels have started offering “pillow menus,” which allow you to request a specific kind of pillow before arriving. From the “pillow library” at Kimpton’s 70 Park Avenue hotel in New York, the most popular pillows over the years have been those filled with buckwheat hulls — said to stimulate acupressure points and increase circulation — according to the hotel pillow librarian, who advises guests on the best option for them. The Liaison Hotel Capitol Hill allows guests to choose more than one among six choices: feather & down, sound (thin speakers inside for plugging in an MP3 player), hypoallergenic, magnetic therapy (reduces swelling), buckwheat and Swedish memory (self-molding foam).

The most important feature of a pillow is how it supports your neck, according to Rebecca Carli-Mills, Certified Advanced Rolfer and Movement Therapist in Chevy Chase, Md.  A pillow that’s too firm and too high can cause the neck to over-straighten; too low and too flat has the same problem. “To keep the neck’s natural curve,” says Carli-Mills, “lie on a pillow, reach back under your neck and push up on the cervical spine. There should be some give, and your neck should feel soft and have a slight curve.”

Carli-Mills’ favorite: “old-fashioned down,” she says, “because it can mold to cradle your neck in whatever sleeping position.” Sleepers with allergies, however, need hypoallergenic pillows and should use a zippered pillow protector that is washed weekly.

Buckwheat-hull stuffings tend to get too firm and shift around, says Carli-Mills: “Before you know it, you have a straightened neck.”  As for Tempur-Pedic pillows — composed of “viscoelastic foam” developed by NASA research to protect airplane passengers in case of  an accident — they can work well unless you are over-straightening your neck and tucking your chin down, she said. Among the different Tempur-Pedic pillows, she advises finding the correct size for your height: For the small- to average-height person, the small size is usually good.

One of the latest entries on the pillow market is MyPillow, stuffed with torn-up pieces of foam. While some sleepers rave about its ability to support and keep the right shape for their heads and necks, others complain that it starts sagging after a few months.

Over the past decade, many pillows have claimed they prevent snoring and protect against sleep apnea, which can result from blocked airways. A 2013 survey by Living Healthy 360 looked at several models, including the ObusForme Anti-Snore Pillow, the Silentnight Anti-Snore Pillow, the  Brookstone Anti-Snore Pillow and the FDA-approved as a medical device for snoring and mild sleep apnea, the SONA Anti-Snoring Pillow . Each had mixed reviews, most likely because the cause of snoring varies among individuals.

Turning on one side can help stop snoring. In a recent national survey by The Company Store, 59 percent of Americans sleep on their sides, 18 percent on their backs and 13 percent on their stomachs. According to Carli-Mills, side sleepers usually do best with a normal rectangular pillow that has an additional panel on each side, making it slightly firmer than those for back sleepers. Stomach sleepers, who have a problem with their necks getting turned at a strong angle, should sleep with a firm pillow under their body “like floating on a water raft to lessen the neck rotation.” For most of her clients, who report that they don’t stay in any one position, goose down that adapts to different positions is the best.

Those who can’t afford the time or money for a night at a pillow-testing hotel are stuck with the old method: trial and error. On a positive note, Carli-Mills says she has gotten inexpensive pillows at Ikea that do as good a job as expensive brand-name models. A side sleeper, she currently rests on a two-pillow combination: on the bottom, something harder like a Tempur-Pedic or lately a Chiroflow pillow that you fill with water; on top, a pillow of fluffy down.

Carli-Mills tried a medical “sleep study” —  with electrodes on her head to detect periods of REM sleep — but found it so hard to sleep under the study conditions that the results didn’t show anything useful. And she pointed out that those medical professionals “didn’t care about the pillows.”

For those who believe their nights are insufficiently restful, Carli-Mills has non-pillow advice: “People have unrealistic expectations about how they will feel in the morning.  Scanning your body for tension and doing simple movements and self-massage before going to sleep can improve how you feel while sleeping, so that you wake feeling refreshed.  A supportive pillow is beneficial but does not fully solve the problem for someone who goes to sleep clenching their jaw.”

What happens first thing in the morning is also important, she says: “Joints lose mobility with age. Preferably before getting out of bed, you need to stretch — the way cats stretch before they move when they have been lying around for long periods — moving your body in all different directions, reaching with arms and legs, maybe some ankle and wrist rolling, and breathing — like a full body yawn.”

 — Mary Carpenter

If you’re wondering what to do with your old pillows, International Pillow Fight Day  is tomorrow, April 5. The fun begins at 2 p.m. at the Washington Monument.

Be brave. Talk to your doctor. / iStock

LIKING MY DOCTOR  too much was my biggest mistake. For at least half of each visit over our decade together, we chatted about having kids with learning difficulties, McLean School vs. Lab School, then colleges — large and cold like Michigan or small and warm like Elon.  We rolled our eyes together through menopause, and when we had similar bouts of arthritis, she took my pain seriously and sent me to a good specialist.

But one July, after three visits and unreturned phone calls in between — all spent failing to convince her that I felt worse than ever before in my life, and being advised simply to take more Advil — I realized the chatty repartee wasn’t working. Having grown up terrified by the story of The Little Boy Who Cried Wolf, I could not bring myself to moan in her presence as I had for hours at home for more than a week. Determined to set the record straight, I marched into our next appointment, forced myself not to smile in the polite, friendly way I had been taught to do, and spoke as firmly as I could muster. “I am not succeeding in telling you how sick I am,” I said, prepared with the evidence: “Every night I go to bed around midnight, knowing I will wake up half an hour later, which I do, and then I pace for the rest of the night, wide awake. The pain in my bones, muscles, joints is so bad that I lie on cold packs whenever they are cold enough, send them back to the freezer and wait for them to get cold again.”

Dr. G. looked startled. “Yes,” she said, taking a step backward, “that sounds serious.”  She agreed finally to the Lyme disease test I’d been begging for since two weeks earlier when I’d developed flu-like symptoms — which in summertime suggest Lyme (though recently H1N1 has become another possibility).  But having no characteristic bullethole-shaped rash and no tick, I’d been consigned to the large group of people who believe they have Lyme but cannot persuade doctors to treat them.

Although the Lyme test results wouldn’t be available for five days, a raised, red rash covering my entire body the next morning persuaded Dr. G. far better than my words to start me on doxycycline — which I’d also been begging her to do (I cannot understand why obviating the risk of antibiotic overuse is more important than alleviating the miserable symptoms of people who suffer from Lyme as I did). For sleeping, she now prescribed extra-strength Ambien, which produced no more than my usual half-hour, maybe because my problem was not insomnia but Lyme disease; and left for her weekend on the Cape.

 My next mistake in doctor-patient communication came that afternoon when, in intolerable pain, thinking maybe bone cancer or imminent death, I went to the Sibley Hospital ER.  I was certain I would be admitted and put on a morphine drip.  When asked to rate my pain on a scale of 10, I gave it a 10, which a nurse friend later explained is for drug-seekers; to get medical attention, you need to say 9.  After six hours in the waiting room — at midnight on a Friday — the Sibley doctor suggested I might be depressed.  How about sleepy?  Looking pretty tired too, she released me.

A night later, I had my first communication success. Realizing that what really hurt were my muscles — not sharp pain but an indescribably agonizing ache, I waited for the first light of dawn in the hope of getting a better reception, and made a final cry for help.  Ready to be as firm as I had finally been with Dr. G., I reached the on-call doctor for her practice, whose sweet young female voice sounded desperately sleepy, and told her, “I can tell you the long story — pain, no sleep, probably Lyme disease — but I know what I need. It’s muscle pain.  I need Valium.”  A pause.  Then I heard a miracle: “Okay,” she said. “I’ll phone it in!”  Success — though with no idea why: Had Dr. G. given her a heads-up about me? I got the Valium, took one and slept for hours.  I felt better.

When the Lyme tests came back positive, Dr. G. called me — first at home, then on my cell, really trying hard to reach me.  She sounded amazed, even impressed: “They were all positive!” she said repeatedly. My muscle aches lasted for months, subsiding slowly: Apparently the longer the wait before Lyme is treated, the longer the symptoms last — another reason, I would think, to give doxycycline early.

But the insomnia persisted — which leads to a final communication tip: Don’t let doctors know your age. Before the Lyme disease, I’d never had trouble sleeping: On lazy vacations, I could easily put in a 10-hour night, and actually envied insomniacs who stayed up reading into the early morning.  When I told my new doctor about the insomnia, he said, “Well, women over 50…”

The women in my yoga class agree about this problem. When our Iyengar-class star — a woman who stands on her head, on her hands, and probably on any part of her body — suddenly had neck pain, a true aberration for her, the doctor said, “Well, women over 50…”  In both cases, sudden symptoms in younger women would have had the doctors scrambling for explanations and/or treatments.  For us “women over 50,” doctors should at least find better words, because in the age of information one thing that’s hard to hide, change or fake — especially from one’s doctor — is age.

–Mary Carpenter

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IN A CONVERSATION with two psychoanalysts, I told them I had written an essay about being an introvert, which was published in The Washington Post. One analyst said to the other, “I don’t think there’s any such thing as an introvert,” and the other agreed: “No such thing.”  That was in February 2007.

In the seven intervening years, the word has spread.  Most credit is due to Susan Cain’s bestselling “Quiet: The Power of Introverts in a World That Can’t Stop Talking,” and the TED talk she gave on the subject.  Not sure where you fall in the camp between innies and outies? An August 2013 Huffington Post article, by Carolyn Gregoire, “23 Signs You’re Secretly an Introvert,” enumerates the ways you can tell the differences.

Just last week, BuzzFeed posted a graphic map of what every introvert’s brain looks like. Do you always come up with “really convincing excuses of why you can’t go to that thing?”  Is there a “part of your brain that makes you look down at your phone when someone is walking in your direction?” Chances are good you’re an innie.

–Mary Carpenter

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IMPROVEMENTS IN VOCABULARY, better big-picture thinking and greater empathy rank among upsides to the aging brain. But it’s worries about the downsides that are compelling Americans to spend more than $1 billion on “brain fitness,” a number that will continue to rise dramatically, according to market research firm SharpBrains.

The “brain-training” site Lumosity, launched in 2007, now has about 40 million users, most paying some $14 per month. The question is, Can “brain exercises” actually improve mental capacities, in particular those that decline with age? Among these capacities, Lumosity claims to improve attention, flexibility, problem-solving and working memory, the last defined as the ability to hold several units of information in the mind and manipulate them over a short period of time.

Interest in brain training got started in the early 2000s after new evidence demonstrated that the brain, whose abilities were thought to be fixed in early life, had unimagined plasticity.  Brain scans on London cab drivers, required to memorize detailed maps of London neighborhoods, showed larger hippocampi — structures in the brain that process memory and emotion — than those of London bus drivers. The conclusion: The cabbies’ intense memorizing had created new neuronal connections.

After that first surge, interest exploded. Most credit the 2008 study by Maryland psychologist Suzanne Jaeggi, Michigan psychologist Martin Buschkuehl and others, in which subjects in their mid-20s were trained on one memory challenge, called the dual n-back, for anywhere from eight to 19 sessions lasting 25 minutes each, while a control group received no training. The result: The more hours of training, the bigger the gain in “working memory,” and thus of problem-solving ability.

Attempts to replicate the study by Michigan State psychology professor David Hambrick, however, ran into trouble. Using eight different challenges instead of one, and 20 sessions of training, Hambrick sums up his findings as “zip.” He makes the point that “just because you get better in one doesn’t mean you’re smarter.”

To judge brain-training exercises, an important variable is generalizability — whether specific brain exercises lead to improvements on other tasks and in other areas. Does getting better at remembering random letters or numbers mean that you won’t put your car keys in the freezer? Based on meta-analyses (studies that combine the results of many studies), Yale neurologist Steven Novella concludes, on the website he founded called Science-Based Medicine, that “memory training programs appear to produce short-term, specific training effects that do not generalize.”

Dr. Novella sees computer-based brain training as having potential for “maintaining and improving cognitive function” and believes that “existing research is inadequate to rigorously address all variables of brain-training interventions.” More studies need to be done. In addition, he says, “The very concept of brain training is probably flawed.  Just a fancy term for good old-fashioned learning… It’s just learning.”

While Lumosity’s brain exercises — from visually tracking the direction of one bird in a flock to creating words from small roots — can be fun, the dual n-back, the exercise used by the Maryland researchers, requires subjects to keep track of two separate streams of stimuli, usually one auditory and one visual. For example, while a subject watches a series of letters on a screen, he or she listens to a series of numbers, and then each of these series is regularly interrupted with a request for the subject to name the letter or number that he saw or heard one or two steps back or more. Although whole websites are devoted to this exercise, Hambrick’s negative findings may be a relief for anyone who has felt obliged to include it in their brain training.

In a 2013 New Yorker article, author Patricia Marx describes her experiences, first undergoing an online “Brain Fitness Check-up” designed by the Washington, D.C.-based company NeoCorta and then choosing the brain-training platform BrainHQ developed by Posit Science. Posit’s founder Michael Merzenich told Marx that the program “effectively reversed cognitive aging by 11 years, on average, after only 10 hours of training.” Marx trained for one hour every day for six weeks and filled out many questionnaires, after which she was told, “Your advances on these exercises come from brain remodeling” and that her “enhanced brainpower should last several years.” Marx said she didn’t notice her newfound cognitive abilities but adds, drolly, is now “slightly less troubled about the size” of her hippocampus.

 Working-memory deficits, however, can also be caused by stress, both ongoing and post-traumatic, and dealing directly with its effects can stimulate a marked improvement in working memory at any age. Currently the most-touted antidote to all kinds of stress is mindfulness, and the program that  for more than 30 years has helped soldiers, firefighters and thousands of others impaired by stress-related memory deficits is Mindfulness Based Stress Reduction (MBSR), an eight-week course developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, offered locally by the Insight Meditation Community of Washington.

 An appealing alternative to cognitive “brain training” exercises is “neurobics,” exercises that involve employing any one of your senses in a new way; for example, writing or brushing your teeth with your non-dominant hand  (See “Keep your Brain Alive: 83 Neurobic Exercises to Help Prevent Memory Loss and Increase Mental Fitness,” by Lawrence Katz and Manning Rubin). Also, the exercises in “Train Your Brain” by Ryuta Kawashima have many fans but are described by critics as pages and pages of math equations.

 In a recent book, “Smarter: The New Science of Building Brain Power,” Dan Hurley spent several months using several resources at once: Lumosity, the dual n-back challenge, intense physical exercise, mindfulness meditation and learning to play the Renaissance lute — as well as two other potential cognitive enhancers, the nicotine patch and transcranial direct-current stimulation. Test results were ambiguous, but Hurley writes, “I got along better with my wife and daughter, I no longer found myself getting into my car and realizing that I’d forgotten my briefcase…I feel smarter.”

 Reading books, the old-fashioned alternative for exercising the brain — and not necessarily high-brow material — was studied recently at Emory University.  Twenty-one students who read the page-turner “Pompeii,” about 30 pages a day for nine days, received functional MRI scans on the five days before and after the reading, as well as on each of the nine days once that day’s assignment had been completed. Post-reading scans showed heightened connectivity — the goal of brain training — in two areas of the brain, called “shadow activity” because it’s seen after the activity is finished. The conclusion: Simply thinking about movements performed by the book’s characters activated neurons in the reader associated with the physical act of moving. Said the study’s lead author, Emory University neuroscientist Gregory Berns, “Reading a novel can transport you into the body of the protagonist” — exercising your brain, not just figuratively, but “something may also be happening biologically.”

 So don’t toss your thrillers.

— Mary Carpenter

Illustration by Kathy Legg / iStock photos

WHEN WE MOVED to Northwest Washington in 1993, we had lived in New York, Paris and lastly Brussels — capital of the new European Union and home to three American embassies — and felt prepared for the politicians and diplomats of a sophisticated capital city like D.C.

Also, because I had grown up in Delaware and spent weekends at a family home on the Eastern Shore, this area felt like familiar territory. Instead, the best preparation for my life here turned out to be bushwhacking steep rainforest trails in Panama, fending off wild boar in the Venezuelan jungle and ducking flying cockroaches in Senegal.

Across the road from our new house on 27th Street, we found the dense forests of a national park — as in Yellowstone, Glacier, Zion — and in that park, Rock Creek Park, a nature center. At that time, the center housed injured wild animals — either permanently, like the owl that flew around the exhibit room, or temporarily, like the large snake we examined one day in the basement.

On our afternoon drives home from school, we saw albino deer along Foxhall Road. At night, a small herd of does, stags and sometimes fawn congregated on our lawn. Slowly crossing our road one night, a lovely but possibly rabid fox glistened in the moonlight. And luminescent possums with long ghostly tails traversed our porch, unfazed when we pounded loudly on the glass door.

At least the possums kept going. A family of raccoons moved into our back yard, with new babies every spring. Displacing a whole family is difficult, because each raccoon will try desperately to find its way “home” to the others. Years later, during a vacation in Guadeloupe, we hiked up a volcano where people told us we might be lucky to spot a wild raccoon. We shocked them with stories of own raccoon family in the city of Washington, D.C.

We prefer raccoons to rats, which ate an entire (wrapped) loaf of bread on the counter one night, though exterminators eradicated the rats and do a pretty good job with the insects: crickets and spiders in the basement, carpenter bees in the wood, and termites. Most upsetting were the inchworms. Within months of our moving in, the ceiling of our small pantry began to crawl with hundreds inching their way back and forth — and then cocoons spinning in packages of flour and cake mix, and moths flying out of boxes of crackers and cereal. We quickly signed our life away with an annual pest-removal contract.

Venturing into our new national park wilderness one winter morning, my toddler and I  found slopes so steep we had to crawl up on all fours and slither down seated. Suddenly we heard a deep male voice from behind a nearby rock alerting us to an elaborate campsite of two homeless men — complete with clothes drying on a line. The same morning we watched police cars speeding along Broad Branch Road, lights flashing, in search of thieves who’d robbed a Connecticut Avenue store.

After 10 years of Washington living, beginning to pride myself on making peace with this urban wilderness, I happened to look up at a stoplight on Connecticut Avenue to see the official sign: “Watch Out for Bears.” My heart sank. I was ready for a large black bear to saunter across the street, until I saw a panda poster advertising the nearby zoo.

As testimony to the power of D.C.’s own call of the wild, colorful escaped birds like parakeets and canaries can be spotted flying among the park’s high trees; the cockatiel belonging to our neighbors arrived at their window one day. And now our black cat, who started life as a stray but spent eight years sleeping on our bed, bringing up her babies and eating regular meals, has moved into a hole in our back yard.

Fatter and furrier than ever after five months, L.C. (for Little Cat) suns herself on the grassy slope and can be picked up and petted. But when brought indoors, she emits an extremely loud, feral noise before fleeing to freedom. And she ignores our other cat, Stripey, her daughter, as well as our little dog, her old best friend. Either she had enough of the sophisticated city, politicians, diplomats and us — or she’s simply returning to her roots. We hope she won’t convince the other pets they should follow.

 –Mary Carpenter

photo by Bashutskyy / iStock

THE BAD THINGS about getting older — aches, pains and more serious medical issues — are offset by one good thing: years’ worth of personal treatment discoveries, which doctors, if they know about them, rarely reveal. I would suspect a medical conspiracy, but suspiciousness is in the category of bad things. Among the remedies of experience, the most ubiquitous is water: hot water, steam, cold water, salt water and ice.

For migraine headaches, lifetime sufferers require serious medication, even hospitalization. But when my migraines started in my 40s, due to some combination of hormones, weight-lifting and family stress, water helped immensely to stave off full-blown monster headaches if caught early enough: drinking as many glasses of cold water as possible; and splashing my face with alternating icy cold and very hot water, as extreme as possible. If I took Excedrin Migraine and then draped wet washcloths on my face, hot followed by cold, the pain usually subsided; if not, I showered in the two extremes.  Almost always within half an hour, the pain receded until it was merely lurking beneath the surface of consciousness, as long as I moved gingerly and kept drinking water.

For cold sores, the horrific bane of my 20s and 30s and now mostly a distant memory, the slightest tickle around my mouth still sends me searching for ice, more than one cube because it melts quickly on the heated area. If ice is unavailable and a reddish bump begins to raise its ugly head, very cold water smoothes the skin’s surface, and the redness pales away.

Mentioning to doctors the use of water and ice as palliatives for migraines or cold sores has gotten me a few smiles and winks suggesting insiders’ collusion. My own doctor gave a resounding “Yes!” to the ice-cube cure. But asked if doctors might want to share such useful information, she shrugged, smiled and continued hammering away in search of my missing reflexes.

 Among the better-known water cures, ice is recommended for many overheating problems, from oven burns to sun burns, as well as for swollen sprains and sore back muscles. Likewise hot-water baths or hot tubs, especially in the evening, can ease sore muscles, stress, even depression. When I recently attended a conference in Arizona, a dip each evening in the cheap highway-motel pool, heated to the high 90s, under the twinkling Tucson stars revived me enough to eat dinner, review notes and sleep peacefully.

And while a steam room also provides a soothing respite, there is nothing like a sinkful of very hot water for unclogging sinuses: Drape a large towel over your head, lean almost into the sink, hold the towel ends at the sink’s edge to make a little head tent and hover there for as long as possible. The steam penetrates, loosens and otherwise works its wonders.

Salt water — Epsom salts dissolved in a hot bath or foot tub — heals cuts and scrapes, prevents and treats infection, and soothes swelling and tired muscles. Of course, the best water therapy is in the ocean. Between the healthy salt and the chance to swim under blue skies away from pool lane lines and crowds, the ocean heals as it offers a place to think and dream in the peace and weightlessness of eternal youth.

Finally, in its form as a daily libation, water is supposed to be good for you. If drinking two eight-ounce glasses on waking seems unappetizing, however, growing disagreement about that prescription suggests that simply drinking when thirsty is healthy. And in contrast to rising each morning to a disagreeable task, the pleasure of a refreshing glass of water will benefit mental health, which must not be ignored.

— Mary Carpenter

WASHINGTON, D.C. FELT familiar and incomprehensible at the same time when I moved here in the early 1990s–even after moving often during the previous 15 years, to Boston, New York, Paris and finally Brussels. And I had grown up in nearby Delaware.

While living in one D.C. neighborhood, the others remained mysterious. Even within Northwest, I misidentified my location as Forest Hills, only to be scolded by a friend who explained that my house was in “Chevy Chase, D.C.” For entire dinner parties, “inside the Beltway” discussions were so inside-the-inside that the words sounded like a foreign language and the content was incomprehensible.

When I discovered Edward P. Jones’s “Lost in the City,” I devoured the stories for their street scenes and for the characters he placed there: Jones’s stories gave me the sense of these places that I’d been missing. Most took place in Northeast neighborhoods, which I could see on a map were not far away from me. But every city has its own psychological sense of distance: I had thought nothing of living on the Upper West Side of Manhattan and working in Brooklyn. In D.C., I was still learning that some addresses were a lifetime away from each other.

More than a decade after my move, “D.C. Noir” appeared, followed quickly by “D.C. Noir 2,” both containing stories by well-known local writers such as George Pelecanos, Ward Just, Laura Lippman and of course Edward P. Jones. Each story is identified by the D.C. location where it takes place. From George Pelecanos in the first “D.C. Noir” introduction, on D.C.:

There are easier places to live but few as interesting. Nowhere in this country is the race, class and culture divide more obvious than it is in Washington D.C. This American experiment is dissected and discussed, in-your-face style, every day…

No taxation without representation except for the citizens of the nation’s capital…bitterness on the part of Washingtonians toward the federal government…So don’t expect all the locals to get misty-eyed over monuments, inauguration balls…

Aha, I thought, armed with new insight as to why when friends or family call from afar and request the inside dope on federal Washington, I often don’t know or care about the issue. And what I care about — for example, Walmart and raising the minimum wage–is too local for outsiders.

Pelecanos on why “crime/noir” fiction:

It involves a high degree of conflict…also allows us to explore social issues and the strengths and frailties of humanity that are part of our everyday lives here.

In the first “D.C. Noir,” Pelecanos’s “The Confidential Informant” concerns a problem for D.C. police in combating crime: Witnesses in some communities change stories or disappear to protect their own. Rereading his story recently made me think about the progress made since the book’s publication in 2006. In the mid-1990s, the D.C. crime rate started to fall from the 1991 peak of 479 murders to the 2012 figure of 92, the lowest number since 1963. Although credit goes to the slowing of the crack epidemic and to gentrification, it also goes to current Police Chief Cathy Lanier, appointed in 2007 under Adrian Fenty and kept on in Vincent Gray’s administration. Local crime is of great interest to most D.C. residents.

“A.R.M. and the Woman,” which takes place in Chevy Chase, is written by Laura Lippman, considered part of the local journalism community though she lives in Baltimore. In “A.R.M.,” a woman whose marriage has ended doesn’t have enough money to remain in her house. By the time I read the story, I had encountered several women in unhappy marriages who couldn’t afford to stay in the city on their own but didn’t want to move their kids from the good D.C. schools–an issue of expensive cities. Sometimes even these nice women fantasized about “something happening” to their husband as it does in Lippman’s story.

“D.C. Noir 2: The Classics” includes a piece by Paul Laurence Dunbar written in 1900, as well as writing from Langston Hughes and Richard Wright, both the latter about African American D.C. before 1950. Another book, “River Cross My Heart” tells a story of an African American living in 1920s Georgetown. I was acquainted with the author, Breena Clarke, from my husband’s office at TIme magazine, where she also worked, so besides loving the book’s evocation of this D.C. history, I was thrilled when it was selected by the Oprah Book Club.

Because Politics and Prose is the closest store to our house offering gift possibilities, one year my older son asked a clerk there for help choosing books his mother might like and was directed to “The Beautiful Things That Heaven Bears” by Dinaw Mengestu. This movingly fascinating if sad story of the city’s immigrants pulled aside the curtain on another D.C. population unfamiliar to me.

For physical Washington, the Camel Club books by local author David Baldacci, urged on me by my younger son’s friends, introduced me to the islands of D.C. The club meets secretly on Roosevelt Island, which I then located on a map. Days later walking with a friend, we passed Sycamore Island near Cabin John, Md., accessible only by membership in a private “community organization,” in fact a club, founded in the 1880s, known to draw its membership from the CIA.

Reading these books and others began giving me the feeling I’d longed for after so many moves: a better connection to a place. Fiction even made some of inside-the-inside conversations more intriguing. Which brings me to the last and most recently published book on my list, “This Town” by Mark Leibovich. Two friends who grew up in D.C. with parents involved in journalism and politics were reading it on our recent bike trip from Pittsburgh to Cumberland, Md. While I was amused to hear about the book and about local characters through my friends’ eyes, I still have my limits. “This Town” is still one step too far inside the Beltway for me–maybe after another decade, I’ll be ready.

–Mary Carpenter

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AT A FRIEND’S BIRTHDAY DINNER in the mid-1990s, I was seated with several high-ranking government officials, who–to my surprise and possibly as a ploy to keep away from controversial topics–spent the entire meal discussing naps. For example, the napping habits of Albert Einstein, who after lunch sat with his heavy wristwatch in one hand, which  he dangled over the edge of his chair. When the watch fell, the noise woke Einstein–nap over.  All of my dinner partners talked about locking their office doors for short or sometimes longer postprandial snoozes.

In recent years, the nap has become better accepted–and better studied. According to a Pew Research Center Study, one-third of adults in the United States take naps, and more men report napping than women. And New York-based MetroNaps has installed “sleeping pods” for Google, Huffington Post and other organizations, according to a recent Wall Street Journal article. Northwestern football coach Pat Fitzgerald implemented a mandatory nap time on game days, and is now credited with more victories than any previous Northwestern football coach.

Naps can improve mood, alertness and performance as well as boost creativity, reduce stress and aid in weight loss. “A nap allows information to move from temporary storage to more permanent storage, from the hippocampus to the cortical areas of the brain,” explains Rebecca Spencer, neuroscientist at the University of Massachusetts, Amherst, and an advocate for reinstating naps in pre-schools. “You’ve heard the phrase, ‘You should sleep on it.’ Well, that’s what we’re talking about.”  As a result, the hippocampus is cleared of recent learning to make room for more. Sleeping before learning also primes the brain to absorb more.

The National Sleep Foundation recommends a nap of 20 to 30 minutes to improve short-term alertness. A NASA study found that a 40-minute nap improved pilots’ performance by 34 percent and alertness by 100 percent. And a recent study in the journal “Sleep,” comparing the benefits of naps of different lengths and no naps, found that a 10-minute nap produced the most benefit in reduced sleepiness and improved cognitive benefit without causing post-nap grogginess or interfering with nighttime sleep.

“We use naps to compensate for sleep loss, although you can’t make up for terrible nights,” said Dr. Helene Emsellem, medical director of the Center for Sleep and Wake Disorders in Chevy Chase.  “The length of a nap is very personal. For some a five-to-10-minute nap can provide improvement for the next few hours. And a nap in the 20- to 30-minute range can reset you.”

As for how different-length naps fit with sleep cycles, the Wall Street Journal article explained that 60 minutes may be better for “cognitive memory processing” because that amount of time includes “slow wave” sleep. The article described a study in which learning a task was followed by different-length naps and no nap at all; tested one week later, the 60-minute nappers performed far better on the task, while the 10-minute nappers performed as badly as those who took no nap at all. Ninety minutes is what makes up a full sleep cycle, which has been shown to bolster creativity as well as memory.

But long naps come with greater risk of grogginess–what’s called sleep inertia or “sleep drunkenness.”  Emsellem described “the edge we live on: It’s the in-between zone of 45 minutes to an hour that can make you feel poorly.” And, warning that long naps too late in the day can cause “huge problems with the sleep cycle, making it hard to go to sleep and pushing you into the land of the night owl”–she suggests the best napping hours are from 2 to 4 pm.

How best to nap?  Most experts advise finding a place with limited noise and light, and sleeping at least partially upright to reduce sleep inertia. They also suggest drinking a caffeinated drink before napping to smooth the transition back to a waking state and to avoid the post-nap inertia. In a multi-center study on the effectiveness of naps and/or caffeine, the combination of the two had the most beneficial effect.

Sleep deprivation can reduce cognitive functions and impair memory. When focused, someone who is severely sleep-deprived can deliver the same results as someone who is not; but when the brain starts to lose focus, the healthy sleeper can compensate and increase attention, while the sleep-deprived brain has more trouble righting itself. According to experts at Stanford University School of Medicine’s Sleep Center, “a tell-tale sign of being very sleep-deprived” is dreaming during a nap that lasts 20 minutes or less.

Naps are not for everyone. People who take longer naps and wake very groggy can have trouble if they must perform immediately, and sleep inertia can be worse and last longer in people who are very sleep-deprived. Also, some people have trouble sleeping anywhere other than a bed, or during the daytime. Research on people who do not nap shows that these individuals move more quickly into deeper sleep stages when compared with  experienced nappers, who are better at keeping their nap sleep light. The latter also show greater improvements in performance after napping than non-nappers.

The nap stigma still exists: Some people believe naps indicate laziness or low standards.  Dr. Emsellem noted that a “startling number” of companies with facilities for napping found that these were unused, and some have changed the nap rooms back into work rooms. “The media and public education can make napping more acceptable,” she said.  “But attitudinal changes take time.”

Nappers are in good company: In addition to Einstein, nappers have included Winston Churchill, John F. Kennedy and Thomas Edison, along with Ronald Reagan and George W. Bush.

–Mary Carpenter

photo by jehandmade, iStock

YES OR NO, that is the question: to accept your sister’s holiday invitation, to buy a hybrid, to travel to Outer Mongolia — or not? People know that their bodies play an important role in decision-making, by way of our senses, because of phrases like “imagine this” (visual), “sounds good” (auditory) and “I feel this way” (kinesthetic).  Using an age-old method —  called variously “body-centered inquiry,” “focusing” and “insight meditation” —  we can investigate our bodily sensations for advice.

When you get to the point in struggling with a problem that you think, “I’m sick of talking about this,” then it’s time to focus on your body, according to Jonathan Foust, senior teacher at the Insight Meditation Community of Washington (IMCW). “Your issues are in your tissues,” he says, only partly joking. In a day-long workshop on “Body-Centered Inquiry: Mindfulness, Focusing and the Power of Questions,” Foust teaches listening to bodies, both by yourself and with a partner. The latter is called “interpersonal meditation,” with one person speaking while the other listens in silence. Doing this with a partner is about “listening without fixing,” Foust says.

To begin, sit calmly, clear your mind, choose a dilemma and label your alternatives A and B. Then tell your body, I’m going to choose door A, and start listing the pros and cons of A.  Pay particular attention to your throat, chest and stomach. Is there tightness, pressure, nausea? Then come up with the best words to describe these feelings; if you select sick, weak or small, option A may not be the right choice.

Listening to the body can also be used to transform negative feelings: If you think the same thing over and over (for instance, “traveling makes me anxious”), that becomes a belief, then a habit, then part of your character. RAIN is the acronym for the transformative experience. For example, if you are frustrated with a parent or a child, you think: I am about to explode — that’s Recognizing and naming the problem. Next you acknowledge:  Okay, I’m angry — that’s Acceptance. The third step is Investigating your body’s responses: Are your palms sweaty, your neck hot? And what do you believe: that you are a terrible son or daughter, a terrible parent? Now you are ready for the goal: Non-identifying — that is,  defusing the problem by separating it from your feelings. You say: If I don’t believe this about myself, that I’m terrible, what do I feel? For example, now I might feel gratitude for having that parent or child.

“Awareness is liberating,” says Eugene Gendlin, PhD, at the University of Chicago and founder of The Focusing Institute. “Your body ‘knows’ the whole of each of your situations, vastly more aspects of it than you can think.” Dr. Gendlin advocates establishing a regular “focusing partnership,” as something with all the advantages of psychotherapy that “improves one’s life immensely. I would not want to do without mine.”

You can practice body-centered inquiry on your own, or use books or tapes from The Focusing Institute or IMCW. Mindfulness classes and retreats abound locally, many organized by IMCW.

– Mary Carpenter