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Summary: Computational model sheds light on the impact chronic, low-grade inflammation has on the mesolimbic dopamine system and motivational impairments.

Growing evidence shows that the brain’s dopamine system, which drives motivation, is directly affected by chronic, low-grade inflammation. A new paper proposes that this connection between dopamine, effort and the inflammatory response is an adaptive mechanism to help the body conserve energy.

Trends in Cognitive Sciences published the theoretical framework developed by scientists at Emory University. The authors also provided a computational method to experimentally test their theory.

“When your body is fighting an infection or healing a wound, your brain needs a mechanism to recalibrate your motivation to do other things so you don’t use up too much of your energy,” says corresponding author Michael Treadway, an associate professor in Emory’s Department of Psychology, who studies the relationship between motivation and mental illness. “We now have strong evidence suggesting that the immune system disrupts the dopamine system to help the brain perform this recalibration.”

The computational method will allow scientists to measure the effects of chronic inflammation on energy availability and effort-based decision-making. The method may yield insights into how chronic, low-grade inflammation contributes to motivational impairments in some cases of depression, schizophrenia and other medical disorders.

Co-author Andrew Miller, William P. Timmie Professor of Psychiatry and Behavioral Sciences in Emory’s School of Medicine and the Winship Cancer Institute, is a leader in this field and is pioneering the development of immunotherapeutic strategies for the treatment of psychiatric disorders.

“If our theory is correct, then it could have a tremendous impact on treating cases of depression and other behavioral disorders that may be driven by inflammation,” Miller says.

“It would open up opportunities for the development of therapies that target energy utilization by immune cells, which would be something completely new in our field.”

Co-author Jessica Cooper, a post-doctoral fellow in Treadway’s lab, led the development of the computational model.

It has previously been shown that inflammatory cytokines — signaling molecules used by the immune system — impact the mesolimbic dopamine system. And recent research has revealed more insights into how immune cells can shift their metabolic states differently from most other cells.

The researchers built on these findings to develop their theoretical framework.

An immune-system mechanism to help regulate the use of energy resources during times of acute stress was likely adaptive in our ancestral environments, rife with pathogens and predators. In modern environments, however, many people are less physically active and may have low-grade inflammation due to factors such as chronic stress, obesity, metabolic syndrome, aging and other factors. Under these conditions, the same mechanism to conserve energy for the immune system could become maladaptive, the authors theorize.

Studies by Miller and others have provided evidence of an association between an elevated immune system, reduced levels of dopamine and motivation, and some diagnoses of depression, schizophrenia and other mental disorders.

“We’re not proposing that inflammation causes these disorders,” Treadway says. “The idea is that a subset of people with these disorders may have a particular sensitivity to the effects of the immune system and this sensitivity could contribute to the motivational impairments they are experiencing.”

The researchers are now using their computational method to test their theory in a clinical trial on depression.

Funding: The work for the current paper was supported by the National Institute of Mental Health.ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Source:
Emory Health Sciences
Media Contacts: 
Carol Clark – Emory Health Sciences
Image Source:
The image is in the public domain.

Original Research: Closed access
“Can’t or Won’t? Immunometabolic Constraints on Dopaminergic Drive”. Michael T. Treadway, Jessica A. Cooper and Andrew H. Miller.
Trends in Cognitive Sciences. doi:10.1016/j.tics.2019.03.003

Abstract

Can’t or Won’t? Immunometabolic Constraints on Dopaminergic Drive

Converging evidence suggests that the mesolimbic dopamine (DA) system is directly affected by increases in inflammatory cytokines associated with chronic, low-grade inflammation.

The reasons for this immune–DA communication are unclear, but one novel hypothesis is that inflammatory cytokines signal immunometabolic shifts that impact the valuation of future actions as a function of available energy resources.

Future work on effort-based discounting models should incorporate variables related to inflammation and immunometabolic state.

Source: https://neurosciencenews.com/inflammation-dopamine-motivation-14159/

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Fats have gotten a bad rap over the years—but now, it seems we’re finally mending our relationship with this long misunderstood macronutrient and realizing just how necessary it is for brain health, heart health, hormonal health, and even weight loss. Of course, not all fats are created equal (bad fats can increase your risk for weight gain and chronic disease), and with high-fat diets like keto gaining popularity, it’s more important than ever to know which fats are healthy and which aren’t.

Here, learn everything you need to know about why we need fat to thrive, the best and worst types of fat for your health, and some of the best high-fat foods you can add to your diet.

Why your body absolutely needs fat.

We’ve come a long way from our fat-free SnackWell’s days—and thank goodness for that, as fats play multiple crucial roles in the body. Here, functional medicine nutritionist Megan Fahey, R.D., shares some key reasons to embrace fat:

  • Fat is necessary for satiety. Ask anyone who’s switched from a fat-free salad dressing to one made with extra-virgin olive oil and vinegar—you will feel way more full after eating the latter. “Fat is the macronutrient that triggers the brain to recognize fullness when eating,” says Fahey, “which helps regulate internal fullness cues to prevent overeating.”
  • Fat is necessary for vitamin and mineral absorption. Fat can instantly up the health cred of nearly any meal. “Four vitamins necessary for bodily functions can only be absorbed in the presence of fat: vitamins A, D, E, and K,” says Fahey. Plus, numerous antioxidants, like lycopene, are better absorbed in the presence of fat, and research has linked saturated fat to improved calcium absorption and bone health.
  • Fat keeps your brain functioning and nerves firing. “The brain is essentially a blob of fat and cholesterol, so dietary fat is important to provide your brain the building blocks it needs to function,” says Fahey, adding that fat also coats, protects, and insulates nerves, enabling them to send signals between brain and body.
  • Fat and cholesterol fuel your sex drive. Bet you didn’t know this one! Saturated fat and cholesterol are necessary to synthesize sex hormones—estrogen, progesterone, testosterone—and help maintain overall hormonal balance, Fahey says.

What makes something a “healthy fat” anyway?

There’s a lot of debate in this area, but emerging research is helping us come to a more scientifically sound conclusion, and one that’s far more nuanced than simply saying “saturated fats are bad and unsaturated fats are good.” While many benefits of unsaturated fats (which include both monounsaturated and polyunsaturated fats) have long been established, the truth is, research is now starting to vindicate saturated fat and support its consumption from quality sources—in moderation. Current dietary recommendations haven’t necessarily caught up to this research, however.

Coconut oil is about 90 percent saturated fat, and if we followed the recommendations, you would avoid it at all costs,” says registered dietitian Maya Feller, R.D., who works with patients to manage their weight- and diet-related chronic illnesses. “However, consuming moderate amounts of coconut oil gives your HDL (good cholesterol) a boost. So that information now allows us to move coconut oil out of the ‘never’ category.”

More important than whether a fat is saturated or unsaturated: the source of that fat. Experts seem to agree that the majority of your daily fat intake should come from minimally processed, high-quality plant sources while leaving room for high-quality animal sources as well. “Organic, plant-based fats provide a favorable profile of phytochemicals and nutrients, which are strongly linked with enhancing brain and heart health,” says Fahey, adding that some of her favorite high-fat foods include avocados, nuts, seeds, and olives. On the other hand, many experts believe that highly processed plant fats, such as those from low-quality vegetable, seed, and bean oils (think: soybean, corn, safflower, and canola), have a pro-inflammatory effect and are best avoided.

When it comes to high-fat animal foods, the way an animal was raised and what they were fed can drastically affect the fat profile of their meat, eggs, or milk, which you should take into consideration. “Grass-fed beef and grass-fed butter actually contain a more favorable profile of fatty acids and are appropriate to incorporate in moderation,” says Fahey.

Also, it’s generally widely accepted that you should stay far away from lab-made trans fats, which are found in a number of highly processed foods. “They increase systemic inflammation and exacerbate cardiovascular disease while increasing variability in blood glucose and the risk of poor health outcomes overall,” says Feller.

10 of the healthiest high-fat foods.

The above information is a good guide for helping you choose the right fats. But still, there are some standout high-fat foods that deserve their own shoutout. Here, some of the most nutritious fatty foods out there:

1. Fatty fish

Nutritionists, doctors, and medical associations agree: We should be eating at least two servings of fatty fish per week to reap the head-to-toe benefits of their polyunsaturated omega-3 fatty acids, DHA and EPA. These fatty acids are crucial for proper development, cardiovascular protection, and brain health. Deficiencies in omega-3 fatty acids have even been associated with increased depression and anxiety. DHA, in particular, is powerfully anti-inflammatory and has been associated not only with reduced Alzheimer’s risk but improvement of depression as well, neurologist David Perlmutter, M.D., recently told mbg.

2. Whole eggs

Once considered unhealthy due to their cholesterol content (which we’ve learned probably isn’t a big deal), eggs are back on the menu. Not only are they packed with protein, which can keep blood sugar levels stable, but they contain many of the vitamins and minerals our bodies need for good health. A few standouts: choline, which is critical for cognitive function and liver health; vitamin K2, which is protective against heart disease by preventing arterial calcification; and biotin, a nutrient well known for supporting hair, nail, and skin health. All that said, the types of eggs you choose are also very important, so consider opting for pasture-raised varieties, which tend to be higher in omega-3 fatty acids and vitamins K2, E, and A.

3. Avocado

Avocados are loaded with monounsaturated fats (MUFAs)—a type of unsaturated fat associated with improved heart (they’ve been shown to help lower LDL cholesterol) and brain health. But they’re so much more than that. They also contain over 14 minerals; loads of soluble fiber, which helps trap excess cholesterol and send it out of the system; a variety of antioxidants; plant-based omega 3s; and vitamins C, E, and K to name a few. Bonus: Studies indicate that meals that include avocado increase feelings of satiety longer than those without.

4. EVOO

Swap out processed, pro-inflammatory vegetable oil for extra-virgin olive oil, and you’ll immediately boost your health. Like avocados, EVOO is a potent source of heart- and brain-healthy MUFAs, specifically a MUFA called oleic acid. It’s also jam-packed with health-promoting polyphenols, including oleocanthal (the compound that gives good olive oil its peppery bit), which exhibits strong anti-inflammatory properties and has been shown to slow cancer cell growth in lab studies. In fact, one large research review found that women who consumed the most olive oil in their diets had a lower risk of breast cancer as well as cancers of the digestive system. It also helps hydrate and smooth skin from the inside out.Article continues below

5. Olives

We can’t mention olive oil without mentioning olives, one of Fahey’s favorite high-fat foods. Like olive oil, they contain the MUFA oleic acid along with a variety of polyphenols, which, together, reduce inflammation and promote heart and brain health. They’re also an awesome source of gut-friendly fiber, with 3.5 ounces containing about 13 percent of your recommended daily intake. Research has also shown that eating olives results in higher blood levels of glutathione, an antioxidant that’s essential to energy production.

6. Nuts (especially walnuts)

All nuts are pretty darn healthy, given their great composition of fiber, protein, and fats (mostly monounsaturated and polyunsaturated, but it varies a bit by the type of nut), and research suggests they can be a key tool in helping you lose weight. In fact, one large study looking into the effects of the Mediterranean diet found that people who were asked to add nuts to their diet lost an average of 2 inches from their waist over the course of a year. Walnuts, in particular, are often ranked the top nut for having both more healthful antioxidants, called polyphenols, and a higher antioxidant potency than other nuts. They’re also the only nut that contains a significant source of the plant-based omega-3 fatty acid alpha-linolenic acid (ALA).

7. Flax, chia, and hemp seeds

Flax, chia, and hemp seeds are also great sources of the plant-based omega-3 ALA, which helps reduce inflammation throughout the body. They also contain heart-healthy, gut-friendly fiber and a fair amount of protein and magnesium, making them worthy additions to your morning smoothie or oatmeal. Flax is a particularly great source of a type of phytochemical called lignans, which may help lower cholesterol. Pro tip: Opt for ground flaxseeds, which may be easier to digest, and consider soaking your chia seeds (try this chia pudding) to boost your absorption of these beneficial nutrients.Article continues below

8. Dark chocolate

Looking for a nutrient-packed sweet fix that’s not fruit? Nothing really tops dark chocolate, which contains mostly monounsaturated and saturated fats, and is brimming with flavanol antioxidants that may help lower blood pressure and improve brain function—provided you opt for the right kind. Dark chocolate that’s at least 70 to 80% cacao is your best bet (several of these healthy chocolate bars make the cut). Dark chocolate is also a surprising source of stress-busting, sleep-enhancing magnesium, with an ounce containing about 16 percent of your recommended daily intake.

9. Coconut and MCT oil

Coconut oil is largely composed of saturated fat, but, as mentioned above, it’s actually been shown to have a somewhat positive effect on cholesterol. And many experts suspect that consuming coconut oil in the context of a healthy diet is key to this benefit. According to Robin Berzin, M.D., high saturated-fat consumption in a diet that is otherwise void of adequate fiber and leafy greens, and too high in sugar and refined carbohydrates increases bad cholesterol, while high fat consumption from clean sources of unsaturated fats (like olive oil) and saturated fat (organic coconut oil) in a diet high in veggies and fiber, and mainly free of refined carbs, can actually improve cholesterol composition.

Now that we have that out of the way, what’s so great about coconut oil? Coconut oil is composed largely of medium-chain triglycerides (or MCTs)—the fats that are often credited for many of coconut oil’s health benefits. Coconut oil is used to make MCT oil, which, you guessed it, contains an even higher concentration of MCTs.

MCTs may be a useful tool if you’re on the ketogenic diet, as they go straight to the liver, where they may be turned into ketones (the fuel your body runs on while in ketosis), and they’ve even been associated with improved memory in at least one pilot study.

10. Parmesan cheese

Sure, you may not think of cheese as a health food, but real Parmesan (think the kind you find in a block, not a shaker) packs a special punch, containing mostly saturated and monounsaturated fats. Parmesan is high in calcium, containing about 31% of your recommended daily intake in 1 ounce, along with a decent amount of vitamin B12. But, unlike many other forms of dairy, it’s very low in lactose and can often be tolerated by people with lactose intolerance. It also packs a big protein punch, with 11 grams per ounce. Fun fact: Those crunchy crystals you bite through in quality Parmesan are actually tiny bits of an amino acid called tyrosine, which plays a role in the production of the neurotransmittersdopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline)—and thus helps regulate mood and emotional response.

Source: https://www.mindbodygreen.com/articles/best-healthy-fats-and-high-fat-foods?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190608&otm_click_id=6d224451329ae992919c39948f7772b2&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

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The ultimate limit of human endurance has been worked out by scientists analysing a 3,000 mile run, the Tour de France and other elite events.

They showed the cap was 2.5 times the body’s resting metabolic rate, or 4,000 calories a day for an average person.

Anything higher than that was not sustainable in the long term.

The research, by Duke University, also showed pregnant women were endurance specialists, living at nearly the limit of what the human body can cope with.

The study started with the Race Across the USA in which athletes ran 3,080 miles from California to Washington DC in 140 days.

Competitors were running six marathons a week for months, and scientists were investigating the effect on their bodies.

Man in tent
Image captionA Race Across the USA runner has his resting energy expenditure measured

Resting metabolic rate – the calories the body burns through when it is relaxing – was recorded before and during the race.

And calories burned in the extreme endurance event were recorded.

The study, in Science Advances, showed energy use started off high but eventually levelled off at 2.5 times the resting metabolic rate.

The study found a pattern between the length of a sporting event and energy expenditure – the longer the event, the harder it is to burn through the calories.

So people can go far beyond their base metabolic rate while doing a short bout of exercise, it becomes unsustainable in the long term.

The study also shows that while running a marathon may be beyond many, it is nowhere near the limit of human endurance.

  • Marathon (just the one) runners used 15.6 times their resting metabolic rate
  • Cyclists during the 23 days of the Tour de France used 4.9 times their resting metabolic rate
  • A 95-day Antarctic trekker used 3.5 times the resting metabolic rate

“You can do really intense stuff for a couple of days, but if you want to last longer then you have to dial it back,” Dr Herman Pontzer, from Duke University, told BBC News.

He added: “Every data point, for every event, is all mapped onto this beautifully crisp barrier of human endurance.

“Nobody we know of has ever pushed through it.”

During pregnancy, women’s energy use peaks at 2.2 times their resting metabolic rate, the study showed.

Runners in the Race Across the USA
Image captionRunners on the 3,080 mile Race Across the USA in 2015.

The researchers argue the 2.5 figure may be down to the human digestive system, rather than anything to do with the heart, lungs or muscles.

They found the body cannot digest, absorb and process enough calories and nutrients to sustain a higher level of energy use.

The body can use up its own resources burning through fat or muscle mass – which can be recovered afterwards – in shorter events.

But in extreme events – at the limits of human exhaustion – the body has to balance its energy use, the researchers argue.

Dr Pontzer said the findings could eventually help athletes.

“In the Tour de France, knowing where your ceiling is allows you to pace yourself smartly.

“Secondly, we’re talking about endurance over days and weeks and months, so it is most applicable to training regimens and thinking whether they fit with the long-term metabolic limits of the body.”

Source: https://www.bbc.com/news/health-48527798

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There are lots of dubious claims and mysterious ingredients, but yes, by trapping water, moisturizing can help with dry skin.

Dry skin by itself isn’t a medical worry, although serious cases can result in cracks and fissures that invite infection and inflammation. The real issue is discomfort — dry skin can be sore, tender to the touch, and often itchy (although not all itchy skin is dry). There’s also the red, rough, scaly appearance lamented in many advertisements for moisturizers.

This is one problem that hasn’t suffered from lack of attention: there are dozens of creams and lotions for dry skin. They are sold as moisturizers, which is more of a marketing term than a medical or scientific one. Indeed, routine skin care is a realm where there’s little science to be found. Well-controlled studies of ingredients are few and far between. Companies keep information about ingredients proprietary and are careful to limit claims for what the products do to stay within FDA rules.

But sales people learned ages ago that science sells, so labels and ads often use scientific terms. Moisturizers are often billed as hypoallergenic or “allergy tested” — even though there’s no government standard for making such a claim, so any product can do so. Some products brag about being noncomedogenic — an impressive word that means they won’t cause pimples — but that’s not saying much: almost all moisturizers on the market today use ingredients that are noncomedogenic. Lists of vitamins are supposed to get us thinking that moisturizers can nourish skin or stoke it full of antioxidants. Yet in most cases vitamins in moisturizers probably don’t make much difference, either because the amounts used are too small to have much effect, or because the vitamins degrade with exposure to light and oxygen.

The fact is that despite the long lists of obscure ingredients and the pseudoscientific hokum, all moisturizers help with dry skin for a pretty simple reason: they supply a little bit of water to the skin and contain a greasy substance that holds it in. In fact, if greasiness weren’t a problem, we might all go back to using the solution for dry skin that our grandparents used: 100% white petrolatum, which most of us know as Vaseline. One reason for the proliferation of moisturizers is the continuing search for a mix of ingredients that holds in water like petrolatum but feels nicer on the skin. Many products also contain humectants (pronounced hue-MEK-tants), ingredients that sponge up and retain water.

The good news is that despite all the unknowns and salesmanship, you really can’t go very wrong with what moisturizer you choose. Almost all the moisturizers on the market will help with dry skin, and in most cases, the choice comes down to subjective experience — and simply whether you like the feel and smell (nothing wrong with that — it’s your skin, after all). You want to choose one you like and use it regularly.

6 tips for those with dry skin
Turn down the thermostat. Hot air tends to be drier than cooler air.
Use a humidifier. Humidifiers can help. The problem is that moisture may be soaked up in walls and furniture or disperse rapidly, depending on how airtight your home is.
Take warm, not hot, baths and showers. Hot water whisks away the fatty substances in the skin that help it retain water. Some doctors recommend bath oils. You can also use bath oil as a post-bath moisturizer by rubbing yourself down with a teaspoon of it diluted in a couple cups of warm water.
Use a mild soap. Dove is a familiar brand. Cleansers like Cetaphil are an alternative to soap.
Wear loose clothing. Clothing that binds and rubs can dry out skin.
Stay protected. Cold, windy air is very drying, so bundle up and wear warm mittens or gloves to protect your hands.

Dead cells on top

Take a look at the drawings below, and you’ll see that our skin is organized in layers. The outermost one is called the stratum corneum, which consists of cells called corneocytes and various lipids — fats — between them. The corneocytes are often compared to bricks and the intercellular lipids to mortar, an appropriate metaphor for a layer of skin that serves as a barrier, but the stratum corneum looks more to us like phyllo, the thin sheets of dough used to make baklava.

The corneocytes are dead cells without nuclei, but they aren’t just deadwood. They contain various substances that hold water. For our skin to feel smooth and supple the stratum corneum has to be at least 10% water; ideally, it’s 20% to 30%. The stratum corneum can absorb as much as five to six times its own weight and increase its volume threefold when soaked in water. But it’s not simply the water content that matters. It’s the effect that water has on the enzymes that control orderly shedding of corneocytes, a process dermatologists call desquamation. Without water, the corneocytes accumulate, so skin becomes flaky instead of peeling off nicely, and the stratum corneum gets disorganized and full of cracks instead of being tightly packed.

Because moisturizers contain oil, it’s a common misconception that they are replacing lost oil. But most young children have wonderfully smooth skin, and the sebaceous glands in the skin don’t start producing oily sebum until puberty. Dry skin is about lack of water, not oil.

Moisturizer ingredients
OcclusivesOcclusives hold water in after it has been supplied either by the moisturizer or a soak in water.
HumectantsHumectants sponge up water, drawing it up from the dermis and, to a limited extent, in humid conditions, from the air.
EmollientsEmollients fill in rough spots and make skin feel smooth but don’t affect the water content.

Ingredients in moisturizers

Water. Most moisturizers are oil-in-water emulsions, so by definition that makes them creams and lotions. Look at the ingredient list, and you’ll see that water is often the first one. Some of the water evaporates when you apply the moisturizer, but some also soaks in. While the stratum corneum absorbs water nicely, it doesn’t bind it very well, so some oily substance is needed to hold it in. Applying an oily substance to the skin without also resupplying it with water — either from the moisturizer or from another outside source like a bath — is ineffective: you’d just end up with greasy skin that is still dry and cracked. In fact, the optimum way to soften skin is to soak it thoroughly first in water and then cover it with something like Vaseline. But that’s time-consuming and messy so unless your skin is extremely dry, using a moisturizer that contains water is much easier and more practical.

Occlusives. Petrolatum and the other oily substances in moisturizers are sometimes referred to as occlusives because they block the evaporation of water. Despite all the elaborate variations in moisturizers, petrolatum is still a mainstay and is often named third or fourth in the ingredient list. Many fatty or waxy substances can serve as occlusives. The commonly used ones include cetyl alcohol (a fatty alcohol), lanolin, lecithin, mineral oil, paraffin, and stearic acid. Dimethicone and cyclomethicone are silicones that function as occlusives. When products say they are oil-free, that usually means they don’t contain mineral or vegetable oil and depend on dimethicone as an occlusive instead. The Aveeno products tout their “natural” oatmeal content, but in some varieties, the only active ingredient listed is dimethicone. The effectiveness of the occlusives varies. Petrolatum is the best at holding in water, followed by lanolin, mineral oil, and the silicones.

Humectants. Theoretically, humectants pull water into the stratum corneum both from the air and from deeper layers of the skin. However, when the humidity is low, there’s so little water in the air that almost all of the water comes from the inside out. Some of the commonly used humectants include glycerin, honey, panthenol (or vitamin B5, an example of a vitamin being used for its physical, not nutritional, properties), sorbitol (which we are used to seeing as an artificial sweetener), and urea. Humectants can potentially make skin even drier by pulling water into a damaged, arid stratum corneum that doesn’t hold moisturizer. So, as a practical matter, they are almost always used with occlusive ingredients that trap the moisture the humectants draw into the stratum corneum.

Emollients. Emollients aren’t in moisturizers to moisturize, but rather to make the skin feel smooth. Many ingredients that serve as occlusives — dimethicone is a good example — and humectants do double duty as emollients. Because of rubbing alcohol (isopropyl alcohol), we tend to think of alcohols as drying — and out of place in moisturizers. But some alcohols (octyldodecanol, for example) are excellent emollients.

Vitamins. Topical retinoic acid — a form of vitamin A — reduces fine lines and wrinkles in the skin by stimulating the production of collagen and is the main ingredient in prescription antiwrinkle creams. But the vitamin A used in some moisturizers is retinyl palmitate, which has the virtue of being a very stable molecule but isn’t nearly as biologically active as retinoic acid. It’s unlikely that retinyl palmitate in the amounts found in moisturizers has much, if any, effect on collagen and wrinkles. If retinyl palmitate has a benefit, it may be as a humectant.

Vitamin C, usually under the name ascorbic acid, and vitamin E, usually as tocopheryl acetate, are added because of their antioxidant properties. Studies of topical vitamin C have shown some effects, but in high concentrations. Doubts linger about its usefulness in moisturizers because light and oxygen inactivate the vitamin C. Vitamin E as tocopheryl acetate is biologically inactive and probably functions mainly as a preservative.

Menthol. Moisturizers that bill themselves as itch remedies like Sarna often contain menthol. Although menthol doesn’t attack the underlying problem, the familiar cooling sensation does seem to cancel out the itching sensation.

Lactic acid. Skin over the heel can get especially thick, leathery, and dry. Try using a pumice stone or callus file to get rid of the outer layers of skin and then using a moisturizer like AmLactin to soften it up. AmLactin, an over-the-counter lotion, is 12% lactic acid, a heavy-duty humectant that can also loosen up adhesions so heel skin becomes more flexible and less likely to crack. Sometimes products containing lactic acid sting.

Source: https://www.health.harvard.edu/newsletter_article/moisturizers-do-they-work?utm_source=delivra&utm_medium=email&utm_campaign=WR20190607-Skin&utm_id=1382726&dlv-ga-memberid=74610385&mid=74610385&ml=1382726

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PFAS are resistant to breakdown—and have been linked to a slew of health problems.

  • The Food and Drug Administration has confirmed that “forever chemicals,” officially known as PFAS, have infiltrated our food supply.
  • PFAS are very resistant to breakdown in people and in the environment, and have been linked to a slew of health problems.
  • A toxicology expert explains what PFAS chemicals are, why they may be dangerous, and how to potentially avoid them.

The idea of any kind of chemical making its way into your meal is freaky, but the Food and Drug Administration (FDA) has just confirmed that a particularly persistent class of chemicals has infiltrated our food supply. They’re called PFAS (short for perfluoroalky and polyfluoroalkyl substances), and they’re known as “forever chemicals” because they’re tough to break down in both the environment and your body.

The FDA recently investigated PFAS and presented the findings at the 29th annual European meeting of the Society of Environmental Toxicology and Chemistry in Helsinki in late May. The Environmental Working Group shared photos of the FDA’s presentation online, and the agency later confirmed that they were correct.

For its research, the FDA tested a dairy farm near a US Air Force Base where firefighting foams containing PFAS have been used. The agency found that local water samples tested for PFAS levels at 35 times greater than the current Environmental Protection Agency health advisory of 70 parts per trillion.

The researchers tested 13 samples from the farm, including animal feed and milk samples, and found that all had detectable levels of PFAS. While the milk was discarded, the FDA pointed out that the cows would still have PFAS in their bodies for 1.5 years after eating and drinking contaminated food and water for 30 days. The FDA also tested produce samples from farms close to a PFAS manufacturing plant and found that, of 20 samples tested, 15 had detectable levels of PFAS.

What’s more, common items like grocery store meat and seafood—and even off-the-shelf chocolate cake—also contained worrisome levels of PSAS, the Associated Press reports.ADVERTISEMENT – CONTINUE READING BELOW

The FDA is actually planning to present the findings on their website later this week, but they gave CNN advance copy of the text. “Due to potential health concerns related to these chemicals, the FDA is working to better understand the potential dietary exposure to PFAS” it will read, per CNN.

PFAS sound pretty bad, but it’s understandable that you might not be 100 percent well versed in them and what they do. Here’s what you need to know about these “forever chemicals” and how they affect your body.


What are PFAS, exactly?

PFAS are largely used for their ability to repel oil and water. They’re often found in non-stick products, stains, paints, cleaning products, food packages, and firefighting foams.

PFAS “contain very strong chemical bonds, and are very resistant to breakdown in people and in the environment,” says Jamie Alan, PhD, an assistant professor of pharmacology and toxicology at Michigan State University. Unfortunately, PFAS “can easily get into the air, food, soil, and water,” Alan says.


Why are PFAS potentially dangerous?

Once you’re exposed to PFAS, they can accumulate in your body. “They aren’t easily broken down,” Alan says. “Once in the body, they settle in the liver, kidney, and blood.”

PFAS have been linked to a slew of diseases like obesity, hormone suppression and infertility, liver and thyroid disease, and cancer, as well as increased cholesterol, Alan says.

However, research that has linked PFAS with these health issues is only correlative, meaning experts can’t prove that PFAS actually caused these diseases—just that people with these diseases are also more likely to have had PFAS exposure. “We are just beginning to understand the ramifications of these compounds,” Alan says.


How can you avoid PFAS?

It’s actually pretty hard. One study from the Centers for Disease Control and Prevention(CDC) found that PFAS chemicals are detected in the blood of 98 percent of the American population. “These chemicals are everywhere,” Alan says.

However, there are some steps you can take to at least lower your exposure. Contaminated drinking water is a big source of PFAS exposure, so Alan recommends using a water filter when you can.

“Other places you can find these chemicals include fast food containers, microwave popcorn bags, pizza boxes, and candy wrappers,” she says. “Avoiding these products would be another way to avoid the chemicals.” Alan also recommends carefully inspecting labels on things like cookware, cleaning products, and personal care items. Finally, she recommends taking a pass on non-stick pans and opting for things like cast iron pans instead.

Again, it’s hard to say for sure what kind of impact PFAS can have on your body—but it doesn’t look positive.

Source: https://www.prevention.com/health/a27720891/what-are-pfas-chemicals-food-supply-fda/

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It probably doesn’t surprise you to hear this, but sleep is very, very important. Besides being the powerhouse miracle fuel behind everything we do, sleep keeps our hormones balancedrhythms in sync, and our egos sane. And now, according to new research, we have reason to believe that sleep influences our sex lives (or at least, teenagers’ sex lives). Go figure.

A new study from the American Psychological Association found that lack of sleep can increase the likelihood of teens engaging in risky sexual behaviors. These unsafe sexual behaviors included not using condoms and having sex under the influence of alcohol or drugs.

In other words, not getting enough sleep compromises our judgment, and that extends to our sex lives—and it just so happens that teenagers are one age group that consistently doesn’t sleep enough.

Teens by and large are not getting the recommended eight to 10 hours of sleep a night, due to a number of reasons, including biological changes in circadian rhythms, early school start times, balancing school and extracurricular activities, and peer social pressures,” says Wendy M. Troxel, lead author of the study. “Insufficient sleep may increase the risk for sexual risk-taking by compromising decision-making and influencing impulsivity.”

Troxel and her team analyzed data from “a large, long-term study of 1,850 racially and ethnically diverse adolescents and young adults in Southern California.” The average participant age was 16 years old when the study began and 19 years old when it ended—data was collected four times between 2013 and 2017.

Participants reported their sleep schedules and noted whether or not they had difficulty sleeping in the weeks prior to taking the survey. They were also required to report whether they used alcoholmarijuana, or other substances immediately before or during sex, and whether they used protection.

The results were eye-opening: Teens who consistently didn’t get enough sleep were nearly two times as likely to have unsafe sex than those who slept more (specifically those who caught up on sleep during the weekend).

“Teens who were short weekday and short weekend sleepers were not getting adequate sleep during the school week and were not catching up on sleep on the weekends, and thus were chronically sleep-deprived,” Troxel added.

Troxel emphasizes the unsettling results of the study and warns of the consequences of risky sexual behavior—including serious health concerns, like increased risk of sexually transmitted infections like HIV.

While acknowledging that most U.S. teens must adhere to early school start times, she urges parents, teachers, clinicians, and policymakers to prioritize sleep and put an end to chronic sleep deprivation in teens.

“Our recommendation is for parents and teens to find a middle ground, which allows for some weekend catch-up sleep, while maintaining some level of consistency in sleep-wake patterns,” she said. “We also need to encourage school districts to consider delaying school start times because this could make a substantial difference in helping teens get adequate sleep.”

If you, too, have trouble sleeping, try changing up your sleep environmentexercising with sleep in mind, or ditching your technology. It could be the difference between a good and bad sexual decision.

Source: https://www.mindbodygreen.com/articles/sleep-deprivation-can-lead-to-risky-sexual-behavior-study-says?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190604&otm_click_id=85d16aba50d23d527fe58f1d5cdbe03c&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

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And would a jar of liquid soap be a better bet than bar soap?

Q. Are there any health risks to using a communal bar of soap in, say, a health club?

A. No. Bar soap does not appear to transmit disease.

The most rigorous study of this question was published in 1965. Scientists conducted a series of experiments in which they intentionally contaminated their hands with about five billion bacteria. The bacteria were disease-causing strains, such as Staph and E. coli.

The scientists then washed their hands with a bar of soap and had a second person wash with the same bar of soap. They found that bacteria were not transferred to the second user and concluded: “The level of bacteria that may occur on bar soap, even under extreme usage conditions (heavy usage, poorly designed non-drainable soap dishes, etc.) does not constitute a health hazard.”

In 1988, scientists employed by a soap manufacturer confirmed these findings. They inoculated bars of soap with pathogenic bacteria, in this case E. coli and Pseudomonas, and had 16 subjects wash their hands with the inoculated bars. After washing, none of the subjects had detectable levels of bacteria on their hands. They concluded that “little hazard exists in routine hand washing with previously used soap bars.”

Occasional studies since then have documented the presence of environmental bacteria on bar soap, but none have shown bar soap to be a source of infection. On the contrary, recent studies continue to demonstrate the ability of simple bar soap to combat infection, even during outbreaks of serious infections like Ebola virus.

But would a jar of liquid soap be a better bet than bar soap? Scientists with conflicting proprietary interests jousted about the putative benefits of bar soap versus liquid soap beginning in the 1980s. Much of the contention revolved around the numbers of bacteria found on the surfaces of the bar or bottle of soap. But the key question remains not whether environmental bacteria are present but whether they pose a risk of infection.

The Centers for Disease Control and Prevention recommends hand washing as the primary defense against infection and gives the same endorsement to bar soap as it does to liquid soap. Therefore, the only mistake one could make would be to fail to wash one’s hands because of an unfounded fear of contamination.

Source: https://www.nytimes.com/2018/06/22/well/can-a-bar-of-soap-transmit-infection.html

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A rheumatologist explains how a variety of genetic, hormonal, and environmental factors may cause lupus.

It’s difficult to believe that a disease can affect any part of your body and still be mostly hidden to the naked eye. But that’s the reality for the nearly 1.5 million Americans who live with some form of lupus.

Lupus is an autoimmune disease, meaning a person’s immune system starts to attack healthy cells and tissues. Nearly 70 percent of all causes of lupus are classified as systemic lupus, affecting a major organ or tissue, like the heart, lungs, kidneys, or brain, according to the Lupus Foundation of America.

“The immune system is unable to recognize what is part of the body and what is not,” explains rheumatologist George Stojan, MD, an assistant professor of medicine at Johns Hopkins University School of Medicine and co-director of the Hopkins Lupus Center.

Lupus presents a wide variety of symptoms that range from benign to life-threatening, including joint stiffness and swelling, facial rashes (most notably a butterfly-shaped rash across the cheeks and nose), mouth sores, seizures, chest pain due to fluid around the heart or lungs, fevers, swollen glands, and low blood counts, says Dr. Stojan. The buildup of these symptoms can take their toll: 65 percent of lupus patients say chronic pain is the most difficult thing about living with the disease.

But the most mysterious thing about lupus? There are no known concrete causes or cures. “There’s this entire range of things that have been associated with lupus, but association alone doesn’t mean causation,” says Dr. Stojan.

Researchers have linked genetics, hormones, and environmental changes to the development of lupus, but it’s difficult to say which factor plays the biggest role. “It’s probably a perfect storm that occurs and leads to the occurrence of the disease,” says Dr. Stojan.

So, what exactly do we know about the triggers of the autoimmune condition? Here, the possible causes of lupus that researchers are digging into—and what treatment looks like once someone is diagnosed.Genetics

genetics causes lupus

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Lupus tends to cluster in families. In fact, a person has a 20 times higher risk of developing lupus if they have a sibling with the disease. A handful of gene variations have been linked to the development of lupus, and most are thought to be involved in immune system function, according to the U.S. National Library of Medicine.

Certain gene mutations have also presented a link, such as TREX1, but they’re quite rare and not all patients have them, says Dr. Stojan. “It’s thought that there is this combination of susceptibility genes and an absence of protective genes that allow the development of the disease in people who have certain environmental exposures or certain infectious agent exposures,” he adds.Race

race causes lupus

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Lupus disproportionately impacts certain ethnic groups. In fact, the disease is two to three times more prevalent in women of color, including African Americans, Hispanics and Latinos, Asians, Native Americans, Pacific Islanders, and more. One 2014 study determined that the prevalence of lupus reached 1 in 537 black women.

Studies have also shown that women of color develop lupus earlier, suffer from more serious complications, and experience higher mortality rates. Why? Genetics, once again, could increase the risk here, but other factors, like healthcare coverage and access, language barriers, and income levels could also play a role, researchers speculate.Hormones

hormones cause lupus

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Women in general are much more likely to have lupus than men, says Dr. Stojan. Nineout of 10 people diagnosed with it are women between 15 and 44 years old. One big reason for the discrepancy? Hormones like estrogen and prolactin, which are much higher in women, may throw a certain inflammatory pathway (known as type 1 interferon) off balance, says Dr. Stojan, driving lupus in the process.

Landmark research also found that “women who were treated with estrogen-containing regimens, like oral contraceptives or hormonal replacement therapy, had a significantly increased risk of developing lupus.” Estrogen also releases interleukin-1, a group of inflammatory responses that have been linked to lupus flares, he says.ADVERTISEMENT – CONTINUE READING BELOW

Ultraviolet light

uv light triggers lupus

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Ultraviolet light can damage any person’s cells, but people with lupus are much sensitive to it. It has not been identified as a direct cause of the disease, but UV light can modify skin cells in a way that is recognized as a threat by the immune system in people with lupus, activating or worsening symptoms, says Dr. Stojan.

“The ultraviolet light can both induce mutations in certain genes that then become unrecognized by the immune system and become targets, leading to lupus rashes,” he explains. “But it also can directly stimulate keratin inside the cells of the skin to create more inflammatory mediators.”Toxic exposures

toxins cause lupus

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“We know that silica dust that’s present in some cleaning powders and cigarette smoke can increase the risk of developing lupus,” says Dr. Stojan, but researchers aren’t entirely sure why.

However, the connection is strong and well-studied: People who are exposed to silica at work (say, in mining or glass production) have a two to five times higher risk of lupus. Researchers have also linked mercury, pesticides, and smoking tobacco to the development of lupus.Infections

infections cause lupus

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Various viral infections have been linked to lupus flares, including human parvovirus, herpes simplex virus, and hepatitis A. Epstein-Barr, the virus that causes mononucleosis, has been studied closely in particular, and scientists believe that antibodies produced post-exposure may cause an unusual immune system response. However, Dr. Stojan emphasizes that exposure to Epstein-Barr does not guarantee the development of lupus.

“After age 20, approximately 90 percent of Americans are exposed to Epstein-Barr, so it’s almost impossible to say whether that exposure in any way affected someone’s risk, simply because everybody gets exposed,” he explains. “It’s certainly possible but having these antibodies alone doesn’t mean somebody will develop lupus in the future.”ADVERTISEMENT – CONTINUE READING BELOW

Atmospheric changes

atmosphere triggers lupus

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Changes in pollution, wind patterns, barometric pressure, humidity, and temperature are strongly associated with specific forms of organ flares in lupus, preliminary research by Dr. Stojan has found. However, not one variable is associated with all flares, he explains. For example, fine particulate matter pollution has been linked to lung flares, and temperature changes may impact neurologic flares and rashes, while humidity is associated with joint flares. “You can technically predict it based on these changes in atmospheric factors 10 days prior to the time the patient shows up for their clinic visit,” he says.Stress

stress causes lupus

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“I’m not aware of any human epidemiological model that showed how stress affects lupus, but I can tell you that every patient does say that it affects them,” says Dr. Stojan. Anecdotally, lupus patients say that emotional stress (say, a death in the family or divorce) as well as physical stress like surgery or injury may trigger lupus symptoms.How is lupus treated?

Once you’ve been diagnosed with lupus, your treatment will largely depend on the severity of the disease, says Dr. Stojan. If you have mild to moderate symptoms, your doctor will likely start you on antimalarial drugs, like hydroxychloroquine, to reduce pain, skin rashes, and other symptoms in an effort to protect organs and prevent damage to the body.

These medications have been shown to prevent flares by 50 percent and ultimately help patients live longer, says Dr. Stojan. “It’s something that we keep all lupus patients on as long as they can tolerate it,” he adds.

Another option is corticosteroids, which are typically administered to help patients work through a flare, since the drug works quickly. However, doctors generally try to avoid them in the long-run to avoid potential side effects, says Dr. Stojan.

In general, lupus can be tricky to treat because there is no established cure, but working closely with your doctor to create a plan can help you reach the ultimate goal of remission, says Dr. Stojan.

Source: https://www.prevention.com/health/health-conditions/g27667193/lupus-causes-triggers/

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More and more research points to a serious mistake we made in how biomechanics works.

  • A new study from Helsinki found that the more you cushion your feet, the more likely you’ll get injured.
  • This follows previous studies showing that cushioned shoes leave you more susceptible to pain and injury.
  • A few million years of evolutionary design has been usurped by shoe marketing campaigns. 

A lot happened to our feet in the transition from being quadrupeds to exclusively bipedal. While the upright organization of our limbs and organs resulted in many benefits in our communication skills and ability to breathe, for example, it greatly decreased the strength and flexibility of our feet, which once needed bendable toes that could grasp tree branches and a healthy dose of keratin, the protein that forms calluses, which protected us from sharp objects on the ground.

For most of the millions of years we’ve been evolving we didn’t wear shoes; during the 45,000 years we’ve been wearing some form of footwear they’ve been minimal. More aesthetically complex (and biomechanically questionable) fashion-forward shoes and sandals are a few thousand years old, though finding a society that championed elaborate footwear took time. The decision to confine our feet in tighter spaces higher up off the ground was one of status, not anatomy—only”savages” didn’t properly protect and adorn their feet.

It’s been a decade since the (slightly) controversial Born to Run was published, and so it’s been a decade that the minimalist versus cushioned shoe debate has been raging. (The argument for both has existed far longer, but that book brought it to the forefront of the growing running community’s consciousness.) When Vibram was sued for making false health claims, cushioned shoes advocates rejoiced, even if the lawsuit focused on to inflated claims, not the utility of going “barefoot.”

Besides, citizens of economically-advanced societies are not going to go full barefoot. While our feet would likely grow calluses as they (painfully) became accustomed to hard surfaces, what really matters to runners is impact peak. When walking, this force is equal to your body’s weight, but when running that forces triples in weight. Despite constant debate about best running form, some people naturally heel strike, which is easier on your calf muscles and Achilles tendon and allows you to lengthen your stride more easily. When walking, we mostly heel strike first.

But as Christopher McDougall wrote in Born to Run, running is more like jumping than walking. Right now if you jump while barefoot, you’re going to land on your forefeet. Cushioned shoes won’t allow you to forefoot strike naturally; they also cushion the impact peak so that you don’t feel the weight of each strike. While running shoe companies have marketed this as a bonus, Daniel Lieberman points out the downsides:

Runners who generate higher, more rapid impact peaks are significantly more likely to accumulate repetitive stress injuries in their feet, shins, knees, and lower back.

Research he conducted on the Harvard cross country team discovered that heel strikers were twice as likely to be injured than forefoot strikers. Minimalist footwear decreases the likelihood you’ll heel strike, thus decreasing the risk of injury.

Now a new study published in Scientific Reports backs this up—sort of. The Helsinki-based team points out that while seemingly advanced technologies in cushioned shoes keep appearing, rates of injuries do not. Their study notes what Lieberman discovered years ago: the more you pad your feet, the more intense the impact peak, thus the higher the injury rate:

We found that highly cushioned maximalist shoes alter spring-like running mechanics and amplify rather than attenuate impact loading… We attribute the greater impact loading with the maximalist shoes to stiffer leg during landing compared to that of running with the conventional shoes. These discoveries may explain why shoes with more cushioning do not protect against impact-related running injuries.

This small study of twelve men (average age: 27) compared conventional-cushioned shoes with maximally-cushioned shoes, so it’s impossible to use it in making an argument for minimalism. That said, if you consider that impact peak will be reduced with less cushioning, we can extrapolate to confirm what Lieberman (and others) have advocated: the more you swaddle your feet in what biomechanist Katy Bowman calls “foot coffins,” the more likely you’re going to injure yourself.

Feet are amazingly complex structures. We often forget that—until they hurt, which happens more often in modern societies. Each foot has 26 bones and 33 joints that connect over 100 muscles, ligaments, and tendons. Everything we do depends on the health of our feet, yet every day most people slide them into small, padded spaces with little room for movement, and we haven’t even touched the ankle joint yet. But Bowman does:

The ideal footwear is “none” for any human. A shoe will weaken the function of the musculature within the foot (intrinsic) by limiting the motion to the ankle.

Arch support atrophies the muscles up the chain dependent on strong arches; lack of ankle flexility has system-wide effects. Instead of strengthening those muscles, most responses to problems like plantar fasciitis—a condition I see often in my role as fitness instructor—are to continually baby the feet. Fascia needs lubrication to work effectively. Further padding the feet in an attempt to reduce inflammation is the exact opposite path to successful healing, but by the time you’ve acquired this particular ailment, the harder it’s going to be to move without pain, creating a tragic feedback loop that severely restricts movement.

What seems like progress is often regressive, especially when we choose aesthetics over form. Squatting, for example, is the means by which our bodies were designed to defecate. Toilets were a societal advancement that was (and still is in many countries) indicative of class, yet the ninety-degree angle of that seated arrangement does more harm than good to our ability to “go.”

So it is with cushioned shoes. Given the bacterial playground that is the ground, going completely barefoot is not in our best interests. But common sense is. Millions of years of evolving design do not surrender their anatomical wisdom without severe consequences.

Source: https://bigthink.com/surprising-science/is-minimalist-footwear-better-for-you?rebelltitem=3#rebelltitem3

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Defuse the stress and get more out of your doctor’s appointment with these simple tips.

Going to the doctor is more than just stressful, it can be downright awful. Not only do you almost always have to wait forever to get an appointment, but doctors also tend to be overbooked and rushed.

“Developing a good relationship with your doctor is so important, but it can be tough to do,” says Jenni Prokopy, who is in and out of doctors’ offices often and blogs about living with fibromyalgia at ChronicBabe.com. “Physicians’ practices just seem to get busier, which means doctors—and the people who work for them—can be less available and accommodating.”

Even so, there are some things you can do to forge a better connection with your practitioner and make the experience less stressful and more productive, Prokopy adds.

Here are simple tips and strategies that can help you do just that, according to folks living with chronic health conditions that require regular doctors visits.

Prepare questions you want to ask in advance

It may seem unnecessary, but Prokopy says reviewing what she wants to discuss with her doctor can really help her stay on track once she’s in the exam room. She’ll either go over her talking points with her husband or a friend or just simply state them out loud to herself while she drives to her doctor’s office. “Doctors are always short on time, so I rehearse what I need to say to make sure I’m as concise as possible,” Prokopy says. “Practicing what I want to say also helps me pick out the most pertinent points.” 

Mary Leah Caillier Coco, who was diagnosed with a life-threatening heart condition at age 30 (and blogs about her condition on Geaux Red), follows a similar strategy. She says she’ll often run what she wants to ask her doctor by a friend with a similar health issue. “Oftentimes, that friend can answer some of my simpler questions so I don’t waste time on those, and she’ll also give me advice on other points to bring up with my doctor,” Coco says.

Do just the right amount of research

Natasha Tracy, who writes about her bipolar disorder on her blog Bipolar Burble, likes to do a little bit of research about her symptoms on trusted sites—but not too much. “It’s great to be informed about what you want to discuss with your physician, but you also don’t want to come off as that patient who thinks she knows more than her doctor,” she says.

E-mail your MD the topics you’d like to review ahead of time

While this tactic may only work if it’s a doctor you have a good rapport with and who knows your health history, Prokopy says it can really help both the patient and the physician make the most of a limited appointment time. “I e-mail a list of symptoms I’m having to my doctor’s office before my appointment, and oftentimes the doc will skim the info before she walks in to examine me,” says Prokopy. “It leaves more time for discussion—and questions.”

Leisha Davison-Yasol, the author of the personal health blog, Cancer In My Thirties, has a slightly different approach. Rather than e-mailing her doctor before the appointment, she keeps a running list of her symptoms in the “Notes” app on her phone. “If the doctor seems rushed during my appointment, I hand him my phone to read the notes,” she says. “He can read through that list faster than I could explain them to him, which means we have more time to go over my treatment plan.”

Book a double appointment

If you know you’re going to need a significant amount of time with the practitioner, ask the receptionist how long the appointment slots are—and request a double appointment if you’re worried the allotted time won’t be enough, Tracy suggests.

Asking to speak with a nurse practitioner can also be a good tactic, as they often have more time in their schedule. More often than not, they’re able to answer all the same questions as your doctor.

Find a good health advocate (and maybe even bring them to your appointment).

If you’re seeing your doc for something routine—like an annual checkup or sick visit—you can likely handle it on your own. But if you’re worried about something in particular, or have recently been diagnosed with a condition that’s going to involve a lot of follow-up treatment, it’s a good idea to bring a smart and confident friend with you to your appointment, Davison-Yaso says. “You need someone who’s going to help you ask questions, remember the answers, and who isn’t going to be afraid to politely push back when you need more explanation,” she says.

If bringing a friend isn’t an option, Coco recommends voice recording your visit. “Doctors talk fast and throw out a lot of big medical terms,” she says. “If you can play back what she says, you’ll be able to digest it when you’re not so overwhelmed or stunned.”

Source: https://www.prevention.com/health/a20496220/productive-doctor-visits/

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