For some common conditions, these meds are way overprescribed. Here’s what to do instead.

uring the 15 years that Maureen Lake of Denver was a special education teacher, she had four or five urinary tract infections a year. “I couldn’t get to the bathroom when I needed to go, so I’d hold it for hours and develop an infection,” she says. When she felt the telltale stinging sensation, she’d contact her doctor, who’d call in an antibiotic prescription to her pharmacy. “The antibiotics cured my symptoms but gave me terrible diarrhea. By the end of a course of treatment, I was drained and fatigued—literally pooped out,” Maureen says.

Then, a few years ago, she switched doctors, and the next time Maureen developed a UTI, she was taken aback by what her doc said. “She didn’t want to prescribe antibiotics right away, because she wanted to see if my body could clear the infection on its own,” Maureen recalls. “She gave me a prescription but asked me to hold off on taking it for at least two days.” The doctor also advised downing eight to 10 glasses of water daily and loading up on vitamin C.

This didn’t sit well with Maureen. “I’d always heard that UTIs could turn into serious kidney infections if you didn’t treat them,” she says she told her doctor. “She understood my concern and said I should monitor my symptoms and start the drugs immediately if I started getting a fever or chills.”

After 24 hours on the no-antibiotic protocol, Maureen felt better, not worse. Within a few days, her symptoms went away. “I was surprised. I fully expected to fill that prescription,” she says. “The few times since then that I’ve had UTIs, I’ve beaten them on my own. It was eye-opening for me—all those antibiotics I took were probably unnecessary. Waiting it out works just as well.”

The Case for Skipping Antibiotics

As concern about antibiotic resistance continues to rise, there’s a growing movement to use the watch-and-wait approach as the first-line treatment for a number of common ailments. This can feel uncomfortable, even negligent, to those of us who are used to being given antibiotics for every sniffle and sore throat. But many of the pills we’ve swallowed over the years have likely been useless. Common infections for which antibiotics are prescribed are frequently caused by viruses, which don’t respond to them. And even when an illness is caused by bacteria, as in the case of many UTIs, research now shows it can often clear up without medication. “I don’t know where we got the impression that our bodies can’t fight simple infections on their own, but they can—and there are good reasons to let them,” says Jeffrey Linder, MD, a professor of medicine at Northwestern University’s Feinberg School of Medicine.

At least 30 percent of the antibiotics prescribed during office and emergency room visits are unnecessary, according to the Centers for Disease Control and Prevention. And while the medications can be lifesaving in certain circumstances—say, for sepsis or a staph infection, either of which can move quickly and be deadly—they’re not without risks. Of the drugs involved in adverse reactions severe enough to send people to the ER, 16 percent are antibiotics, according to a 2016 study in the Journal of the American Medical Association. “Antibiotics can cause rashes, yeast infections, and diarrhea—sometimes a life-threatening type caused by Clostridioides difficile (C. diff), nasty bacteria that can flourish in your gut when you kill off the good bacteria with antibiotics,” says Dr. Linder.

So how did we come to expect a prescription for every ailment? In part, it’s because we tend to want our docs to do something about our symptoms. And patients “don’t necessarily distinguish between bacteria and viruses. They just want to feel better quickly,” says Brad Spellberg, MD, chief medical officer at the Los Angeles County-USC Medical Center and an expert on antibiotic resistance. “On the physician’s end, it’s sometimes difficult to distinguish between viral and bacterial illnesses based on symptoms, so doctors err on the side of giving patients what they want and expect.”

Patients are also, well, impatient, Dr. Linder adds. “They often say things like, ‘I can’t be sick right now.’ They don’t want to accept that they might not feel great for three weeks,” he says. “But for straightforward ailments in otherwise healthy people, the best treatment is often keeping an eye on your symptoms to make sure they’re not getting worse, using over-the-counter remedies to feel better, and letting your body do the rest.”

Not that you should ignore your symptoms: Watching and waiting is best done with a doctor’s supervision, lest you miss a bigger issue. But if you have one of the following common conditions and a doctor offers you an antibiotic, ask if it makes sense to wait. Here’s how the antibiotic-free approach works:

Skipping Antibiotics with Bronchitis

The symptoms: a lingering cough, often with colored mucus, that can set in after an upper respiratory infection

Why wait? Fully 71 percent of people who see their doctors for bronchitis receive an antibiotic, according to a study conducted by Dr. Linder and his colleagues, but these drugs are almost always unnecessary. “We have 40 years of randomized controlled trials showing that antibiotics don’t help people recover from acute bronchitis,” he says. It’s overwhelmingly caused by viruses, not bacteria, and is largely the result of the body’s immune response to the infection, not the infection itself. “The virus causes inflammation and your body makes green or yellow mucus, which is why you develop that annoying hacking cough,” says Dr. Linder. “But that’s normal—it’s like when you cut yourself and get a scab. When you have a lung infection, you cough. And it takes a while for the lungs to heal.”

How long it takes to recover: 3 weeks on average

What to do to feel better: Get plenty of rest to bolster your immune system; drink eight to 10 glasses of water, soup, or juice every day; use a humidifier or stand in a hot shower and breathe in the steam to loosen phlegm; take lozenges to soothe the tickling sensation in your throat; consider a cough medication at night to help you sleep.

Signs that you may need further treatment: Spiking a fever greater than 101.5°F, wheezing, having chest pain not related to a pulled muscle from coughing, or feeling worse in general—all of this could indicate pneumonia, for which you need an antibiotic.

Skipping Antibiotics with a Sinus Infection

The symptoms: a low-grade fever with copious nasal discharge and facial pain or pressure

Why wait? About 71 percent of sinus-infection patients receive antibiotics, though 90 percent to 98 percent of infections in adults are caused by a virus. According to the CDC, antibiotics may not help even in the rare bacterial case: A 2012 study in the Journal of the American Medical Association found that the recovery of patients treated with 10 days of antibiotics differed little from that of those who took a placebo.

How long it takes to recover: Seven to 14 days, though you should start feeling better in a few days if it’s a routine viral infection, says Priya Nori, MD, medical director of the Antibiotic Stewardship Program at Montefiore Health System. “The reason watch and wait works is because viral infections have a predictable life span: You feel terrible for a few days, then start improving,” she says. “About 2 percent evolve into bacterial infections and need an antibiotic.”

What to do to feel better: Rinse your nasal passages with salt water, using either a neti pot or prepacked saline spray, several times a day. To reduce stuffiness, use over-the-counter nasal decongestants with oxymetazoline or oral decongestants with pseudoephedrine. A nonsteroidal anti-inflammatory can ease the pain. Rest a lot.

Signs that you may need further treatment: A fever higher than 100.4°F, symptoms that are getting worse after 10 days, repeated sinus infections in the course of a year, or symptoms so severe that you don’t get relief with over-the-counter medications.

Skipping Antibiotics with a UTI

The symptoms: pain when you pee, feeling like you need to go even though you just went, fever of less than 101°F

Why wait? It may be noninfectious cystitis—inflammation of the bladder not caused by a UTI. Cystitis is usually caused by an infection, but if you have the classic symptoms without the fever, you may be having a reaction to a medication or irritation from feminine hygiene sprays or spermicidal jellies. The symptoms are so uncomfortable that many patients want to take immediate action. “Most people start antibiotics before they know they have an infection, because they don’t want to wait for the culture to come back,” says David Shusterman, MD, a urologist at NY Urology in New York City. Almost half of women with negative cultures are given meds, adds Betsy Foxman, PhD, a professor of epidemiology at the University of Michigan School of Public Health.

But though true UTIs are typically caused by bacteria, the majority of uncomplicated infections go away on their own without antibiotics. When German researchers compared women who took an antibiotic with those who simply took ibuprofen for three days, they found that two-thirds of the women on ibuprofen recovered without needing antibiotics (the rest were given antibiotics to clear up the problem). As for whether waiting led to the kidney infection patients like Maureen Lake feared, of the 248 women in the ibuprofen group, only five developed kidney infections, and these were mild and responded to antibiotics. In comparison, of 246 women who were given antibiotics from the start, one went on to develop a kidney infection nonetheless. The bottom line is that kidney infections are rare, says Dr. Shusterman. “But it’s good to have an antibiotic on hand so you can start taking it if your symptoms get worse.”

How long it takes to recover: In the German study, 39 percent of women who waited it out were symptom-free by day four and 70 percent were well by day seven; in the antibiotic group, 56 percent felt better by day four and 82 percent by day seven.

What to do to feel better: “The biggest issue with watching and waiting is the pain, but ibuprofen can help, says Foxman. Pyridium, Azo, and Uristat are medications that soothe the lining of the urethra, reducing pain during urination. Drink loads of water, says Foxman. “Frequent urination will help get rid of the bacteria.” Large amounts of vitamin C might limit the growth of bacteria, although the approach hasn’t been proven to effectively treat a UTI.

Signs that you may need further treatment: fever; worsening abdominal, flank, or lower-back pain; or nausea and vomiting.

Source: https://www.prevention.com/health/health-conditions/a27396444/skipping-antibiotic-medicine/

A damning new CDC report shows most maternal deaths are fully preventable.

About 700 women die from pregnancy and childbirth every year in the U.S., according to the CDC.

Most pregnancy-related deaths in the United States are fully preventable — and they can happen up to a year after a woman gives birth, according to a new report from the Centers for Disease Control and Prevention.

Although many people think pregnancy ends in the delivery room, the new report underscores the enormous toll it can take on women’s bodies for a full year after — and, as many moms would argue, much longer.

About 700 women die from pregnancy and childbirth every year in the U.S., according to the report. Of those, 31 percent die during pregnancy, 36 percent die during childbirth or in the first week postpartum, and 33 percent die at some point in the first year after they give birth.

And roughly 60 percent of those deaths could be prevented.

“Every death reflects a web of missed opportunities,” says the CDC, blaming lack of access to health care, missed and delayed diagnoses, and overlooked warning signs.

The CDC defines a pregnancy-related death as one that occurs because of complications from pregnancy or childbirth; because of a chain of events kicked off by a woman’s pregnancy; or because of a seemingly unrelated condition that was worsened by pregnancy.

Severe bleeding and embolisms were the top causes of death during delivery. In the first week postpartum, severe bleeding, high blood pressure and infection were the most common causes of death.

Weakened heart muscles caused most deaths that occurred later — at some point in the first year after a woman gave birth. Pregnancy and childbirth tax the heart and circulatory system, increasing blood volume by up to 50 percent. Women with known heart conditions require special, watchful care.

The United States is the only developed country in the world where the maternal mortality rate is increasing, particularly among women of color — and lack of postpartum support is a major contributing factor.

“We are the only high-income country in the world without paid maternity leave,” Alison Stuebe, a maternal-fetal medicine physician and the medical director of lactation services at University of North Carolina Health Care, told HuffPost. “Moms covered by pregnancy Medicaid are kicked off 60 days after having a baby. These are decisions we have made as a society.”

Indeed, one-quarter of new moms in the U.S. return to work within two weeks of giving birth.

And estimates suggest that up to 40 percent of women do not attend any kind of postpartum visit with a health care provider.

The American College of Obstetricians and Gynecologists is working to address the lack of postpartum support for women but admits that significant policy changes will be necessary to improve health care for recent mothers. Rather than reimbursing expenses for one isolated visit, the group says postpartum care must be covered as an ongoing process.

“Moms are dying in America because we don’t take care of them,” Stuebe said.

Source: https://www.huffpost.com/entry/american-women-dying-pregnancy_l_5cd1a2c4e4b0548b7360689c?guccounter=1

1. Black pepper

According to ayurveda, the pungency and heat of black pepper work to help metabolize food as it is digested in our system. Its warming qualities also help to clear congestion in the respiratory system. Use for indigestion, sinus congestion, excess toxin buildup, fever, sluggish metabolism, and obesity.

2. Cardamom

Known as “the queen of spices,” cardamom is related to ginger. Like ginger, it’s good for improving digestion, soothing stomach pains, and relieving gas. Its warming properties also help to cleanse the body and improve circulation. You will have to break open the pods to discover its plethora of health benefits.

3. Chili, fresh or dried

The heat you feel from cayenne pepper and chili powder comes from capsaicin, a compound that has been shown to invigorate the blood, clear the nasal passages, and thin mucus. Fresh chilies also pack more vitamin C than oranges.

4. Cinnamon

An antibacterial spice found in most households, cinnamon increases general vitality, warms the body, counteracts congestion, improves digestion, relieves menstrual cramping, and improves circulation. Look for Sri Lankan “Ceylon cinnamon” (Cinnamomum verum), also known as “true cinnamon,” not cassia bark (Chinese cinnamon, Cinnamomum cassia). Grate the bark straight into your concoctions.

5. Clove

Cloves are the aromatic flower buds of a medicinal tree once indigenous to the Indonesian “spice islands.” Also found in the spice racks of most homes, cloves are known to have antiseptic, anesthetic, anti-inflammatory, warming, soothing, and flatulence-relieving properties.

6. Cumin

The cumin seed was once thought to promote love and fidelity—it was thrown around at weddings, and soldiers were even sent off to battle with a fresh loaf of cumin-seed bread. It’s traditionally used as a carminative, to help settle the stomach and ease bloating and trapped wind.

7. Garlic

Aphrodisiac, currency, food, medicine, vampire repellent—garlic has had several uses in many cultures for thousands of years. Its pungent sulfurs and antibacterial and anti-inflammatory properties are used to prevent colds and flu and treat a wide range of conditions and diseases.

8. Ginger

The best-known member of the family: primarily for its flavor but also for protecting and promoting a healthy digestive system. It’s one of the most ancient medicinal plants used in Chinese, ayurvedic, and Indonesian medicine. In Asia, ginger is known to warm the body, ease nausea, rev up the appetite and digestion, help ward off any aches and pains, as well as restore strength to those suffering from illness. Steeped hot ginger teas help relieve symptoms of cold and flu. When combined with turmeric, its effects multiply. The skin can be left on, as long as it is rinsed thoroughly.

9. Lemongrass

An aromatic healer with a distinct lemony flavor and citrusy aroma, lemongrass is nature’s acetaminophen: It reduces pain and inflammation, helps to bring down high fevers, and relieves headaches. It’s known as “fevergrass” in Jamaica. Lemongrass also helps to restore our vital systems, including digestion, respiration, excretion, and the nervous system. Heavily bruise the white part of this grass root to unlock its potential.

10. Onion

Onions have been used to reduce inflammation and heal infections for centuries. They’re also one of the healthiest foods you can eat. A natural antihistamine, onions are also rich in vitamin C, sulfuric compounds, flavonoids, and other phytochemicals that can soothe the throat and clear stuffed-up nasal passages. An onion a day may help keep the doctor away.

11. Star anise

Used in traditional Chinese medicine to fight flu by clearing mucus from the respiratory tract, this spice is effective in fighting viral, bacterial, or fungal infections, as well as inflammation. It’s also a common ingredient in medicinal teas, to treat coughs and chest infections. The seeds can be chewed before meals to stimulate the appetite or afterward to relieve gas and bloating.

12. Turmeric

Turmeric is king when it comes to spice. Its yellow color has long been considered sacred in the Eastern world. Yellow symbolizes the sun—a source of light, energy and growth—which is why this color is associated with royalty and is believed to offer protection from evil spirits throughout Asia.

Source: https://www.mindbodygreen.com/articles/12-healing-herbs-and-spices-that-add-flavor-to-any-dish?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190506&otm_click_id=0c725fade4c7c1394057022d9d1ff8d1&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

Even if you’re at a healthy weight, being out of shape may increase your risk of heart disease just as much as if you were overweight, a study in the March 1 Journal of the American College of Cardiology reports.

The study included data from people ages 40 to 79 who were at a healthy weight or overweight based on their body mass index (see www.health.harvard.edu/bmi for a calculator). The participants also provided information about their exercise habits, how long they sat each day, and whether they ever felt short of breath when hurrying or walking up a slight hill.

Using a standard heart disease risk calculator, researchers determined that nearly 30% of the people at a “healthy” weight were at increased risk for heart disease. Factors such as having a large abdomen, not getting recommended amounts of physical activity, and becoming breathless with exertion were all characteristics of a sedentary lifestyle. Having these factors increased the risk for cardiovascular disease of “healthy” weight people to that seen in people who were overweight, according to the authors.


I’ve struggled with anxiety and obsessive-compulsive tendencies for as long as I can remember. However, it was only when I started going to therapy and examining the root of my mental compulsions that I realized a lot of the behaviors stemmed from copious amounts of self-blame and feeling responsible for things out of my control. A new study published in the International Journal of Cognitive Therapyvalidates my experience and that of many others, finding a correlation between strong feelings of responsibility and the likelihood of developing obsessive-compulsive disorder (OCD) or generalized anxiety disorder (GAD).

Researchers sent out an online questionnaire to university students in the U.S. to understand their attitudes about personal responsibility and how much they thought about it, in addition to assessing their behavior patterns. The survey results showed people who had what researchers called “inflated responsibility” had an increased likeliness of exhibiting behaviors resembling OCD or GAD.

Inflated responsibility, according to the researchers, involves a sense of personal blame for negative outcomes, feeling responsible for preventing or avoiding danger or harm, and the embedded responsibility to continue thinking about a problem. All three behaviors, but particularly personal blame for negative outcomes and the responsibility to overthink a problem, were strongly linked to being susceptible to developing OCD and GAD.

These findings don’t signify that if you typically feel inflated responsibility in areas of your life that you will unequivocally develop clinical OCD or GAD. But anxiety and obsessive behaviors can feel all-consuming, regardless of diagnosis.

Why feeling inflated responsibility can be unhealthy.

The problem with feeling responsible for everything all the time is that healthy boundaries are often absent. According to positive psychology coach Diane Dreher, Ph.D., being compulsively responsible puts our nervous systems on red alert and causes chronic stress because the body and brain are in perpetual fight-or-flight mode. “Our hearts beat faster, muscles tense, and immune systems shut down to deal with a perceived threat,” Dreher writes on Psychology Today. “But the threat is only too much to do in too little time: a work deadline, complaining colleague, intrusive relative, an endless list of errands, and our own compulsive push to do ‘one more thing’ before leaving work.”

And this chronic stress doesn’t only predispose someone to OCD and GAD: “Chronic stress can undermine our health, leading to hypertension, inflammatory disease, metabolic syndrome, type 2 diabetes, cardiovascular disease, depression, cognitive disorders, and other serious illnesses,” Dreher explains.

How to stop being so hard on yourself.

Fortunately there are ways to work on not housing so much self-blame and not feeling responsible for everything. For me, it started with working on being more accepting toward myself and getting curious about the root of my compulsive acts. Aisling Peartree, an educator and song-healing guide, finds solace in a technique called the imaginal exposure story, “in which you write a brief, concise story of your worst fear being true,” she tells mbg. “Along with reading your story, you refrain from engaging in your compulsion. You expose yourself to your trigger and then prevent the response. It is meant to be uncomfortable, painful even.”

Getting curious by intimately sitting with your anxieties and compulsions isn’t meant to be easy. But if you’re willing to do the work, you might realize that you never were responsible for everything—and perhaps it will be the prelude to developing more self-acceptance.

Vedic meditation teacher James Brown recommends meditation as another way to sit with your anxieties and develop more self-acceptance: “We live in our heads and not in the world, and this is why we suffer. So how can we choose differently? First by getting out of our heads, i.e., by knowing ourselves as something other than our thoughts and feelings,” he writes at mbg. “One of the great gifts of meditation is that it allows us, twice a day, to know the truth of our essential nature: that beyond our thoughts, our ego, our doubts, and our frustrations, we are perfect, whole, and complete. We allow our mind to settle to quieter and calmer layers of consciousness, perhaps having an experience of that baseline level of transcendental consciousness at which there are no problems, no speculation, no thinking at all. Just pure, unbounded, blissful silence. And having had that experience, we re-enter the world of thinking and doing with a bit more perspective, a bit more of an ability to accept the situation, any situation, for what it is: temporary.”

To me, self-acceptance means holding space for myself and allowing myself to be here as I am, even when I can’t change my anxiety and compulsive tendencies. It’s also about practice and having awareness of my inflated sense of responsibility and innate “need” to control things: knowing that I have the power to change that narrative through things as simple as my breath, getting curious, meditating, and sustained, gentle reminders that there are many things out of my control.

Source: https://www.mindbodygreen.com/articles/science-shows-this-unhealthy-thought-pattern-can-lead-to-anxiety-and-mental-illness?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190427&otm_click_id=b05c44bfac7b6613ae6c27c190add71a&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

The rise of Candida auris embodies a serious and growing public health threat: drug-resistant germs.

Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.

Dr. Shawn Lockhart, a fungal disease expert at the Centers for Disease Control and Prevention, holding a microscope slide with inactive Candida auris collected from an American patient.CreditMelissa Golden for The New York Times

ImageDr. Shawn Lockhart, a fungal disease expert at the Centers for Disease Control and Prevention, holding a microscope slide with inactive Candida auris collected from an American patient.CreditMelissa Golden for The New York Times

For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine.

“It’s an enormous problem,” said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review on the rise of resistant fungi. “We depend on being able to treat those patients with antifungals.”

Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines.

Yet even as world health leaders have pleaded for more restraint in prescribing antimicrobial drugs to combat bacteria and fungi — convening the United Nations General Assembly in 2016 to manage an emerging crisis — gluttonous overuse of them in hospitals, clinics and farming has continued.

Resistant germs are often called “superbugs,” but this is simplistic because they don’t typically kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body’s defenses.

Scientists say that unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier populations. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in 2050, eclipsing the eight million expected to die that year from cancer.

Dr. Johanna Rhodes, an infectious disease expert at Imperial College London. “We are driving this with the use of antifungicides on crops,” she said of drug-resistant germs.CreditTom Jamieson for The New York Times
Dr. Johanna Rhodes, an infectious disease expert at Imperial College London. “We are driving this with the use of antifungicides on crops,” she said of drug-resistant germs.CreditTom Jamieson for The New York Times

In the United States, two million people contract resistant infections annually, and 23,000 die from them, according to the official C.D.C. estimate. That number was based on 2010 figures; more recent estimates from researchers at Washington University School of Medicine put the death toll at 162,000. Worldwide fatalities from resistant infections are estimated at 700,000.

Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.

Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy.

With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.

All the while, the germs are easily spread — carried on hands and equipment inside hospitals; ferried on meat and manure-fertilized vegetables from farms; transported across borders by travelers and on exports and imports; and transferred by patients from nursing home to hospital and back.

C. auris, which infected the man at Mount Sinai, is one of dozens of dangerous bacteria and fungi that have developed resistance.

A projection of the C. auris fungus on a microscope slide.CreditMelissa Golden for The New York Times
A projection of the C. auris fungus on a microscope slide.CreditMelissa Golden for The New York Times

Other prominent strains of the fungus Candida — one of the most common causes of bloodstream infections in hospitals — have not developed significant resistance to drugs, but more than 90 percent of C. auris infections are resistant to at least one drug, and 30 percent are resistant to two or more drugs, the C.D.C. said.

Dr. Lynn Sosa, Connecticut’s deputy state epidemiologist, said she now saw C. auris as “the top” threat among resistant infections. “It’s pretty much unbeatable and difficult to identify,” she said.

Nearly half of patients who contract C. auris die within 90 days, according to the C.D.C. Yet the world’s experts have not nailed down where it came from in the first place.

“It is a creature from the black lagoon,” said Dr. Tom Chiller, who heads the fungal branch at the C.D.C., which is spearheading a global detective effort to find treatments and stop the spread. “It bubbled up and now it is everywhere.”

Candida Auris

A deadly, drug-resistant fungus is infecting patients in hospitals and nursing homes around the world. The fungus seems to have emerged in several locations at once, not from a single source.

By The New York Times | Sources: Centers for Disease Control and Prevention; Emerging Infectious Diseases; Emerging Microbes & Infections; Clinical Infectious Diseases; Journal of Infection; Mycoses; Doherty Institute. Image from Kazuo Satoh et al., Microbiology and Immunology

In late 2015, Dr. Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical center in London. C. auris had taken root there months earlier, and the hospital couldn’t clear it.

“‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Dr. Rhodes said she was told. She agreed to help the hospital identify the fungus’s genetic profile and clean it from rooms.

Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C. auris, the theory being that the vapor would scour each nook and cranny. They left the device going for a week. Then they put a “settle plate” in the middle of the room with a gel at the bottom that would serve as a place for any surviving microbes to grow, Dr. Rhodes said.

Only one organism grew back. C. auris.

It was spreading, but word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement.

“There was no need to put out a news release during the outbreak,” said Oliver Wilkinson, a spokesman for the hospital.

“Somehow, it made a jump almost seemingly simultaneously, and seemed to spread and it is drug resistant, which is really mind-boggling,” said Dr. Snigdha Vallabhaneni, a fungal expert and epidemiologist at the C.D.C.CreditMelissa Golden for The New York Times
“Somehow, it made a jump almost seemingly simultaneously, and seemed to spread and it is drug resistant, which is really mind-boggling,” said Dr. Snigdha Vallabhaneni, a fungal expert and epidemiologist at the C.D.C.CreditMelissa Golden for The New York Times

This hushed panic is playing out in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to publicize outbreaks of resistant infections, arguing there is no point in scaring patients — or prospective ones.

Dr. Silke Schelenz, Royal Brompton’s infectious disease specialist, found the lack of urgency from the government and hospital in the early stages of the outbreak “very, very frustrating.”

“They obviously didn’t want to lose reputation,” Dr. Schelenz said. “It hadn’t impacted our surgical outcomes.”

By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its I.C.U. for 11 days, moving intensive care patients to another floor, again with no announcement.

Days later the hospital finally acknowledged to a newspaper that it had a problem. A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.” (Later research said there were eventually 72 total cases, though some patients were only carriers and were not infected by the fungus.)

Yet the issue remained little known internationally, while an even bigger outbreak had begun in Valencia, Spain, at the 992-bed Hospital Universitari i Politècnic La Fe. There, unbeknown to the public or unaffected patients, 372 people were colonized — meaning they had the germ on their body but were not sick with it — and 85 developed bloodstream infections. A paper in the journal Mycoses reported that 41 percent of the infected patients died within 30 days.

Outside the Royal Brompton Hospital near London. By June 2016, the hospital had seen at least 50 “proven or possible” cases of C. auris, and decided to shut down its intensive care unit for 11 days to address the contamination.CreditTom Jamieson for The New York Times
Outside the Royal Brompton Hospital near London. By June 2016, the hospital had seen at least 50 “proven or possible” cases of C. auris, and decided to shut down its intensive care unit for 11 days to address the contamination.CreditTom Jamieson for The New York Times

A statement from the hospital said it was not necessarily C. auris that killed them. “It is very difficult to discern whether patients die from the pathogen or with it, since they are patients with many underlying diseases and in very serious general condition,” the statement said.

As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not.

One author of the article in Mycoses, a doctor at the hospital, said in an email that the hospital did not want him to speak to journalists because it “is concerned about the public image of the hospital.”

The secrecy infuriates patient advocates, who say people have a right to know if there is an outbreak so they can decide whether to go to a hospital, particularly when dealing with a nonurgent matter, like elective surgery.

“Why the heck are we reading about an outbreak almost a year and a half later — and not have it front-page news the day after it happens?” said Dr. Kevin Kavanagh, a physician in Kentucky and board chairman of Health Watch USA, a nonprofit patient advocacy group. “You wouldn’t tolerate this at a restaurant with a food poisoning outbreak.”

Health officials say that disclosing outbreaks frightens patients about a situation they can do nothing about, particularly when the risks are unclear.

“It’s hard enough with these organisms for health care providers to wrap their heads around it,” said Dr. Anna Yaffee, a former C.D.C. outbreak investigator who dealt with resistant infection outbreaks in Kentucky in which the hospitals were not publicly disclosed. “It’s really impossible to message to the public.”

Officials in London did alert the C.D.C. to the Royal Brompton outbreak while it was occurring. And the C.D.C. realized it needed to get the word to American hospitals. On June 24, 2016, the C.D.C. blasted a nationwide warning to hospitals and medical groups and set up an email address, candidaauris@cdc.gov, to field queries. Dr. Snigdha Vallabhaneni, a key member of the fungal team, expected to get a trickle — “maybe a message every month.”

Instead, within weeks, her inbox exploded.

Glo Gel under a black light in a room at Mount Sinai Hospital, before a simulation “terminal” cleaning of that room. Hospital workers place the gel in unexpected places to check that a room has been deeply cleaned — a necessary precaution after the hospital had to spend $1 million on cleaning equipment to protect against C. auris.CreditHilary Swift for The New York Times
Glo Gel under a black light in a room at Mount Sinai Hospital, before a simulation “terminal” cleaning of that room. Hospital workers place the gel in unexpected places to check that a room has been deeply cleaned — a necessary precaution after the hospital had to spend $1 million on cleaning equipment to protect against C. auris.CreditHilary Swift for The New York Times

In the United States, 587 cases of people having contracted C. auris have been reported, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the C.D.C.

The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal.

The earliest known case in the United States involved a woman who arrived at a New York hospital on May 6, 2013, seeking care for respiratory failure. She was 61 and from the United Arab Emirates, and she died a week later, after testing positive for the fungus. At the time, the hospital hadn’t thought much of it, but three years later, it sent the case to the C.D.C. after reading the agency’s June 2016 advisory.

Candida Auris by State

Most cases in the United States have been in nursing homes in New York City, Chicago and New Jersey.

This woman probably was not America’s first C. auris patient. She carried a strain different from the South Asian one most common here. It killed a 56-year-old American woman who had traveled to India in March 2017 for elective abdominal surgery, contracted C. auris and was airlifted back to a hospital in Connecticut that officials will not identify. She was later transferred to a Texas hospital, where she died.

The germ has spread into long-term care facilities. In Chicago, 50 percent of the residents at some nursing homes have tested positive for it, the C.D.C. has reported. The fungus can grow on intravenous lines and ventilators.

Workers who care for patients infected with C. auris worry for their own safety. Dr. Matthew McCarthy, who has treated several C. auris patients at Weill Cornell Medical Center in New York, described experiencing an unusual fear when treating a 30-year-old man.

“I found myself not wanting to touch the guy,” he said. “I didn’t want to take it from the guy and bring it to someone else.” He did his job and thoroughly examined the patient, but said, “There was an overwhelming feeling of being terrified of accidentally picking it up on a sock or tie or gown.

Dr. Tom Chiller, head of the fungal branch at the C.D.C. “It is a creature from the black lagoon,” he said of C. auris.CreditMelissa Golden for The New York Times
Dr. Tom Chiller, head of the fungal branch at the C.D.C. “It is a creature from the black lagoon,” he said of C. auris.CreditMelissa Golden for The New York Times

As the C.D.C. works to limit the spread of drug-resistant C. auris, its investigators have been trying to answer the vexing question: Where in the world did it come from?

The first time doctors encountered C. auris was in the ear of a woman in Japan in 2009 (auris is Latin for ear). It seemed innocuous at the time, a cousin of common, easily treated fungal infections.

Three years later, it appeared in an unusual test result in the lab of Dr. Jacques Meis, a microbiologist in Nijmegen, the Netherlands, who was analyzing a bloodstream infection in 18 patients from four hospitals in India. Soon, new clusters of C. auris seemed to emerge with each passing month in different parts of the world.

The C.D.C. investigators theorized that C. auris started in Asia and spread across the globe. But when the agency compared the entire genome of auris samples from India and Pakistan, Venezuela, South Africa and Japan, it found that its origin was not a single place, and there was not a single auris strain.

The genome sequencing showed that there were four distinctive versions of the fungus, with differences so profound that they suggested that these strains had diverged thousands of years ago and emerged as resistant pathogens from harmless environmental strains in four different places at the same time.

“Somehow, it made a jump almost seemingly simultaneously, and seemed to spread and it is drug resistant, which is really mind-boggling,” Dr. Vallabhaneni said.

The C.D.C. in miniature. In the United States, two million people contract resistant infections each year, and 23,000 die from them, according to the official C.D.C. estimate.CreditMelissa Golden for The New York Times
The C.D.C. in miniature. In the United States, two million people contract resistant infections each year, and 23,000 die from them, according to the official C.D.C. estimate.CreditMelissa Golden for The New York Times

There are different theories as to what happened with C. auris. Dr. Meis, the Dutch researcher, said he believed that drug-resistant fungi were developing thanks to heavy use of fungicides on crops.

Dr. Meis became intrigued by resistant fungi when he heard about the case of a 63-year-old patient in the Netherlands who died in 2005 from a fungus called Aspergillus. It proved resistant to a front-line antifungal treatment called itraconazole. That drug is a virtual copy of the azole pesticides that are used to dust crops the world over and account for more than one-third of all fungicide sales.

A 2013 paper in Plos Pathogens said that it appeared to be no coincidence that drug-resistant Aspergillus was showing up in the environment where the azole fungicides were used. The fungus appeared in 12 percent of Dutch soil samples, for example, but also in “flower beds, compost, leaves, plant seeds, soil samples of tea gardens, paddy fields, hospital surroundings, and aerial samples of hospitals.”

Dr. Meis visited the C.D.C. last summer to share research and theorize that the same thing is happening with C. auris, which is also found in the soil: Azoles have created an environment so hostile that the fungi are evolving, with resistant strains surviving.

This is similar to concerns that resistant bacteria are growing because of excessive use of antibiotics in livestock for health and growth promotion. As with antibiotics in farm animals, azoles are used widely on crops.

“On everything — potatoes, beans, wheat, anything you can think of, tomatoes, onions,” said Dr. Rhodes, the infectious disease specialist who worked on the London outbreak. “We are driving this with the use of antifungicides on crops.”

Dr. Chiller theorizes that C. auris may have benefited from the heavy use of fungicides. His idea is that C. auris actually has existed for thousands of years, hidden in the world’s crevices, a not particularly aggressive bug. But as azoles began destroying more prevalent fungi, an opportunity arrived for C. auris to enter the breach, a germ that had the ability to readily resist fungicides now suitable for a world in which fungi less able to resist are under attack.

The mystery of C. auris’s emergence remains unsolved, and its origin seems, for the moment, to be less important than stopping its spread.

An empty hospital bed at Mount Sinai.CreditHilary Swift for The New York Times
An empty hospital bed at Mount Sinai.CreditHilary Swift for The New York Times

For now, the uncertainty around C. auris has led to a climate of fear, and sometimes denial.

Last spring, Jasmine Cutler, 29, went to visit her 72-year-old father at a hospital in New York City, where he had been admitted because of complications from a surgery the previous month.

When she arrived at his room, she discovered that he had been sitting for at least an hour in a recliner, in his own feces, because no one had come when he had called for help to use the bathroom. Ms. Cutler said it became clear to her that the staff was afraid to touch him because a test had shown that he was carrying C. auris.

“I saw doctors and nurses looking in the window of his room,” she said. “My father’s not a guinea pig. You’re not going to treat him like a freak at a show.”

He was eventually discharged and told he no longer carried the fungus. But he declined to be named, saying he feared being associated with the frightening infection.

Ana Harrero contributed reporting from Caracas, Venezuela, and Raphael Minder from Valencia, Spain.

Source: https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html?smid=nytcore-ios-share

We know the importance of a good night’s sleep cannot be understated, as prioritizing your sleep affects everything from your stress response to appetite regulation to mood. What’s more, every minute really does count: A new study published in Sleep Health (Journal of the National Sleep Foundation) revealed that losing just 16 minutes of sleep can detrimentally affect your productivity, which isn’t exactly the best news for those trying to conquer the workweek while skimping on their slumber.

Soomi Lee, a sleep researcher and aging studies professor at the University of South Florida, and her colleagues surveyed and interviewed 130 healthy employees working in IT and parenting at least one school-aged child. They measured sleep timing, duration, quality, and latency as well as “cognitive interference,” including the ability to control your thoughts and suppress intrusive or avoidant thinking. (An example of one of these questions would be “How often did you think about personal worries today?” or “How often did you have trouble concentrating today?”)

Researchers found that when participants slept just 16 fewer minutes than usual and reported unsatisfactory sleep quality, they experienced a heightened amount of cognitive issues the next day—that is, they were more distracted and couldn’t think as clearly. Because of this, their stress levels increased, especially concerning the maintenance of work-life balance. According to the researchers, heightened stress and lack of clearheadedness may have directly resulted in poorer work performance and poorer socially interactive decisions—and also further continued to mess with their sleep, with the more stressed and distracted workers tending to go to bed and wake up earlier because of their exhaustion. The researchers also compared workdays to weekends and found the consequences of less sleep were absent when someone had the next day off from work.

“These cyclical associations reflect that employees’ sleep is vulnerable to daily cognitive stress and also a contributor to cognitively stressful experiences,” Lee explained in a news release. “Findings from this study provide empirical evidence for why workplaces need to make more efforts to promote their employees’ sleep. Good sleepers may be better performers at work due to greater ability to stay focused and on task with fewer errors and interpersonal conflicts.” (Indeed, research shows people are more hostile when they’re sleepy—just saying.)

The science clearly demonstrates getting enough sleep is not, well, enough: That sleep also needs to be consistent and regular. People with more irregular bedtimes tend to have worse cardiovascular health and a slower metabolism, and people who wake up at the same time each morning tend to be more satisfied with their work-life balance.

That means it’s worth getting strategic about your sleep schedule. Sleeping soundly each night is by no means the easiest task out there, but there are actionable measures you can take on your own in order to improve your sleep schedule, boost your productivity, and, in turn, improve your health altogether. If you’re having trouble staying away from the snooze button in the morning or shutting off the lights at night, consider booking a.m. workout classes to hold you accountable or scheduling short meditations in the evening to help you wind down. Strategizing your sleep in this way can help you avoid skimping on precious minutes of shut-eye and subsequently create a more solid, uninterrupted sleep experience.

Source: https://www.mindbodygreen.com/articles/how-losing-just-16-minutes-of-sleep-affects-your-productivity-research-shows?otm_medium=onespot&otm_source=inbox&otm_campaign=Daily+Mailer&otm_content=daily_20190425&otm_click_id=e3e436e456c14465227f43b6b7e42f2b&os_ehash=4366f4a34c67ce527584ae17c656bb4bd17ce861

Constantly feeling overwhelmed is a telltale sign—but you can overcome that feeling.

We all know what it feels like to be overwhelmed. But if it feels like you can never catch a break—a frank conversation with your boss on Friday has you in tears all weekend, then you turn around to go to work on Monday and want to scream at every bad driver on the road—it might be something more. You may be what experts call a highly sensitive person.

The term “highly sensitive” has been used to describe several different personality types—people who overreact, for instance, or people who get upset easily. But the true, research-backed definition of a “highly sensitive person” is an individual who “has a sensitive nervous system, is aware of subtleties in his or her surroundings, and is more easily overwhelmed when in a highly stimulating environment,” according to Elaine Aron, PhD, a psychologist who has studied high sensitivity since 1991.

This personality type is actually pretty common. In fact, about 20 percent of the population identifies with it, says Aron, which is why it isn’t classified as a disorder. And oddly enough, about 30 percent of people who are highly sensitive are alsoclassified as extroverts, so it can be difficult to discern if high sensitivity is something you live with, says Aron.

So, how can you tell if you are a highly sensitive person? Here’s how to spot the most common qualities of the personality type—and what you can do to live better as one.

What are the common traits of a highly sensitive person?

Being highly sensitive isn’t a bad thing. In fact, it’s a personality that’s entirely innate. But in order to be classified as highly sensitive, you need to have four specific characteristics. “If you don’t have all four, you’re probably not what we’re defining as highly sensitive,” says Aron. These characteristics, known as DOES, include:

Depth of processing

This simply means that you process things more deeply and observe more carefully before you act. The result? You tend to react more cleverly to situations, says Aron. “This is the most important one,” she says. “This is a survival strategy found in at least 100 species.” And although we don’t know exactly what the purpose of this characteristic is in highly sensitive people, we do know that it has some kind of advantage to survival.

For example, if you’re packing for a trip, you may think, plan, and imagine everything that you might need while you’re away—so you end up being the person who comes equipped with the items others forgot about.


Thinking about things so deeply means you tend to notice every single detail, which can tire you out more easily. “That is the only downside of the personality,” says Aron. “We’ve done studies in which we find that sensitive people are noticing subtleties and their brains are processing things at a higher level in the sense that it’s not just their eyes and ears and noses that are so sensitive, but it’s noticing subtle aspects of a complex situation.” And that keen observance is ultimately what leads to overstimulation, causing a highly sensitive person to sometimes feel frazzled, rushed, or drained.

Emotional response and empathy

Highly sensitive people have strong emotional responses in order to deeply process the things and situations they’re experiencing, says Aron. They also tend to be more empathetic than average, both to people they know and to strangers.

For example, you may be preparing for a job interview and start worrying about all the questions you have to prepare for, causing you to slow down—but then your empathy kicks in when you think of your family, who is depending on you to succeed, so your brain tells you to keep going.

Sensitivity to subtleties

This characteristic is ultimately what breeds overstimulation, says Aron: being sensitive to all the small things that may be occurring at any given time that other people don’t tend to notice.

But picking up on subtle details has quite a few upsides that could help you both personally and professionally. According to Ryne Sherman, PhD, a psychologist and chief science officer at Hogan Assessments which runs personality tests, these positive traits include:

  • Being able to find problems and spot issues easily
  • Being dissatisfied with things, leading to progress and change
  • Trying to improve the way things are

How to tell if you’re a highly sensitive person

The easiest way to find out if you’re a highly sensitive person is to take Aron’s self-test, which includes research-backed questions to find out where you land in terms of the above characteristics. But there are some key indicators that could help you determine if you’re highly sensitive, including if you identify with any of the following:

  • You think deeply about things and life has to be meaningful.
  • You’re easily overstimulated and avoid noisy places.
  • If you’ve had a full day, you’d rather stay home than go out.
  • People say you have a lot of empathy for others.
  • You cry easily.
  • You notice things other people miss.

The trouble is, most of us have a hard time recognizing our own tendencies and reactions to things, because “we tend to think other people see us just the way we see ourselves,” says Sherman.

This is where getting some outside perspective to determine if you’re highly sensitive could be helpful. Try to think about yourself and your reactions to things from other people’s perspectives, and think about how they’d react in a given situation. If it feels like you react more strongly than those in your inner circle or you notice more than those you surround yourself with do, that could provide some insight.

How to adapt to your emotions if you’re highly sensitive

If you’ve found that you identify with being highly sensitive and have been looking for an excuse for a lazy Saturday, here it is: The key to coping with your high sensitivity is getting plenty of down time. “Everyone talks about down time these days, but it’s important for highly sensitive people that it be really quiet,” says Aron. “You need quiet down time to allow that overstimulation and depth of processing to overstimulation to wind down.”

Make time for rest

Whatever your version of self-care is, prioritize that. This might mean that when you go on vacation, it’s more important for you to catch up on sleep and rest rather than participating in a full day of activities, says Aron. Or, it might mean that instead of going out and playing tennis with friends or going to a party after work on a Friday, you go home and have some time to yourself. The important thing here is making sure you get quiet time to let yourself reset.

Try meditation

Meditation is a great way to soak in the quiet. “I think meditation is really important, and I think transcendental meditation is the best because it’s the most restful,” says Aron. “Mindfulness involves observing your breathing or your body or your thoughts, and transcendental meditation doesn’t include any of that.”

Try doing transcendental meditation—which simply includes focusing on a mantra or sound and letting your mind fall to silence—for about 15 to 20 minutes per day.

Consider seeing a therapist

It’s important to remember that being highly sensitive isn’t a bad thing. “People shouldn’t feel hopeless,” says Aron. If it’s something you’re struggling with, start attending sessions of psychotherapy, which sensitive people are naturally more responsive to. “We think that sensitive people do better than others in intervention like psychotherapy because they’re paying more attention,” says Aron. “If they’re seeing a good therapist, they’re paying more attention to the therapist’s feedback and feelings about them and should get more from that.”

Source: https://www.prevention.com/health/mental-health/a27019841/highly-sensitive-person/

I’m perhaps the biggest evangelist for a green smoothie breakfast. Smoothies take less than five minutes to make and they’re the best way to eat more vegetables before noon than most people eat all week. Because of my fervent passion for my morning green shake, I often find myself in the position of solving people’s smoothie-based hangups—the most frequent of which I hear is, “I’m always still hungry after eating a smoothie!”

Yes, smoothies can you leave you feeling hungry, but no—they absolutely don’t have to. The secret is filling your smoothie with a heaping amount of greens, a good amount of healthy fat, and enough protein to turn off your hunger hormones and keep your blood sugar super stable well past noon. For protein, I tend to eschew protein powders and reach for more whole-food smoothie add-ins. Here are my five favorites.

1. Hulled hemp hearts

Hulled hemp hearts are top of my protein list—each tablespoons packs 9 grams of complete protein in plant-based form. Hemp hearts are also rich in healthy omega-3 fats, which help your body fight inflammation and further encourage satiety. From a culinary perspective, I love adding hemp to smoothies because they become super creamy—if you blend hemp hearts and water, you get hemp milk, so when you add hemp hearts and water to your smoothie, the effect is as if you’d blended in milk. Beyond the creamy texture, the flavor is fairly neutral, making hemp hearts an ideal addition to almost any smoothie.

2. Nut butter

A smoothie bar staple, nut butters also make my list, although because they’re more expensive, I reach for them less often. I like to keep an almond, cashew, and peanut on hand—beyond making a smoothie super creamy and thick, they also add a rich, almost-dessert like flavor that makes them taste extra decadent. Because of the more pronounced flavor, I reserve nut butters for smoothies that highlight the nut butter, like Chocolate Peanut Butter or a Cardamom Strawberry Cashew.

3. Chia

Like hemp hearts, chia seeds offer a one-two punch of protein (4 grams per one ounce serving) healthy fat in the form of omega-3s (5 grams per one ounce serving). Their real power, though, is in their fiber content—a whopping 11 grams per serving. It’s no wonder that famed doctor Terry Wahls, M.D. named them as one of her favorite constipation-busting foods! Chia thickens smoothies quite a bit (think chia pudding), so when I use it, I avoid or go light on other thickening ingredients like banana, cauliflower, and avocado.

4. Pepitas

Shelled pumpkin seeds, or pepitas, have 7 grams of protein per one-ounce serving, alongside a whole host of other nutrients, including 30 percent of the RDI of manganese and magnesium. Magnesium is a powerful mineral that many of us are deficient in, and adding more of it to your diet is a great way to help manage stress and anxiety. Like hemp seeds, pepitas offer a lovely creamy quality to smoothies, although they have a slightly more toasty, nutty flavor. I like to pair them with cacao-based, chocolatey smoothies and some spices (a pepita-spiked Mexican Hot Chocolate smoothie is my favorite blend).

5. Collagen

The only non-plant-based protein option on this list, collagen earns its spot through its mega quantity of protein and myriad other health benefits. One 20 gram serving contains a whopping 18 grams of protein, the vast majority of which is comprised from various amino acids that play a role in aiding joint health, helping skin elasticity, and contributing to a healthy digestive system. Because collagen is an animal product, it’s important to be particular about sourcing, and only purchase from suppliers whose products are grass-fed and third-party certified. A good quality collagen will taste completely neutral, and won’t change the flavor or texture of your smoothie in any noticeable way.

Half of all pregnant women who experience depression do not get any treatment, and some may turn to alcohol, marijuana, and opioids to self-medicate, a study of national data found.

The research, which was published this month in Psychiatric Services in Advance, involved responses from 12,360 women to the National Survey on Drug Use and Health between 2011 and 2016. Researchers compared responses for pregnant and nonpregnant women between the ages of 18 and 44, all of whom had an episode of major depression.

They found 51 percent of pregnant women and 43 percent of nonpregnant women did not get any treatment for depression.

“In general, treatment rates are very, very low,” said Maria X. Sanmartin, a coauthor of the study and assistant professor of health professions at Hofstra University.

But pregnant women seem to be particularly underserved. Even among those who did get some treatment, pregnant women were significantly more likely to say it was not enough to meet their needs.

“What we would expect is that pregnant women are visiting the ob-gyn more and they should have more opportunities to see a psychologist or psychiatrist,” Sanmartin said. “But that is not what we found.”

Guidelines from both the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists recommend doctors screen all pregnant women for depression and refer those at risk to counseling.

The study didn’t ask women if they were screened, but maternal-health experts say depression in pregnant and postpartum women is consistently underdiagnosed. Many women are not asked about depression symptoms, and even those who are may feel too ashamed to answer truthfully.

For women of color, an added fear of child welfare services deeming them unfit can keep women from admitting symptoms and seeking care.

When mental illnesses go untreated, there can be serious consequences, research shows — from deteriorating physical health for the mother to developmental delays for the baby. People with untreated mental illness are also at higher risk for substance use.

The study found that in the month before women took the survey, 23 percent of pregnant women reported using alcohol, 17 percent used marijuana, and 6 percent used opioids. That indicates a significant health concern for mother and child, Sanmartin said.

In Pennsylvania, more than 3,000 drug-exposed newborns were born in 2017 — a number that has soared over the last decade as the opioid crisis grows. Experts suggest getting women proper mental-health and substance-use treatment could lower these numbers.

But what should treatment look like?

Maternal mental-health guidelines suggest therapy and consultations with a psychiatrist should be the first option. Yet the study found prescription medication was the most prevalent form of treatment among pregnant women.

“The easiest way to cope with these things is to just give medication,” Sanmartin said. “But medication alone might not be what would help the patient.”

The American Psychiatric Association says there is growing evidence that it’s safe for pregnant women to use antidepressants, and they can be helpful for some. But combining medication with therapy helps people address environmental and social factors that influence their mental health too.

Often, cost gets in the way, Sanmartin said.

The study found both pregnant and nonpregnant women cited financial concerns as the main barrier that kept them from getting treatment. More than three-quarters of the women in the study had insurance, but some had high deductibles or could not afford the copay.

Under the Affordable Care Act, all insurance plans are required to cover mental health and substance use treatment. But that doesn’t necessarily make accessing care easy or affordable.

Studies have shown many insurance plans have few in-network mental-health providers, forcing people to pay high fees for an out-of-network provider or skip treatment altogether. Add to that the shortage of psychiatrists across the nation and wait times for appointments that can stretch weeks, and the obstacles can be insurmountable for some.

Sanmartin said it would help to have doctors work in teams — an ob-gyn with a psychiatrist, for example — to detect depression in pregnant women and improve treatment rates.

It’s also crucial to improve patient education, she said. Doctors need to let women know about the possibility of experiencing depression during pregnancy and that there are treatment options. “Otherwise women might not know it’s not normal what they’re feeling,” she said.

Source: https://www.philly.com/health/pregnant-women-depression-treatment-mental-health-addiction-20190417.html