depression

These are unprecedented times. Given the real and tangible threat of the coronavirus pandemic on personal, community, and societal levels, it is normal to experience anxiety and sleep problems. Sleep is a reversible state marked by a loss of consciousness to our surroundings, and as members of the animal kingdom, our brains have evolved to respond to dangers by increasing vigilance and attention — in other words, our brains are protecting us, and by doing so it’s harder for us to ignore our surroundings.

Despite the threat of the coronavirus and its rapid and pervasive disruption to our daily lives, many of us are an in a position to control our behaviors and dampen the impact of the emerging pandemic on our sleep. Cultivating healthy sleep is important; better sleep enables us to navigate stressful times better in the short term, lowers our chance of developing persistent sleep problems in the longer term, and gives our immune system a boost.

Daytime tips to help with sleep
Keep a consistent routine. Get up at the same time every day of the week. A regular wake time helps to set your body’s natural clock (circadian rhythm, one of the main ways our bodies regulate sleep). In addition to sleep, stick to a regular schedule for meals, exercise, and other activities. This may be a different schedule than you are used to, and that is okay. Pay attention to your body’s cues and find a rhythm that works for you and that you can maintain during this “new normal.” Make this a priority for all members of your household.

Get morning light. Get up, get out of bed, and get some light. Light is the main controller of the natural body clock, and regular exposure to light in the morning helps to set the body’s clock each day. Natural sunlight is best, as even cloudy days provide over double the light intensity of indoor lighting. If you are living in an area with shelter-in-place, try to expose yourself to natural light by stepping outside, at a distance from others, for at least 20 minutes.

Exercise during the day helps improve your sleep quality at night, reduces stress, and improves mood. Fit in exercise as best as you can. If you need to go outside for exercise, maintain proper social distancing at least six feet away from others. Avoid any group exercise activities, especially contact sports. Many gyms and yoga studios are now “at home” and offering virtual programs at low or no cost.

Don’t use your bed as an escape. While the gravity of the pandemic certainly makes us all tired, try not to spend too much time in bed during the day, especially if you are having trouble sleeping at night. If you must take a nap, try to keep it short — less than 30 minutes.

Avoid caffeine late in the day
Helping others may help with feelings of uncertainty or unease. Even if you do not work in an “essential” industry, your role in maintaining physical distance is critical in our fight against coronavirus. If you would like to be more actively involved in helping people, seek out ways to contribute your skills, donate money, or leverage your social capacity locally, such as providing virtual social connection to your loved ones by checking in on elderly family members or a friend, or providing in-kind donations. Doing altruistic acts may provide a sense of purpose, reduce helplessness, and alleviate some of the uncertainty contributing to sleep problems.

Nighttime tips to help with sleep
Prepare for bedtime by having a news and electronic device blackout. Avoid the news and ALL electronics at least one hour before bedtime. Avoid the news and ALL electronics at least one hour before bedtime. (Yes, it’s so important, I am saying this twice!) The nonstop news cycle seldom provides new information in the evening hours that you can’t wait until morning to hear, and will likely stimulate your mind or incite fear, making it harder to fall and stay asleep. Remind yourself by setting a timer or putting your television on the sleep setting. Make a pact with your family members to respect these parameters.

Cell phones, tablets, and all electronic devices make it harder for your brain to turn off, and the light (even dim light) from devices may delay the release of the hormone melatonin, interfering with your body clock. If you need something to watch to help you unwind, watching something that you find relaxing on TV from far away and outside the bedroom is likely okay for a limited time. You can also curl up with a book or listen to music.

Minimize alcohol intake. While alcohol can help people fall asleep, it leads to more sleep problems at night.

Set a regular bedtime. There are certain times at night that your body will be able to sleep better than others. If you feel sleepy but your brain is busy thinking, it can’t shut off and go to sleep. It may be helpful to sit down with a pen and paper in the evening and write down the things that worry you; you can review this list in the morning and attend to any important concerns. If you have a bed partner, enlist their support to helping you stick to your schedule.

Reduce stress. The evening and bedtime hours are also a good time to perform some relaxation techniques, such as slow breathing or yoga. There are many free resources available for bedtime meditation.

Create a comfortable sleep environment, a place that is cool, dark, and quiet.

Don’t spend too much time in bed during the night (or the daytime). Minimize spending time in bed in which you are not sleeping. If you are having trouble going to sleep or staying asleep, don’t stay in bed for more than 20 minutes. Get out of bed and do a quiet activity — read a book, journal, or fold some laundry.

What if I am doing all these things and I still can’t sleep?
This may be a sign that you have a clinical sleep problem, such as insomnia disorder or sleep apnea. If you are doing all the right things, and still have trouble falling or staying asleep, you should discuss your sleep problems with your doctor.

What if I have been diagnosed with a sleep disorder?
If you have a history of insomnia and take sleep medications and can’t sleep, contact your doctor for medical advice, including questions about making changes in your medication. Many doctors are doing virtual visits now and they can review your current sleep problems and changes to management. You can also consider online programs for insomnia, such as Sleeping.

Remember, don’t stress out about sleep

Disrupted sleep is a normal response to stress, and it is okay to have a few nights of poor sleep as you adjust to new routines and big changes to your work and personal life. But with some simple measures you can preserve your sleep and improve your well-being during these uncertain times. We can’t control what’s happening in the world right now, but we can control our behaviors and dampen the impact of the emerging pandemic on our sleep.

*Dr. Suzanne Bertisch writes for Harvard Health Blog

An analysis of pooled data from 15 population studies around the world suggests that higher levels of trace lithium — a metal used in some psychiatric medicines — in public drinking water is associated with lower rates of suicide.

Lithium is primarily prescribed by doctors to help stabilize the moods of people with bipolar disorder and to reduce their risk of suicide.

Most rocks contain trace amounts of the element. Weathering washes it into groundwater and standing water, which is how the chemical finds its way into the public water supply.

Several studies over the years have found associations between relatively high amounts of lithium in drinking water and lower rates of suicide across various populations.

Recently, researchers at Brighton and Sussex Medical School and King’s College London, both in the United Kingdom, have now pooled data from 15 of these studies in a meta-analysis.

The studies included had been conducted in the United States, Austria, Greece, Italy, Lithuania, the U.K., and Japan, encompassing a total of 1,286 regions, counties, and cities.

The new meta-analysis suggests a clear relationship between higher levels of lithium in public drinking water and lower rates of suicide among these populations.

The research has been published in The British Journal of Psychiatry.

Individuals who take lithium as a mood stabilizer are monitored to prevent excess amounts from building up in the blood, which can have toxic effects. However, the amounts of lithium in drinking water are hundreds of times lower than those in medications.

“The levels of lithium in drinking water are far lower than those recommended when lithium is used as medicine, although the duration of exposure may be far longer, potentially starting at conception,” says Prof. Allan Young, the senior author of the new analysis and director of Centre for Affective Disorders at King’s College London.

Possibilities and ethical implications

Suicide is a major cause of preventable death around the world, and public health experts are searching for new ways to reduce the toll and address the underlying suffering of individuals and their loved ones.

The National Institute of Mental Health estimate that, in 2017, more than 47,000 people in the U.S. died by suicide. Among people ages 10–34 years old, suicide was the second leading cause of death after “unintentional injury.”

The World Health Organization (WHO) report that globally there are around 800,000 deaths by suicide every year, which is equivalent to one such death every 40 seconds.

“In these unprecedented times of the COVID-19 pandemic and the consequent increase in the incidence of mental health conditions, accessing ways to improve community mental health and reduce the incidence of anxiety, depression, and suicide is ever more important.” – Lead author Prof. Anjum Memon

The study authors say that the next step may be to investigate the effects of adding lithium in trace amounts to the water supplies of particular communities.

They suggest that the research could focus on communities or areas with a high risk of suicide and high prevalences of mental health problems, chronic substance abuse, and violent criminal behavior.

While this may seem like a promising way of controlling suicide rates at a community level, the notion is highly controversial from an ethical point of view.

In a study paper published in Public Health Ethics in 2019, Dr. Jared Ng, Dr. Manne Sjöstrand, and Prof. Nir Eyal discuss the idea of adding higher levels of lithium to the water sources serving allegedly at-risk communities and critique its ethical implications.

They discuss the potential harms and benefits and focus particularly on the ways in which it would bypass individual autonomy.

“Whether and how we should administer trace amounts of lithium depends in part on what future empirical evidence reveals,” they argue.

‘Grounds for further investigations’?

Commenting on the findings of the current study, Prof. Carmine Pariante, from the Royal College of Psychiatrists, in the U.K., who was not involved in the research, suggests that “This study shows that the boundaries between medication and nutritional interventions are not as rigid as we used to think, opening up the possibility of new treatments that span both domains.”

Speaking to the Science Media Centre, in London, Prof. Keith Hawton, director of the Centre for Suicide Research, at the University of Oxford, observes:

“Whether the results of this review truly indicate a potentially useful element for suicide prevention policy remains unclear. Nevertheless, there would appear to be grounds for further investigating whether supplementing lithium levels in domestic water supplies could help to prevent some deaths, especially in countries with higher suicide rates.”

While the idea of adding a mood-altering chemical to drinking water is controversial, there may be another argument in its favor: There is some evidence that microdoses of lithium may also help reduce the risk of Alzheimer’s disease.

Research in rat models of the disease suggests that lithium could stop the progression of the disease.

Clinical trials investigating the effects of lithium microdoses on the risk of dementia in people, however, have yet to be performed.

Still, an epidemiological study in Denmark found an association between higher levels of lithium consumed by populations in their drinking water and a lower risk of dementia.

Overall, the current findings contribute to an ongoing discussion about the merits and risks of lithium microdoses on mental and neurological health.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.

A new study has found that cannabis may improve the mood of people who experience chronic pain from sickle cell disease.

New research suggests that cannabis may help improve the mood of people with chronic pain from sickle cell disease. This proof of principle study also found that cannabis was a relatively safe intervention.

The research, published in the journal JAMA Network Open, paves the way for future studies to verify the initial findings and expand the investigation on cannabis-based interventions on chronic pain.

According to the Centers for Disease Control and Prevention (CDC), sickle cell disease is a type of red blood cell disorder that causes the cells to become misshapen and look similar to the crescent shape of a sickle.

Sickle red blood cells die sooner than normal cells, which means less oxygen is transported throughout a person’s body. Furthermore, sickle cells tend to clog smaller blood vessels, resulting in acute or chronic pain, infection, and other serious cardiovascular issues.

According to the CDC, treatments for mild pain from sickle cell disease include over-the-counter analgesics, such as ibuprofen and aspirin.

For people in more severe pain from this condition, doctors can often prescribe daily opioid medications, such as morphine. However, opioids come with various side effects and risks, including addiction and overdose.

Consequently, it is important to find other ways of managing the pain associated with sickle cell disease.

Addressing a research gap

In the United States, cannabis is increasingly popular as an analgesic. It is legal for medicinal use in 33 states, as well as the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

Cannabis use as an analgesic has been found to have the best evidence base compared with its use for other interventions. However, the authors of this study note that there are relatively few human studies that explore the use of cannabis as a treatment for pain from chronic health conditions.

To address this issue, the authors developed a double-blind, placebo-controlled, randomized proof of principle study. Their aim was to test the hypothesis that cannabis can effectively relieve chronic pain in adults with sickle cell disease, compared with placebo.

The study enrolled participants who had sickle cell disease and were receiving an opioid analgesic to manage their pain.

Participants were also required to have prior experience of smoking cannabis to ensure that they would be able to inhale the medication and would recognize its effects. However, people currently using cannabis were asked to discontinue their use 1 week before the trial began.

However, the team excluded those who declared themselves to have serious health issues or substance use disorders.

This resulted in a study group of 27 participants, of whom 23 completed the full trial. The researchers included these individuals in the analysis of the results.

During the trial, participants made two 5-day trips to an inpatient research center that were at least 30 days apart. They inhaled either vaporized cannabis or a vaporized placebo three times a day.

During this period, the researchers assessed participants’ pain levels and the interference of pain in a range of daily activities and mood. They also monitored the side effects.

Reducing the effect of pain on mood

The researchers found that inhaled, vaporized cannabis did not significantly improve the intensity of participants’ experience of pain compared with a placebo.

However, they observed that when participants inhaled vaporized cannabis, the pain interfered less with the participants’ mood.

Finally, cannabis use did not have any significant adverse side effects compared with the placebo.

According to Dr. Kalpna Gupta, Professor of Medicine at the University of California Irvine’s Center for the Study of Cannabis and co-lead author of the study:

“These trial results show that vaporized cannabis appears to be generally safe. They also suggest that sickle cell patients may be able to mitigate their pain with cannabis — and that cannabis might help society address the public health crisis related to opioids. Of course, we still need larger studies with more participants to give us a better picture of how cannabis could benefit people with chronic pain.”

This research does have limitations. As a proof of principle study, it only had a small number of participants, meaning that larger studies are necessary to verify its findings.

Furthermore, aside from the short treatment duration, the participants took the vaporized cannabis three times a day during the study. This might not reflect how people typically use medical cannabis to manage their pain.

However, the research findings show promise for the development of new treatments to manage chronic pain.

Serious senior woman in her 90s, with eyes closed. CreativeContentBrief 686998459: Senior Portrait

A study looks at the impact of having both hearing and vision impairment on the chances of developing dementia.

Researchers have linked hearing impairment and vision impairment individually to an increased chance of developing dementia. However, a new study finds that an individual’s chances of developing dementia are significantly higher when they have both conditions.

The risk of developing dementia increases by 86% for individuals who have both hearing and visual impairment.

“Evaluation of vision and hearing in older adults may predict who will develop dementia and Alzheimer’s. This has important implications for identifying potential participants in prevention trials for Alzheimer’s disease, as well as whether treatments for vision and hearing loss can modify risk for dementia.” – Study lead author Phillip H. Hwang, University of Washington

Re-purposing a previous study’s data

The research, “Dual sensory impairment in older adults and risk of dementia from the GEM Study,” appears in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

According to the study, some 33% of people aged 70 and older experience hearing loss, and vision loss affects about 18% of people in this age group. Since these conditions worsen with age, researchers think that a correlation exists between the advance of these conditions and the loss of a person’s functionality and mortality.

Previous research found a less obvious connection between hearing or visual loss and the onset of dementia.

The two leading theories indicate that either these specific impairments result from similar physical processes that cause dementia, or that hearing and visual loss lead to an increasing sense of social isolation, depression, and physical inactivity, each of which may lead to dementia.

The new study looks at the impact of having both conditions together. It refers to this combination as “dual sensory impairment.” According to the study:

“Although most prior studies have focused on impairments in hearing and vision individually, the impact of having combined hearing and visual impairment, or dual sensory impairment (DSI), on dementia risk is unclear.”

To investigate the impact of DSI on developing dementia, the researchers analyzed data collected by the Gingko Evaluation of Memory (GEM) study, a double‐blind randomized‐controlled trial investigating the value of Ginkgo biloba for preventing dementia in older people.

The GEM study involved adults aged 75 or older who, at the outset of the study, had normal cognitive function, or at most, mild dementia. The researchers studied the participants for 8 years.

In addition to collecting self-reported data regarding the individuals’ hearing and vision, follow-up examinations of participants assessed the development of dementia.

DSI and the risk of dementia

The final data set that Hwang and his colleagues studied consisted of 2,051 individuals. Of these, 1,480 people had neither hearing nor visual loss. 14.9% reported visual impairment, and 7.8% reported hearing loss. Just 5.1%, or 104 individuals, had DSI.

Compared to participants who did not have hearing or visual loss, those reporting DSI were more likely to be male, have other comorbidities, and describe themselves as smokers and drinkers.

The GEM study’s follow-up examinations revealed the following likelihoods of developing dementia:

  • 14.3% of those without any reported hearing or vision loss developed dementia.
  • 16.9% of those reporting a single impairment developed dementia.
  • 28.8% of those with DSI developed dementia.

People with both hearing and visual loss were nearly twice as likely to develop dementia as those without such impairments.

However, according to the results, the increased risk of dementia for an individual with DSI is only somewhat related to the severity of hearing and visual impairment.

While those classified as having a high level of DSI are at the greatest risk of developing dementia, those with lower DSI levels also have a significantly higher risk of dementia.

Risk for different forms of dementia

The researchers analyzed the link between DSI and three types of dementia: all-cause dementia, Alzheimer’s-related dementia, and vascular dementia.

The chances of acquiring Alzheimer’s’-related dementia are even higher. The study indicated that people with DSI are 112% more likely to develop Alzheimer’s than those without any impairment.

Hwang and his colleagues found no association between DSI and vascular dementia.

The implications of this research

The study’s conclusions suggest that doing more to mitigate hearing and visual loss in older people may be a way to hold off or thwart the onset of dementia.

The authors conclude, “Further research is needed to characterize the exact role of sensory impairments and whether treatments that improve sensory function, such as surgery or sensory aids, devices, and prostheses, can modify this risk.”

The study’s authors add that shifts toward an older general population make addressing the prevalence of dementia in the elderly more urgent.

They write: “Because the public health burden of dementia will increase over the next three decades, evaluation of vision and hearing function in older adults may help identify patients at elevated risk of developing dementia.”

Photo series of a virtual dinner date with video call during lockdown.

New research suggests that low-to-moderate alcohol consumption may reduce cognitive decline in older adults.

A new study has found that low-to-moderate alcohol consumption may slow cognitive decline in adults of middle age or older.

The research, which appears in the journal JAMA Open Network, lays the ground for future research to corroborate these findings and determine the underlying mechanism for the relationship.

Alcohol and health

Drinking alcohol is a central part of many cultures across the world. Beyond the immediate adverse effects of a hangover, drinking alcohol in excess has associations with various poor health outcomes.

According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use includes heavy drinking (more than eight or 15 drinks a week for women and men, respectively), binge drinking (drinking four or five drinks in about 2 hours for women and men, respectively), or drinking while underage or pregnant.

The CDC define a drink as 14 grams of pure alcohol. This amount roughly equates to a 12-ounce (oz) can of 5% beer, a 5-oz glass of 12% wine, a 4-oz glass of 15% wine, or a single 1.5-oz shot of 40% distilled spirit or liquor.

The CDC note that excessive alcohol drinking is associated with various health problems. These include:

  • damage to the liver
  • inflammation of the pancreas
  • increased risk of cancer
  • hypertension
  • psychological disorders
  • unintentional injuries that a person sustained while drunk
  • harm to the fetus if a woman drinks while pregnant
  • sudden infant death syndrome
  • alcohol use disorder

Research has shown that the misuse of alcohol is a leading cause of illness and death and that any level of alcohol drinking, particularly in men who drink spirits, increases the risk of high blood pressure and stroke.

However, there is also evidence that low-to-moderate alcohol consumption — fewer than eight or 15 standard drinks in the United States per week for women and men, respectively — can have a beneficial effect on health, including various cardiovascular diseases.

The effects of low-to-moderate alcohol consumption on cognitive decline in later life have been mixed. Some research has found evidence that it may be protective, while other research suggests that it is probably not harmful. Conversely, some studies have found that it can exacerbate poor brain health.

The authors of the present study noted that previous studies exploring the relationship between alcohol consumption and cognitive decline are often limited in two ways.

First, they typically rely on single measures of cognitive decline, when it can present in a variety of ways. Second, they typically take into account net follow-up time to cognitive decline, despite the decline often being greater or lesser depending on age rather than general time passed.

As a consequence, the authors of the present research developed their study to take these factors into account, with the aim of better understanding the effects of low-to-moderate alcohol consumption on cognitive decline in older age.

About 20,000 participants

The authors drew on data from the Health and Retirement Study, which was a longitudinal study involving about 20,000 adults of middle age or older living in the U.S.

The sample that the researchers used was representative of the U.S. population, and they tracked the participants for an average time of 9.1 years.

The team regularly assessed the participants’ cognitive functioning during this time, focusing on three measures: total word recall, mental status, and vocabulary. They split the participants into those with persistently high scores across time and those with persistently low scores across time.

The participants also gave information on how many alcoholic drinks they consumed on average. During the data analysis, the researchers separated them into three groups: those who never drank, those who used to drink, and those who currently drink.

They then further classified drinkers as low-to-moderate drinkers (fewer than eight or 15 drinks per week for women and men, respectively), or heavy drinkers (more than moderate drinking).

Low-to moderate drinking may protect against cognitive decline

After analyzing the data, the researchers found that low-to-moderate drinking was associated with better cognitive outcomes across all three measures for middle-aged and older adults.

As other factors could be responsible for this association, the researchers took age, sex, race/ethnicity, educational level, marital status, and body mass index (BMI) into account in the analysis. The association between consistently high cognitive scores and low-to-moderate drinking persisted.

While this was true in general across the study, the researchers found that the association between low-to-moderate alcohol consumption and protection against cognitive decline was stronger for white participants than for Black participants. However, there were fewer Black participants, and this could account for the lack of strong association.

The researchers also noted that about 5% of women and 15% of men drank excessive amounts of alcohol, meaning that public health awareness campaigns that focus on this issue are still crucial. Drinking more than 14 drinks (self-defined) had worse cognitive outcomes for vocabulary, while more than 10 drinks impacted negatively on word recall.

Future research

While the study demonstrates an association between low-to-moderate alcohol drinking and protection against cognitive decline in later life, it is not yet clear why this is the case. According to study author Dr. Ruiyuan Zhang of the Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, and his co-authors:

“The role of alcohol drinking in cognitive function may be a balance of its beneficial and harmful effects on the cardiovascular system. Among low-to-moderate drinkers, the beneficial effects may outweigh the harmful effects on the cardiovascular system.”

Future research to corroborate the study’s findings is important, given the previous conflicting research on the topic. In addition, if research conclusively demonstrates low-to-moderate alcohol consumption as protective against cognitive decline in older age, future research to help understand why this is the case is important so that clinicians can best advise their patients.

In the short-term, eating too much sugar may contribute to acne, weight gain, and tiredness. In the long-term, too much sugar increases the risk of chronic diseases, such as type 2 diabetes and heart disease.

According to the Centers for Disease Control and Prevention (CDC), people in the United States consume too much added sugar. Added sugars are sugars that manufacturers add to food to sweeten them.

In this article, we look at how much added sugar a person should consume, the symptoms and impact of eating too much sugar, and how someone can reduce their sugar intake.

How much sugar is too much? 

According to the Dietary Guidelines for Americans 2010-2015, on average, Americans consume 17 teaspoons (tsp) of added sugar each day. This adds up to 270 calories.

However, the guidelines advise that people limit added sugars to less than 10% of their daily calorie intake. For a daily intake of 2,000 calories, added sugar should account for fewer than 200 calories.

However, in 2015, the World Health Organization (WHO) advised that people eat half this amount, with no more than 5% of their daily calories coming from added sugar. For a diet of 2,000 calories per day, this would amount to 100 calories, or 6 tsp, at the most.

Symptoms of eating too much sugar

Some people experience the following symptoms after consuming sugar:

  • Low energy levels: 2019 study found that 1 hour after sugar consumption, participants felt tired and less alert than a control group.
  • Low mood: A 2017 prospective study found that higher sugar intake increased rates of depression and mood disorder in males.
  • Bloating: According to Johns Hopkins Medicine, certain types of sugar may cause bloating and gas in people who have digestive conditions, such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO).

Risks of eating too much sugar 

Consuming too much sugar can also contribute to long-term health problems.

Tooth decay

Sugar feeds bacteria that live in the mouth. When bacteria digest the sugar, they create acid as a waste product. This acid can erode tooth enamel, leading to holes or cavities in the teeth.

People who frequently eat sugary foods, particularly in between mealtimes as snacks or in sweetened drinks, are more likely to develop tooth decay, according to Action on Sugar, part of the Wolfson Institute in Preventive Medicine in the United Kingdom.

Acne

2018 study of university students in China showed that those who drank sweetened drinks seven times per week or more were more likely to develop moderate or severe acne.

Additionally, a 2019 study suggests that lowering sugar consumption may decrease insulin-like growth factors, androgens, and sebum, all of which may contribute to acne.

Weight gain and obesity

Sugar can affect the hormones in the body that control a person’s weight. The hormone leptin tells the brain a person has had enough to eat. However, according to a 2008 animal study, a diet high in sugar may cause leptin resistance.

This may mean, that over time, a high sugar diet prevents the brain from knowing when a person has eaten enough. However, researchers have yet to test this in humans.

Diabetes and insulin resistance

2013 article in PLOS ONE, indicated that high sugar levels in the diet might cause type 2 diabetes over time.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) add that other risk factors, such as obesity and insulin resistance, can also lead to type 2 diabetes.

Cardiovascular disease

A large prospective study in 2014 found that people who got 17–21% of their daily calories from added sugar had a 38% higher risk of dying from cardiovascular disease (CVD) than those who consumed 8% added sugars. For those who consumed 21% or more of their energy from added sugars, their risk for CVD doubled.

High blood pressure

In a 2011 study, researchers found a link between sugar-sweetened beverages and high blood pressure, or hypertension. A review in Pharmacological Research states that hypertension is a risk factor for CVD. This may mean that sugar exacerbates both conditions.

Cancer

Excess sugar consumption can cause inflammationoxidative stress, and obesity. These factors influence a person’s risk of developing cancer.

A review of studies in the Annual Review of Nutrition found a 23–200% increased cancer risk with sugary drink consumption. Another study found a 59% increased risk of some cancers in people who consumed sugary drinks and carried weight around their abdomen.

Aging skin

Excess sugar in the diet leads to the formation of advanced glycation end products (AGEs), which play a role in diabetes. However, they also affect collagen formation in the skin.

According to Skin Therapy Letter, there is some evidence to suggest that a high number of AGEs may lead to faster visible aging. However, scientists need to study this in humans more thoroughly to understand the impact of sugar in the aging process.

How to eat less sugar

A person can reduce the amount of added sugar they eat by:

  1. checking food labels for sweeteners
  2. reducing foods with added sugar
  3. avoiding processed foods in general

Checking food labels

Added sugar and sweeteners come in many forms. Ingredients to look out for on a food label include:

  • brown sugar
  • fructose
  • glucose
  • sucrose
  • maltose
  • honey
  • corn sweetener
  • corn syrup
  • high fructose corn syrup
  • raw sugar
  • molasses
  • malt syrup
  • evaporated cane juice
  • agave nectar
  • maple syrup
  • invert sugar
  • fruit juice concentrates
  • trehalose
  • turbinado sugar

Some of these ingredients are natural sources of sugar and are not harmful in small amounts. However, when manufacturers add them to food products, a person might easily consume too much sugar without realizing it.

Reducing foods that contain added sugar

Some food products contain large amounts of added sugars. Reducing or removing these foods is an efficient way to reduce the amount of sugar a person eats.

The Dietary Guidelines for Americans 2010–2015 state that soda and other soft drinks account for around half a person’s added sugar intake in the U.S. The average can of soda or fruit punch provides 10 tsp of sugar.

Another common source of sugar is breakfast cereal. According to EWG, many popular cereals contain over 60% sugar by weight, with some store brands containing over 80% sugar. This is especially true of cereals marketed towards children.

Swapping these foods for unsweetened alternatives will help a person lower their sugar intake, for example:

  • swapping soda for water, milk, or herbal teas
  • swapping sugary cereals for low sugar cereal, oatmeal, or eggs

Avoiding processed foods

Manufacturers often add sugars to foods to make them more appealing. Often, this means people do not realize how much sugar a food contains.

By avoiding processed foods, a person can get a better sense of what their food contains. Cooking whole foods at home also means someone can control what ingredients they put into their meals.

When to see a doctor

People should see their doctor if they experience the symptoms of high blood sugar. According to the NIDDK, symptoms include:

  • increased thirst and urination
  • increased hunger
  • fatigue
  • blurred vision
  • numbness or tingling in the hands or feet
  • unexplained weight loss
  • sores that do not heal

These symptoms may indicate a person has diabetes. A doctor can test for diabetes by taking a urine sample.

People should also speak to a doctor if they experience other symptoms after eating sugar, such as bloating.

Summary

Consuming too much added sugar has many adverse impacts on health, including tiredness and weight gain, and more severe conditions, such as heart disease. Added sugars are present in many processed foods and drinks.

People can reduce their sugar intake by knowing what to look for on food labels, avoiding or reducing common sources of sugar, such as soda and cereals, and prioritizing unprocessed whole foods.

If a person is concerned about weight gain, symptoms that may indicate diabetes, or other symptoms they experience after eating sugar, they should speak to a doctor.

A study of people experiencing a first episode of psychosis has shown that higher levels of the antioxidant glutathione are associated with quicker responses to treatment and may improve early intervention outcomes.

The time that it takes for somebody to respond to treatment for psychosis is a key indicator of their long-term outcome.

Psychosis can be a symptom of a number of psychiatric disorders, including schizophrenia and schizoaffective, bipolar, and major depressive disorders.

In around one-third of people with schizophrenia, the condition is considered resistant to treatment. This is associated with more severe symptoms and more time spent in the hospital.

The medical community has yet to fully understand why some people respond to antipsychotic treatments within weeks, while others take months.

A new study that appears in Molecular Psychiatry set out to understand this disparity. In a collaborative effort among a range of Canadian institutions, researchers looked at the levels of a protective antioxidant in the brains of people experiencing a first episode of psychosis.

They found that higher levels of the antioxidant were associated with quicker response to treatment, suggesting that boosting the amount of the antioxidant in the brain could improve outcomes for people experiencing psychosis.

The glutathione-glutamate balance

In the study, the researchers investigated an antioxidant called glutathione. Scientists believe that glutathione protects neurons against free radicals, which are highly reactive molecules known to damage cells. Glutathione is the most prominent antioxidant found in brain cells.

Some studies have found a lack of glutathione in people experiencing psychosis, specifically in the cingulate cortex — a part of the brain associated with emotion regulation, which is highly important in schizophrenia.

The lack of glutathione seems to be most striking in patients who have continuing symptoms, even after receiving treatment, suggesting that the molecule could be associated with response to treatment.

Glutathione is also important in relation to another chemical called glutamate. At high levels, glutamate can be toxic to neurons, and this is known to occur in first-episode psychosis. Excess glutamate has also been associated with reduced responsiveness to the treatment of psychosis.

These two chemicals are tightly linked in the brain; glutamate is a precursor of glutathione, and glutathione can protect the brain when glutamate levels become dangerously high.

Ultrapowerful imaging

To measure the levels of these two chemicals in the brain, and specifically in the cingulate cortex, the researchers behind the present study used a type of MRI called ultrahigh field magnetic resonance spectroscopy.

The research involved 26 people with a diagnosis of a schizophrenia spectrum disorder who had been referred to the Prevention and Early Intervention Program for Psychoses, at the London Health Sciences Centre, in Ontario.

All participants provided written consent and were recruited before they received antipsychotic treatment. The team separately recruited healthy controls, 27 in total, with no personal or family history of psychosis.

The team measured brain antioxidant levels, both before the patients started treatment for psychosis and 6 months later.

Boosting brain antioxidants

The researchers found no significant differences in levels of glutathione between the group with schizophrenia spectrum disorders and the control group. However, there were important differences among the participants with schizophrenia.

In particular, the team found that having higher glutathione levels was associated with responding to treatment more quickly.

Conversely, higher levels of glutamate were associated with having greater social difficulties. The researchers determined this using the Social and Occupational Functioning Assessment Scale, which measures function in social or work situations.

The findings suggest that higher levels of glutathione — which help regulate levels of glutamate — could help people with schizophrenia or other conditions that cause psychosis respond more quickly to treatment and have better overall outcomes.

Dr. Lena Palaniyappan, an associate professor at the University of Western Ontario and the senior author of the study, explains, “This study demonstrates that if we can find a way to boost the amount of antioxidants in the brain, we might be able to help patients transition out of hospital more quickly, reduce their suffering more quickly, and help them return earlier to their work and studies.”

The authors suggest that interventions to increase glutathione levels in the brain could be a valuable therapeutic avenue.

The researchers estimate that just a 10% increase in glutathione levels could reduce the time that a person spends in the hospital by at least 1 week. And this may not be too difficult to achieve, as a supplement called N-acetylcysteine has already been shown to increase antioxidant levels in the brain and improve symptoms of schizophrenia.

Surveys from around the world show that men everywhere find it difficult to open up about mental health, though they are significantly more at risk of attempting suicide than women. In this Special Feature, we look at why this may be and how to address this issue.

In high-income countries, three times as many men as women die by suicide, according to a World Health Organization (WHO) report from 2018.

The American Foundation for Suicide Prevention also cite 2018 data, noting that in that year alone, “Men died by suicide 3.56 [times] more often than women” in the United States.

And Mental Health America, a community-based nonprofit, reference data suggesting that more than 6 million men in the U.S. experience symptoms of depression each year, and more than 3 million experience an anxiety disorder.

Despite these staggering figures, the National Institute of Mental Health (NIMH) report that men are less likely than women to have received formal mental health support in the past year.

Why is this the case? Recent research offers some explanations and proposes ways of remedying the situation.

Stigma around men’s mental health

In their 2018 report, the WHO emphasize that cultural stigma surrounding mental health is one of the chief obstacles to people admitting that they are struggling and seeking help.

And this stigmatization is particularly pronounced in men.

“Described in various media as a ‘silent epidemic’ and a ‘sleeper issue that has crept into the minds of millions,’ with ‘chilling statistics,’ mental illness among men is a public health concern that begs attention.”

Thus begins a study from The University of British Columbia (UBC), in Vancouver, Canada, published in 2016 in Canadian Family Physician.

Its authors explain that prescriptive, ages-old ideas about gender are likely both part of the cause behind the development of mental health issues in men and the reason why men are put off from seeking professional help.

Another study from Canada — published in Community Mental Health Journal in 2016 — found that, in a national survey of English-speaking Canadians, among 541 respondents with no direct experience of suicidal ideation or depression, more than one-third admitted to holding stigmatizing beliefs about mental health issues in men.

And among this group, male respondents were more likely than females to hold views such as: “I would not vote for a male politician if I knew he had been depressed,” “Men with depression are dangerous,” and “Men with depression could snap out of it if they wanted.”

Among 360 respondents with direct experience of depression or suicidal ideation, more male than female respondents said that they would feel embarrassed about seeking formal treatment for depression.

One contributor who spoke to Medical News Today also pointed out that it is not easy for men to be open with their peers about mental health struggles.

“Talking about mental health isn’t something that tends to come up readily in particular social environments, such as when playing football,” he told us.

“Often, the relationships there are tied into the game and little else away from the pitch, which is a real shame,” he added.

Further stumbling blocks for men of color

Men of color and men of diverse racial and ethnic backgrounds face additional challenges when it comes to looking after their mental health.

According to Prof. Norman Bruce Anderson, former CEO of the American Psychological Association — in the U.S., Black and Latino men are six times more likely to be murdered than their white peers.

Prof. Anderson also notes that American Indian men are the demographic most likely to attempt suicide and that Black men are most likely to experience incarceration.

According to Dr. Octavio Martinez Jr., executive director of the Hogg Foundation for Mental Health, the effect of these disparities on the mental health of people of color and of diverse ethnic and racial backgrounds is “a double whammy.”

“Add the stigmatization of help-seeking behavior by men of all races to the unique stressors faced by men and boys of color, and it’s no wonder men and boys of color are at higher risk for isolation and mental health problems. These challenges can manifest as substance use or acting out through violence and aggression — which can lead to more stigma and a continuation of the cycle.”

On top of this, the authors of a study published in 2015 in the Journal of Health Care for the Poor and Underserved point out that “Medical experimentation on African Americans during slavery laid a foundation of mistrust toward healthcare providers.”

All of these issues taken together lay a further barrier to people of color seeking and accessing care for mental health when they need it.

Men may have different symptoms

Specialists also point out that men and women can experience different symptoms of the same mental health issues. This, they say, may be partly a “side effect” of divergent views of mental health.

For instance, NIMH specialists explain that “Some men with depression hide their emotions and may seem to be angry, irritable, or aggressive, while many women seem sad or express sadness.”

They also note that some symptoms of depression are physiological, such as a racing heart, digestive issues, or headaches, and men “are more likely to see their doctor about physical symptoms than emotional symptoms,” according to the NIMH.

The organization also note that self-medicating with alcohol and other substances is a common symptom of depression among men and that this can exacerbate mental health problems and increase the risk of developing other health conditions.

So what can mental health professionals and policymakers do to ensure that men feel confident and comfortable seeking support and that they receive the appropriate care?

Better mental health education

The first step in addressing these issues, researchers argue, is enhancing education about mental health.

In the Canadian Family Physician study, the researchers emphasize the importance of “disrupting how men traditionally think about depression and suicide by breaking down the stigma that surrounds these topics” through nationwide campaigns.

They also explain that it is important to help men change the idea of receiving support from “a mark of weakness” to a necessary step in maintaining one aspect of health that is as important as any other.

Anecdotal evidence supports these suggestions. One MNT respondent, for instance, told us that:

“[One] area I feel needs improvement is education. […] I had spells of bad mental health in my childhood. It wasn’t until my teenage years, when I became aware of my mother’s and grandfather’s history of mental health problems, that I realised what was going on with me. As a child, feeling anxious and/or depressed for no apparent reason was terrifying and only made my symptoms worse.”

“Also, not knowing what was going on made me embarrassed, and I usually wouldn’t tell anyone what was going on with me,” this contributor went on to say.

“I don’t know for sure, but if there had been education about mental health in my childhood, I reckon my symptoms wouldn’t have scared me as much, and I would have been more open about talking about it with my parents, teachers, healthcare professionals, etc.”

Another step in providing better support for men, the UBC researchers say, is “changing the landscape” of care for mental health by offering community-based programs that help counter risk factors for mental health problems, such as a sense of isolation among older people.

But no intervention is complete until it accounts for the groups that face systematic marginalization, such as men of color and those of diverse ethnic and racial backgrounds.

Specialists have found that Black men in the U.S. are more likely to seek support in informal settings, such as places of worship. Based on this, they have suggested “community-based participatory research” as an important first step.

This approach will require researchers to gain trust and seek collaboration from Black Americans in finding out what needs to change to make formal support more accessible.

Dr. Martinez, referring to a report from 2014, also emphasizes the importance of community-based approaches.

He promotes interventions aimed to encourage men and boys of color and of diverse backgrounds to connect on a personal level. “Stigma fades when men and boys see resilience and mental health self-care modeled by their fathers, brothers, teachers, faith leaders, and friends,” he says.

“Seek ways to demonstrate the connection between individual mental health and popular traditions of mentorship, cultural pride, self-emancipation and community action among men.”

A study in mice has found that scientists can switch off a gene responsible for an aggressive form of breast cancer. Silencing the gene not only shrinks tumors but also prevents their spread around the body.

Around one in eight females in the United States will develop breast cancer, according to the American Cancer Society.

In 2019, doctors diagnosed an estimated 268,600 new cases of invasive breast cancer in females in the U.S., while around 41,760 individuals died from the disease.

Up to a fifth of breast cancers are a more aggressive form known as triple-negative breast cancer that is difficult to treat.

Unlike the majority of breast cancers, estrogen and progesterone do not fuel the growth of triple-negative tumors, so drugs, such as tamoxifen, that block these hormones are ineffective.

A molecule that switches off a particular gene in triple-negative tumors could be a promising alternative treatment, according to research at Tulane University School of Medicine in New Orleans, LA.

The scientists report their discovery in the Nature journal Scientific Reports.

The effect of gene silencing

The research combined in vitro studies of cells growing in dishes with in vivo studies involving mice.

The team began by working with cultures of a triple-negative cancer cell line that originally came from a patient treated in 1973 at the M. D. Anderson Cancer Center in Houston, TX.

The researchers compared the effects of switching off two known breast cancer genes, one called Rab27a and the other TRAF3IP2.

To deactivate or “silence” the genes, they targeted them with molecules of short hairpin RNAs called lentiviral-TRAF3IP2-shRNA. These are strands of RNA twisted back on themselves like a hairpin that prevent a specific gene from being read or “transcribed” to make a protein.

The researchers discovered that switching off TRAF3IP2 had a more disruptive effect on cancer-associated metabolic pathways in the cells than switching off Rab27a.

They confirmed this by switching off the genes individually in a mouse model of breast cancer.

Switching off Rab27a did slow down tumor growth in the mice, but a very small number of cancer cells spread, or “micrometastasized.”

When the researchers switched off TRAF3IP2, however, this not only suppressed new tumor growth but also prevented metastasis for up to 1 year. Better still, the treatment shrank existing tumors until they were undetectable.

“This exciting discovery has revealed that TRAF3IP2 can play a role as a novel therapeutic target in breast cancer treatment,” says Dr. Reza Izadpanah, assistant professor of medicine at Tulane University School of Medicine, who led the research.

Future studies ‘to further validate’ findings

The scientists are now seeking approval from the Food and Drug Administration (FDA) to start clinical trials as soon as possible.

They write that, first, they will need to confirm their results by transplanting breast cancer cells from human patients into mice, in a process known as ‘xenotransplantation.’

“A limitation of the present study is that we used a single breast cancer cell line to investigate potential roles of silencing Rab27a and TRAF3IP2 on tumor growth. Our future studies will involve the use of patient-derived xenotransplants to further validate these fundamental first in vivo and in vitro results.”

– Eckhard U. Alt et al.

Silencing TRAF3IP2 may turn out to be an effective treatment in several cancers and even heart failure.

The gene is known to activate various cellular pathways that promote inflammation, which plays an important role not only in cancer but also in heart failure.

In their breast cancer research, the team at Tulane School of Medicine collaborated with Dr. Chandrasekar Bysani at the University of Missouri School of Medicine in Columbia, who identified the part played by TRAF3IP2 in promoting inflammation in heart failure.

Dr. Bysani also took part in recent research that found that switching off TRAF3IP2 could be an effective strategy for treating glioblastoma, a malignant type of brain cancer.

Encephalitis is a rare condition that is most often caused by viruses (viral encephalitis). It can also be caused by non-infectious diseases, such as systemic lupus erythematous and Behcet’s disease (an autoimmune disorder). The leading cause of severe encephalitis is the herpes simplex virus.

Other causes include enterovirus infections or mosquito-borne viruses; Eastern equine encephalitis (EEE); Western equine encephalitis (WEE); Venezuelan equine encephalitis (VEE); Japanese encephalitis; and Zika virus.

The very young and the elderly are more likely to have more severe encephalitis.

Exposure to viruses can occur through breathing in respiratory droplets from infected people, certain insect bites, and direct skin contact.

What are encephalitis symptoms and signs?
The signs and symptoms of encephalitis can range from very mild flu-like symptoms to potentially life-threatening events. Signs and symptoms of encephalitis include sudden fever, headache, vomiting, visual sensitivity to light, stiff neck and back, confusion, drowsiness, unsteady gait, irritability, loss of consciousness, poor responsiveness, seizures, muscle weakness, sudden severe dementia, and memory loss.

How do health care professionals diagnose encephalitis?
A health care professional diagnoses encephalitis after performing a thorough history and exam. The exam will incorporate special techniques to look for signs of inflammation of the membranes that surround the spinal cord and brain (meninges). The doctor will order specific tests to help determine the diagnosis.

Tests that evaluate individuals suspected of having encephalitis include cerebrospinal fluid analysis, brain scanning such as computerized tomography scan (CT or CAT scan)/ Magnetic resonance imaging (MRI) scan, and an evaluation of the blood for infection and the presence of bacteria.

The most common method of obtaining a sample of cerebrospinal fluid (or CSF) for examination is a spinal tap. A spinal tap, or lumbar puncture (LP), involves the insertion of a needle into the fluid within the spinal canal. The needle goes between the spine’s bony parts until it reaches the CSF. A medical professional then collects a small amount of fluid to send to the laboratory for an exam.

Evaluating the CSF is necessary for a definitive diagnosis of encephalitis and to decide on the best treatment options.

Abnormal spinal fluid results confirm the diagnosis and, in the event of an infection, by identifying the organism that caused the infection.

What is the treatment of encephalitis?
People require urgent treatment with antibiotics and/or antiviral medications if a physician suspects that person has encephalitis. Patients may need to take sedatives for irritability or restlessness. Doctors may administer other medications to decrease fever or treat headaches.

Prevention
Basic steps to avoid the spread of infections (handwashing, covering mouth when coughing, etc.) can help prevent encephalitis.

*Dr. Nwaoney is an epidemiologist, Chief Executive Officer (CEO) and Medical Director of Richie Hospital and El Shaddai Group.