People don’t generally connect diet with mental health, and it’s certainly not on the radar of most health professionals when treating depression. But as global rates of depression and other non-communicable diseases have risen, the average diet quality has changed drastically.
Recent studies have shown that not only are diet and depression related, but people with unhealthy diets are more likely to become depressed. (That’s even after controlling for factors like smoking, alcohol, physical activity, marital status, education, and income.) Conversely, healthy diets are protective.
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After years of exploring the effects of nutritional supplements on mental health as a researcher at the University of South Australia, I became frustrated. After all, people eat food, not nutrients. Food delivers a virtual orchestra of vitamins, minerals, proteins, fats, carbohydrates, fiber, and phytonutrients, all of which contribute to the symphony that is our living body and brain.
It’s no accident I say body and brain — they are intimately connected. Confirming Hippocrates’ observation circa 400 BC, scientists have identified multiple connections between the brain and the rest of your body. Most revealing are pathways between the brain and gut. This “gut-brain axis,” or the biochemical signaling between your gastrointestinal tract and nervous system, can affect everything from mood to libido. (And vice versa. Think of the queasy, fluttering feeling in your stomach before a speech or job interview.)
So what does the gut-brain axis tell us about depression? This debilitating condition afflicts over 300 million people and carries the largest burden of disease worldwide. Not the least of that burden is a higher rate of heart disease and other protracted ailments. Biological factors, like inflammation, poor nutrition, and dysbiosis (imbalanced gut bacteria), are related to both physical illness and depression, so they might help explain this connection. But the best way to show cause and effect – to answer the question of whether diet improves mood, or if depression causes poor diet – is with a randomized controlled trial.
So in 2014 and 2015, my team recruited people with depression. We eventually signed up 152 people, ages of 18 to 65, with self-reported or diagnosed depression. These volunteers visited our clinic for blood tests and completed questionnaires about their diet and mental health. Then we randomly allocated them to a diet intervention or control group. To keep everything else constant, participants were instructed not to change any existing treatments or start any new ones.
Running this kind of study is no easy task, and our group was one of the first to do it in people with depression. In some clinical trials, it’s easy to design a controlled experiment: participants take an active supplement or placebo and everyone finds out afterward which one they took. But changing people’s diets is a different matter. First, we researched strategies that nudge people towards healthier eating. Then we tested the program. Our multi-pronged approach included interactive nutrition education, individual goal setting, food hampers, recipes and – yes – cooking workshops. Eat your heart out, MasterChef. My post-doc, Dorota Zarnowiecki, and I even made some cooking videos, bloopers and all. (Turns out, you can’t put an onion back together if you messed up while chopping it.)
Depressed people often feel better just by engaging in research or activities that generate peer support. So volunteers allocated to the control group not only continued their normal diets, they attended social groups instead of cooking workshops. In these they shared holiday tales, played games, amused themselves with personality tests, and enjoyed tea and snacks. Cooking workshops and social groups were held once a fortnight for three months. Our team was so wonderful that everyone enjoyed themselves – I even started worrying the social group was having too much fun.
Cook like a nonna
Married to an Italian whose parents cultivated their own produce and pressed home-grown olives into oil, I am partial to a Mediterranean diet. It turns out abundant research strongly supports this traditional diet’s health benefits for chronic disease, and its bountiful nutrients sustain healthy brain function. So this is what we recommended.
Over years of cooking for a family while studying and working, I had developed a portfolio of simple, quick, tasty Mediterranean-style meals that could be reheated as leftovers or frozen. Popular recipes included chili beans with avocado, eggplant parmigiana, and Greek lentil soup. They sound simple – and they are. One participant summed it up nicely: “I like the fact that you turn up to a cooking class and you’ve got half a dozen ingredients sitting on a bench, and you sort of look at them and go, ‘Oh, that’s not gonna add up to much.’ But then you cook it up and go, ‘Wow, that small number of ingredients cooked up to make such delicious food.’”
The recipes embodied Mediterranean diet principles: abundant plant foods like vegetables, fruit, legumes, nuts, seeds, and olives, as well as generous dollops of extra virgin olive oil, fish, and moderate portions of dairy. Traditional Mediterraneans ate virtually no processed food like refined grains, sweets, or red meat. Because people with mental illness have particularly low omega-3 levels, we also supplemented the diet group with fish oil to boost their omega-3s.
One of the challenges we faced was that human studies are often plagued by drop-outs. Several people pulled out before they even got to baseline assessment — understandable if you suffer depression. Others left once they discovered their group allocation. (Many wanted to do the dietary intervention.) So we ended up testing 95 people after three months, and 85 after six months. Fortunately, clever statistical analyses enabled us to factor in all cases; in other words, to estimate the missing data for those who had left the program.
As suspected, the results showed all mental health parameters improved in both groups. But mood improved significantly more in the Mediterranean diet group: the severity of depressive symptoms was 45 percent lower in the diet group, compared to 26.8 percent in the social group. At the beginning of the study, 80 percent of all participants reported ‘extremely severe’ depression; this dropped by 60 percent overall. Some people made life changes and got new jobs. One participant went so far as to describe herself as “born again,” saying, “It’s really changed me – it’s changed my life.” She now uses her deep-fryer basket to blanch bulk vegetables.
Our budding chefs rejoiced in shunning low-fat diets and embracing extra virgin olive oil – and some even lost weight. Many reported a new-found love of legumes. But others found it hard; for instance, when going out, or if partners or children were reluctant to depart from old favorites. Our team reported that encouraging participants to plan ahead helped some of them mitigate these barriers.
How we can be confident these changes in diet played a role in the participants’ recovery? The diet group increased their Mediterranean diet score on a 14-item questionnaire, and reported eating more fruit, vegetables, nuts, legumes, and greater diversity of fruit and vegetables. They also ate less red meat and unhealthy snacks. Better yet, improved diet and the correlated mental health changes were still apparent at six-month follow up assessments. Blood omega-3 levels increased in the treatment group, and were associated with some mental health outcomes, but surprisingly not with reduced depression.
This study was limited, since it wasn’t a double blind trial for obvious reasons (people were clearly assigned to groups that either cooked or just socialized). This could influence participants’ perceptions or reports of their diet and mental health. Future research would also benefit from measuring blood indicators of improved diet, like carotenoid – the pigments responsible for bright red, yellow, and orange hues in plants – as a proxy for increased fruit and vegetable consumption. It would also be useful to measure inflammatory markers, like C-reactive protein, interleukins, or tumor necrosis factor, to investigate physiological changes that could help explain enhanced mood. Longer term follow-ups would show if improved diet and mental health can be sustained.
This research and another recent pioneering study with similar findings tell us the benefits of wholesome diets extend beyond better physical health. My dream is for children to grow up enjoying real food. Imagine the difference it would make if health professionals embraced diet as an essential tool in their clinical kits: doctors could prescribe food vouchers and cooking workshops, or subsidize healthy food for people with chronic health issues, including depression. It may seem strange now, but research is catching up to common sense: eating well makes you feel better.
An international research team has discovered that reduced levels of serotonin in the blood may be linked to heightened somatic awareness, a condition where people experience physical discomforts for which there is no physiological explanation.
Symptoms of heightened somatic awareness may include headaches, sore joints, nausea, constipation or itchy skin. Patients are also twice as likely to develop chronic pain, as the condition is associated with illnesses such as fibromyalgia, rheumatoid arthritis and temporomandibular disorders. The illness tends to cause great emotional distress, particularly since patients are often told it’s “all in their head.”
“Think of the fairy tale of the princess and the pea,” said Dr. Samar Khoury, a postdoctoral fellow at McGill University’s Alan Edwards Centre for Research on Pain.
“The princess in the story had extreme sensitivity where she could feel a small pea through a pile of 20 mattresses. This is a good analogy of how someone with heightened somatic awareness might feel; they have discomforts caused by a tiny pea that doctors can’t seem to find or see, but it’s very real.”
The study, recently published in the Annals of Neurology, found that patients who suffer from somatic symptoms share a common genetic variant. The mutation leads to the malfunctioning of an enzyme important for the production of serotonin, a neurotransmitter with numerous biological functions.
“I am very happy and proud that our work provides a molecular basis for heightened somatic symptoms,” said Dr. Luda Diatchenko, lead author of the new study and a professor in McGill’s Faculty of Dentistry.
“We believe that this work is very important to patients because we can now provide a biological explanation of their symptoms. It was often believed that there were psychological or psychiatric problems, that the problem was in that patient’s head, but our work shows that these patients have lower levels of serotonin in their blood.”
The findings have laid the groundwork for the development of animal models that could be used to better characterize the molecular pathways in heightened somatic awareness. But mostly, the researchers hope their work will pave the way for treatment options.
“The next step for us would be to see if we are able to target serotonin levels in order to alleviate these symptoms,” said Diatchenko, who holds the Canada Excellence Research Chair in Human Pain Genetics.
As much as we tout the importance of practicing safe sun, we get it, sunburns happen. And while they're NEVER a good thing for your skin (your risk for developing melanoma doubles if you've experienced five or more sunburns, according to The Skin Cancer Foundation) there's no denying that they can range from mild to more severe.
Enter sun poisoning, which, while not a technical medical diagnosis, is a larger umbrella term that encompasses everything from super extreme sunburns to sun-induced rashes. Ahead, top derms weigh in on what you need to know about sun poisoning, how to recognize the symptoms of sun poisoning, and how to treat it.
Sun Poisoning Symptoms
Sun poisoning can actually make you feel sick.
"If a sunburn has left you with systemic symptoms—fever, nausea, fatigue—this can be an indication of sun poisoning," explains Chicago dermatologist Jordan Carqueville, M.D. Basically, if your sunburn symptoms are more than just skin-deep, you may have crossed over from sunburn to sun poisoning. (Oh, and on the skin note, large areas of blistering are another telltale sign. And to the previous point about skin cancer, it's also worth noting that even one of these types of blistering sunburns during childhood or adolescence nearly doubles your chance of developing melanoma, according to the American Academy of Dermatology.)
When you get sunburned, your body triggers an immune response to try and heal the skin, which is why you can end up feeling almost like you have the flu, adds New York City dermatologist Rita Linkner, M.D., of Spring Street Dermatology.
Sun poisoning can also show up as a rash.
Some people are just extremely sensitive to sun exposure and develop a rash; the technical term for this is polymorphous light eruption, explains Dr. Linkner. (While it's more common in lighter skin types, it can happen to anyone.) This manifests as bumpy red patches (that can also be itchy) that can show up anywhere on the body, though it usually happens in the early part of the summer after your skin is first exposed to sunlight, she adds.
"Many people confuse this kind of rash with a sunscreen allergy, but if you haven't used a new product, and you experience this year after year, it may simply be the sun that your skin is reacting to," says Dr. Linkner. While it's still best to attempt to limit your sun exposure as much as possible, this is less cause for alarm than a super extreme sunburn, since it's more so that your skin is 'adjusting' the sun again. (Related: 5 Weird Side Effects of Too Much Sun)
How to Treat Sun Poisoning
In the case of sun poisoning, the best offense is a good defense. In other words, protect your skin from the sun. (More on that in a minute.) But if the sun has already gotten the best for you, there are a few things you can do. If you're feeling sick, first and foremost, get yourself inside, stat (hopefully that goes without saying, but we'll say it anyway, just in case).
Cooling and soothing are the name of the game for treating your skin—think chilled aloe vera gel or even an over-the-counter steroid to help bring down some of the inflammation, says Dr. Carqueville. Dr. Linkner advises popping a baby aspirin, too; other pain-killers such as acetaminophen or ibuprofen can help, but aspirin specifically turns off prostaglandins, the compounds responsible for making you feel sick, she says. Plus, it will alleviate some of the pain and can even tamp down some of the redness in your skin.
Above all, hydrate, both internally and externally. "A sunburn wreaks havoc on the skin barrier, allowing all of the moisture to escape, so you want to both use moisturizer and drink plenty of water," says Dr. Carqueville. (Related: The Best Moisturizers with SPF 30 or Higher)
If rashes are cropping up on your body, Dr. Linkner says the best thing to do is to pay a visit to your dermatologist. Not only will he or she be able to correctly diagnose you (i.e. make sure those bumps are in fact being caused by the sun and not something else), but the best fix for this is a prescription-strength cortisone cream. (Related: What's Causing Your Itchy Skin?)
All of this being said, if you have widespread blistering all over your body or are feeling seriously ill, get yourself to a doctor, ASAP.
How to Prevent Sun Poisoning
Here's a recap of some of the best sun-safe behaviors that will help you avoid all of the above. One, whenever possible, stay out of the sun during peak hours, namely 10 am to 4 pm. If you do have to go outdoors, hang in the shade, and protect yourself with a wide-brim hat, sunnies, and SPF clothing. (Related: How to Protect Your Skin From the Sun—Besides Wearing Sunscreen.)
And finally, the star of the show, SUNSCREEN. While daily application 365 days a year is paramount, now's the time to be extra diligent about your 'screen strategies; UVB rays, those responsible for burning your skin, are strongest during the summer. Opt for a broad-spectrum formula with at least an SPF 30 and reapply every two hours, especially when you're outdoors. (Related: The Best Face and Body Sunscreens for 2019)
Benji Jones: Wait, how zoomed-in are you? The internet is good for many things, but providing trusted advice on natural remedies is definitely not one of them, especially when it comes to apple cider vinegar. A quick Google search will show you that people use it for everything from cleaning their teeth to curing yeast infections. So if people on the internet are doing it, it's worth trying, right? Definitely wrong. Because not only is there little evidence to support most of the uses for apple cider vinegar, but some of them are straight-up bad for you. Apple cider vinegar is basically just fermented juice. Yeast turns the sugars in apple juice into alcohol, and bacteria then turns that alcohol into acetic acid, the chemical linked to most of cider vinegar's alleged benefits. But here's the thing: This process isn't unique to apple cider vinegar. In fact, acetic acid is in all types of vinegar, from white wine to balsamic. The main thing that makes cider vinegar different is that it might be easier to swallow than a straight-up swig of balsamic. And if you are so inclined to gulp it down, there's at least one benefit you can look forward to. Research shows that drinking cider vinegar after a meal may help lower your blood-sugar levels.
Edwin McDonald: So studies have demonstrated that when people eat a high-starch meal and follow it with a little bit of apple cider vinegar, the blood sugars after eating those meals may not go up as much compared to when you eat placebo.
Jones: That's doctor and trained chef Edwin McDonald. He says that ingesting as little as 20 grams of apple cider vinegar has been shown to slow the release of food from your stomach into your intestines. That's where your body breaks down starches like pasta into sugars, and as a result...
McDonald: You're not gonna absorb those sugars as quickly. So when you don't absorb sugars as quickly, your insulin levels really don't rise as much, and your blood sugar doesn't rise as much.
Jones: And that's great news for anyone who's diabetic or pre-diabetic. Now, despite what you read online, it probably won't help you lose weight.
McDonald: I also run a weight-management clinic, and this question comes up all the time.
Jones: But lowering your blood sugar after a meal is just about the only benefit of drinking apple cider vinegar. Research does suggest that acetic acid can slow down the accumulation of body fat and prevent metabolic disorders in mice and rats. But there's little evidence that it has the same effect on humans. In one weight-loss experiment, 30 volunteers drank two tablespoons of either apple cider vinegar, malt vinegar, or a placebo drink, twice a day, for two months straight, and none of them lost weight. In an older study with a similar design, participants did lose weight, but only about a third of a pound each week, which McDonald says isn't much. But if not for weight loss, what about using cider vinegar to whiten your teeth?
McDonald: I caution people against that.
Jones: That's because cider vinegar is an acid. In fact, most brands have a pH between 2 and 3, which is similar to stomach acid, so swishing it around in your mouth can over time wear down the enamel around your teeth, leaving them feeling rough to the touch and more susceptible to cavities and decay. Yikes. Then there are the people who use apple cider vinegar as a shampoo replacement. And as it turns out, there's actually a pretty good reason for that. Because cider vinegar is so acidic, Dr. McDonald says it can kill some of the microbes that make your hair stink, and it can also limit the population of a type of fungus that can lead to dandruff. But there's a flip side. Because cider vinegar is so acidic, it can also burn or irritate your scalp. So you should always dilute it with water. Oh, and despite what you read online, cider vinegar is not effective against head lice. In fact, one study found that among six home remedies that people use to eliminate lice, like olive oil and mayonnaise, apple cider vinegar is the least effective. None of them worked though. The claims of what apple cider vinegar can do don't stop there. Just keep in mind that at least for now, none of them is supported by a large body of scientific research. Now, of course, we're not talking about taste. When it comes to cooking, there's no uncertainty: Apple cider vinegar is delicious. I use it all the time when making dressing, pickles, and sauces. Yes, I cook. I just don't walk away from meals thinking I've just swallowed some ultimate cure-all.
Source Business Insider
Even with supportive spouses, many women still find themselves helping the kids with homework and cleaning up household messes, often while scrambling to make dinner after a 10-hour workday filled with deadlines and challenging colleagues.
All that stress could put women at higher risk than men for having a stroke or developing diabetes, heart disease and other chronic conditions, according to a growing number of studies.
If women expect to continue to take care of their loved ones, they must first take care of themselves, said Dr. Gina Lundberg, medical director of the Emory Women's Heart Center in Atlanta. She likens it to the safety instructions given to airplane passengers before each flight: In case of an emergency, parents should put the oxygen mask on themselves before they help their children with the masks.
"You have to take care of yourself. But with women, their little internal voice says, 'Oh, that's selfish. You should be doing for others.' And then you end up neglecting yourself," Lundberg said.
"Women need to make time for their general maintenance and health care. And we have to promote that it's not selfish to get your exercise, get your sleep, go to your doctor, get your mammogram, go get your (cardiac) stress tests."
Women who reported high levels of work-related stress were 38 percent more likely to have a cardiovascular event than coworkers with low levels of stress, according to one study.
In other research, older women who suffered from traumatic events, as well as chronic home- and work-related pressure, nearly doubled their risk of developing Type 2 diabetes. Psychosocial stressors, even when associated with something positive – like getting a promotion at work – trigger a hormonal reaction in the body that has been linked to weight gain and increased risk for heart disease.
Such stressors also are linked to behaviors that can lead to unhealthy lifestyle habits, said Dr. Sherita Hill Golden, professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.
"Many times, if individuals are too stressed, it's very easy to say, 'Well, I have so much to do that I don't have time to exercise.' Or maybe not eat as healthy as one should. I often joke that ice cream is much more soothing than an apple when you're in a period of stress," Golden said.
In addition to combating stress, sticking to healthy routines can have beneficial side effects, she said.
"When you set aside time for exercise and self-care and really taking time to eat a heart-healthy diet, you're training your children to do the same thing."
Golden also urged women to find a good primary care physician, someone other than a gynecologist, who they can rely on for regular monitoring of cholesterol levels and other cardiovascular disease risk factors.
Lundberg agreed, stressing that it's especially important for women who have a family history of heart disease to speak regularly with a physician they trust.
"There's so much we can do in prevention," she said.
Besides taking steps to control blood pressure, cholesterol and to stop smoking, experts also recommend women engage in a hobby that can help relax them physically or mentally.
One way of doing that is to regularly "unplug" or find another way to get away from electronics, Lundberg suggests.
"Actually turn your phone off. Meditate, pray, do whatever you need to de-stress. Drink more water and get a good night's sleep."
Anyone visiting their primary care physician will be asked, “Are you also on hormonal birth control?” Anyone who goes to a therapist may get these questions: “Are you depressed? Have you lost all desire for sex?” On closer inspection, these factors might be more intimately intertwined than many in the medical and psychological fields realize.
While 2016 and 2017 studies from the University of Copenhagen made international headlines by finding connections between hormonal contraception use and increased risk for depression and increased risk for suicide, the sad truth is that this information was really nothing new. As evidenced by transcripts from the 1970 Nelson Pill Hearings, doctors and researchers have been voicing concerns about the Pill and its impact on women’s mental and emotional health since use of the Pill became widespread in the 1960s.
Recently, it seems that lowered libido has also been another hot topic of discussion when it comes to birth control, but again, the evidence for it is really nothing new. The reasons behind birth control’s effects on libido are not entirely understood, but it is suspected that the Pill’s testosterone-lowering effects could be the culprit behind why some women experience decreased sex drive while on the Pill. Although women need much less testosterone than men, proper testosterone levels are crucial to a woman’s libido. Lowered testosterone may have other effects that ultimately lead to lowered libido, from shrinking a woman’s clitoris and changing the vascularization of her vulvar tissue (which in turn leads to less frequent desire for sex, less frequent orgasms during sex, and pain during sex), vaginal dryness, and depression (which also has a way of dampening libido).
Unfortunately, these mental and emotional health effects of the Pill are all too often downplayed in the medical community. Some doctors may be reticent to ascribe a woman’s issues with libido to her use of the Pill, citing studies that indicate that, on the whole, women have a “mixed bag” of sexual reactions to the Pill. Instead of encouraging women to try other family planning options, many doctors simply prescribe another drug, this time in the form of antidepressants. Of course antidepressants come with their own side effects, one of which is lowered libido. For women on both the Pill and antidepressants, the quest to resolve the libido problem can feel like a vicious cycle.
Depression and libido are of course incredibly complex issues in their own right, and some women may experience either or both conditions wholly unrelated to their use of hormonal contraception. Libido, in particular, is incredibly difficult to measure, as a variety of factors contribute to sexual desire. But for the women who experience lowered libido and/or depression as a direct result of their use of prescription drugs, it’s fair to say we can do better to offer solutions that help them reach their health potential.
Perhaps the greatest irony in all of this is that the birth control Pill has long been hailed as the tool for women’s sexual liberation, the very thing that is meant to make women more available for sex—but it’s also the very thing that may be causing them to desire sex less and less.
If you’ve ever done a strenuous workout—you know, the kind where you push yourself and feel that rush of accomplishment—chances are you’ve rolled up to the mirror afterward looking sweaty and red-faced. And if you really went for it during your workout, you might still look red even after you’ve showered. Ever wonder why that is?
Believe it or not, that post-workout redness is a form of inflammation. But it’s not the chronic, unhealthy kind per se. Let’s break it down a bit.
Why does working out vigorously cause inflammation?
Working out at a high intensity tears itty bitty holes in our muscles—and as we recover, those holes heal and we become stronger. But during that post-workout and recovery period, our muscles are technically inflamed.
“Inflammation is your body’s way of working to repair damaged tissue,” says Will Cole, D.C., IFMCP, a functional medicine expert and mindbodygreen Collective member. “While this is an essential and normal process, overexercising without a break doesn’t allow your body enough time to repair itself between workouts, and that can contribute to ongoing inflammation.”
So why does my face turn red?
According to Dr. Cole, when we exercise, our blood vessels dilate in order to allow blood to pass through our body more quickly and supply our muscles with oxygen. This process also moves the extra heat that we generate while exercising to the surface of our skin.
As for the red hue we see on our face—that’s actually heat trying to escape our bodies. And the more superficial blood vessels we have on our face, Dr. Cole notes, the more likely we are to experience facial redness after a workout.
Help! What do I do?
For those of us who experience facial redness on the reg, there are some easy remedies to calm our skin after a workout. Dr. Cole recommends utilizing cool-downs and periods of stretching after an intense workout to rebalance your body. And if your workouts are repeatedly turning you red, there are some supplements you can take, too.
“If you know you’re engaging in a particularly strenuous workout, taking turmeric supplements can help soothe inflammation in the body,” he says. “Additionally, adding in an L-Glutamine supplementcan help restore muscles and reduce inflammation as it is considered an essential amino acid.”
And just like that—poof! The redness will start to subside! If it takes a few hours, that’s okay; try to give yourself a break. You just slayed your workout and your body needs to recover. That redness is a badge of honor! (And seriously, it’ll go away soon).
Source: MindBodyGreen.com -mbgmovement
Whatever form your particular regimen takes—a revamped diet, a rigorous exercise program, or some combination thereof—if it really works, you are probably going to hate every minute of it.
“I’m concerned,” said Amy Gorin, a New York-based nutritionist. I had just finished telling her about my efforts to lose weight: 25 pounds in six weeks. She did not approve of my chosen methodology, and she was not alone.
“Wow, that’s a lot of weight in a short period of time,” said Ginger Hultin, a Seattle-based registered dietician and a spokesperson for the Academy of Nutrition and Dietetics.
“Did this all really happen?” asked Rebecca Scritchfield. She’s a nutritionist in D.C., and author of a book called Body Kindness. “It would be rare for me to hear everything you described, and for somebody to come see me and say that they don’t have any problems or concerns whatsoever. That would just not normally happen.”
“I’m definitely not a fan,” Lauren Harris-Pincus, a nutritionist in New Jersey, told me.
What has them so concerned? In part, the pace of my weight loss, sure. But also, the fact that I told them the key to succeeding, for me, was suffering.
Here are some things to know about me: I’m 36, and about six feet tall. I would describe my body type as “skinny, but with a belly.” And I had back surgery in April to fix a herniated disc. For most of my adult life, I’ve fluctuated between 165 and 185 pounds. But when I weighed myself after a physical therapy session and a light workout on Saturday, September 8, I saw I had crept up to 188.
I should pause here to say some very important things. I know 188 is not an unreasonable weight for someone like me. It is, after all, just a number. This is not about how much you “should” weigh, or what you “should” look like. I don’t think those things matter for most people, as long as you’re happy with how you feel. If you are one of those people, you can stop reading right now! You have already found your holy grail.
But I wasn’t happy. I felt unhealthy, and I didn’t like what I saw in the mirror. In my 20s, my beer belly was “cute,” as one ex-girlfriend put it; now, in my late 30s, it was not. Slowly, I stopped wearing clothes that outlined my muscles, which seemed to have melted away from the bones on which they once sat. I realized I hadn’t gone skiing in years—an activity I used to love. Now, I didn’t think I’d be very good at it anymore, and had quietly decided I didn’t want to find out.
For years, my girlfriend and I had started off our days with a smoothie, not as a weight-management strategy but as a quick and reasonably-healthy breakfast on our respective ways out the door: One banana, two dates, a cup of unsweetened coconut almond milk, a scoop of peanut butter, and a fistful of spinach. Nutritionally, it’s a little like eating a salad, but tastes more like drinking dessert. The next day, I went from downing this 500-calorie concoction in the morning—and eating whatever I wanted at all points in between—to having a smoothie for both breakfast and dinner. For lunch, I had a bowl of soup or a small sandwich. No more Thursday morning bagels at work; no more flanks, ribeyes or New York strips; and definitely no snacks.
I felt hungry all the time. I went to bed hungry. I woke up hungry. The only time I wasn’t hungry was after a smoothie, and that fleeting moment of satiety never lasted. The parts of my brain that had once been reserved for “What should I have for dinner?” were now occupied only by hunger and, in a cruel twist, trying not to think about being hungry.
Time slowed to an agonizing, glacial pace. When you eat three square meals and as many snacks as you please, your day unfolds in measurable chunks, none of them more than a few hours. But when your “meals” take only minutes to prepare and consume, passing the time between tiny lunch and liquid dinner starts to feel like filling a pool with a garden hose: You can see the water going in, and you know, intellectually, that the pool level is increasing with each passing minute. But it still isn’t enough to swim, and it seems like it never will be. For the rest of the afternoon, the only thing you can do is stand there, staring at the bottom, thinking about how badly you want to do a cannonball.
Nights were not quite as hard. (A pair of caveats: I didn’t want the routine to get in the way of my social life, so occasional dinners with friends went on as planned. For the same reason, I didn’t give up alcohol, although I’m a light drinker.) I addressed occasional evening stomach rumblings by popping cans of La Croix. Going to sleep hungry felt like an accomplishment—like I was making progress. And in the morning, I felt like I had earned that breakfast smoothie, even though I knew I’d be hungry soon after finishing it. Blend, sleep, repeat.
A weird thing happens when you start drinking most of your food. At first, you miss chewing. After a week, the thought of swallowing any more green sludge was nauseating. The goop had nasty habits of sticking to the side of my Vitamix and dripping onto my counter, highlighting dark-green specks of semi-blended spinach floating in a sea-foam green cloud of health.
Then, the very idea of chewing starts to horrify you. Smoothies are so easy. The thought of laboring through a chopped salad for lunch—my only solid food on most days—started to feel exhausting. On rare dinners out at restaurants, I chose entrées based primarily on how I expected my jaw to feel after all the boring chewing had concluded. A separate horror began to gnaw at me: What if I’ve become incapable of ever enjoying a ribeye again?
Another caveat: What I’m about to share is not for people who struggle with eating disorders. It’s also not for people who are unable to change their bodies through diet and exercise, whether due to medical reasons, or some other complicating set of circumstances. It is also not for people who don’t want to change their bodies at all. (Again, you have the grail! Good for you.)
For everyone else: If you want to make a meaningful change to your body, there is only one dependable path, and that path is suffering. Whatever form your particular regimen takes—a revamped diet, a rigorous exercise program, or some combination thereof—if it really works, you are probably going to hate every minute of it.
Think about it this way: Why are your habits, well, your habits? Because they are easy to develop, and comfortable to maintain. For me, it required no effort to eat whatever I wanted, whenever I wanted, and it felt comfortable to skip the gym in favor of the latest David Attenborough nature documentary. But when I wanted to change my body, I had to change those habits. That was hard! It’s hard to be hungry when you’d rather be eating; it’s hard to knock out 40 minutes on the bike when you’d rather be watching Planet Earth II on repeat.
There is a lot of money riding on you not believing this is the case. The weight loss industry is a $66 billion business. Half of all Americans say they’re trying to lose weight, and about 45 million of them start diets every year. Most of these efforts, studies show, will fail. Yet for those legions of beleaguered calorie-counters, nearly every nutritionist and weight loss expert I spoke to offered the same reason for hope: It’s easy, in fact, to achieve the results you’re chasing, as long as you carefully follow their method—which, besides being easy, is affordable, too. How convenient!
“No, you don’t have to suffer! Suffering isn’t a necessity,” Trudie German, a certified personal trainer in Canada, assured me. “At some point, you have to stop suffering. Why do you want to keep suffering?“
“I don’t think it’s necessary to suffer,” Liz Arch, a life coach and yoga teacher, told me. “We can put this idea on ourselves that we have to suffer in order to get to whatever grand goal we’re trying to meet, but I don’t think we have to suffer. I think there’s an easier, gentler path."
“I actually think that’s actually the problem with most diets—that people believe they have to suffer to get the results,” said Ayse Durmush, a lifestyle coach and syndicated radio host.
A related reason that humanity’s weight loss hivemind, over time, has not asymptotically approached perfection: Science keeps learning new things about the body, which the industry then packages into a new product for sale to a new cohort of dieters. In reality, any ephemeral consensus about what “works” is less important than whatever message resonates with consumers at that particular moment. In the 1940s, studies linked high-fat diets to high cholesterol levels and heart disease. By the 1960s, low-fat diets were popular. By the 1980s, the medical profession, the food industry, and even the U.S. government were touting the low-fat lifestyle as a proven method of combating the burgeoning obesity epidemic.
Today, we know (or at least we think we know!) more: that some fats are good and other fats are bad. Eggs, dairy, sugar, carbohydrates—practically everything we eat, aside from, say, raw kale—have all gone through similar hero-goat-hero progressions. Even among experts, opinions differ based on the last thing they read, or where they got their certification, or what worked for them once upon a time. “If you talk to 100 people about what kind of diet they recommend, you’ll get 100 different answers,” said weight loss expert Scott Schmaren. (For the record, he believes the true key to success lies somewhere in the manipulation of one’s subconscious.)
What the health and fitness industry is selling, in other words, isn’t your long-term happiness; it’s the latest selection from its collection of programs. And how do you get people to buy in? You promise in the marketing materials that the experience will be fun and comfortable and successful throughout—even though it almost certainly cannot be all those things at once.
When I Google “help me lose weight,” both of the top sponsored results make a similar, sunny pledge. First, an outfit called Sweet Defeat proclaims that its product “makes it easier to live a healthier lifestyle by stopping sugar cravings in seconds.” Perhaps customers of Sweet Defeat have had a different experience, but I’ve never experienced a “craving” for anything that magically disappears without the imposition of a lot of willpower.
The other result is for Noom, a lifestyle startup—think Weight Watchers for millenials—that invites you to start your weight loss journey by filling out a 30-second personal assessment. As I go through the online form, I see what looks like a social media post from an allegedly real person, which has already received several “likes” despite appearing “1 minute ago.” (It is an authentic post, Noom president and co-founder Artem Petakov told me, though he admits the vintage is inaccurate.) “I don’t feel like I’m deprived of any food,” a user named Candace assures me, a prospective customer who hopes to unlock the secrets to her success. “I’m enjoying myself, and my family has noticed my weight loss.”
When I ask about the company’s marketing practices, Petakov says that Noom has studied the best messaging to secure the buy-in of people who will be successful with its program. And the company sent me studies claiming that its methods result in lasting weight loss for more than half its clients. “It’s important not to make it seem too easy, but also important not to scare people off too much,” Petakov explained.
After I answer a few more questions about my height, weight, habits, and lifetime fitness goals, another marketing message pops up on the screen. Its tone is cheerful, almost congratulatory, even though I haven’t done a thing yet: “Sticking to a plan can be hard, but Noom makes it easy”—and for only $32.25 a month.
A few weeks into my adventures with smoothies, I decided to experiment with intermittent fasting: A few days a week, I skipped breakfast and lunch altogether, and ate a normal dinner. The hunger stemming from this layer of my regimen came in intense waves at first, and so I did something many of us do for temporary relief from self-induced anguish: I complained. (Usually over G-Chat, mostly to my now-fiancée, and always in the form of melancholy proclamations that I was not going to make it home alive that night.)
But once my stomach’s growling subsided—perhaps once it realized no relief would be forthcoming—I started to feel great. At the office, it seemed like I could concentrate better, as if an elemental survival instinct had kicked in, and only typing faster and working harder would help me escape danger.
Small reductions in weight can result in large reductions in metabolism, studies have shown, meaning that as you lose weight, it gets harder to lose more weight. I thought I might be able to fight off this phenomenon by walking and biking and going to the gym more often. But a recent study of Biggest Loser contestants indicated that physical activity did not prevent a significant drop in metabolism. It might have helped; it might not have mattered all that much. I don’t know.
Nevertheless, after six weeks of regular fasting, diligent smoothie consumption, and a renewed dedication to scrounging up time in which to stay active, I weighed myself again. 163 pounds. I had thought—or at least hoped—I was making progress, but until this point had resisted the temptation to check, and frankly, I didn’t expect the news to be this good. I felt incredulous and elated at the same time, like (I imagine) how one reacts when they realize all six numbers on the Mega Millions ticket they hold match the sequence on TV. I called my fiancée, and then called her on WhatsApp when she didn’t answer there, and then tried her work number when she didn’t answer there, either, until I finally reached her, breathless, to recount what I had just seen.
This wasn’t only about the number on the scale. My body was trimmer, and I felt lighter and healthier and happy with myself. People were noticing, too. The first person to notice was me, mostly because my pants were falling down. I went out and got two notches added to my belt; I also bought new pants.
Here is the story of Lauren Harris-Pincus, a registered dietician and one of the many skeptical experts with whom I spoke. During her senior year of high school, she went on what she calls a “suffering diet”—a calorie-restriction regimen not unlike the one I went through. “I was so sick and tired of being teased and tortured, and I wanted a new life where I wasn’t heavy. It was a survival instinct,” she said “I grew up in Livingston, New Jersey, and everyone was wealthy and perfect. I’m not a fan of suffering because it steals joy from your life, and I don’t think it’s necessary.”
Harris-Pincus tells me her diet so affected her metabolism that even today, she carefully monitors her calorie intake to maintain the fitness level she wants. It is a telling indictment of her industry’s promises that she accomplished her goals only after deciding that she was willing to suffer—a method she wouldn’t advocate for you, even though it worked for her.
It worked for me, too. After a few weeks of liquid meals and food-free afternoons, I found I had learned to embrace the suffering, because I could see the weight coming off. I derived a real sense of satisfaction in completing my routine, like a machine unaffected by appeals to emotion and/or the allure of microwave pizza. It is the same transformative dynamic I’ve heard described by friends who endured the pain of getting a tattoo; they knew it was a necessary prerequisite to enjoying a long-sought-after reward.
“Diet and exercise are not the key. The key is the picture you have inside of your head—how you see yourself,” Scott Schmaren told me one day. (He’s the subconscious guru, remember.) If weight loss were truly that simple, he would be a billionaire—and to my knowledge, he is not—but he might have a point: When I didn’t want to go to the gym or do that last set of leg lifts, I told myself I was the kind of person who did that last set and squeezed that last rep. There were days when I ate more than I intended, and others when I shortened a workout I should have finished. But I stuck with it, even though everything about the experience, to use a technical term, sucked.
Do the experts think I can keep it up?
“Radical changes in short period of time are possible, but not sustainable,” health coach Aurimas Juodka wrote to me. “It's easy to lose weight putting people on crash diets, but eventually, they’re going to fall back to their old ways.“
“People will get sick of two smoothies a day,“ said Scritchfield.
“Can you sustain that? I would say probably not,” said Sczebel.
As I write these lines, it’s six months since I launched myself into this mostly-smoothie diet. I’ve now lost 36 pounds, down to 152. I’m still eating less than I used to, but I don’t really think about it much. Resisting the mindless, boredom-driven urge to have a snack feels normal; it’s just part of my new routine. And I’m doing things I would have avoided before all this took place. On the first day of our honeymoon in Costa Rica this past winter, I bruised my ribs learning to surf. (It didn’t stop me from surfing for four straight days. Surfing, it turns out, is a lot of fun.)
My new goal is to put on some muscle. I lift weights now, and I recently bought my first-ever enormous vat of whey protein powder. And when the “suffering” still tests my resolve, I remember those who said I could never lose weight without the benefit of their expertise, and who hustle hard every day to get more customers who will pay to have stevia-sweet nothings whispered in their ears. I smile, and stuff some more spinach—and maybe an extra scoop of protein—into the blender.
Over the past 40 years, doctors have gotten a lot better at treating heart disease. In the 1960s, it wasn’t unusual for adults to die or become severely disabled from heart attacks in only their fifth or sixth decade of life. And while heart disease is still the number-one killer in the United States, it’s also no longer a guaranteed death sentence, thanks to newer medications, improved surgical techniques, and better understanding of the disease.
Society as a whole has also gotten better at preventing heart disease. A 2018 study in the journal Circulation found that the overall rate of heart disease in the U.S. had declined 38% since 1990. Other developed countries have seen even greater reductions.
But these improvements haven’t benefited everyone equally—and one new study shows a troubling trend among young people, and young women, in particular. When researchers looked at hospitalization rates for heart attacks between 1995 and 2014, they found that those numbers had steadily increased among people ages 35 to 54. More specifically, hospitalization rates remained relatively stable among men in this age group but increased significantly (from about 21% to 31%) among women.
The findings, published last month in Circulation, aren’t the first to suggest that young women are being left behind when it comes to advancements in heart disease treatment and prevention. Now, doctors are trying to figure out why.
Disturbing heart trends for young women
Scientists can’t say for sure what’s causing an increase in heart disease among young women, but they do have some ideas. Last month’s study found that not only had hospitalization rates for heart attacks increased among young people since 1995, but that hypertension and diabetes rates had increased as well. The young women in the study were also more likely to be black than the young men, suggesting that heart disease is hitting young black women especially hard.
The study didn’t look at patients’ body mass indexes, but co-author Melissa Caughey, PhD, a research instructor at UNC School of Medicine, notes that hypertension and diabetes tend to be associated with obesity.
“We know that there’s an obesity epidemic going on in the United States, and we know that women—especially black women—tend to have higher obesity rates than men,” Caughey tells Health. “It may be that these are actionable areas where physicians could do better to manage risk factors in these high-risk patients.”
Another interesting finding was that, compared to the young men in the study, the young women were less likely to have previously been treated for conditions like high blood pressure, high cholesterol, or stroke. This suggests that women are being under-treated for heart disease risk factors, wrote Viola Vaccarino, MD, PhD, an epidemiologist at Emory University, in a commentary published along with the study. Prevention guidelines may also underestimate risk among this age group, she added.
“Notably, there was no indication that the sex-related treatment gap improved between 1995 and 2014; if anything, there was a tendency for the disparities to worsen over time," wrote Dr. Vaccarino.
Another challenge is that women tend to experience heart attacks differently than men—so they, and their doctors, may not even recognize it when it’s happening, and their treatment may suffer as a result.
“Traditionally, a heart attack is described as the man clutching his chest and suddenly falling out of his chair,” says David Goff, MD, director of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. “But heart attacks are seldom that dramatic, especially for women.” Women are more likely to report back pain, nausea, sweating, lightheadedness, or dizziness, Dr. Goff tells Health, rather than chest pains.
“When women present with these symptoms, the sad reality is that too often, the health care system doesn’t think about heart attacks first,” he says. “Women might be told that it’s anxiety or it’s gastroesophageal reflux or some other problem, because physicians still don’t know to look for heart problems.”
What needs to change
The new Circulation study did find some promising trends. Young women in the study were less likely to smoke than their male counterparts and were more likely to have health insurance. Indeed, says Dr. Goff, the decline in smoking rates over the last 50 years has been a big part of the overall decline in heart disease across all age groups.
Caughey stresses that the overall risk of heart disease for young women “remains quite low,” and that it increases significantly after menopause. “I don’t think this is anything for young women to panic over, but I do think it’s a warning sign that maybe women of this generation are not as healthy as those of previous generations were.”
Dr. Goff paints a slightly more concerning picture. “One out of four women in our country will die of heart disease, and 60% will have a major cardiovascular event before they die,” he says. “This means that none of us can really ignore our heart health—whether you’re older and overweight or you’re young and lean and otherwise healthy.”
Young women can improve their lifestyle and decrease their risk for heart disease by getting more physical activity, eating a healthier diet, and avoiding both first- and secondhand smoke, says Caughey. “And even if you’re already doing that, you should still know your numbers and check in every year or so with your doctor,” she adds.
Ultimately, experts say, doctors need to watch young women for symptoms of heart disease, so they can be diagnosed and treated before their conditions worsen. Doctors also need to pay attention to risk factors that could make young women more vulnerable to heart attacks and other forms of heart disease in the future.
For example, Dr. Vaccarino wrote, young women who have heart attacks are more likely than men to have depression or post-traumatic stress disorder, to report high levels of stress and more life adversities, and to fall into lower education and income brackets. Female-specific conditions like polycystic ovary syndrome (PCOS), premature menopause, or a history of preeclampsia may also play a role in heart disease risk.
“Younger adults, and women in particular, have been inadequately studied in cardiovascular research,” Dr. Vaccarino wrote. “It is now time to pay attention to this group to optimize prevention strategies and promote cardiovascular health among women.”
For now, Caughey says, it’s up to women to look out for themselves. “It’s probably not something that’s on the radar for a lot of young women,” she says, “but it’s never too early to focus on living a heart-healthy lifestyle.”
Nutrition is an important part of staying healthy and these days good nutrition involves feeding your body nutrients via taking adequate supplements to make up for the pollution and denatured food on our planet. There are many reasons we don’t always get our full supply of nutrition. Sometimes even when we eat well, we find out we are malnourished. It has to do with how much you are actually absorbing from the foods you eat. Also, medication can be responsible for minerals and vitamins being sucked out of our systems at a faster rate than we can absorb them and we end up deficient.
Some medications can interfere with the absorption of the natural nutrients you may think you are getting through your diet. This can then cause health problems that you wouldn’t think would be caused by those medications because they are “supposed” to make you better. It is important to keep a list of all your medications and their dosage in your bag, phone or wallet and the dates you started taking them for emergency situations. This also helps you keep check so you don’t overuse your medication.
It is important to know what your medication is used for and not to just take it blindly. Check with your doctor or pharmacist as to the side effects so if you feel unwell, you can decipher if it’s a result of the medication or you genuinely are unwell. If you use the same pharmacist every time, they will keep track of it for you. Always check to see if medications conflict with each other as this can make you very sick.
Many medications, while treating one part of your illness, can lead to nutrition deficiencies, which cause headaches, cramping, low immunity, depression and can increase the risk of clots and osteoporosis. You may also suffer from such side effects as fatigue, bone weakness, dermatitis, dry skin and acne.
Some everyday medications that can interfere with absorption include tricyclic antidepressants, which affect the levels of vitamin B2 and coenzyme Q10; aspirin, ibuprofen and naproxen. which affect iron, folate, zincand vitamin C; the anti-diabetes drug metformin, which can affect folate, vitamin B12 and coenzyme Q10; and the contraceptive pill, which can affect the levels of B vitamins, vitamin C, magnesium, selenium and zinc.
Antibiotics can also deplete the body of essential nutrients. Penicillin such as amoxicillin can lower potassium absorption, while tetracycline such as doxycycline has an effect on calcium and magnesium. This is why it is important if you are regularly taking medications to at least take a multivitamin every day as these vitamins are not stored in the body and if you don’t get your quota one day, then your body becomes nutrition deficient on that day. Put all the days that you don’t get your quota together and you build up a lot of nutrition deficiencies, which will make you ill.
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