After the death of Caroline Rustigian’s mother earlier this year, her physical health took a tumble. “I stopped eating and couldn’t keep food down,” says Rustigian, a public relations consultant and podcaster in Laguna Beach, Calif.
Desperate to feel better, Rustigian went to urgent care, where she was told that acid reflux was one cause of her tummy troubles. The doctor recommended medication, which eased her discomfort. However, the mother of two still didn’t feel like her old energetic self. “I was fatigued and just trying to get through each day,” she recalls.
Finally, Rustigian met with her naturopathic doctor, who said grief was the culprit. “My doctor said emotional stress and not eating threw off the healthy bacteria in my stomach, which compromised my microbiome.” A veritable universe living within us, the microbiome has been garnering attention from scientists and the medical community for its impacts on human health.
“The microbiome is made up of trillions of microbes, including bacteria, yeast, and viruses,” says Thalia Hale, a naturopathic practitioner in Palo Alto, Calif. These tiny organisms reside in our gut and on our skin. Like a hard drive that keeps a computer running, this network helps the body synthesize and process key nutrients like thiamine, a B vitamin made by intestinal bacteria that fuels brain function
A possible link
According to Hale, grief can throw the body off course, upsetting the gastrointestinal tract. For starters, stress can activate the sympathetic nervous system, more commonly known as the fight-or-flight response. In this survival state, “heart rate and blood pressure rise, as do levels of the hormone cortisol,” Hale adds. And when the body is warding off danger, it’s not focused on digestion or eating. Rustigian says that after her mother died, she didn’t eat for days. And research has found that dietary changes can shift the microbiome in a matter of days.
While it’s well known that heartache can make the belly ache, research examining the connection between bereavement stress and gut health is limited. However, one 2020 paper published in the journal Frontiers in Psychiatry suggests that “gut microbiota may play a role in influencing health outcomes following bereavement” because chronic and ongoing stress can disrupt the microbiome.
It’s challenging to solely examine bereavement, because grief includes other emotions such as anger, sadness, and denial. When these feelings linger, they can contribute to mental health concerns like anxiety and depression. These conditions’ ebbs and flows have been linked to the bacteria residing in the gut.
What science tells us
The connection between our brain and our gut, including the microbiota that thrive there, was surprising when it was first discovered more than 10 years ago. Thus far, most of the relevant research has focused on animals, according to Karina Alviña, a neuroscientist at the University of Florida whose lab uses mice to investigate how gut flora influence brain function. “In an animal model, you can [use antibiotics to] deplete nearly all of the gut microbiome and feed the mice with a particular formulation [of bacteria],” she says, which allows scientists to directly test the effects of a single bacterial species or a combination.
In humans, the picture is murkier. But a team of scientists in Belgium was among the first to tie the characteristics of an individual’s gut microbiome to measures such as overall happiness and depression in a large-scale population study published in 2019. “People who report low quality of life tend to have disturbed gut microbiomes—and there was a notable loss of certain bacteria that was very specifically associated to this loss of well-being,” says Jeroen Raes, a bioinformatician and senior author of the study.
Mental health and the gut-brain axis
Losing a loved one is by far one of the most stressful life events. “My mom was my best friend,” Rustigian says. “When she died, I lost my true advocate, and I felt numb.” This emotionally low period can result in the loss of sleep and appetite, as well as loneliness. And the ongoing stress may affect what scientists call the gut-brain axis.
Barely a decade ago, the brain was thought to be completely isolated from the rest of the body. So for Alviña, “the biggest mindset change” was the realization that the brain not only instructs the body to move and breathe, but that signals from the gut as well as other organs and tissues can also alter how the brain functions.
How the mechanism behind this bidirectional communication works is an open question, but several possible explanations have emerged. In the Belgian study, people with depression had fewer gut bacteria that produced butyrate, a fatty acid essential to intestinal health, with anti-inflammatory properties. The resulting inflammation in the gut due to the lack of these butyrate producers is “linked to the neuro-inflammation we often see in the context of depression,” Raes says.
More directly, gut bacteria produce molecules such as dopamine and serotonin, which play vital roles in neural signaling. Low levels of these neurotransmitters can cause depression and neurological diseases like Parkinson’s.
These neurotransmitters might interact with the nerve endings of the vagus nerve—which is responsible for involuntary movements such as breathing and digestion, and connects the brain to most of the body’s organs, including the gut. Experiments on mice bolster this view. For animals where the vagus nerve was cut, microbiome-mediated effects on their behavior disappeared.
Probiotics: help or hype?
Given the tantalizing evidence, an obvious next step would be to supply the gut with beneficial probiotics. Raes, however, stresses that research on the gut microbiome and its impact on grief and mental health is still in its infancy. And while “the potential for probiotic intervention is exciting, there’s not [currently] enough evidence to advise people with depression to take them,” Raes says.
Dr. Ripal Shah, an integrative medicine specialist and psychiatrist at the Stanford University School of Medicine, agrees that the jury’s out on which bacterial species will prove most helpful to people. But at the same time, gut health and tweaking gut flora are frequent topics in the weekly integrative mental health group she leads with a colleague.
Overall, grief is a full-body experience, and Hale says that both stress-management and dietary practices can aid in recovery.
Research suggests that diet plays a significant role in determining which gut bacteria continue to thrive. And eating foods naturally imbued with probiotics like fermented products and yogurt is one easy way to help restore gut health, says Shah. “But because we don’t know exactly which species are helpful—and how much—it’s actually useful to think [of the goal] as increasing the diversity of your gut flora.”
Switch up the cuisine, Shah advises. If you’re having kimchi one week, kombucha the next week, and kefir the following week, you’re exposed to a wider range of active cultures than if you’re just grabbing the same brand of kimchi every time.
Just one episode of depression or anxiety can create a feedback loop, priming us for recurrences. “One of the pathologies of depression and anxiety might be that they contribute to the ratio [of gut flora] going out of whack,” Shah says. “And then ongoing stress continues to skew or worsen that ratio.” Because of this, Shah says it’s crucial to find ways to de-stress.
On the flip side, Shah says, “the potential of positive mood to influence the microbiome is actually reassuring” because it means gut health may be able to be manipulated with mental-health interventions.
During periods of immense mourning, stress management might seem like putting a bandage on a gaping wound. However, Hale says these tools can help the nervous system switch gears, putting the parasympathetic nervous system (which helps calm us down) back in the driver’s seat.
One easy exercise is called “square breathing” or “box breathing.” Simply take a breath in and hold for four counts, exhale for four counts, and repeat four times. Used by Navy Seals in high-stress situations, this breathing technique helps calm the autonomic nervous system, which restores relaxation.
A 2017 study in the journal Frontiers in Immunology found that exercises such as yoga and tai chi may help reverse the effects of stress on the body. The researchers state that these mind-body interventions “reversed genes involved in stress-induced inflammatory reactions.”
Shah also suggests acupuncture for her patients, which has been demonstrated to relieve stress in numerous studies, and to engage in at least 30 minutes a day of moderate-intensity exercise.
Lastly, “any sort of vitamin and mineral deficiency can be worsened or caused by stress,” Shah notes. So addressing these deficiencies—primarily through diet rather than supplements—is of tantamount importance. Similarly, avoid consuming foods that promote inflammation, such as refined sugar, fried foods, or foods that you’re allergic to.
One way to cope with bereavement is to embrace additional support. “We’re not meant to grieve alone,” says Abigail Levinson Marks, a clinical psychologist in San Francisco who specializes in grief. “In nearly all cultures, the way we deal with loss is collective, because community helps us heal,” she adds.
Grief support groups and online forums can be therapeutic, because they give you a chance to meet and befriend fellow mourners. Marks adds that seeing your experience reflected in someone else’s story can help you feel less alone.
Since each person’s path differs, group support might not be right for everyone. If that’s the case, speaking with a counselor can also help. Not only will your therapist listen and empathize, but expressing your thoughts and feelings may have a positive effect on your physical health too. For instance, one 2022 paper in the journal Dialogues in Clinical Neuroscience reiterates that holding in our emotions may lead to low-level stress, hindering the body’s immune response.
In addition to therapy and group support, give yourself permission to say yes when loved ones offer help. For example, friends might take on your household chores or run errands, or your employer may provide bereavement leave. “Anything that lightens your load can give you more time for self-care,” Hale says.
In our rush-to-recovery culture, we may judge ourselves when suffering lingers. But keep in mind that healing is a journey, not a sprint. So even if your loss was months ago or before the pandemic began, self-care, support, and healthy eating can still be beneficial. Hale also reiterates that self-compassion is vital.
In the end, Caroline Rustigian found that an antidepressant, probiotics, exercise, and therapy helped to ease her grief—and her gut issues. “It took a while to figure out what was going on,” she says. “But once I started a combination of therapies, my stomach troubles disappeared, and I got better.”
One of the things that makes exercise interesting is that there isn't one way to get fit and burn fat. Sure, some people love running, others walking, some prefer yoga, and others swear by strength training, but at least one leading health expert has made the case for playing more pickleball. One site in the UK did a deep analysis of leisure sports and found that playing golf on foot could burn upwards of 1,640 calories in a single day. Any movement is good movement, and even short bursts of exercise over the course of your day will add up.
Depending on your goals and your physique, you may find that some exercise may be better than others, of course. If you want big muscles, you need to perform resistance training, and if you want to improve your stamina for a marathon, it's helpful to pursue more cardio. But if you're approaching middle age or getting even older and you're looking to trim down your waist size, a new study published in Annals of Internal Medicine found that one surprising exercise—an ancient meditative martial-art practice—is actually incredibly helpful. If you're curious to know what it is, read on, because we break it all down right here. And for more life-changing exercise advice, see here for the Secret Exercise Tricks for Keeping Your Weight Down for Good.
1 Meet Tai Chi
If you've ever seen people in a public park gracefully moving their limbs slowly through the air while breathing in a slow, meditative way, you've seen tai chi in action. It's colloquially known as "meditation in motion." According to the UK's NHS, "tai chi, also called tai chi chuan, combines deep breathing and relaxation with flowing movements. Originally developed as a martial art in 13th-century China, tai chi is now practiced around the world as a health-promoting exercise."
Research has showed that tai chi is great at improving balance, posture, mobility—all things that can help you fight arthritis—and can help promote stronger muscles (primarily in your legs). It's also known to be an effective way to deal with stress. According to the health experts at The Mayo Clinic, tai chi is also shown to help "enhance the quality of sleep, enhance the immune system, help lower blood pressure, improve joint pain, improve symptoms of congestive heart failure," and "improve overall well-being." And for more great exercise advice, check out The 15-Second Exercise Trick That Can Change Your Life.
2 It's Also Effective at Targeting Belly Fat
According to the new study, conducted by researchers at the University of Hong Kong, the Chinese University of Hong Kong, and UCLA's David Geffen School of Medicine, tai chi is also helpful at slimming down and reducing your belly fat. The researchers recruited more than 500 adults with central obesity (or a larger midsection) all over the age of 50 and assigned them to one of three groups: those who performed tai chi, those who performed "conventional exercises" such as brisk walking or strength training, and those who didn't exercise at all. The test ran for a total of 38 weeks, and those who did tai chi or exercised performed three one-hour sessions every week that were led by an instructor. Participants did not vary their diets at all.
3 Here's What the Results Found
At the end of the study, both the exercisers and those who performed tai chi experienced a loss in body fat around their waist and lost weight overall. Both groups experienced a drop in their high-density lipoprotein cholesterol (HDL-C), though those who performed tai chi were better able to maintain that lower cholesterol by the study's end. The study concludes with a single sentence: "Tai chi is an effective approach to reduce [waist circumference] in adults with central obesity aged 50 years or older."
4 Do You Want to Try Tai Chi?
If you'd like to try your hand at tai chi, it's best to seek out professional instruction near you to ensure that you're performing the ancient martial art correctly. But, as you can imagine, there are plenty of instructionals you can find online, as well. According to the health experts at VeryWellFit, you'll find a best-in-class online series by referenceing this video here. It's titled "Tai Chi for Energy," and it's led by Dr. Paul Lam. And for more great fitness tips, don't miss these Secret Tricks for Walking Better Starting Now, Say Experts.
Many parents know how seriously American schools have taken nut allergies in recent years. Today, medical experts report there's a new food allergy threat that's every bit as serious. Unfortunately, this has been a staple of the American diet for decades… and it might be a tougher food to eradicate from all the places children go.
WebMD has reported that food-induced anaphylaxis (allergic reactions) led to a 25% increase in hospitalizations among children between 2006 and 2012, according to an analysis of pediatric hospital data performed in 2019. While for years, peanuts and some tree nuts were to blame more than other foods, cow's milk is now "the most common food allergy in children younger than five years," according to the WebMD report. Astoundingly, cow's milk is said to account "for about half of all food allergies in children younger than one."
It's reported that in the U.K., cow's milk was the food allergy most likely to lead to death in school-aged children. Carla Davis, M.D., director of the food allergy program at the Texas Children's Hospital in Houston was quoted saying, "Cow's milk allergy is the most distressing of the food allergies. Many people are unaware that it can cause anaphylaxis that is so severe." Davis added: "People do not think about how much of this is in our food."
The report explains that cow's milk has been a popular drink for children for its calcium, vitamins, and other nutrients, like protein. However, some of these same proteins are the very triggers that the body identifies as foreign and attacks, which produces the allergic reaction event. Some experts say all this is why it's so important to educate the public about the dangers of dairy today.
If there's good news, it's that as children age, reports suggest that some outgrow the cow's milk allergy.
If COVID-19 taught us anything, maybe it’s that some things are out of our control. Life is going to throw us curveballs — from unexpected bills to unwanted diagnoses to delays to global pandemics — no matter how much yoga or deep breathing we practice.
It’s not the absence of these stressors that defines our wellbeing; it’s how we are able to respond to them that makes us mentally strong, psychologists say.
Dr. Meredith Coles, professor of psychology and director of the Binghamton Anxiety Clinic at Binghamton University, pointed out that stress (and the anxiety it causes) helps us survive and thrive: “It motivates us to ... get out of the way of a speeding car.”
But our bodies aren’t designed to constantly be under that pressure. And we have to learn healthy ways to deal with the stressors that don’t go away, adds Dr. Seth J. Gillihan, psychologist in private practice in Haverford, Pennsylvania. “Key is being able to process the stress, so it's not building to a breaking point.”
When the body registers a situation as stressful, the body prepares for physical danger (the “fight or flight” response). The heart pumps faster to send more blood to your muscles, your pupils dilate so you can see better, and you become hyper-vigilant.
The body is really good at returning to a baseline, non-fight-or-flight state once your brain registers that the threat has passed, explained Dr. Margaret Seide, a psychiatrist in private practice in New York City and on faculty at New York University. The sticky point is getting the brain to register that that stressor is no longer a threat.
"If I am reliving or worrying about something, I can be going through the same biological stress response over and over,” she said. The response might be lower grade later on than when you first opened that bill or lashed out at your partner, but over time the persistent effects of stress (even if they are minor) can tax the body greatly. They’ve been linked to higher risk of chronic heart problems, digestive disorders, sleep problems, mood disorders and cognitive decline.
So, how do you not let short-term stress turn into the problematic, long-term kind you can’t let go of? You have to be able to shift your thinking. It can feel like your worries are out of your control, but you have the power to shift your thoughts, Seide said, “even the stressful and anxiety-provoking ones.”
Here’s how to do it:
1. Get to know your stress response
We all respond to stress in different ways, particularly that long-term festering stress associated with worry. Pay attention to how stress affects you. Maybe it’s feeling more irritable, maybe it’s a headache or stomach cramps, or maybe it’s feeling sad. “A lot of the times it’s subtle,” said Gillihan, who is also the author of “The CBT Deck,” a book about techniques to train your brain to better cope with stress.
To get to know your stress response, check in with yourself a few times throughout the day: What’s my stress level? Do I need anything?
2. As soon as you notice things heating up, hit pause
When you’re in that moment when you can feel the blood rushing to your head and your thoughts swirling toward a doom-and-gloom place, hit pause. Most of the stressors we encounter in our everyday lives (that bill, that newscast, that argument) are not immediate threats to our safety, Seide said. Reminding yourself that you are safe can help get back to that baseline, non-alarmed state, and deal with whatever the problem is from a calmer starting point.
Do it by noticing your surroundings. Take inventory of the furniture in the room. Count the leaves on a plant. Pay attention to what colors you see.
It’s been said over and over again because it works. Taking a deep breath (or a few) is the most immediate way you can start to quiet the alarm bells stress is setting off in your head and body, Gillihan said. Slow, thoughtful breathing signals to the nervous system it can ease up on that stress response, he explained. “Keep it really simple. Breathe in. Breathe out.”
4. Stay objective
Here’s the part where you have to start thinking about whatever set off your stress alarm bell to begin with. Keep your attention on what the problem is and what you’re going to do about it. Don’t let your thoughts run off and panic about how this problem is going to create a dozen other ones, Coles said.
You get a flat tire. Recognize it’s going to take a few hours to get it fixed. Make a plan to get it fixed. Don’t beat yourself up for not being able to get all the things done you had planned on doing today, Coles said. “Flat tires — and other unexpected stressors — are part of life.”
Question the stories you’re telling yourself, Gillihan said. Are you being objective? “In times of high stress we might see danger everywhere, or see ourselves as weak and overwhelmed,” he said.
5. Make a plan
If the stressor is not a flat tire and requires a little more thinking to figure out how to address it, make a plan to figure it out. Put some time on your calendar to call the hospital about the bill that came through. Make a plan about when you’ll study for that big exam. Figure out what you need to do to constructively deal with the stressor and decide when you’ll do that, Seide said.
6. Then move your thoughts to something positive
If you’re not in that time and place where you’re constructively working through a problem — let’s call these nonconstructive thoughts “worries” — it’s time to shift your thinking, Seide said. “Change the channel in your mind.”
Focus on affirmative thoughts. Think of song lyrics. Count backwards from 100. Listen to a podcast (or a bedtime story if the worries are coming before sleep). Distract yourself, Seide said.
7. Practice mental health maintenance, too
Self-care practices (all the things you do to promote good health) — like getting plenty of sleep, exercising regularly, eating a balanced diet, taking time to manage chronic conditions, and connecting with friends and family — all help keep your baseline in an optimal starting place for when stressors do show up. Think of it as building up your body’s defenses for the unexpected attacks, Seide said.
But those defenses are not going to be very strong if you don’t keep up with them regularly, she said: “It’s not going to work if you wait until you’re having the worst day ever and then try pulling out a candle or dusting off your journal.”
Here’s the thing about coffee: there’s never been much scientific debate about whether it’s healthy. Yes, people have been concerned about it since the 16th century, but as long as we’ve been analyzing its effects we’ve observed that drinking coffee tends to improve your health, not harm it. In moderation, of course.
The fear that coffee harms us is pervasive, though, and as a result it feels like there's been a lot of back-and-forth. One day it's good for you. The next it's bad. In reality, the large-scale analyses of the harms or benefits of a cup o' joe have pretty much all shown definitive upsides, or at the very least no effect at all. It's not going to cure all that ails you or make you live forever, but most evidence suggests coffee is part of a healthy diet.
On Monday, another of these giant studies came out, this time looking at residents of the United Kingdom. Researchers there wanted to examine how coffee habits affected overall health, as measured by a statistic called all-cause mortality. That basically means they grouped people by how many cups of coffee they drank per day, then looked to see whether those groups that consumed more cups had more deaths during the course of the study. If the cohort that drank eight cups per day had fewer deaths than the group that drank just two, that would imply that somehow the high-volume coffee drinkers were more healthy. And that's exactly what they found. Across 502,641 participants ranging from 38 to 73 years old, both male and female, the more coffee a person drank the less likely they were to die. The researchers published their results in JAMA Internal Medicine on Monday.
The differences weren’t giant, but they were statistically significant. This is getting a little into the weeds here (skip down a paragraph if you hate statistics), so bear with for a moment. When doing a large observational study like this, researchers use a hazard ratio to measure how much of an effect a variable like coffee consumption has. For example, in this case a hazard ratio of 1 means there’s no difference in how often people die, whereas a hazard ratio of 0.5 would mean the group that drank coffee died only half as often as the non-coffee drinkers. This study grouped participants into six cohorts: those who drank less than one, one, two to three, four to five, six to seven, and more than eight cups of coffee per day. The researchers found that the hazard ratios generally declined as the number of cups consumed increased, indicating that the more coffee people drank, the less likely they were to die during a set period. In order, the hazard ratios were 0.94, 0.92, 0.88, 0.88, 0.84, and 0.86. All but the first ratio are considered statistically significant—meaning that the difference between the groups was profound enough to (probably) be more than random chance.
Studies like this can only ever tell us what health outcomes tend to look like for people who drink coffee. They're observational—no one is assigning groups of participants to drink five or two or zero cups per day and then making sure their lives are otherwise identical, so they can't provide any real causation. But because we're never going to run a clinical trial in which coffee gets prescribed, observational studies are the closest we'll get. That's why it's important to gather a lot of people—hundreds of thousands or even millions are ideal—so that you can be assured that your finding isn't just a statistical fluke. Drinking coffee may be associated with lots of other habits that influence health, or perhaps not drinking coffee is associated with something. For instance, people who have serious illnesses like cancer may not drink coffee, but these people are also more likely to die—that would artificially increase mortality for the non-coffee-drinking group.
The researchers in this study looked to see which other traits were associated with drinking lots or no coffee—things like smoking, body weight, socioeconomic status, and so on—and tried to control for those factors to prevent them from interfering with the results. Coffee drinkers tended to be male and white, for example, and also drank more alcohol and were former smokers. Particularly high coffee consumption was correlated with being a current smoker. Drinking between one and three cups correlated with having a university degree and being older, and well as reporting “excellent” health.
All of these findings generally line up with what other large-scale studies have found: drinking more coffee tends to correlate with good health and fewer deaths. Here is a 2017 European study showing that, with 521,330 people. Here's one from 2012 involving 5,148,760 Americans finding the same inverse correlation. And here's another from 2017 focusing on nonwhite populations in the U.S., still finding that drinking coffee is generally associated with lower risk of death.
This study is, for the most part, the same as the rest, except for one thing: it looked at genetic variations in caffeine metabolism. Relatively recent work has established certain mutations that make a person respond to caffeine in different ways. Researchers think this may partly explain why some people can down a cappuccino after dinner and sleep fine, whereas others have to stop drinking joe after 4 p.m.
The U.K. researchers used a large database containing genetic information about participants to test whether certain variants correlated with better or worse health outcomes. Perhaps those that respond quickly and easily to caffeine would fare worse—they just weren’t sure. But even looking across 400,000 people for whom genetic data was available, the researchers found no difference in outcomes between those whose genes predisposed them to caffeine sensitivity and those who didn’t. That is, across genetic variants, those who drank more coffee tended to have lower risk of death.
They did find, somewhat unsurprisingly, that those with a higher "caffeine metabolism score"—those who metabolize caffeine faster—tended to drink more coffee.
If you're one of those people who can't have more than a cup without getting jittery, but still want to drink joe, don't worry—you can drink decaf and still get the health benefits. This study, like others, found that the caffeine content made no difference to the risk of death. Even instant coffee seems to work, though the researchers note that the associations for ground, caffeinated coffee were "generally stronger." Researchers aren't sure what's in coffee that seems to boost our health, but the scientists on this study noted it provides further evidence that the secret ingredient isn't caffeine. Christopher Gardner, a professor studying food and health associations at the Stanford Prevention Research Center, told NPR that it may be the many antioxidant-rich compounds in our morning brew. One 2005 study in JAMA suggested that it could be compounds that reduce inflammation and insulin resistance, like lignans, quinides, and magnesium.
Of course, none of this means that coffee isn't an addictive substance or that pregnant people should be chugging it (the American College of Obstetricians and Gynecologists recommends no more than 200 milligrams per day, or about two cups of coffee). Caffeine is a stimulant, and though "too much" depends on your personal metabolism, an overload can give you headaches, irritability, restlessness, a fast heartbeat, and muscle tremors. Plus it can deprive you of sleep. The Mayo Clinic recommends limiting yourself to about 400 milligrams a day for that reason. It also doesn't mean that you can put oodles of sugar and cream in without having other negative health effects, like obesity or heart disease. But it does mean that the average person can drink their moderately-sugared, lightly-creamed joe in peace—even though we already knew that.
Mental stress and anger may have clinical implications for patients with heart failure according to a new report published in the Journal of Cardiac Failure.
Heart failure is a life-threatening cardiovascular disease in which the heart is damaged or weakened. This can lead to a reduced ejection fraction, in which the heart muscle pumps out a lower amount of blood than is typical with each contraction.
In this study of patients who had heart failure with reduced ejection fraction, the authors — including researchers at Yale — evaluated the effects of stress and anger on diastolic function. Diastolic function describes the ability of the heart to relax and refill between muscle contractions and is predictive of mortality risk.
For one week, participants completed daily questionnaires about their experiences of stress, anger, and negative emotions during the previous 24 hours. Participants then completed a standardized “mental stress” protocol in which they solved challenging arithmetic problems and described a recent stressful experience. Echocardiograms were performed to assess diastolic function at rest and during the stress task.
Patients who reported experiencing anger in the week prior to the laboratory mental stress protocol exhibited worse baseline resting diastolic pressure, the researchers said. Furthermore, most patients demonstrated stress-provoked changes in diastolic function, including decreased early relaxation and increased diastolic pressure.
“Mental stress is common in patients with heart failure due in part to the complexities of disease self-management, progressively worsening functional limitations, and frequent symptom exacerbations and hospitalizations,” said the lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale.
“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events. Clarifying the relevant behavioral and physiological pathways is especially important in the era of COVID-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors,” Harris said.
“Factors such as mental stress and anger often go unrecognized and are under-addressed,” said Matthew Burg, a Yale clinical psychologist and senior author of the study. “This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischemic heart disease (narrowed arteries) and arrhythmic disease.”
Burg said that while stress management and related techniques have been shown to reduce risk for adverse events among patients with ischemic heart disease (narrowed arteries), further work is needed to identify factors that increase vulnerability to the effects of stress in heart failure, and to determine whether stress management can improve outcomes for these patients.
Raise your hand if you’re one of the many that found themselves walking a lot more during lockdown? Us too.
With the gyms shut, pubs closed and social gatherings cancelled, walking has been our go-to distraction. A way to separate the mundane work day and step away from our not-so-comfortable makeshift desks. Or a means of socialising (when restrictions lifted).
Depending where you’re at, at your fitness level, you may not be able to run, but the vast majority can walk – even if it’s only a very short distance. But if you’ve become a recent convert who plans to pack away the pedometer once the spin studios and weight rooms reopen, consider this: Walking is the most accessible, easiest way to stay fit. That might seem unlikely if you’re into more intense forms of exercise. After all, if you’ve spent half your life at Barry’s Bootcamp (in person or online), walking isn’t going to make much of a difference… Or is it?
Since the 1970s, ‘no pain, no gain’ has been the ever-present motto of trainers and running clubs. If you’re not working at 80% of your overall max, you’re not working hard enough. While that sort of high-intensity training is great for significantly boosting fitness and preparing for races and competitions, it’s not always sustainable. With training hard on a daily basis, you run the risk of injury, fatigue and even a drop off in interest.
Low impact steady state cardio (LISS), on the other hand, is still great for heart health and you can do it every day. In fact, a 2013 study claimed that walking briskly can help your heart health as much as running. Published in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology, researchers compared data from two studies of 33,060 runners and 15,045 walkers. Walkers experienced greater health benefits than runners: seeing the risk of first-time high blood pressure drop by 7.2%, compared to runners’ 4.2% – while cholesterol risk was cut by 7 % for walkers compared to 4.3% for runners. Both had the same 12 percent cut in risk for first-time diabetes.
“Walking and running provide an ideal test of the health benefits of moderate-intensity walking and vigorous-intensity running because they involve the same muscle groups and the same activities performed at different intensities,” says study leader Dr Paul Williams, from the Lawrence Berkeley National Laboratory in California. “People are always looking for an excuse not to exercise, but now they have a straightforward choice to run or to walk and invest in their future health.”
In a report that included findings from multiple studies, researchers found that walking reduced the risk of cardiovascular events by 31% and cut the risk of dying by 32%. These benefits were equally prevalent in men and women and were apparent by covering just 5.5 miles a week at a speed of two miles per hour. If you walk 10,000 steps a day, you’re covering almost five miles a day so you really don’t have to go far at all to reap the cardio protections. People who walked longer distances or walked at a faster pace (or both) resulted in the largest reduction of risk for cardiovascular disease.
While any form of walking is good, Dr Georgina Stebbings, Senior Lecturer in Sport & Exercise Physiology from the Manchester Metropolitan University, explains that intensity does make a difference: “Ideally, it’ll be intense enough to get you out of breath (i.e. moderate intensity), which could be a short power-walk or a longer, slower paced walk over more difficult terrain”.
“In a society when sedentary/sitting time averages approximately eight hours per day for adults, it’s not only important to be active, but to also reduce the sitting time. So, even if you’re not able to complete moderate intensity walking/activity, simply breaking up prolonged periods of sitting every 30 minutes with light intensity movements/walking is sufficient at keeping blood sugar levels lower throughout the day (which is helpful in staving off diabetes).”
She points to a 2016 Health Survey for England which estimated that less than 35% of adults manage to complete the recommended 150 minutes of moderate intensity exercise a week. In order to walk your way to that target, you could go for a 10-minute power walk three times a day – easily achievable when many of us are still working from home and are more able to take a quick break from our desks.
Her point confirms the findings of a 2017 study by the University of Leicester which found that slow walkers were around twice as likely to die of a cardiovascular issue than people who considered themselves to be ‘brisk’ walkers. The study tracked 420,727 healthy adults over a six year period and – after factoring in things like smoking and hours spent watching TV – researchers found that the link between walking pace and heart health was still strong. Professor Tom Yates, lead author of the study and reader in Physical Activity, Sedentary Behaviour and Health at the University of Leicester said that this “suggests habitual walking pace is an independent predictor of heart-related death”.
Back in 2018, Public Health England (PHE) and the Royal College of General Practitioners encouraged the nation to incorporate at least 10 minutes of brisk walking into their day, calling it the ‘Active 10’ in order to cut the risk of type II diabetes and other conditions related to inactivity.
“I’d advise anyone of any age and activity level to fit in at least one 10-minute brisk walk a day as a simple way to get more active, especially those who may be taking medication for a long-term health condition – you will receive even more benefits from walking briskly for 10 minutes or more a day,” Professor Sir Muir Gray, clinical advisor for the Active 10 app and PHE’s One You campaign said at the time.
The Active 10 wasn’t designed to be a leisurely stroll. Although low-impact, power walking is a full-body workout that sculpts arms, legs and core muscles. Benefits also include firing up the metabolism and improving blood circulation, blood pressure and cholesterol. Getting outdoors even for 10 minutes enables you to get a good dose of that hard-to-find vitamin D too.
During lockdown, Diren Kartal – head coach at Project X Training – has been taking to his Instagram Stories to encourage his followers to get up and start their day by hitting 10,000 before breakfast.
“People don’t necessarily have to hit 10,000 steps a day – I just advocate people to move more,” he explains.
Pregnant women with hypertensive disorders, particularly preeclampsia, a form of high blood pressure during pregnancy, are at greater risk of having children with mental health issues, according to a new study conducted by researchers from the University of Helsinki in Finland.
Women were recruited into the study in early pregnancy at Finnish maternity hospitals. The children in the study were born between 2006 and 2010 and were tracked until the end of 2016 when they were 6.4 to 10.8 years old. Mental disorders were identified from Care Register for Health Care.
Overall, the research team looked at 4,743 mother-child pairs and found a link between hypertensive pregnancy disorders, including chronic hypertension (high blood pressure), gestational hypertension, preeclampsia and eclampsia, and childhood mental disorders.
Preeclampsia is a common pregnancy complication often characterized by high blood pressure and protein in the urine, which can indicate damage to other organs including the liver and kidneys. Eclampsia is a severe complication of preeclampsia in which high blood pressure during pregnancy results in seizures.
The study findings show that maternal preeclampsia and its severity are linked to an increase in the risk of any childhood mental disorder and psychological development and behavioral and emotional disorders.
Specifically, the research team found a 66 percent higher risk of mental health disorders among children whose mothers had preeclampsia. They also found a two-fold higher risk of childhood mental health issues among children whose mothers had severe preeclampsia.
“While previous studies have shown significant effects of preeclampsia on ADHD, autism spectrum disorder and schizophrenia in the offspring, a novel aspect of our findings was that the predisposing effects of maternal preeclampsia extended to any childhood mental disorder in the offspring,” said Dr. Marius Lahti-Pulkkinen, one of the senior researchers of the study and a docent at the University of Helsinki.
The research team also noted that the combination of maternal hypertensive disorders, overweight/obesity and diabetes disorders in pregnancy increases the cumulative prevalence of childhood mental disorders from 6.6 percent among children of mothers with none of those conditions to 22.2 percent in offspring exposed to all three of these negative maternal conditions.
In addition, the link between the mother’s preeclampsia and mental disorders in her offspring could not be explained by her own mental health disorders, age, substance use, number of previous pregnancies, education, overweight/obesity or diabetes disorders or by the father’s mental or hypertensive disorders.
“The findings emphasize the need for preventive interventions and treatments for maternal hypertensive disorders, since such interventions have the potential to benefit both the well-being of the expectant mother and her offspring,” said Lahti-Pulkkinen.
“The findings also shed important new light on the etiology of childhood mental disorders. This information may help in targeting preventive interventions and support for families at risk, and aid clinicians in understanding issues and the underlying causes of childhood mental disorders.”
Hypertensive disorders in pregnancy are also key risk factors for maternal mortality, stillbirth, preterm birth and intrauterine growth restriction, and these disorders can predict cardiovascular morbidity in the mother and her offspring.
A high-salt diet is not only bad for one's blood pressure, but also for the immune system. This is the conclusion of a current study under the leadership of the University Hospital Bonn. Mice fed a high-salt diet were found to suffer from much more severe bacterial infections. Human volunteers who consumed an additional six grams of salt per day also showed pronounced immune deficiencies. This amount corresponds to the salt content of two fast food meals. The results are published in the journal Science Translational Medicine.
Five grams a day, no more: This is the maximum amount of salt that adults should consume according to the recommendations of the World Health Organization (WHO). It corresponds approximately to one level teaspoon. In reality, however, many Germans exceed this limit considerably: Figures from the Robert Koch Institute suggest that on average men consume ten, women more than eight grams a day.
This means that we reach for the salt shaker much more than is good for us. After all, sodium chloride, which is its chemical name, raises blood pressure and thereby increases the risk of heart attack or stroke. But not only that: "We have now been able to prove for the first time that excessive salt intake also significantly weakens an important arm of the immune system," explains Prof. Dr. Christian Kurts from the Institute of Experimental Immunology at the University of Bonn.
This finding is unexpected, as some studies point in the opposite direction. For example, infections with certain skin parasites in laboratory animals heal significantly faster if these consume a high-salt diet: The macrophages, which are immune cells that attack, eat and digest parasites, are particularly active in the presence of salt. Several physicians concluded from this observation that sodium chloride has a generally immune-enhancing effect.
The skin serves as a salt reservoir
"Our results show that this generalization is not accurate," emphasizes Katarzyna Jobin, lead author of the study, who has since transferred to the University of Würzburg. There are two reasons for this: Firstly, the body keeps the salt concentration in the blood and in the various organs largely constant. Otherwise important biological processes would be impaired. The only major exception is the skin: It functions as a salt reservoir of the body. This is why the additional intake of sodium chloride works so well for some skin diseases.
However, other parts of the body are not exposed to the additional salt consumed with food. Instead, it is filtered out by the kidneys and excreted in the urine. And this is where the second mechanism comes into play: The kidneys have a sodium chloride sensor that activates the salt excretion function. As an undesirable side effect, however, this sensor also causes so-called glucocorticoids to accumulate in the body. And these in turn inhibit the function of granulocytes, the most common type of immune cell in the blood.
Granulocytes, like macrophages, are scavenger cells. However, they do not attack parasites, but mainly bacteria. If they do not do this to a sufficient degree, infections proceed much more severely. "We were able to show this in mice with a listeria infection," explains Dr. Jobin. "We had previously put some of them on a high-salt diet. In the spleen and liver of these animals we counted 100 to 1,000 times the number of disease-causing pathogens." Listeria are bacteria that are found for instance in contaminated food and can cause fever, vomiting and sepsis. Urinary tract infections also healed much more slowly in laboratory mice fed a high-salt diet.
Sodium chloride also appears to have a negative effect on the human immune system. "We examined volunteers who consumed six grams of salt in addition to their daily intake," says Prof. Kurts. "This is roughly the amount contained in two fast food meals, i.e. two burgers and two portions of French fries." After one week, the scientists took blood from their subjects and examined the granulocytes. The immune cells coped much worse with bacteria after the test subjects had started to eat a high-salt diet.
In human volunteers, the excessive salt intake also resulted in increased glucocorticoid levels. That this inhibits the immune system is not surprising: The best-known glucocorticoid cortisone is traditionally used to suppress inflammation. "Only through investigations in an entire organism were we able to uncover the complex control circuits that lead from salt intake to this immunodeficiency," stresses Kurts. "Our work therefore also illustrates the limitations of experiments purely with cell cultures."
High blood pressure, diabetes, and cardiovascular disease are so commonplace that everyone reading these words likely knows somebody with at least one of these maladies.
They are also the “underlying conditions” most associated with severe cases of COVID-19, based on early clinical profiles on the disease. Even though 80 percent of COVID-19 cases are mild, these reports reveal that the novel coronavirus can endanger people other than the elderly and infirm.
The idea that the virus only poses a threat to older people comes from focusing too heavily on COVID-19’s death rate, which the World Health Organisation updated last Wednesday to 3.4 percent. This rate is an average across ages, and the chances of dying do rise among older people.
But evidence also shows that COVID-19 is more fatal across all age groups than seasonal influenza, with death rates six to 10 times higher for those under 50. Moreover, death isn’t the only danger, and severe cases of COVID-19 are more common among young adults than you might think.
A study published February 28 in the New England Journal of Medicine, for example, examined the age breakdown for 1,099 coronavirus patients. The majority of non-severe cases—60 percent—are teens and adults between 15 to 49 years old, which might suggest this group is spared the worst of the virus.
In truth, severe cases were slightly more abundant among this younger demographic. Of the 163 severe cases reported in the study, 41 percent were young adults, 31 percent were aged 50 to 64, and 27 percent were above 65. The only age group spared by severe COVID-19 appeared to be kids under 14.
Millennials and Gen Z are also just as likely to catch the coronavirus as older groups, according to the largest profile to date on COVID-19, a clinical report of more than 72,000 patients published February 21 by the Chinese Centre for Disease Control and Prevention. So rather than rely on age to gauge who is most threatened by COVID-19, doctors say you may want to look at common underlying conditions and how they correspond with the death rates reported by the Chinese CDC. Doing so can offer clues on how to protect you and your loved ones.
“The death rate from this outbreak is high. We shouldn’t categorise it by young or senior,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation, said during a Monday briefing. “We cannot say that we care about millions when we don’t care about an individual who may be senior or junior … Every individual life matters.”
The novel coronavirus tears apart the lungs, but the underlying condition most connected with COVID-19’s worst outcomes are afflictions of the heart.
Nearly half the adults living in the United States have high blood pressure. Likewise, diabetes is a household name. Both can factor into cardiovascular disease, a wide spectrum of disorders that kill one person roughly every 37 seconds in the United States alone.
Though the specific influence of COVID-19 on the cardiovascular system remains unclear, the American College of Cardiology states, “there have been reports of acute cardiac injury, arrhythmias, hypotension, tachycardia, and a high proportion of concomitant cardiovascular disease in infected individuals, particularly those who require more intensive care.” One study of 150 patients from Wuhan, China—the epicentre of the coronavirus outbreak—found that patients with cardiovascular diseases had a significantly increased risk of death when they are infected.
That’s because the heart and lungs are incredibly interconnected. Breathe in and out rapidly, and your pulse automatically increases its pace. But if your heart is already weak or you have blocked arteries, then you are working harder than a normal person to circulate blood and oxygen throughout your body.
“If this new virus enters our communities as it has been, I really worry for my cardiac patients,” says Erin Michos, a cardiologist and director of Women's Cardiovascular Health at Johns Hopkins Medicine in Baltimore. “During their day-to-day existence, their heart is having trouble pumping efficiently, and then you add a serious respiratory infection on top of that. That's the tipping point.”
Cardiac distress is yet another arena where the coronavirus mirrors what happens with the flu. Influenza has long been established as a propellant for heart attacks and cardiovascular disease, so much so that some doctors have wondered if the seasonal virus is a direct cause. A 2018 study published in the New England Journal of Medicine found that within seven days of a flu diagnosis, people were six times more likely to have a heart attack.
“I don't think the community fully appreciates it,” Michos says. “We know that viruses can trigger a heart attack or stroke.”
Moreover, people can be infected by more than one disease at the same time, further exacerbating any existing heart conditions. In a preliminary study of coronavirus patients from Wuhan, four percent of confirmed cases were infected with a second virus, mostly influenza.
“If your immune system is weakened already ‘cause you're fighting off one major pathogen, you're much more susceptible to get a secondary infection,” Michos says.
That’s why she, the U.S. Centres for Disease Control and Prevention, and the American Heart Association recommend that cardiac patients take extra precautions as the coronavirus outbreak grows, which includes getting vaccinated for the flu and bacterial pneumonia.
When it comes to matters of the heart, many people may also be at risk from underlying conditions they don’t even know they have. For example, high blood pressure—or hypertension—contributes to atherosclerosis, a process whereby the walls of a person’s blood vessels grow dense plaques made of fat and tissue fibres. If one of these plaques erodes or ruptures, it can block the blood vessel, leading to a heart attack or stroke.
Michos says a lot of people are walking around unaware with plaques and hypertension. The CDC estimates that 108 million Americans have hypertension, but at least 11 million have no idea.
That’s where the threat of respiratory infections such as influenza and coronavirus comes in. These infections can create a “blood storm” of inflammation that courses throughout a person’s body. (Once your body's infected, this is what coronavirus does.) An early study of Wuhan patients spotted “fulminant myocarditis,” an unusual syndrome that erodes the muscles in the heart.
“We know, especially for people who have no history of cardiovascular disease, that inflammation can be a trigger for a plaque rupture,” Michos says. Diabetes can also spur atherosclerosis and accelerate these plaque ruptures, and those with the disease also have relatively suppressed immune systems, making them more vulnerable for infections.
Given we are in the midst of flu season and the coronavirus crisis, Michos recommends that cardiac patients and diabetics make sure that they have enough of their regular medications, and that everyone checks that their blood pressure is under control.
Asthma action plan
Beyond cardiac health, the coronavirus outbreak has serious implications for people with chronic respiratory illnesses such as cystic fibrosis, chronic obstructive pulmonary disease, asthma, or allergies, as well as for people with lung damage linked to smoking. Even mild cases of a cold or the flu can aggravate these conditions, increasing one’s chances of landing in the hospital.
One alarming distinction with COVID-19 is the long incubation period before symptoms appear, which ranges from two to 14 days. This contributes to a situation in which members of the general public can be infected and contagious, yet have no awareness of their illness. And a new study published Monday in Lancet found that coronavirus patients shed the virus, an indicator of being contagious, for between eight to 37 days.
“I would advise anyone with a chronic respiratory illness before they travel, especially using public transportation, that they sit down and come up with a plan of protection,” says Enid Neptune, a pulmonologist at Johns Hopkins Medicine. Such a plan could be as simple as upping dosages of routine medications, or as thorough as pinpointing which nearby hospitals employ respiratory specialists.
“That may also mean not going to certain parties or gatherings where you don't really know where people have been or what their health status is,” Neptune says. Most of all, patients should not shy away from seeking professional advice.
“Sometimes patients feel that they're being alarmist and are inappropriately notifying their physicians,” Neptune says. “When there's a great deal of misinformation in the public arena and when there's much that we don't know yet about the virus, this is the time to use your medical contacts.”
Cancer patients are also in the group that needs to be concerned about respiratory conditions. People being treated with intensive therapy for leukemia or lymphoma, and those receiving bone marrow transplants, are among those more prone to catching pneumonias, including the viral versions. That’s because their immune systems are often compromised as a result of their tumors or due to the treatments they receive.
“Patients who have had cancer treatment in the past may also remain immunologically compromised even though they appear to have recovered,” says J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society in Atlanta.
These cancer patients are sometimes so jeopardised that they cannot take vaccinations and must rely on the protection afforded by community-wide immunisation. For now, the sole intervention for vulnerable cancer patients is social distancing and enhanced hygiene practices for their family and health care workers.
“That's difficult, because obviously cancer patients are at different stages of their illness, and people want to be with their loved ones,” Lichtenfeld says. “But we're all in this together, and we need to all take appropriate steps to protect ourselves and protect those we love.”
The kids are alright?
At the same time, all the data collected so far suggest that COVID-19 is rare and less severe in children. Through February 11, the Chinese CDC recorded 44,600 confirmed cases, but only 400 involved kids under 9 years old, and none died. So does this mean children are less likely to be infected, or that they just don't get very sick?
“All of us in the field think the latter is true,” says John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center. Early tracing among close contacts and in households has found that children are just as likely to catch the novel coronavirus as adults. The low number of childhood cases reported so far could be due to testing being concentrated at hospitals, Williams notes. “Once testing involves more mild patients, outpatients in clinics, and doctor’s offices, you will find more adults and probably a lot more kids.”
Seeing fewer kids with severe COVID-19 has some precedence among other coronaviruses and infectious diseases. Pediatric cases occurred during the SARS coronavirus epidemic 20 years ago, but most were mild. And while chickenpox is occasionally fatal for kids, unvaccinated adults who catch the disease are much more likely to suffer severe pneumonia and end up in the hospital.
“For any infectious disease, part of the symptoms and damage are caused by the germ itself, while part is caused by our immune system responding to the infection,” Williams says. “So the thought is that perhaps children, because their immune systems are less mature, just don't mount as much of a response to the infection as adults do.”
Despite this youth benefit, the school closures seen worldwide are justified, because children are the major spreaders of every respiratory illness known to exist. In the U.S., about 20 percent of American children get infected with the flu every year, versus 5 percent of adults.
“We also have a lot of vulnerable children in this country with chronic conditions,” Williams says, such as transplant recipients, cancer chemotherapy patients, or children with chronic heart and lung diseases. “We don't know yet if those kids are going to be at higher risk for more severe COVID-19 disease, but based on other viruses, my guess would be yes.”
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