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  • How to get to the Abyssal Woods in Elden Ring: Shadow of the Erdtree

    How to get to the Abyssal Woods in Elden Ring: Shadow of the Erdtree

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    The Abyssal Woods from Elden Ring’s DLC, Shadow of the Erdtree, is a land of horrors and madness. Frenzied Flame followers inhabit the woods and nightmarish creatures skulk about. It can be quite tricky to reach as you’ll need to do a bit of exploration, but should you find its entrance, you’ll be warned to turn back whence you came.

    Should you heed their warnings and retreat? Or should you continue on face the madness? Read on to find out how to get to the Abyssal Woods in Elden Ring.

    How to get to the Abyssal Woods in Elden Ring: Shadow of the Erdtree

    To find the Abyssal Woods, you’ll first need to reach the Ruins of Unte, which is hidden behind an illusionary wall in the Shadow Keep.

    Graphic: Johnny Yu | Source images: FromSoftware/Bandai Namco via Jeffrey Parkin

    Starting from the Storehouse, First Floor Site of Grace, head down the elevator behind you, which will lead you back towards the main gate of the Shadow Keep.

    Defeat or run past the Fire Knight, and turn to the left towards the golden boats. On the left side of the path, you’ll find a ladder leading down to a lower level of the Shadow Keep. Climb down the ladder and walk into the waterfall to reveal a hidden space.

    Ladder leading to the hidden wall in the Shadow Keep of Shadow of the Erdtree.

    Graphic: Johnny Yu | Source images: FromSoftware/Bandai Namco via Johnny Yu

    Go down the ladder ahead of you and follow the path to find a room with the “Domain of Dragons” painting. On the southwestern wall, you’ll spot two torches and a seemingly ordinary wall between them. Hit the space between the two torches to reveal an illusionary wall.

    Hidden doorway in the Shadow Keep of Elden Ring Shadow of the Erdtree.

    Image: FromSoftware/Bandai Namco via Johnny Yu

    Follow the path to find a stone coffin that will take you to the Castle Watering Hole Site of Grace.

    From the Castle Watering Hole Site of Grace, head southeast to find a pathway along the rockface, which has the Recluses’ River Upstream Site of Grace. Follow the path and jump over the gaps until you can cross over to the path on your right.

    Path from the Castle Watering Hole Site of Grace to the Abyssal Woods in Elden Ring’s DLC, Shadow of the Erdtree.

    Graphic: Johnny Yu | Source images: FromSoftware/Bandai Namco

    Continue along the path and drop off the southern end to find the Recluses’ River Downstream Site of Grace. Look over the eastern edge of the cliff to find gravestones that lead to the bottom of the waterfall. Hop your way to the bottom and head southeast to find another set of gravestones at the edge of the cliff.

    Path along the Recluses’ River that leads to the Abyssal Woods in Elden Ring’s DLC, Shadow of the Erdtree.

    Graphic: Johnny Yu | Source images: FromSoftware/Bandai Namco

    Make your way to the bottom of the cliff and cut through the woods to the east to find the entrance to the Darklight Catacombs. Progress through the Darklight Catacombs and defeat Jori, Elder Inquisitor to make it to the Abyssal Woods.

    Entrance to the Darklight Catacombs and the boss, Jori, Elder Inquisitor in Elden Ring’s DLC, Shadow of the Erdtree.

    Images: FromSoftware/Bandai Namco via Johnny Yu

    Looking for more Shadow of the Erdtree guides? Check out our guides on new Elden Ring DLC weapons, armor, map fragments, sites of grace, and talismans. We’ve also got location guides on where to find Scadutree Fragments and Revered Spirit Ashes, and an interactive Elden Ring DLC map.

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    Johnny Yu

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  • The Coming Russian Escalation With the West

    The Coming Russian Escalation With the West

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    To judge from the editorial pages and Capitol Hill currents that both shape and reflect Washington’s perceptions of the world, the doomsayers sounding alarms over the risk of direct military conflict between the U.S. and Russia over Ukraine have been proved wrong. Despite many Russian warnings and much nuclear saber-rattling, the United States has managed to supply advanced artillery systems, tanks, fighter aircraft, and extended-range missiles to Ukraine without an existential contest—or even significant Russian retaliation.

    For Washington’s hawkish chorus, the benefits of providing increasingly greater lethality to Ukraine outweigh the dangers of provoking a direct Russian attack on the West. They insist that the U.S. not allow fears of an unlikely Armageddon to block much-needed aid for Ukraine’s defense, particularly now that battlefield momentum has swung toward Russia. Hence the White House’s recent decision to green-light Ukraine’s use of American weapons to strike into internationally recognized Russian territory and its reported deliberations over putting American military contractors on the ground in Ukraine.

    Read More: Inside Ukraine’s Plan to Arm Itself

    There are several problems with this reasoning. The first is that it treats Russia’s redlines—limits that if crossed, will provoke retaliation against the U.S. or NATO—as fixed rather than moveable. In fact, where they are drawn depends on one man, Vladimir Putin. His judgments about what Russia should tolerate can vary according to his perceptions of battlefield dynamics, Western intentions, sentiment inside Russia, and likely reactions in the rest of the world.

    It is true that Putin has proved quite reluctant to strike directly at the West in response to its military aid for Ukraine. But what Putin can live with today may become a casus belli tomorrow. The world will only know where his red lines are actually drawn once they have been crossed and the U.S. finds itself having to respond to Russian retaliation.

    The second problem is that by focusing narrowly on how Moscow might react to each individual bit of American assistance to Ukraine, this approach underestimates the cumulative impact on Putin and the Kremlin’s calculations. Russian experts have become convinced that the U.S. has lost its fear of nuclear war, a fear they regard as having been central to stability for most of the Cold War, when it dissuaded both superpowers from taking actions that might threaten the other’s core interests.  

    A key question now being debated within Russia’s foreign policy elite is how to restore America’s fear of nuclear escalation while avoiding a direct military clash that might spin out of control. Some Moscow hardliners advocate using tactical nuclear weapons against wartime targets to shock the West into sobriety. More moderate experts have floated the idea of a nuclear bomb demonstration test, hoping that televised images of the signature mushroom cloud would awaken Western publics to the dangers of military confrontation. Others call for a strike on a U.S. satellite involved in providing targeting information to Ukraine or for downing an American Global Hawk reconnaissance drone monitoring Ukraine from airspace over the Black Sea. Any one of these steps could lead to an alarming crisis between Washington and Moscow.

    Underlying these internal Russian debates is a widespread consensus that unless the Kremlin draws a hard line soon, the U.S. and its NATO allies will only add more capable weapons to Ukraine’s arsenal that eventually threatens Moscow’s ability to detect and respond to strikes on its nuclear forces. Even just the perception of growing Western involvement in Ukraine could provoke a dangerous Russian reaction.

    These concerns undoubtedly played a part in Putin’s decision to visit North Korea and resurrect the mutual defense treaty that was in force from 1962 until the Soviet Union’s demise. “They supply weapons to Ukraine, saying: We are not in control here, so the way Ukraine uses them is none of our business. Why cannot we adopt the same position and say that we supply something to somebody but have no control over what happens afterwards? Let them think about it,” Putin told journalists after the trip.

    Last week, following a Ukrainian strike on the Crimean port of Sevastopol that resulted in American-supplied cluster munitions killing at least five Russian beachgoers and wounding more than 100, Russian officials insisted that such an attack was only possible with U.S. satellite guidance aiding Ukraine. The Foreign Ministry summoned the U.S. ambassador in Moscow to charge formally that the U.S. “has become a party to the conflict,” vowing that “retaliatory measures will definitely follow.” The Kremlin spokesperson announced that “the involvement of the United States, the direct involvement, as a result of which Russian civilians are killed, cannot be without consequences.”

    Are the Russians bluffing, or are they approaching a point where they fear the consequences of not drawing a hard line outweighs the dangers of precipitating a direct military confrontation? To argue that we cannot know, and therefore should proceed with deploying American military contractors or French trainers in Ukraine until the Russians’ actions match their bellicose words, is to ignore the very real problems we would face in managing a bilateral crisis.  

    Unlike in 1962, when President John F. Kennedy and his Russian counterpart Nikita Khrushchev famously went “eyeball to eyeball” during the Cuban missile crisis, neither Washington nor Moscow is well positioned to cope with a similarly alarming prospect today. At the time, the Soviet ambassador was a regular guest in the Oval Office and could conduct a backchannel dialogue with Bobby Kennedy beyond the gaze of internet sleuths and cable television. Today, Russia’s ambassador in Washington is a tightly monitored pariah. Crisis diplomacy would require intense engagement between a contemptuous Putin and an aging Biden, already burdened with containing a crisis in Gaza and conducting an election campaign whose dynamics discourage any search for compromise with Russia. Levels of mutual U.S.-Russian distrust have gone off the charts. Under the circumstances, mistakes and misperception could prove fatal even if—as is likely—neither side desires a confrontation.

    Pivotal moments in history often become clear only in hindsight, after a series of developments produce a definitive outcome. Discerning such turning points while events are in motion, and we still have some ability to affect their course, can be maddeningly difficult. We may well be stumbling toward such a moment today.

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    George Beebe

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  • What to Do if You Can’t Afford Your Medications

    What to Do if You Can’t Afford Your Medications

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    After Jackie Trapp was diagnosed with multiple myeloma, an incurable blood cancer, in 2015, she thought her biggest health shock was behind her. Then came the bills for Revlimid, a powerful cancer drug that her doctor said was her best hope for controlling the disease. The first month’s supply cost $11,148; the second, $12,040—and her insurer denied coverage. “I’d need to take the drug every month, for years,” says Trapp, 59, a former high school teacher and realtor from Muskego, Wis. “My husband and I had done well in our careers, we’d been frugal and we’d saved, but there was no way paying $120,000 a year or more was sustainable.”

    Figuring out how to pay for the drug that’s keeping her alive has become an all-consuming project. Trapp fought her insurer’s denial and won, and has switched health plans twice to ensure continued coverage. To afford her annual co-pays for Revlimid—$15,000 to $21,000 a year recently, before a new law capping out-of-pocket costs for people on Medicare took effect in 2024—she’s tapped into assistance programs from drug makers and grants from health care foundations. She has also drawn down savings, taken out two mortgages, sold her car, some furniture, and her husband’s classic truck, and lives as cheaply as possible, growing her own vegetables and DIY-ing everything from lawn care to hair cuts.

    “I am grateful for the drug that has saved my life,” says Trapp. “But I am also resentful that the financial burden is draining my life at the same time.”

    Nearly three in 10 Americans, like Trapp, struggle to afford the medications they need, according to a poll last year by health policy organization KFF. Some cope by not filling prescriptions or skipping doses, taking on debt to pay for their meds, or even foregoing basic needs like gas and groceries, according to research published last year in JAMA Network Open. But the same study found that many people have landed on creative workarounds that do not threaten their physical or financial health, including using discount coupons, switching to cheaper medications, or comparison shopping among pharmacies to find the lowest price.

    “There are a range of easy solutions that may be available to you,” says Stacie Dusetzina, the study’s lead author and a health policy professor at Vanderbilt University Medical Center in Nashville. “They may not work for everyone, but they’re worth trying for anyone struggling to pay.”

    Here is a closer look at six strategies that have helped lower costs dramatically for some families—and how they may help you save too.

    Ask members of your care team for help

    The first step when you’re hit with an unaffordable price for a medication you need, says Dusetzina: talk with your doctor and pharmacist. They may be able to recommend a similar, less expensive drug that works just as well, give you free samples, or be familiar with insurance strategies and programs that can help lower your costs.

    For Melissa Tavares, 32, asking the doctor if there was a more affordable drug than Vimpat, the medication prescribed to control her two-year-old daughter’s epilepsy, was initially uncomfortable. “I had some mom guilt about shopping and negotiating as if I were buying a mattress instead of life-saving medication for my child,” says Tavares, a school-based occupational therapist from Edgewater, Md. But Vimpat cost her $102 a month, nearly 10 times what she paid for Keppra, an anti-seizure medication prescribed for her three-year-old son, who also has epilepsy. “It may not be a lot of money to some people, but it was pricey for my family,” Tavares says.

    As it turned out, there wasn’t a good alternative drug, but a nurse who was part of her daughter’s health care team suggested Tavares might save money by switching to mail-order delivery instead of buying the drug at a brick-and-mortar pharmacy. That reduced her out-of-pocket cost from $306 to $212 for a three-month supply. Then, an insurance representative suggested she could work with her doctor on an appeal, or medical justification, to have Vimpat covered at the same price as Keppra, since they’d tried the cheaper drug first for her daughter but found it didn’t work.

    Tavares is in the middle of that process now and hopeful the cost will come down. And while the stress has taken a toll—she struggles with anxiety, depression, and TMJ, which causes her jaw to lock painfully—it’s also revealed a strength she didn’t know she had. “I’m just here to advocate for my daughter and get these prices where they need to be,” she says.

    Be a comparison shopper

    When Margot Cochran, 67, developed a severe intestinal infection called C. diff last year, she was stunned by the price of the cure: $1,200, after insurance, for a month’s supply of the antibiotic Vancomycin at her local CVS in Montclair, N.J. A physician friend suggested trying GoodRx, a pharmacy cost-comparison site, to see if she could get a better price elsewhere. Success! A nearby RiteAid was selling the same medication for $183 for the first month, then $153 for subsequent doses. Total savings for her three-month supply: $3,111.

    “I was surprised by how much prices fluctuated from place to place,” says Cochran, a retired human resources manager. “I walked out of that RiteAid feeling on top of the world.”

    Those cost differences can easily run to hundreds of dollars, sometimes even thousands, for the same medication and dosage, says Rich Sagall, founder of NeedyMeds, a nonprofit that tracks money-saving prescription programs and also offers a drug-price comparison tool. That’s partly because there isn’t a standard price that all pharmacies pay for the prescription drugs they sell; instead, individual pharmacies and drugstore chains negotiate prices directly with middlemen (called pharmacy benefits managers), then impose their own mark-ups. No single pharmacy consistently offers the best price and costs change frequently, Sagall says, so check regularly—on both new prescriptions and meds you take on an ongoing basis—to make sure you have the lowest price.

    Hunt for discounts

    GoodRx and NeedyMeds are also among a number of sites that offer discount coupons to reduce drug costs, in some cases by as much as 80%. Other sites that provide discounts include Mark Cuban Cost Plus Drug Company, RxSaver, SingleCare, Blink Health, and WebMDRx.

    You can also nab discounts by joining a retailer’s prescription drug plan. Amazon’s RxPass program, for example, allows Prime members to purchase more than 50 common medications for a flat fee of $5 a month. GoodRx Gold ($9.99 a month; $19.99 for families) provides discounts of up to 90% on thousands of generic and brand-name drugs. Costco, Walmart, and supermarkets such as Shoprite have programs as well. 

    Important to note: you can’t combine pharmacy discounts and health insurance to pay; it’s an either-or proposition. And if you use the discount, your outlay won’t count toward your deductible, when better coverage kicks in. But the savings can be worth those drawbacks, says Dusetzina: “You may find you can get your drug for much, much less money if you pay cash.”

    One other place to look for coupons: your drug manufacturer’s website. When Bob Parant, 71, a retired health insurance sales executive from Westbury, N.Y., was prescribed Entresto to treat heart failure in 2020, his first month’s bill came to $765, even with his Medicare Part D drug coverage. A one-time-use coupon for Medicare recipients from Novartis, the drug’s manufacturer, reduced the cost to zero. He has also used coupons to help manage spending to control his Type 1 diabetes.

    “As a retiree on Social Security with no other income, it’s been stressful to see my savings whittled down each year by the cost of living with diabetes and heart failure,” says Parant, who now volunteers with a nonprofit called Patients for Affordable Drugs. “Every dollar I save helps.”

    Seek help from the drug maker

    Many pharmaceutical companies also have financial assistance programs that help with copays for patients who have commercial or private insurance (people on Medicare are usually not eligible) or provide drugs at low or no cost to patients who meet certain income requirements. The limits are often fairly generous, Sagall says, noting that a maximum of 400% above the poverty level—$60,240 for individuals and $103,280 for a family of four in 2024—is not uncommon, and some programs may be even higher. (Find a list of programs here and here.) 

    Using a drug maker’s assistance program has helped Jacquie Persson, 35, sharply cut her out-of-pocket costs for the medications she takes for frequent migraines and Crohn’s disease, a chronic inflammatory bowel condition. A graphic designer from Waterloo, Iowa, Persson has good insurance through work but faced a co-pay of around $200 a month for a drug called Stelara (list price: $27,843 for a monthly shot) to manage Crohn’s; a manufacturer’s program brought her copays down to $5. She recently switched to an assistance program for specialty meds offered by her insurer that has brought the costs down even further, to zero. Still, she says, “Not a day goes by that I don’t worry about the what-ifs: What if my insurance changes at work or what if I lose my job?”

    Persson knows first hand how quickly things can change when it comes to her meds. In past years, she was able to get a monthly 16-tablet supply of Nurtec (list price: $2,123), a migraine medication, for free from the manufacturer. But that program was discontinued and her insurer initially declined coverage. Eventually she got approval from her insurer, but for only half the previous dosage, forcing Persson to bridge the gap with samples from her doctor and ration her usage; she waits to take the drug, she says, until her pain becomes unbearable. “All this just ends up running your whole life,” Persson says. “All my career moves and personal financial decisions are dictated by making sure I can pay for the drugs I need to function.”

    Get a hand from nonprofits

    Grants from health care foundations and associations that specialize in particular diseases can also be hugely helpful, as Janet Kerrigan, 68, a former critical care nurse from Myrtle Beach, S.C., has learned. (Check out a database of charitable organizations that offer financial assistance with drugs and other healthcare costs here.) 

    Kerrigan, who has multiple myeloma like Jackie Trapp, faced similarly staggering costs for the cancer drug Revlimid. After being diagnosed in 2011, Kerrigan’s first monthly co-pay for the drug came to $11,000, setting off a multi-year struggle to find ways to make her medications more affordable. “I’d spend eight hours a day researching, like a full-time job, while I was tired and drained from the cancer,” she says. 

    That work has paid off. Over the years, Kerrigan has gotten grants, averaging $11,000 each, from the PAN Foundation, the HealthWell Foundation, and the Leukemia & Lymphoma Society. She’s also gotten financial help from Revlimid’s manufacturer.

    Still, these efforts have not been able to stave off financial hardship. To help pay for her meds, Kerrigan has also run through her 401(k), cashed in a small pension and life insurance policy, and sold her grandmother’s silver. “I’m grateful I’ve been able to live many years with a disease I was told was terminal,” she says. “But no one should have to live with this constant worry, wondering if the drugs keeping you alive will be covered.”

    Lean on government aid

    Some good news for patients: measures designed to help lower prescription drug costs, passed as part of 2022’s Inflation Reduction, have started to kick in. That includes, for the first time, a cap on out-of-pocket spending for anyone with prescription-drug coverage under Medicare Part D—$3,300 this year, $2,000 in 2025—plus a $35 monthly out-of-pocket cap for insulin. Starting in 2026, Medicare will negotiate directly with drug companies to lower prices on the first 10 of an eventual 60 medications.

    “The savings for patients is going to be life-changing,” says Merith Basey, executive director of Patients for Affordable Drugs, a Washington D.C. nonprofit. “Medicare negotiation is the biggest lever we have to pull to help lower drug prices.”

    States are also taking action. AARP reports that last year states passed nearly two dozen bills to make prescription drugs more affordable, with another 45 bills in 17 states in play this year. The 2023 measures included moves to import cheaper medications from Canada, impose caps on out-of-pocket spending, and expand statewide drug savings programs. To find out what you might qualify for in your state, check this database from the National Conference of State Legislatures and the status of recent and pending state laws from the National Academy for State Health Policy. 

    It was a state law requiring insurance parity for certain oral cancer medications that gave Trapp the ammunition she needed to successfully fight the initial denial of coverage for the drug that’s helped keep her alive over the past nine years. As a result, her prescription for Revlimid was processed as a medical benefit, instead of a pharmaceutical benefit. She says she feels like she’s been fighting ever since.

    That’s tough to do, especially when you’re not feeling well, but patients say the potential payoff is worth the fight. “My advice is not to give up,” says Jacquie Persson, who pushed back against three denials of coverage before her latest prescription for migraine meds was approved by her insurance company. “Sometimes it feels like you hit a roadblock or you’re out of options, but if you just keep at it, all of sudden you find out about a new program or strategy, and somehow it all works out.”

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    Diane Harris

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  • What’s the Best Pillow Setup for Sleep?

    What’s the Best Pillow Setup for Sleep?

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    When most of us think about how to get the perfect night’s sleep, we consider things like how firm our mattress is, how cool or dark our room is, and what time we go to bed. One factor we sometimes fail to consider? Our pillow setup.

    “I think pillows are often incredibly overlooked,” says Dr. W. Christopher Winter, a neurologist, sleep specialist, and author of The Sleep Solution.

    Winter says he always asks patients what kind of pillow they have and where they bought it. “It’s really surprising how few people can actually answer the question,” he says. “It’s like they just always had the pillow or it just showed up in their bed at some point and they never really questioned it.”

    Finding the perfect pillow is an opportunity for people to improve their sleep without buying a new mattress, which can be time-consuming and costly, says Winter, who also hosts the “Sleep Unplugged” podcast. 

    The following advice can help ensure your pillow setup will get you the best sleep possible. 

    Not too low, not too high

    The most comfortable sleeping position is highly personal. Some people will feel most comfortable sleeping on their stomach, while others will get the best sleep on their side or back. (Generally speaking, side and back sleeping are best for the alignment of the spine.)

    Pillow height is highly personal, too; there’s no scientific consensus yet on the ideal pillow height. But a good rule of thumb is to use a pillow that fills the gap between your shoulder and ear, as this helps align your neck and spine, says Craig Hensley, associate professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine.

    Read More: Why You Sweat So Much at Night—And What to Do About It

    “If the pillow is too thick, it will bend and put stress on your neck,” he says. “If it’s not thick enough, it’ll bend your neck the other way, which could compress some of your joints.”

    Find the right firmness and material 

    Most people sleep better with a firmer pillow, Hensley says. Firm pillows support the head and neck better than soft ones. Just beware of a pillow that’s too firm, as this can cause stiffness from hyperextension of the neck, says Dr. Rachel Salas, a sleep neurologist at the Johns Hopkins Center for Sleep and Wellness. 

    The composition of pillows matters, too. One study compared five different pillow types: polyester, foam, contour foam with a groove for the neck, feather, and latex (which is bouncy and moldable). The study looked at whether each pillow type contributed to participants waking up with a stiff spine, headache, or arm pain. The researchers found that feather pillows performed the worst, while latex pillows performed the best.

    An added benefit of latex pillows is that they can protect against dust mites, Winter says. Certain materials, like goose down, are porous, and therefore more likely to trap dust mites than latex pillows.  

    Replace your pillows and wash your pillowcases regularly 

    If you wake up congested or with a post-nasal drip, it could be due to allergens in your pillow. One study found that 10% of a two-year-old pillow’s weight is due to dust mites and their excrement. Pillows can also contain dead skin, mold, and pet dander. 

    “If pillows are old, they can trap a lot of dust mites and human skin, and that can interfere with sleep quality,” Salas says.

    Read More: How People Relax Around the World

    The Asthma and Allergy Foundation of America suggests replacing your pillow every two years. Hypoallergenic covers can be beneficial if you’re particularly prone to allergies.

    You should also wash your pillowcases at least once a week. One study found pillowcases that hadn’t been cleaned in a week contained 17,000 times more bacteria than a toilet seat. This bacteria can be particularly rampant if you drool, sleep with makeup on, or sweat a lot. 

    Strive for a cooling effect

    If your head gets too hot while you sleep, your sympathetic nervous system can become activated, according to one 2015 study. This can prevent you from achieving deep sleep, which is essential for health. Using a pillow with a cooling effect can help you sleep better, especially if you’re prone to overheating at night. 

    If you’re looking for a pillowcase that will keep you cool, avoid synthetic materials like polyester, since they can retain heat, says Dr. Sudha Tallavajhula, medical director of the Neurological Sleep Medicine Center at TIRR Memorial Hermann in Houston. Instead, opt for pillowcases made from natural fabrics like cotton, silk, and bamboo. 

    Pillows aren’t just for your head

    When you picture the perfect pillow setup, it’s important to think beyond just the pillows under your head, Winter says. 

    Pregnant women, for example, might benefit from pillows that support their abdomen or legs. People with back pain can also benefit from using support pillows on their body. Hensley often recommends people with back pain who sleep on their back put a pillow under their knees, as this can decrease stress on the lumbar spine. People with back pain or sciatica who sleep on their side, he says, should put a pillow between their thighs, as this can lower the stress on the sciatic nerve.

    Read More: How to Share a Bed While Getting the Best Night’s Sleep

    For those with shoulder pain, Hensley recommends sleeping on the opposite side of the injury, and placing a pillow under the injured shoulder. For example, if you have right-sided shoulder pain, sleep on your left side and place a pillow under your right shoulder. 

    Many people like to sleep with their arm under their pillow. But doing so can put too much weight on your arm, especially if you have a shoulder injury. If you feel the most comfortable sleeping with your arm under your pillow, consider a specialty pillow that comes with a slot for your arm, Winter says. 

    Some people will benefit from added height

    Most people should only sleep with one or two pillows, Salas says. But there are exceptions to this rule. For example, sleeping slightly more elevated can help pregnant women dealing with shortness of breath and heartburn. 

    If you have gastroesophageal reflux disease (GERD), your sleep quality will also likely improve if your pillow setup is a little bit higher, Winter says. When you sleep slightly elevated, the contents of your stomach can flow downward more easily. “When we lie flat, they’re more likely to regurgitate through the esophageal sphincter,” he says. “When you’re more upright, gravity holds things down better.” (Tallavajhula adds that sleeping on the left side is better for people with acid reflux due to the position of the stomach.)

    Read More: 8 Ways to Stay Hydrated if You Hate Drinking Water

    Snoring can also improve if you use a pillow that’s a little bit higher. Snoring is often a sign of obstructive sleep apnea, a condition in which the airway becomes blocked and our breathing pauses. Sleep apnea should be treated with a CPAP machine. (Companies now make pillows that accommodate CPAP machines.) Allergies, obesity, and sleeping on your back can also cause snoring. Regardless of why you snore, sleeping with more pillows or a slightly higher pillow can help open your airway and reduce snoring.

    “Something as simple as propping your head up can improve snoring, improve sleep apnea, and then it also tends to make elements of GERD much better,” Winter says.

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    Jamie Friedlander Serrano

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  • What’s the Least Amount of Exercise I Can Get Away With?

    What’s the Least Amount of Exercise I Can Get Away With?

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    A few years ago, personal trainer Anna Maltby cut back on exercise as she juggled work with being a new mother. Like some of her clients, she suddenly lacked the time and energy to work out the way she used to. She could manage no more than several 15-minute workouts per week, “but I actually felt like I got my minimum effective dose for that stage of my life,” she says.

    Many of us feel like we’re too busy for exercise. Others actively avoid it. But research shows that doing at least some exercise is important for longer, healthier lives without dementia, heart disease, diabetes, or cancer. Other advantages are reaped right away: we’re happier and more energetic on a daily basis.  

    So, just how little exercise can you get away with, while still getting these benefits? Here’s how low you can go, according to experts. Getting there may require changing how we define exercise in the first place.

    Meet the minimum guidelines

    Official guidelines from the World Health Organization, the U.S. government, and other groups give adults a few choices for how low they can go with aerobic physical activity on a weekly basis. One option is getting at least 75 to 150 minutes of “vigorous” activity, meaning your level of huffing and puffing makes conversation difficult, and your heart rate rises to about 80% of its peak. Another option takes longer, but it’s less intense: 150 to 300 minutes of “moderate” activity, at 60-70% of your maximum heart rate. 

    You could also combine just enough vigorous and moderate exercise so they add up to the weekly minimum. Because tougher workouts are especially health-giving, they count more toward your weekly goal; every minute of vigorous activity is equivalent to two minutes of moderate activity. (This means that if you got 50 minutes of vigorous activity, that would count 100 minutes toward the 150-minute requirement for moderate activity. Then, you’d only need to add 50 minutes of moderate activity to meet your weekly minimum.)

    Read More: Your Brain Doesn’t Want You to Exercise

    These bare-minimum amounts deliver the biggest rewards for the fewest drops of sweat, according to decades of research. “If you look at the statistical curve, the increase in benefits is most dramatic” when these minimums are achieved, says Regina Guthold, an epidemiologist at the WHO. If you go higher—over 300 minutes of moderate exercise, for example—you’ll keep accruing greater health, but the gains become smaller. 

    Similar thresholds also support mental health, says Mary de Groot, a psychologist and associate professor of medicine at Indiana University School of Medicine. In a study with more than one million people, those who exercised 120 to 360 minutes per week had the best mental health, compared to those who did more or less. 

    Save time with hybrid workouts

    But here’s the catch: On top of cardio, strength training is a must, no less than twice per week. If you neglect it, some unsavory effects of older age may await you, like muscle atrophy and osteoporosis. 

    Now, the time-saving loophole: strength training can be mixed into cardio sessions. By using your own body weight as resistance (instead of heavier barbells), you can do more repetitions, upping your heart rate along with building muscle. Seniors in particular should focus on this “multicomponent activity,” the guidelines say, including moves that improve balance to help reduce the risk of falls.  

    Cardio-strength workouts include pushups, Turkish get-ups, mountain climbers, burpees, air squats, and lunges. With this hybrid approach, you could still wrap up exercise for the week in as few as 75 minutes.

    Skip days, not months

    Work gets busy; parenthood, vacations, and colds disrupt routines. We often need to skip exercise for several days in a row. (After all, we’re only human—not exercise robots.) So, how do the weekly minimums translate into everyday life? Must we bust a move every single day or face imminent demise? 

    Thankfully, no, Guthold says, as long as you catch up later in the week. “Weekend warriors get the same benefits as those who are active every day for less time,” she says. “There’s no evidence it needs to be spread out.”

    How about if you skip a week or two at a time? Well, if you reach the minimum amount of physical activity for only, say, three out of every four weeks, that’s much better than never reaching it. “It’s normal for people to have highs and lows with physical activity, even if they love it,” adds Stella Volpe, a professor of exercise and nutrition at Virginia Tech and president of the American College of Sports Medicine, another influential organization that publishes activity guidelines.

    Read More: How to Get Back to Sleep After Waking Up at Night

    “Life happens,” says Katrina Piercy, an exercise physiologist at HHS who leads development of the Physical Activity Guidelines for Americans. “But if you’re working toward meeting the guidelines in a typical week, you’re going to see benefits.” 

    Even on your off-weeks, just five minutes of activity per day will send more blood pumping through the body, which supports health by preventing blood vessels from stiffening. It could also improve blood sugar and sleep quality, Piercy says. But the more weeks that pass without meeting the guidelines, the more your health may eventually suffer, notes Volpe. Just two weeks straight being very sedentary causes aerobic fitness and muscle mass to decline significantly, potentially paving the way for disease. 

    Combine exercise with movement breaks

    Stay still for over an hour, and your feet may start tingling as the blood pools there, compelling you to get up and stretch. This light movement is important, but for most people, it’s not taxing enough to count toward their weekly exercise minimum. So here’s another way to save time on exercise: use these breaks to get your heart rate up so it qualifies as moderate or even vigorous exercise.

    Studies show that the more movement breaks you take, the lower your risk of death (at least anytime soon), says Keith Diaz, an associate professor of behavioral medicine at Columbia University Medical Center. It’s necessary to take these breaks even if you also exercise. “The other 98% of the day you’re not moving does matter,” Diaz says. 

    To save time, you can use four or five of these breaks as mini-exercise sessions, each about five minutes long. If you’re healthy enough to ramp up the intensity, try one-minute exercise snacks, 20 times per week or more, says Martin Gibala, a professor of kinesiology at McMaster University, who wrote a book called The One-Minute Workout. That could mean walking quickly or running up some stairs, depending on your fitness level. “Your total time spent exercising will be reduced, and there’s the simultaneous benefit of breaking up periods of prolonged sedentary behavior,” Gibala says. 

    We shouldn’t “blow off exercise completely” on days we’re too busy for one long workout, Gibala says. “Exercise doesn’t have to be this special thing you do at a special place.” In a study with over 25,000 people wearing fitness trackers, Gibala and colleagues found that people who didn’t formally exercise but got three separate bouts of vigorous activity, each lasting only 1 to 2 minutes, during their everyday lives lowered their risk of dying from cancer by about 40% and heart disease by 50% over a period of about seven years.

    Read More: How to Properly Cool Your Home With a Fan

    Diaz found that adults who engaged in five minutes of walking every 30 minutes improved their blood sugar, blood pressure, mood, and energy levels. Taking such breaks actually leads to more productivity at work, not less, according to Diaz’s preliminary findings. “Humans tend to have trouble focusing for longer than 20 minutes at a time anyway,” he notes.  

    You could have speed-walking meetings, or run from your office to the coffee shop. Volpe, the ACSM president, has a friend who watches TV with his kid but mutes the commercials, puts on music, and dances with the kid until the show resumes. “You’ll be amazed how good you feel by dancing a little instead of getting a snack,” Volpe says. 

    Piercy, the HHS physiologist, turns supermarket shopping into races, timing herself while carrying her groceries in a basket for muscle-strengthening. “Some days I don’t have a formal workout,” she says, “but I grocery shopped, or found other ways to multitask some activity.” 

    Redefine “exercise”

    Here’s the ultimate hack to reduce exercise time: find physical activities that don’t feel like exercise at all. (Warning: This may involve being social, having fun, and bonding with nature.) For example, you could ask a friend to join sessions of high-intensity interval training at a park. HIIT mixes bursts of activity with recovery breaks. When you can talk with people you like during the rest intervals, exercise drudgery transforms into a mobile hangout. 

    Sports like tennis count as HIIT. So does interval walking if it gets your heart rate up. The kicker is that the recovery intervals also go toward your minimum weekly exercise goal. “The rest intervals certainly count toward total minutes because your heart rate stays high during the breaks,” Volpe says. Magically, your 75 minutes of vigorous exercise could drop below 40.

    You may forget you’re exercising when distracted by the park’s natural beauty, leading to more benefits. “The improvements in mood…are even better when people exercise outside,” Diaz says, “away from their tech.” So-called “green exercise” improves emotions and self-esteem, and protects against depression, de Groot says.

    Find your ME

    This game of exercise limbo—how low can you go—involves more than the official guidelines. Your level of minimum exercise—your “ME”—depends on who you are. “When working with people on physical activity plans, the first thing I do is encourage them to think about their goals and values,” de Groot says.

    If you prioritize longevity and defying your age, your self-chosen ME will be higher than others’ minimums. “The more you exercise, the longer you’ll live free of chronic disease,” Diaz says. “But that’s not everyone’s goal.” Some care more about finding a sustainable amount that helps them feel good in the present moment, Diaz says, so they can carry groceries or climb steps without fatigue or pain.

    Here are some factors to consider in setting your ME: 

    • Time commitments: Some of Maltby’s clients are pregnant. “What counted as a great workout before this season of life just may not be possible in a few months,” she says.
    • Physical capacity: Activity guidelines may differ for those with illness or disability.
    • Stage of development. Kids need more activity than adults—they should average at least 60 minutes per day. 
    • Psychological makeup: Teens with ADHD, for instance, may need more exercise to “optimize their brain functioning,” says Erin Gonzalez, a clinical psychologist specializing in ADHD and health behaviors at Seattle Children’s Hospital.

    Fitness trackers and mood apps can show how different MEs translate into heart health, sleep quality, and positive emotions, and HHS created a “Move Your Way” weekly activity planner. “Monitoring your health data and progress objectively is very helpful,” Gonzalez explains. 

    Fitness wearables can also make exercise more efficient by turning it into family time through family fitness tracking. Instead of telling your teen to run around the house, strive toward your minimum goals together. “Doing so can sustain family lifestyle change,” Gonzalez says.

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    Matt Fuchs

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  • How to Cool Your Body Down Fast

    How to Cool Your Body Down Fast

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    As much as people enjoy the warm summer months, high temperatures can be hard on the human body. “As mammals, we live close to the thermal edge of life and death,” says Craig Heller, a physiologist and biology professor at Stanford University. “We run at 37°C [98.6°F], and only a couple of degrees above that puts us into heat illness and heat stroke.”

    Not every part of the body is the same temperature, however, “and blood flow determines where the heat is distributed,” Heller says.

    What part of the body cools down the fastest? And can we use that knowledge to cool down more quickly when it’s hot outside?

    Focus on your core

    In order to prevent the negative health effects of high temperatures, scientists say the most important goal is to reduce your core temperature. The most effective way to do this is to apply cooling methods, like a cold towel or ice water, to as large of a surface area as possible.

    “Cooling a body segment is not going to do much good when it comes to trying to reduce core temperature, which is the key determinant of heat-related illnesses,” says Ollie Jay, a professor of thermal physiology at the University of Sydney.

    Read More: Why You Sweat So Much at Night—And What to Do About It

    As the body warms up, it tries to get rid of heat by opening up blood vessels closer to the skin and sending more blood to those areas. This moves heat away from the core toward the surface of the skin, where it can dissipate from the body. Putting cold water or ice on the skin helps speed up this process, and cools down the body more quickly when water evaporates off the skin.

    Jay recommends pouring cool water over as much of the body as possible or placing a towel with ice on the chest for a minute or two at a time every 10 minutes until you feel more comfortable.  

    Target your hands and feet

    If taking a dip or wrapping yourself in a cold towel isn’t immediately feasible, “then cooling a limb, for example, is probably a good idea,” Jay says. Basic physics can help determine where to start. Every object has what is called specific heat, which is how much energy is required to heat it up or cool it down by 1°C. Objects with large surface areas and smaller masses have lower specific heats. This means the extremities—like the hands and feet, which have a lot of skin but not a lot of mass—are the most efficient at cooling down.

    Ice-cold water is best, “and the more skin surface area that’s covered, the faster you’re going to cool,” says Douglas Casa, a professor of kinesiology at the University of Connecticut and CEO of the Korey Stringer Institute, a nonprofit at the university dedicated to heat-stroke prevention.

    Read More: How to Spend Time Outside if You Hate Getting Sweaty

    Another  unique aspect of these areas is that they’re essentially hairless—and Heller has found that the parts of your skin without hair can quickly heat up and cool down. “The palms of your hands and the soles of your feet are radiators,” he says. This is, in part, because there are large networks of blood vessels in these areas that can quickly exchange heat through the blood. 

    Know when it’s time to step things up 

    If you’re truly overheated, cooling off one body part at a time may not be sufficient. Most negative effects from heat, like heat stroke or heat illness, come from when a person’s core temperature reaches dangerous levels, or the heat has put excess strain on their heart. 

    It’s not always obvious to a person when they’ve reached this point. How hot someone feels is not always connected to how hot their core temperature is.

    “Behavior is driven by how hot you feel, and health is driven by how hot you are,” Jay says. “You can have wildly different skin temperatures for a given core temperature.” For example, applying a cold towel to the neck and face can cool arteries heading toward the brain—which gives the body a signal that it is actually colder than it is. Some areas, like the face, have a lot of receptors to detect temperature—so cooling them may make someone feel like they are cooling off quickly when they aren’t.

    One way to know it’s time to cool off is to keep an eye out for signs of heat exhaustion: symptoms like nausea, cramps, dizziness, and an elevated heart rate. If a person experiences any of these, they should get out of warm environments, seek medical attention, and use methods to immediately cool off.

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    Anil Oza

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  • How to Navigate Dating When You Have IBD

    How to Navigate Dating When You Have IBD

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    Anthony Andrews, a 34-year-old training manager at a bank in London, had been candid from the very beginning, when he directed Jessica Lockett, an art director, to his Instagram profile, @ibdlife. They had matched on Hinge in January 2020, and he wanted to ensure that she understood what life with inflammatory bowel disease (IBD) and an ostomy bag meant before they got too involved. “Do you still like what you see?” he messaged. Back then, Andrews had been suffering with ulcerative colitis (UC) for 11 years and was days away from a surgery that would require him to wear a bag for the rest of his life. Lockett, intrigued and compassionate, scrolled through his posts, learning quickly exactly what that meant.

    “A lot of us [IBD patients] will probably feel like they can’t necessarily open up, but I would openly tell people,” says Andrews, joking that it was his “unique sales pitch” on dating apps. Most women were supportive, he says, but “there were a number of times when people were just like, ‘What’s that? That sounds disgusting. I don’t really want to deal with that.’”

    Lockett was different. She messaged back, “Of course I’m still interested.” That put him at ease before they even went on their first date.

    IBD, which includes UC and Crohn’s disease, is an incurable autoimmune disease that affects the digestive system. It brings unpredictable symptoms like diarrhea (sometimes with blood), abdominal pain, fatigue, and weight loss—and often first shows up just as young adults are hitting the dating scene, which can make it even more daunting.

    Treatments range from nutrition support and medications to more extreme procedures such as ostomy surgery, which typically involves creating an opening in the abdomen, known as a stoma, to allow waste to exit directly from the intestines into a bag outside the body. Surgeries are typically necessary when parts of the digestive system are diseased or damaged and need to be bypassed or removed. With or without surgery, IBD can alter body image and self-esteem, adding a layer of complexity to personal relationships, which can be hard enough without the added pressure of managing a stigmatized disease. 

    “Everybody’s got challenges, but it feels that IBD can be more challenging on sexuality and intimacy because bloody diarrhea is typically not sexy,” says Marci Reiss, a licensed clinical social worker and the founder and president of the IBD Support Foundation, based in Los Angeles.

    But there are many patients, advocates, and medical experts who say the disease can also just be part of your regular life, dating included. From figuring out the right time and way to share your IBD status, to smart planning for outings and sex, here are some tips to help make dating more comfortable for everyone involved.

    Read More: How to Maintain Your Social Life When You Have IBD

    Reveal your IBD when the time feels right 

    Everyone with IBD feels differently about opening up about their condition. Some people, like Andrews, may want to get it out of the way before even meeting someone face-to-face. Others may take months to broach the topic. 

    “It becomes so difficult for people to share, because it’s their deepest pain,” says Reiss. “People think to themselves, ‘Am I lovable with this?’”

    Sara Levitt (Instagram @saralevs) posing during a personal photoshoot celebrating World IBD Awareness Day on May 19th 2024, capturing words of affirmation.Yvon Steinthal (Instagram @yspamplemoose)

    Montreal-based content creator and model Sara Levitt, 29, would sometimes wait three or four months before sharing her medical condition with guys she dated, requiring stealthy ways to conceal her ostomy bag in the bedroom. To divert their attention, “I would just tell them, ‘I have Crohn’s disease, I have scars…I’m self conscious,’” says Levitt. This allowed her to tuck the bag under a sweater or tank top and keep her arm strategically wrapped around her waist. However, covering it up came with a price. “I would feel constricted and stressed out…and it held me back from developing emotional connections.”

    Last year, however, she went public about her IBD, ostomy, and proctectomy (in which the diseased rectum and anus are removed and sewn closed permanently), a.k.a. “Barbie Butt” surgery—so-called by patients themselves because it reminds them of a doll’s bottom. Levitt, who had her first surgery at 13 and is known as “The Bag Bish” on Instagram, spent years learning how to accept her condition and turning it into a blessing. In January, she became the first “ostomate” featured in the monthly men’s magazine MAXIM Australia. “I just reached a point where I was mentally and physically exhausted from hiding the bag, and I realized that I’m living the life I’m living because of it.”

    Prepare your elevator pitch

    Even before you decide to share, it’s helpful to have a short “elevator pitch” ready, says Laurie Keefer, a gastropsychologist and professor of medicine at Icahn School of Medicine at Mount Sinai Health System in New York City. One of her biggest pieces of advice: “Don’t make it a bigger deal than it has to be.” Her script goes something like this: “I have X condition; I was diagnosed X years ago; this is how it’s treated (medication and/or surgery), and this is how it affects me.” The last point, for example, may be a simple statement about needing to avoid certain foods or alcohol, or the possibility that you might need to get up suddenly to use the bathroom.

    Keefer wants her patients to be able to deliver this pitch in their sleep, so they can stop being anxious about it. “Most people, if they don’t have a chronic GI disease, are pretty clueless about what the digestive tract does or is. So for better or for worse, you can use that to your advantage,” says Keefer. Don’t catastrophize every reveal. “Even when you tell people you have an ostomy, they’re like ‘Oh, OK, my grandma had one of those.’ It doesn’t occur to them that that means you’re going to the bathroom outside of your body…most people don’t have an appreciation enough of anatomy and physiology that they even really fully understand what you’re saying.”

    Read More: Why Bathroom Access Is a Public Health Issue

    Scout the menu and restroom facilities before a date

    Before heading out on a date, do a little recon on the venue. Check out the menu online to make sure there are options that work for you. Investigate the restroom situation. Patients and experts agree that having a plan can ease any nerves and let you focus on enjoying the date. 

    With an invisible disability like IBD, it also helps to know your rights in public and private places. The Restroom Access Act, or “Ally’s Law,” (named after Allyson Bain, a Crohn’s patient from Illinois, who was 14 when she was denied access to a restroom in a department store, leading to a humiliating accident) has been passed in 17 states in the U.S., giving you the right to access a business’s private restroom if you ask. The non-profit organization Girls With Guts has made exercising this right even easier, with its “I Gotta Go” cards. You can easily replicate these at home; they’re super handy to discreetly communicate your urgency to skip the line or ask for restroom access where it’s usually off-limits.

    Talk to your GI doctor and other sexual health specialists

    Certain IBD symptoms, including pain during sex, leakage, and fistulas (an unusual tunnel between organs, which can get infected) may significantly affect your love life. Regardless of gender or sexuality, surgeries can disrupt or halt certain sexual activities, such as making anal penetration impossible, which can be frustrating to some people.

    Your IBD team can point you to specialists like OB-GYNs, urologists, pelvic floor therapists, and even sexual therapists such as psychologists and psychotherapists who understand and can support you. Plenty of people with IBD have vibrant, loving, and intimate relationships.

    “There is a connection between the physical and the psychological and vice versa. But sometimes it’s just physical because of all the damage that has been done to the nerves in that area,” says Dr. Aline Charabaty, director of the Inflammatory Bowel Disease Center at Sibley Memorial Hospital in Washington, D.C. Even your GI doctor may hesitate to discuss sensitive topics like emotional and sexual health, says Charabaty, but there should be questions like: How is this disease affecting your emotional health? How is it affecting your sexual health? Are you dating or in a relationship? If that’s not happening, bring it up yourself and ask for referrals.

    A heads-up on contraception: If you’re using pills and your IBD causes you to vomit or have severe diarrhea, they might not work as well. Also, some symptoms of STIs can look a lot like IBD flare-ups, so if something feels off, it’s smart to check in at a sexual health clinic. And remember, condoms are your go-to for protecting against STIs while you navigate everything else.

    Anticipate the unexpected during intimacy

    Navigating intimacy with IBD can be daunting, but there are effective ways to manage leakage and incontinence without ruining a romantic mood. Cherabaty says medications such as Imodium can help patients gain better control over bowel movements, particularly before engaging in sexual activities. Those experiencing ongoing symptoms of diarrhea or incontinence despite managing their disease may need additional strategies: pelvic physical therapy for strength, fiber supplements to firm up stools, or bile acid sequestrants like cholestyramine for the bile acid diarrhea often seen in Crohn’s patients. Some of Cherabaty’s patients who engage in anal sex have reported success using enemas beforehand to ensure cleanliness and comfort. Integrating the job of changing an ostomy bag into your “freshening up” routine can also help manage concerns, allowing you to feel more secure and relaxed.

    Also remember that sometimes accidents happen. How you and your date or partner respond to them could say a lot about the strength and understanding in your relationship. Alicia Aiello, 34, the president of Philadelphia-based Girls With Guts, recalls an embarrassing incident with her first serious girlfriend. “She kicked the ostomy bag off by accident in a hotel room with white sheets. And [the waste] went everywhere. It was all over her. It was all over me. It was one of the most mortifying experiences of my life, and I was only 20 then,” she recalls. Thankfully, Aiello and her girlfriend at the time had been dating long enough that they were able to take a pause and a deep breath before assessing the situation and cleaning up as best they could. (And avoid paying a $400 cleaning fee from the hotel.) “That was a positive moment where that was probably the worst thing that could have happened to me while dating someone. And while it was momentarily mortifying, looking back now, I can laugh about it.”

    Read More: Should You Tell Your Boss You Have IBD? Plus More Tips for Coping at the Office

    Explore ways you can make yourself feel sexy

    Dr. Neilanjan Nandi, a gastroenterologist and associate professor of clinical medicine at the University of Pennsylvania’s Penn Presbyterian Medical Center, actively supports his IBD patients in gaining sexual confidence. “Feeling sexy is a mind game,” he explains, emphasizing the importance of open communication and helpful products. For those with an ostomy, for example, stylish stoma pouch covers and support belts, or specialized lingerie, such as high-waisted crotchless panties, can make intimacy more comfortable. If odor is a concern, oral ostomy deodorizer pills can be helpful, too.

    Nandi also recommends letting your partner get up close and personal with your stoma, perhaps involving them in changing the ostomy bag, or making it part of a shared shower, a tip he got from one of his patients. “You have the water, you can get hot and steamy. You can play with the stoma; you can explore it together,” he says. “If there’s an accident, it’s a comfortable place to wash it off. I know that sounds crazy if you’re new to this, or even if you’re not, but it can make it a big difference.” This openness can not only boost your confidence, but deepens your connection, making intimate moments feel more natural and spontaneous.

    Anthony Andrews and Jessica Lockett celebrate their engagement.Anthony Andrews and Jessica Lockett

    Four years have now elapsed since Andrews met Lockett on Hinge—four years that included an amazing first date at a wine bar in London’s Borough Market, his ostomy surgery, and moving in together during the pandemic. Now, the two are planning to wed on the fifth anniversary of the day they met. Lockett has held his hand and cried with him in the hospital, cleaned up a messy stoma mishap, and walked around with an ostomy bag herself to understand what it’s like. Andrews admits that what started as casually scrolling the apps to distract himself from his surgery has blossomed into a love more real than he could have ever imagined. “She has been so unbelievably supportive…she’s my best friend,” says Andrews. To others still looking, he says, “Don’t lose hope.”

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    Claire Sibonney

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  • How to Cope With the Financial Toll of Cancer

    How to Cope With the Financial Toll of Cancer

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    Cancer isn’t just emotionally and physically taxing: It can take a steep financial toll on patients, caregivers, and families.

    In fact, two years after a diagnosis, adults with cancer are 71% more likely to experience financial problems than those without a cancer diagnosis, according to January 2022 research in the Journal of Clinical Oncology. This type of financial hardship due to medical bills is sometimes referred to as financial toxicity, or when out-of-pocket medical costs not covered by health insurance cause money problems for a patient.

    Cancer care costs vary widely by the type of disease and the stage at which it’s diagnosed. Insurance claims for an initial kidney cancer diagnosis average about $39,500 annually, according to July 2020 research in Cancer Epidemiology, Biomarkers, & Prevention. For end-of-life kidney cancer care, that number can stretch to an average of $92,300 a year, with an additional $11,400 for prescription medications.

    If you have insurance, you aren’t responsible for all of that, but depending on your coverage, you can still owe thousands. Some people with cancer say they spend more than 20% of their annual income on medical care, according to the National Cancer Institute (NCI).

    Joe Gillette, 58, of Brooklyn, N.Y., is intimately familiar with these statistics. A long-time American Cancer Society (ACS) volunteer, he was shocked when he received his own diagnosis, on August 5, 2022, his 57th birthday: stage 4 kidney cancer that had spread to his lungs, stomach, and brain.

    Gillette’s treatment plan called for brain surgery first, which would require a week’s hospital stay, then radiation and immunotherapy. He planned to be out of his job as an attorney for a week. Due to complications, he ended up in a coma for two and a half months, and his office put him on disability leave. There was a six-month wait for the payments to kick in.

    “Thankfully with my wife working, we were able to barely cover the mortgage,” he says. “We had some savings we had to go through.” Though his wife is sensitive to the cold, “she learned not to turn on the heat in the house unless it was truly freezing,” Gillette adds. “The grocery bill was bare necessities, which was not how I had ever lived.” 

    The disability payments amount to much less money than Gillette made when he was working. But he feels more secure now than during those six precarious months. “We treaded water for that time period,” he says.

    Others may have to shift finances around more dramatically. “They may delay treatment because they don’t have the funds to get to treatment or a second opinion,” says licensed clinical social worker Vilmarie Rodriguez, vice president of patient assistance and community engagement at the cancer support organization CancerCare. “Financial toxicity reduces quality of life, because [patients are] constantly worrying about medical bills or struggling to pay rent or mortgage or put food on the table. Their employment gets affected because they’re constantly going to treatment. All of this combined leads to worsening health outcomes.”

    Of course, your financial situation before cancer is a large predictor of how you may weather that storm, as is the type of cancer you’re diagnosed with, how advanced it is, and the treatment it requires. But regardless of your unique scenario, the following tips can help you prevent or lessen the effects of financial toxicity during cancer treatment.

    Speak with a social worker or patient navigator

    Many health-care facilities have social workers or knowledgable people known as patient navigators on their oncology teams who can help you from many angles: emotional, physical, and financial. But you might not know about these resources unless you ask what’s available. “The worst they can tell you is, ‘No, we don’t have that,’” Rodriguez says. 

    Hospital social workers in particular are familiar with the money-saving options you might have, including prescription assistance plans, transportation assistance, and bill negotiation or payment plans. “They do an outstanding job of being the patient advocate and looking out for patients in general,” says Alan Klein, chief development officer of the HealthWell Foundation, a non-profit that assists the underinsured by offering help with medication copays, insurance premiums, deductibles, and other out-of-pocket expenses, including for behavioral health care.

    Read More: How to Talk to Kids When a Parent Has Cancer

    Ask about costs up front

    Once you’ve connected with a social worker or patient navigator—or even a trusted doctor or nurse—try to learn as much as you can about the financial load ahead. “Patients should always ask the cost up front,” Rodriguez says.

    For example, your treatment plan might change without your knowledge to include a doctor who is out-of-network, resulting in a much larger out-of-pocket cost to you. Asking about your share will remind your health-care team to keep you in the loop.

    Although it does require some extra work on your part, don’t give up until you’re satisfied. Sometimes that takes repeated reminders to a doctor or patient navigator that you are on unstable financial ground and need their support, which isn’t always easy to do. But it’s the only way these professionals will know to reach out on your behalf, Rodriguez says.

    If you do get a surprise bill that’s more than $400 over the estimated charge, you may be able to dispute that charge under the No Surprises Act, says Zhiyuan (Jason) Zheng, a senior principal scientist and health economist at the ACS.

    Connect with support organizations

    Groups like the ACS, CancerCare, HealthWell, and the Cancer Financial Assistance Coalition offer various types of monetary help for people with cancer and their families or can connect you to local or national groups that do, Rodriguez says.

    These groups typically do a brief assessment of your diagnosis, medication, and finances, then come up with an action plan to get you the support you need. It usually takes less than 10 minutes, Klein says.

    Here’s how to contact them:

    • Call the American Cancer Society helpline at 800-227-2345.
    • Apply online for a HealthWell grant at healthwellfoundation.org or call 800-675-8416.
    • Call the CancerCare hopeline at 800-813-4673.
    • Search the Cancer Financial Assistance Coalition database at cancerfac.org.

    Don’t shrug these expenses off as mere pocket change: Since opening a kidney cancer-specific fund in 2015, HealthWell has awarded more than $200 million to more than 32,000 recipients, Klein says.

    Stick to your treatment plan

    Skipping follow-up appointments or delaying treatment is dangerous for your health and shouldn’t be part of your approach to handle the financial toll of cancer (or any diagnosis).

    “We routinely hear that patients who cannot pay for their medication regimen as prescribed only fill their prescriptions or receive their medication treatment in intervals they can afford, which is often suboptimal, especially in oncology. Affording their cancer medications should be the last thing those patients should be worried about,” Klein says.

    Financial hardship is associated with higher rates of death, including from cancer, according to March 2024 research in JAMA Network Open that Zheng co-authored. “You have to make the horrible decision to either pay for medication or for rent or food, and that’s just not acceptable,” Klein says.

    Even in the case of an advanced diagnosis, remain hopeful and committed to your treatment plan. “I was diagnosed with stage 4 cancer because it had spread to my stomach, lung, and brain,” Gillette says. “When you first hear that, you think, ‘It’s over.’” But immunotherapy has successfully reduced the size of many of his tumors. “Thankfully, through treatment, they were able to stop it in its tracks for now.”

    Consider crowdfunding

    When Gillette was really strapped for funds, his community pulled through: Friends he had made through volunteering with the ACS started a GoFundMe campaign that has raised more than $43,000 for his care, he says.

    Crowdfunding for medical care is a popular tool and can be “an excellent show of support to that particular person through that person’s network,” Klein says. “I just wish it didn’t have to be that way. There should be a more systematic approach available to a patient that could point them in the right direction of all available resources at their disposal. These folks might qualify for things they don’t even know about. It’s a complicated web to have to navigate.” 

    This approach isn’t for everyone: You or your family may not have the time or energy to start a campaign, you could have concerns about privacy, or it might not be acceptable in your culture or family to ask publicly for money, Zheng says. But if you’re curious and want to try it, “it’s better than doing nothing,” Klein says.

    Read More: Why Are So Many Young People Getting Cancer? It’s Complicated

    Push for policy change

    The U.S. does not currently have national standards for paid sick leave, despite many other industrialized countries requiring this benefit to employees. Consider voting for local and national candidates who champion paid sick leave policies and contacting your senators and representatives to express your support for paid sick leave if and when you have the energy to do so.

    “Regardless of the generosity of paid sick leave, it is typically not enough for patients who need to go to a radiation center three days a week for a period of six months, for example,” Zheng says. Still, “any paid sick leave policy is associated with earlier stage diagnosis and better treatment outcomes.”

    Remember, navigating the financial toll of cancer might feel like it’s a task left to you alone to handle, but there are resources available to you that you may not know about yet. “It’s a matter of looking for them and being vulnerable enough to say, ‘I need help,’” Rodriguez says.

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    Sarah Klein

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  • How Air Quality Affects Asthma—and What to Do About It

    How Air Quality Affects Asthma—and What to Do About It

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    Alana Yañez’s severe asthma had been completely under control for years. But when the 2020 wildfires started pumping thick plumes of ugly black smoke into the southern California sky, the 41-year-old Los Angeles resident began to wheeze. 

    She felt her chest tighten and then become painful. Yañez shut all the windows in her house, cranked the air conditioner, and turned on an air filter. But those measures barely made a dent in her symptoms.   

    “I was sucking on my inhaler every couple of hours,” Yañez says, adding that no matter what medications she was given, the pain in her chest persisted.  

    After several miserable days, Yañez remembered that she’d always breathed easier on the coast. When she checked local air quality maps, she saw that the air was far cleaner by the ocean. So she packed up her work and her little boy and headed for Redondo Beach.

    “With every mile, my lungs felt better,” she says. “By the time I took the exit for the beach, I was able to breathe without pain.”

    While dirty air—whether it’s due to diesel exhaust, traffic fumes, industrial pollution, or wildfires—can make breathing difficult for anyone, it hits people with severe asthma much harder, with some ending up in the emergency room or even hospitalized.

    During the spring and summer of 2023, when Canadian wildfires were shooting thick clouds of smoke into the air, asthma-associated emergency room visits in the U.S. spiked 17% higher than what would normally be expected. 

    The research linking air pollution exposure to asthma attacks “is very consistent,” says Dr. Akhgar Ghassabian, an associate professor of pediatrics and population health at the NYU Grossman School of Medicine. Even low levels of exposure can trigger an exacerbation, she says, and the most at-risk groups are children and seniors.

    Read More: What to Know About the Latest Advances in Managing Severe Asthma

    How does dirty air harm the respiratory system and exacerbate asthma?

    Over the past few decades, volunteers, one at a time, have entered a small chamber in a lab at the University of North Carolina and either pedaled on a stationary bike or sat quietly while components of diesel exhaust or smoke from burning wood were pumped into the room.  

    The volunteers had been carefully selected to avoid any severe reactions. They were all relatively young, under 45, and healthy overall, although some had mild asthma. After a few hours in the chamber, the study participants gave sputum samples, which helped researchers identify those who were sensitive to the fumes and exactly how their airways and lungs were being affected.

    Early experiments by the researchers from UNC and the U.S. Environmental Protection Agency (EPA) looked at the impact of exposure to diesel exhaust components, which included fine particles (PM2.5), ozone, and other gases. In some volunteers, the fumes sparked increases in airway inflammation, says Dr. David Peden, senior associate dean of translational research and medical director of the Center for Environmental Medicine, Asthma and Lung Biology at the University of North Carolina School of Medicine.  

    “Our studies are designed to get an idea of the underlying biology, and to use this information and these methods to identify particular interventions,” Peden says. Inhaling exhaust constituents sparked neutrophilic and eosinophilic inflammation. “The most important thing we find with most air pollution is that it irritates the airway epithelium.”

    Most people will acutely experience some degree of airway inflammation when they encounter air pollution or wildfire smoke, Peden says. “For many, it’s simply an annoyance, and they may not worry about it,” he adds.

    But for those with severe asthma, the impact can be much greater, Peden says. That’s especially true for children: Their respiratory rates tend to be higher than those of adults, so even a small amount of polluted air can make a big impact.

    The center’s most recent research has focused on potential treatments for exposure to pollution and wildfire smoke in the volunteers who were found to be sensitive. It’s yielded promising results. For example, people who overproduce mucus in response to dirty air may be helped by inhaling hypertonic saline solution. “When they inhale the solution, it loosens up the mucus,” Peden explains. 

    The research has also suggested a role for a certain type of vitamin D (gamma-tocopherol) that appears to calm the eosinophil response to pollution. But, Peden cautions, “this is a very early phase study. It’s not definitive.”

    Ongoing research is examining the genetics that impact sensitivity to wildfire smoke and air pollution, as well as ways to protect people with respiratory diseases, such as studies to determine the efficacy of N95 masks.

    Read More: An N95 Mask Is Your Best Outdoor Defense Against Wildfire Smoke

    Dirty air’s impact on people with severe asthma

    Exposure to any kind of dirty air can make asthma a lot worse, says Dr. Stokes Peebles, section chief for allergy and immunology at Vanderbilt University Medical Center. “It can lead to a feeling of tightness in the chest, coughing and shortness of breath,” he says. “The fine particulate matter, PM2.5, can get down into the very lowest parts of the airways.”

    Those ultrafine particles can also get deep inside the lungs, says Dr. Barbara Mann, an associate professor of medicine in the division of pulmonary, critical care and sleep medicine at the Icahn School of Medicine and at Mount Sinai in New York City. “They can evade most of the body’s defenses and wreak havoc.”

    Air pollution can cause two airway issues: constriction and inflammation. And it doesn’t stop there, Mann says. The tiniest particles can leach into the bloodstream and cause systemic inflammation. The more severe a person’s asthma is at baseline, the smaller the dose of polluted air it takes to kick off an exacerbation, and the worse those flare-ups might be.

    Wildfire smoke: an urgent danger 

    Wildfire smoke is an especially troublesome type of air pollution. It “dwarfs other kinds of air pollution,” Mann says. “It’s a toxic mix of both organic and inorganic materials that have been burned.”

    As Peden points out, wildfires can significantly raise the amount of fine particles in the atmosphere. “In 2018, when the Camp Fire was burning, the amount of fine particles in San Francisco was up three- to five-fold,” he says. 

    Unlike industrial and traffic related air pollution, wildfire smoke is likely to also contain fumes from the burning of manmade items, such as houses and vehicles. That can be a nefarious combination.

    Read More: What Wildfire Smoke Does to the Human Body

    New asthma kicked off by air pollution

    Along with exacerbating asthma, air pollution can spark new onset airway disease in those who are exposed, says Matt Perzanowski, an associate professor of environmental health sciences at the Columbia University Mailman School of Public Health. 

    Moreover, studies done at Columbia have shown that when people are exposed to diesel smoke, they can develop allergies to proteins they weren’t previously allergic to. “We study children in the South Bronx,” Perzanowski says. “When they’re exposed to cockroaches and diesel exhaust, they are more likely to develop an allergy to cockroaches.”

    Perzanowski recommends that parents limit their children’s exposure to pollution, especially wildfire smoke. 

    How to protect yourself

    If you have asthma, the most important step you can take to avoid an exacerbation due to wildfire smoke and pollution is to check local air quality reports daily. “There’s good data available in real time,” Ghassabian says. AirNow.gov, for example, is a terrific resource.

    On bad air quality days, take precautions to protect yourself from exposure to the dirty air. These are doctors’ favorite strategies:

    • Check ozone levels online and stay inside if they’re high. Close all the windows and block other spots where outside air could seep in.
    • Invest in a HEPA filter. According to the EPA, these can remove at least 99.97% of dust, pollen, mold, bacteria, and other airborne particles.
    • If the air quality index goes over 100, don’t exercise outside. If it’s over 150, don’t exercise at all. 
    • When the index is lower than 100 but still relatively high, you can exercise outside, but only in the early morning or evening.
    • Switch the setting on your home and car air conditioners to recycle, so you’re not bringing in outside air.
    • Use an N95 mask when you go outside.
    • When wildfire smoke is at high levels, consider temporarily relocating to a spot where air quality is better.

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    Linda Carroll

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  • The Tragedy of Mexico’s Election

    The Tragedy of Mexico’s Election

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    That it is a foregone conclusion that Claudia Sheinbaum will be Mexico’s next President is a tragedy for Mexican democracy. Sheinbaum is Mexico’s presidential frontrunner and the anointed successor of the country’s powerful President, Andrés Manuel López Obrador. She leads most polls with a large double-digit margin that has remained virtually static for the entire campaign.

    The tragedy isn’t that she is likely to win—a large majority of Mexicans will happily and democratically cast their ballots on June 2 for what will be the country’s first woman President (and the first of Jewish descent). It is how easily this triumph has been handed to her, even after campaigning on a platform of continuity in a country ravaged by violence, lawlessness, and twin fiscal and environmental crises.

    Sheinbaum’s allies rebut this criticism by pointing to the positive impact the current Morena government has had through its more progressive policies—salaries have gone up and the economy is growing. They add that the numbers speak for themselves: the President has a 66% approval rating. But that figure is misleading; López Obrador’s approval rating falls within the average of virtually every President from the past 30 years.

    Most Mexicans don’t necessarily adore the current government. They simply have not been given a decent alternative to vote for. And the opposition is in disarray in ways that will have a profound impact on the country’s future.

    President López Obrador swept into power in 2018 on a promise that he would cleanse Mexico of the corruption, violence, and stagnation that plagued it. His triumph smashed the old two-party system that dominated Mexican politics for decades. One was the PRI, which ruled Mexico for most of the 20th century, ideologically swinging from left to right for convenience and repressing the democratic will through rigged elections, clientelism, and corruption. Then there’s the right-wing PAN, which took the presidency from the PRI in 2000 only to unleash the cartel violence that still haunts Mexico.

    Sheinbaum receives the baton of command from Andres Manuel Lopez Obrador, President of Mexico, at the facilities of the Porrua bookstore in Mexico City on Sept. 07, 2023.Gerardo Vieyra—NurPhoto/Getty Images

    Six years have passed but many of Mexico’s issues remain or have worsened. The old rivals of PAN and PRI have since joined forces, nominating the relatively unaffiliated Xóchitl Gálvez as their “citizen candidate.” Gálvez’s selection by the Alliance for Mexico, as this pact is known, was a tacit acknowledgement that neither on their own can command considerable support given their past failures.

    The campaign was therefore designed as an anti-López Obrador alliance and its strategy has been to try to point out how badly Morena has run Mexico. But, throughout the campaign, Gálvez’s and the Alliance for Mexico have seemed set to show that anything they accuse the government of would be far worse in their hands.

    The Alliance accuses Morena of cronyism. Yet it was jarring when, in the final presidential debate, Gálvez attacked Sheinbaum for giving ambassadorships to corrupt politicians. The only problem was that the politicians in question were former PRI governors.

    The Alliance accuses Morena of corruption, only for the leader of the PAN to voluntarily tweet out how the Alliance was auctioning off political and administrative posts. It was a form of cronyism so normalized by these old parties that their leaders didn’t even realize that what they were publishing was illegal. 

    The Alliance, which is only united in their opposition to López Obrador, has predictably not been able to produce a coherent platform. This has reinforced the view that they are only running for the sake of remaining in office. 

    Claudia Sheinbaum during a news conference in Mexico City on June 11, 2023.
    Claudia Sheinbaum during a news conference in Mexico City on June 11, 2023. Luis Antonio Rojas—Bloomberg/Getty Images

    This is not necessarily far from the truth. Gálvez’s folksy charisma and personal honesty made her a contender early in the campaign. But, once it became apparent she was struggling to take off in the polls, PAN and PRI have focused on down ballot races. Money that was meant to go toward her presidential run was instead spent on the campaign’s of old political grandees looking to preserve any inkling of their past power.

    Mexicans clearly want answers to their country’s ills. In the final days of the campaign, Citizen’s Movement (MC), a minor party with a progressive platform, has seen steady growth in the polls at the expense of Sheinbaum’s considerable lead. An MC win looks incredibly unlikely—their poll numbers have only gone from 7 to 12% in the past days—but its steady draw on voters shows how open this election truly was. 

    More likely is a win for Sheinbaum and a majority in Congress for Morena and its allies. They will be faced with a crumbling opposition.

    The checks and balances that make up Mexico’s democracy cannot function without a working opposition. Many of Sheinbaum’s policies are set to continue down the disastrous path of militarization and the undermining of Mexico’s institutions. 

    The Alliance’s clumsy campaign stands in stark contrast with the serious accusations it has made about López Obrador’s Morena government, mainly that the Supreme Court and the electoral commission (INE) will be stripped of their autonomy. Unhelpfully, the Alliance has adopted the INE’s branding and colors. The tactic has made it seem to many that one of the country’s most respected independent democratic institutions is somehow aligned against the government, making it easier for Sheinbaum and her allies to claim bias and foul play.

    Even if Morena weren’t to gain a majority, members of the opposition—particularly the PRI—have had a track record of voting with the government anyway. Many have simply switched to Morena after being elected for another party—one of the PRI’s leaders defected to the Sheinbaum camp a week before the election.

    Ironically, Morena has done so well so quickly by pragmatically opening its doors to anyone that would defect from PAN and PRI. The result may be that Mexico might soon begin to see an opposition from within the party. 

    The internal opponents to a Sheinbaum presidency will come from many flanks. Some will stem from ideologues who have felt the party has veered too far from its original left-wing vision. Others will simply resent not being given a desired post. Still others will spot an opportunity to undermine a future President Sheinbaum who does not have the iron grip on the party that López Obrador has.

    It would be a return to the bad old days prior to 2000 in which Mexican politics was conducted within a single party. Yet, this single party rule wouldn’t have come about by the conniving of the ruling party, but by the ineptitude of the opposition. If and when they lose, they will only have themselves to blame—while the rest of Mexico pays for their folly.

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    Alex González Ormerod

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  • What to Eat Before and After Your Workout

    What to Eat Before and After Your Workout

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    Through the ages, humans have fueled their most physically demanding efforts with meaty proteins. Ancient Greeks loaded up on red meat before Olympic contests, and medieval knights recovered from war with venison and pork. The tradition continues today, with world-record-setting weightlifters breakfasting on chicken thighs, eggs, and bacon.

    But experts recommend that the modern, average person eat several other foods before and after tough workouts, even if the knights may have tossed them from their castle windows.

    The missing ingredients

    During exercise, blood carries the nutrients we’ve consumed to our strained muscles, where they’re absorbed. “We are what we eat,” says Keith Baar, a molecular exercise physiologist at the University of California, Davis. “And when we exercise, we’re more of what we just ate.” With proper nourishment, our muscles perform better, exercise feels easier, and we recover faster.

    The ancients weren’t exactly wrong about protein. It’s critical in forming the building blocks of muscle tissues during exercise and afterward, when the fibers are beaten up and need repairs. But many athletes and weekend warriors focus too much on protein, says David Nieman, who leads research on exercise and nutrition at Appalachian State University’s Human Performance Lab. “Unfortunately, a lot of people still act like protein is everything,” he says.

    Carbohydrates matter just as much, especially for cardio workouts. (And high-fiber carbs, in particular, tend to support long-term health compared to carbs with fewer nutrients.) “We’ve known since the 1960s that the muscles want carbs,” Nieman says. After we eat carbs, they’re converted into something called glycogen, which is stored in muscles until it’s needed for energy. “The research is so strong, you’d be foolish not to use it,” Nieman adds.

    Read More: Why Your Diet Needs More Fermented Pickles

    But the best exercise fuel you’re not eating may be fruits, nuts, dark greens, and other plants. They’re full of essential nutrients like folate, magnesium, and vitamins A, D, and E, which can reduce stress and inflammation from exercise. Yet most Americans don’t get enough. “Over 90% of our recommendations for many people come down to eating more whole plant-based foods,” Nieman says. For light exercisers, “everything else is minor.”

    For people who are just trying to meet the minimum exercise recommendations of 150 minutes per week, try to follow the baseline, daily recommendations for vegetables, protein, and carbs. It doesn’t really matter whether you eat them before or after your workout, experts agree.

    For more intensive exercise, though, you’ll want to adjust nutrition before and after—or your workout could involve more rigor than vigor.

    Before your workout

    Power up with nuts and berries

    You may be surprised to find a ream of sports nutrition research pointing to a humble bowl of blueberries and almonds. Many ancient warriors overlooked these foods, but they offer an unusually high variety of polyphenols, compounds found in plant-based foods that reduce inflammation from prolonged workouts.

    Blueberries, especially wild ones that you can find frozen, have this effect in competitive cyclists and untrained athletes alike. Their polyphenols are antioxidants, meaning they counter harmful molecules caused by inflammation during exercise—like firefighters putting out flames. This speeds up the recovery process. Jenna Stangland, team dietitian for the Minnesota Timberwolves, infuses the NBA players’ diets with polyphenols, she says; the Timberwolves’ second-best regular season in franchise history was powered by blueberry vinaigrettes, added recently to the team’s salad station. (Stangland is also an advisor to Momentous, a supplement company.)

    Nieman also has found that snacking on about 40 almonds per day for four weeks before heavy exercise contributed to less muscle damage. In a study this year, people who ate almonds for two weeks weren’t as sore after running 30 minutes downhill. Because almonds are high in calories, stay very active when upping your intake.

    Decades of research support the general health benefits of polyphenols, but their role in exercise is a recent discovery. “They’re the future of sports nutrition,” Nieman says.

    Eat a slice of sourdough two hours before

    For tough exercise, increase your intake of carbs above the minimum guidelines. Swimmer Michael Phelps set a world record after having three slices of sugar-covered French toast (plus a five-egg omelet). However, Phelps isn’t your average human. Healthier sources of carbs are chickpeas, lentils, and sourdough bread. They take longer to digest, providing a slow, steady release of energy to fuel exercise later in the day. Aim to have these types of carbs about two hours before working out, says Elaine Lee, a kinesiologist who directs the University of Connecticut’s Human Performance Laboratory.

    Eat a banana immediately before

    Carbs with more sugar and less fiber, such as bananas, get broken down faster. If you time them just before or during your sweat session, the body can use them right away. (Bananas, a high-carb, polyphenol-rich fruit, promote recovery as well as sports drinks according to Nieman’s research.) 

    Read More: 11 Foolproof Ways to Start a Conversation

    Stangland likes honey for her players because it contains the right mix of simple sugars for energy. “I give out honey sticks right before tipoff and at halftime,” she says. Eating these foods too early, by contrast, “can cause blood sugar to crash before exercise,” Baar says. “Then your performance will be very poor.”

    Sate your hunger with eggs

    You may benefit from combining pre-workout carbs with protein, such as eggs or Greek yogurt.  Because protein is more filling than other foods, it overcomes a big obstacle to exercise: hunger. “You’ll feel sated for longer, which can play a role in how you perform,” Baar says.

    Vegetarians, worry not; recreational athletes do just as well with plant-based protein compared to meat. Lentils pack ample amounts. “We have some players who prefer plant protein,” says Stangland. Brown rice and pea protein powder is the perfect mix for them, since these two plant powders combined provide all of the amino acids that support exercise.

    Consider coffee and collagen an hour before exercise

    Research supports only a few pre-workout supplements, found in food, as safe and effective for athletic performance. One is caffeine. Fewer studies point to a protein called collagen for reducing joint pain; mixing it with orange juice, an hour before exercise, may increase absorption. (Stangland makes a pre-game “watermelon collagen shot” for her players, especially the ones who are more prone to tendon injuries.) Amy Bream, an adaptive CrossFit athlete from Nashville, says collagen has helped her back pain. “It’s in my coffee every morning,” she says.

    After your workout

    Refuel with sweet potatoes 1 to 4 hours after

    Post-exercise, it’s key to start replacing the fuel that was exhausted—especially the glycogen—to prepare for future workouts. Lee, who coached and rowed at the NCAA division 1 level, recommends combining high-fiber carbs, protein, dark greens, and hydration within 1 to 4 hours after exercise, saying, “That’s when your tissues are most metabolically active.” Sweet potatoes are ideal as the carb portion, offering plenty of fiber and nutrients such as polyphenols and electrolytes, good for rehydration. Stangland serves the Timberwolves sweet potatoes at least twice per day. “It’s great for them, and they like them—a win-win,” says Stangland.

    If you’re older, have protein immediately after

    Protein can be enjoyed when convenient throughout the day. Scientists used to think you had to eat it right after the gym to gain muscle, but recent studies find that the timing makes little or no difference in healthy younger people. Seniors benefit more from protein immediately following exercise, Baar says, because their bodies target it better to the muscles at this time. Another strategy that helps with protein absorption: chewing food thoroughly and opting for ground meats instead of steaks, Baar says.

    Don’t overdo it with the vitamins

    It’s possible to get too many antioxidants, including vitamins. If consumed post-workout, they could block the benefits of exercise. Studies show that athletes supplementing with excess vitamins C and E have more inflammation and molecular stress during their recoveries. But that’s no reason to skip your veggies. It’s next-to-impossible to reach this threshold from food alone, experts say.

    Read More: Why Walking Isn’t Enough When It Comes to Exercise

    Many studies do support taking a post-workout supplement called creatine, based on a natural compound in muscle cells. Taken daily, it boosts recovery and performance in weightlifting and high-intensity interval training.

    Experiment with recovery shakes and other combinations

    “We don’t yet have a magic shake” for exercise recovery, Lee says. “Everyone has a different tolerance for what they can eat and how much.”

    But you can test one dietary change at a time to see how it affects your performance and recovery. Maybe try having a post-workout, polyphenol-rich bowl of almonds, blueberries, and greens—an AB&G instead of a PB&J—each day to see if it improves your exercise over two weeks. If you measure your heart rate during and after exercise, keep track of the answers to questions like: can you push your heart rate higher than before the change? Or achieve the same workout at a lower heart rate? Afterward, does your heart rate return to normal faster than usual?

    Stangland makes a different recovery shake for every player on the team, with extra carbs for Edwards’s all-out performances, for instance. Like all of nutrition science, ultimately “it’s a customization,” Lee says. “You have to find what works for you.”

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    Matt Fuchs

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  • Is ‘Mommy Brain’ Real? What Happens to Your Mind and Body When You Become a Mom

    Is ‘Mommy Brain’ Real? What Happens to Your Mind and Body When You Become a Mom

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    Recently, I was catching up with a friend who’d just given birth to her first baby. I thought about all of the changes I’d experienced since having my 1- and 3-year-old daughters. “I feel like I’m a completely different person,” I said.

    As soon as the phrase came out of my mouth, I questioned it. Nearly 2 billion people in the world are mothers. Surely they didn’t all feel completely different after giving birth. Or did they?

    Most people are familiar with the term “mommy brain,” a phrase that describes the brain fog and forgetfulness that many pregnant women and new moms experience. But it turns out there’s way more going on than just forgetting the name of your college professor, and it’s something called matrescence. 

    Coined by medical anthropologist Dana Raphael in 1973, matrescence is, quite simply, the process of becoming a mother. It’s an immense physical, psychological, emotional, and social shift—and one that’s far more intense than most people realize.

    “When I was pregnant with my first child, I thought pregnancy was a one-time, transient hormonal event, and that when [my daughter] was born, I would just go back to myself,” says Lucy Jones, a journalist and author of Matrescence: On the Metamorphosis of Pregnancy, Childbirth and Motherhood. “But that’s just not what it is at all. It’s actually the most dramatic, seismic, endocrinological, and neurobiological experience you can have in adult life.”

    Major changes are at play

    Although it’s common knowledge that women undergo massive hormonal shifts on their way to becoming a mom, there’s been a lack of research into new moms’ brains until very recently. But several groundbreaking neuroscience studies have been published in the past few years, Jones says. One showed that pregnancy leads to significant structural and functional changes in the brain, while another demonstrated alterations to gray matter in certain areas of pregnant womens’ brains. (Interestingly, these changes persisted for years after childbirth.) 

    Countless other changes are happening too, though they’re harder to quantify. Ask any new mom if she feels like some of her relationships with family and friends have changed since having kids, and she’ll likely say yes. There are also pronounced physical changes—like embracing new postpartum bodies that function differently, whether that means pelvic floor problems, hair loss, or weakened abdominal muscles. Plus, there are emotional changes, like a newfound and fierce protectiveness over our children.

    Read More: There’s a New Way for Moms in the U.S. to Recover After Childbirth. Most Can’t Afford It

    During the early postpartum period, there’s an immense learning curve. Although this phase can feel overwhelming, one study suggests that if the cognitive challenges present during this time are continued across someone’s lifespan (meaning someone is actively parenting for many years), it can actually be beneficial for brain health later in life. “What we know about the brain is that novelty and complexity and cognitive challenge are very stimulating,” says study author Edwina Orchard, a postdoctoral research associate at the Yale Child Study Center at Yale University. In other research, Orchard has even shown that the more children someone has parented, the younger their brain looks—and that middle-aged parents actually have quicker response times and better visual memories than their childless counterparts.

    That suggests a neuroprotective effect of parenthood on brain age. Other research has shown moms’ brains change to varying degrees, says Orchard, who also works at the Before and After Baby Lab, a research group at Yale. “Mothers who experience more pronounced changes also show more sensitive caregiving behaviors,” she says. “They have better attachment or more positive feelings about their child.”

    Stronger than before

    “Mommy brain” is a real thing, particularly when it comes to word recall and memory. But the idea that new moms undergo some sort of early onset dementia during matrescence is misguided, says Abigail Tucker, author of Mom Genes: Inside the New Science of Our Ancient Maternal Instinct.

    Experts believe the cognitive deficit many pregnant women and new moms face when they forget someone’s name or put the cereal in the fridge could very well be the result of sleep deprivation, Tucker says. Or, it could simply be from the shift in focus that new moms are experiencing. 

    “All of a sudden, the new mother’s thoughts revolve around a tiny person who didn’t exist a few months or even minutes ago, and everything else falls by the wayside,” Tucker says. “Perhaps there is temporarily less brain power left over for other stuff that suddenly seems so much less important, like remembering to mail a letter.”

    Read More: How to Start Strength Training if You’ve Never Done It Before

    I was definitely sleep-deprived, forgetful and absentminded during pregnancy and the early postpartum period. (My older daughter used to ask me why I was spacing out so much). But I had this innate sense that I’d also become mentally sharper in many ways. It turns out I was onto something.  

    Research has shown pregnant women and new moms are better at facial recognition and reading peoples’ emotions, Tucker says. They’re more alert and even better at identifying colors and scents, possibly to detect potentially harmful foods. They can also be surprisingly calm in stressful situations: One research study found that women late in pregnancy rated an earthquake in California as less stressful than other survivors.

    All parents—not just moms—undergo a neural transition 

    Moms aren’t the only ones who experience a major identity shift when they become parents.

    “Science is showing that, particularly with hands-on, affectionate care, spending time with a child affects a father or a non-biological parent’s hormone levels, shape of the brain, anatomy of the brain, and response to the baby,” Jones says.

    One study found the degree to which a new father’s testosterone and cortisol levels changed when his baby was born could predict how involved he’d be with his child later on. Another study found that very involved dads experienced more activation in the amygdala, the area of the brain responsible for decision-making, instinct, and the fight-or-flight response. One study also suggested foster mothers experience similar oxytocin changes as gestational mothers when bonding with their babies.  

    Increased awareness

    Experts believe matrescence is as significant of a transition as adolescence. Yet the term matrescence (which doesn’t even appear in the Merriam-Webster dictionary) still hasn’t gained much traction in the 50 years since it was coined. 

    “Everyone knows adolescents are uncomfortable and awkward because they are going through extreme mental and bodily changes,” Jones writes in Matrescence. “But, when they have a baby, women are expected to transition with ease—to breeze into a completely new self, a new role, at one of the most perilous and sensitive times in the life course.”

    Read More: How to Cultivate Hope When You Don’t Have Any

    More research on matrescence is being done each year. Historically, perinatal mental-health researchers thought it was important to study moms for the sake of their babies, says Sheehan Fisher, a perinatal clinical psychologist at Northwestern Medicine. “Now, we’ve shifted so that moms’ mental health matters in and of itself.”

    More awareness about the changes women go through during this time can be beneficial on both an individual and societal level. Perinatal mental health conditions are common—one in five women experience one during this vulnerable time—plus the majority of new moms in the U.S. still don’t have access to paid maternity leave. 

    “I think our understanding of this as a sensitive period should be positioned as strongly as possible to encourage governments to federally mandate paid parental leave for all new parents, not just birthing parents,” Orchard says. “Not just as a physical recovery from birth, but as an acknowledgement of the huge environmental and behavioral identity shifts that are happening through this time.”

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    Jamie Friedlander Serrano

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  • How to Start Strength Training If You’ve Never Done It Before

    How to Start Strength Training If You’ve Never Done It Before

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    The weight room at the gym can be an intimidating place. The equipment looks like it could crush you if you use it wrong. People grunt as they haul heavy things up and down. And why don’t these machines come with instruction manuals, anyway?

    Figuring out how to start strength training as a beginner can be tough, but it’s worth the effort. Modern exercise science shows that strength training offers a host of benefits, like stronger bones, decreased inflammation, lower risk of cancer and cardiovascular disease, plus better sleep, mental health, and cognitive function. And, of course, stronger muscles. “We start to lose muscle tissue as early as our 30s if we don’t [work to] maintain it,” says exercise physiologist Alyssa Olenick. That’s why current federal guidelines recommend that adults work all of their major muscle groups with strengthening activities two days a week, in addition to doing cardio.

    Fortunately, getting started is simpler than you might think. “You definitely do not need a personal trainer to start strength training,” says Kristie Larson, a New York–based personal trainer who specializes in working with beginners. Many of the basic moves you probably learned in grade-school gym class can be the foundation of an effective routine. 

    The best exercises to start with

    So, what exactly counts as strength training? “Any sort of exercise modality that is putting your tissues under load with the intention of increasing strength or muscle tissue over time,” Olenick says. That can include bodyweight-only exercises like planks, or working with resistance bands, dumbbells, kettlebells, barbells, or resistance machines.

    A smart place to start is with exercises that simulate the activities you do in everyday life. “Things like squatting to a bench, which mimics sitting in a chair, or a lunge where we’re getting up from the ground using one leg,” Larson says. “It’s easy to feel how that is going to benefit your life.” 

    To hit all the major muscle groups, you’ll want to check off each of the four foundational movement patterns: pushing (like with push-ups or bench presses), pulling (like with rows or biceps curls), squatting (like with lunges, leg presses, or squats), and hinging (like with deadlifts, where you lift a weight from the floor to hip level). “[Make] sure you have one of those on each day so you’re getting a little bit of everything,” Olenick says.

    Read More: Why Walking Isn’t Enough When It Comes to Exercise

    Also add in some targeted core work. Larson likes to give beginners moves like planks, bear holds (planks with bent knees hovering just off the ground), weighted marches (marching in place while holding weights), and heavy carries (where you just pick up a heavy weight and walk with it).

    Feel free to skip the barbells if they feel too intimidating. Instead, you can start with dumbbells, resistance bands, or just your body weight. “Just get comfortable being in the gym, doing these new movement patterns,” Olenick says.

    If you’re not sure how to put together a well-rounded program, you can find structured beginner workout plans online. (Larson, for instance, offers free simple guides to get started.) Just avoid any plans that offer unrealistic promises. “It should be scalable and modifiable—something where you can actually make it personalized to yourself,” Larson says. Each exercise should come with a suggested range of reps (the number of repetitions to do before taking a break), sets (how many rounds of those reps), and information about how long to rest between sets. 

    Don’t be surprised if you start to feel stronger pretty quickly. “The first six to eight weeks of resistance training, you’re getting a lot of neuromuscular adaptations,” Olenick says. “Your nervous system is getting better at recruiting and contracting your muscle fibers. They call them newbie gains.”

    How to pick the right weight

    Newcomers sometimes get stumped by which weights to choose off the rack. “For a beginner, you want to feel like you can do between 10 to 15 repetitions without a break,” Larson says. “If you get to the end of your 10 reps and you feel like you could do 10 more, the weight’s too light. If you’re fighting to do that last rep or two and you’re a true beginner, that weight is a bit too heavy.” (Although you might see videos about “training to failure” on social media—meaning lifting weights until you hit your absolute limit—Larson says that’s an advanced method beginners shouldn’t worry about.)

    Read More: Why Your Diet Needs More Fermented Pickles

    Olenick likes to choose weights based on your rate of perceived exertion: On a scale of one to 10, where one feels super easy and 10 feels like the heaviest you can lift, she suggests aiming for about a six or seven. Over time, as you get stronger and more comfortable with the motions, you can start to reach for heavier weights. 

    How much strength training to do

    Although the two-day-a-week federal guidelines don’t specify how long you should spend on your strength workouts, Larson recommends putting in 30 to 60 minutes per session. For each move, she says a good range to shoot for is two to three sets of 10 to 20 reps. “I would say 10 to 15 for weighted, externally-loaded exercises, and 15 to 20 if we’re talking about bodyweight [exercises],” she says. Then, between each set, take enough of a rest to let your muscles recover so you can give another quality effort.

    Read More: 8 Ways to Stay Hydrated If You Hate Drinking Water

    No matter how excited you are to begin, remember to keep your workouts doable. “Start with less than you think, then build from there,” Olenick says. “Make it maintainable for life.” 

    How to start strength training without getting injured

    In nearly every strength-training exercise you do, you’ll want to focus on maintaining a neutral spine—a tall, open-chested posture with your rib cage stacked over the pelvis. But Olenick points out that form exists on a spectrum, rather than simply being good or bad. “Most things you do in the beginning will not be with perfect form,” she says, adding that that’s okay. “You’re not automatically going to get injured just because you’re doing it imperfectly.” 

    The truth is, most beginners aren’t actually the novices they might think they are. “A lot of people have fear around strength training. But we lift heavy things in our everyday lives all the time: We’re carrying heavy grocery bags. We’re bringing in the dog food. We’re opening heavy doors against the wind,” Larson says. “Most people underestimate what they can lift.” 

    No matter how you start or what your technique looks like, you’ll still be building muscle. As long as you keep things manageable, “you can’t mess it up in the beginning,” Olenick says. “Everything you do is beneficial.” 

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    Jennifer Heimlich

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  • The Health Hazards of Legalizing Marijuana

    The Health Hazards of Legalizing Marijuana

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    In a dramatic example of government yielding to public opinion the Senate has introduced legislation to legalize cannabis on the federal level. Though passage before the November election is unlikely, this long overdue legislative action seeks to update a statute stemming [pun intended] from marijuana’s demonized image as depicted in the 1936 documentary film “Reefer Madness” and better reflect public opinion and liberal social trends. Currently, under the Federal Controlled Substances Act (CSA) of 1970, cannabis is considered to have “no accepted medical use” and a high potential for abuse and physical or psychological dependence. This Federal statute contrasts with the claims of therapeutic benefits of cannabis’ biochemical constituents such as cannabidiol and THC (tetra-hydro-cannabinol) when the sole FDA indication for their use is a rare childhood (Lennox-Gasteau) seizure disorder.

    While the scientific information to officially endorse cannabis products as having therapeutic benefits is lacking, a recent Pew Research Center Survey found that 88 percent of Americans felt that marijuana should be legal for medical or recreational use. This wave of popular opinion has led to marijuana’s approval in 38 states for medical use, in 24 states for recreational use and decriminalization in an additional seven states.

    Who could have anticipated that in less than two decades, a naturally grown recreational intoxicant, cannabis sativa, would go from demonization (as) to mainstream, and begat a tsunami of popular demand for legalization and a gold-rush of commercialization fueled by $61 billion of investment. Some may see this as an impressive demonstration of social progress, while others consider it the result of reckless and ill-conceived policies that have created a tangled matrix of laws and conflicting incentives based on confused logic and incomplete knowledge.

    Americans now have access to a recreational intoxicant that is arguably no more dangerous than alcohol or tobacco without fear of the disproportionately severe punishments previously meted out to those apprehended for possession and use. But at the same time, there are numerous inconsistencies and cross-purposes integral to the legalization and commercialization of cannabis products. The most obvious of these is the fact that Federal law considers the use, sale, and possession of cannabis illegal.

    Read More: What Marijuana Reclassification Means for the United States

    The consequence of the latter was not just that the exaggerated therapeutic claims were not born out by scientific research, but that it served as a “Trojan Horse” to galvanize public opinion and advance cannabis advocates ultimate goal of unfettered access. This came to fruition when the state legislatures of Colorado and Washington voted to legalize the commercial production and sale of cannabis products in 2012. This triggered a stunning demonstration of states’ rights in which a majority of states followed suit by liberalizing their cannabis laws despite Federal prohibitions. 

    The legislative conflict between Federal and state laws is not ideal, but not a grievous problem in large part because the conflict is tolerated and not enforced. More onerous is the conflict between legislative reform and public health that has emerged. By acceding to public opinion and false claims of salutary effects, state governments are exposing their constituents to health hazards. Compounding this misguided policy is the fact that state governments are incentivized by the prospect of increased tax revenues.

    In a glaring recent example of governmental missteps, on March 17, Gov. Kathy Hochul declared New York State’s commercialized cannabis licensing and distribution system “a disaster” and announced “a top-to-bottom review of the NYS Cannabis Control Board and its system for regulating legalized cannabis products.” The main purpose of the review was to process applications faster and enable more cannabis vendors to open. Just weeks before  Hochul’s executive order which was intended to give New Yorkers greater access to cannabis, the American Heart Association had issued a warning on the higher risks of cardiovascular events associated with heavy cannabis use. This was based on a National Institutes of Health (NIH)-funded study of nearly 435,000 American adults reported last November which found that “Daily use of cannabis –– was associated with a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared to non-use of the drug.”

    Prior to that, the NIH issued the following warning: “Regular recreational marijuana users had psychotic disorders at a greater rate than any other recreational drug. More than cocaine, methamphetamine, amphetamine, LSD, PCP, or alcohol. The risk of negative mental health effects is increased about five times by regular use of high potency marijuana.” High potency refers to the fact that the commercialized pot sold legally today is not the same naturally grown weed smoked by constituents of the counterculture.

    Such health hazards are not some abstract possibility or unconfirmed scientific speculation, but a growing current reality. As a practicing psychiatrist I have witnessed these effects first-hand as a burgeoning number of cannabis-induced medical and mental disturbances—particularly in young people—show up in our hospital emergency rooms and are referred to me for consultation.  And while the rising numbers of adverse effects occurring in the wake of legislative reform are disturbing, they are not surprising. Rather, they were anticipated.

    At the start of the movement to liberalize access to cannabis in 2014, Roger Dupont, the founding director of the National Institute of Drug Abuse, and I published an article in the medical journal Science that predicted such adverse effects.“The debates over legalization, decriminalization, and medical uses of marijuana in the United States are missing an essential piece of information: scientific evidence about the effects of marijuana on the adolescent brain,” we wrote. “Much is known about the effects of recreational drugs on the mature adult brain, but there has been no serious investigation of the risks of marijuana use in younger users.”

    Part of the argument for legalizing cannabis was that it was no more dangerous than other legal recreational intoxicants like alcohol and tobacco. However, as Kevin Sabet, National Drug Control Policy Advisor in the Bush and Obama administrations pointed out in his book SmokeScreen: What the marijuana industry doesn’t want you to know, legislators didn’t reckon on the possibility that commercialization of cannabis would lead to inconceivably high potencies (with THC concentrations in some products approaching levels up to 99.9% as compared to less than 10% in naturally grown pot sold on the black market).

    This was revealed in an NBC News report on states enacting legislation to legalize cannabis in April 2022: “We were not aware when we were voting [in 2012] that we were voting on anything but the plant,” said Dr. Beatriz Carlini, a research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute. She has led the effort in Washington state to research high-potency pot and is now exploring policy options to limit access. Her team concluded in 2020 that “high-potency cannabis can have lifelong mental health consequences.”

    So while possible therapeutic value has been the lever, tax revenue for states and profits for new industries—resulting from broad access—has clearly become the goal with unsuspecting users as the potential victims. This is the template now driving rapid legalization of a host of previously prohibited recreational drugs including MDMA (ecstasy) and psychedelics.

    There are reasons to believe in, and support, the therapeutic potential and safe recreational use of cannabis. However, it is imperative that accurate knowledge derived from research carried out with scientific rigor, objectivity, and dispassion inform legislation and policy that will affect the lives of millions of Americans and particularly youth. Until we have this knowledge, we must be prepared to temper the irrational exuberance of advocates for unrestricted recreational use and restrain the commercial interests from expanding the user base and potency of cannabis products. The responsibility for this resides with government. Governors and legislators must hold the line and not succumb to the pressure of public opinion and temptation of additional tax revenues.

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    Dr. Jeffrey Lieberman

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  • It’s Time to Treat Sugar Like Cigarettes

    It’s Time to Treat Sugar Like Cigarettes

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    The food we eat impacts every aspect of our lives and our bodies: our hormones, brain chemistry, immune system, microbiome; the list goes on. As consumers, we deserve the right to easily understand our foods’ nutritional value in order to make informed decisions about what we consume and how that will impact our health and well being. This is especially important when it comes to ingredients that are detrimental when eaten in excess, such as sugar. As researchers in functional medicine, longevity, AI, and nutrition, as well as inventors of health-enhancing and life-saving solutions, we have dedicated our professional lives to improving the health and well-being of millions everywhere. And while we applaud the Food and Drug Administration (FDA) taking important strides to pass mandatory front-of-package labeling for packaged foods in the U.S., this is a change that cannot come soon enough. Everyone’s health depends on it. 

    The FDA recommends adults consume no more than 50 grams of added sugar per day (based on a 2,000 calorie diet), but the average American consumes closer to one-third of a pound of sugar daily, more than three times the recommended amount. To put that into perspective, the average American consumes over 100 pounds of sugar per person per year. With that much sugar consumption, it is no wonder that 49% of American adults are diabetic or pre-diabetic. What’s worse is that much of the sugar we consume occurs without our even realizing it. There are over 60 different ways sugar is identified on nutrition labels, making a consumer’s attempt to regulate their sugar intake unfairly complicated.

    Extensive academic research published in medical peer-reviewed journals backs common knowledge that excess sugar consumption can lead to serious chronic conditions, as well as fatigue, anxiety, memory loss, ADHD, and even to a shorter life.

    Seventy four percent of packaged foods in the U.S. contain added sugar, including seemingly healthy foods, such as salad dressing, coleslaw, and even baked beans, marinades, and yogurt; some sweetened yogurts contain more sugar than a can of soda. The fact that sugar is so biologically addictive — studies indicate it is eight times more addictive than cocaine — makes the reality that it’s hidden in so many foods even more harmful. Most of us are addicted to sugar and we don’t even know it.

    This cycle of addiction is relentless and hard to break: we eat food with sugar, which then triggers a blood sugar spike, which lights up the pleasure center in our brain. When the inevitable sugar crash comes, we seek that spike again in the form of craving more sugar. Without easily discernible food labeling, shoppers unknowingly create this cycle inside their own bodies, even while they erroneously think the food they’re buying is healthy.

    Read More: How the World Got Hooked on Sugar

    In many countries, labels on packaged foods serve a similar function to labels on cigarette cartons: to warn consumers of risk. In Chile, a policy of “high in” labels on the front of sugary drinks dramatically reduced the consumption of those beverages. In Israel, a front-of-package labelling system, wherein a red label indicates an item high in sugar, has led to significant positive changes in 76% of the population’s food buying habits. We’re excited to see what a similar program in the U.S. would yield.

    Those in the U.S. lobbying against this front-of-package change, unsurprisingly, have an interest in the continued popularity of their products. In a February 2023 joint filing, the nation’s largest cereal producers threatened a lawsuit after proposed changes would not allow them to label products as “healthy” if they didn’t meet nutritional standards. The front-of-package suggested change would rightfully prevent many cereals on the market with excess sugar from calling themselves “healthy.”

    This dynamic is similar to changes made in cigarette advertising in the 20th century. In the 1940s, a famous Camel cigarettes campaign featured the slogan, “More doctors smoke Camels.” By 1969, a mandatory warning label was added to cigarettes, giving consumers clearer access to information about risks, allowing them to make more informed choices about their health. Today the percentage of Americans who smoke is 11% compared to nearly 50% back in the day when “more doctors smoked Camels”. Life expectancy rose nearly 11 years in that span of time too, and the decrease in smoking certainly contributed.

    While front-of-package labeling on packaged foods is a crucial first step towards a healthier society, education and awareness alone will only get us so far. To drive even more significant change in the way most Americans eat, a change that will lead to a healthier population, we must also incentivize the production and widespread distribution of healthier alternatives. These alternatives—a packaged cookie with healthier ingredients, for instance—must be just as delicious, and readily available as those loaded with sugar. The recently announced new standards by the U.S. Department of Agriculture (USDA) that will limit added sugars in school meals can greatly help with the availability of healthier alternatives, especially when children form their eating habits. For the rest of us, though, front-of-package labeling is an important step one in this journey towards national wellness and it will also encourage producers to create healthier options for consumers; readily available healthier alternatives is step two.

    FDA leadership ensuring labeling of high contents of sugar in packaged foods could increase awareness and reduce the negative impacts of sugar and help millions live healthier longer lives. This change would help us make more informed choices about our food and our health. We believe it is our right, and every American’s right, to have clear and visible information about the sugar content of the foods we are eating in order to make more informed decisions.

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    Mark Hyman and Ron Gutman

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  • Why Is It So Bad to Pop a Pimple?

    Why Is It So Bad to Pop a Pimple?

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    It’s tough to resist squeezing a juicy pimple. You probably want to get rid of it quickly and may feel like you know exactly how to do it after having watched hundreds of pimple-popping videos online. Dermatologists get the temptation, but say you should leave your zits alone.

    “As a general rule, you shouldn’t pop your pimples,” says Dr. Jody Alpert Levine, a dermatologist and director of dermatology at Plastic Surgery & Dermatology of NYC. 

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    Pimples form when excess oil, bacteria, and dirt clog hair follicles. When the trapped follicles stay beneath the skin and form a white bump, they’re referred to as whiteheads. Blackheads are plugged follicles that reach the skin’s surface and open up; exposure to air turns their contents black. 

    Whatever color they are, squeezing, popping, or picking at pimples to release the gunk clogging the pore can disrupt the healing process and cause a host of problems, from scarring to infections, Levine says. 

    Still, she recognizes that people do pop their pimples from time to time. While it’s best to treat acne under the guidance of a dermatologist, Levine says she often teaches her patients the proper technique for extracting blemishes. 

    Popping painful, unsightly spots may not seem like a big deal. Dermatologists explain the risks, some tips for getting rid of zits, and what to do if acne is a persistent problem. 

    The risks of popping a zit 

    Squeezing pimples traumatizes the skin around them, says Dr. Paul Curtiss, a dermatologist with U.S. Dermatology Partners in Carrollton, Texas. This can lead to long-term scarring, inflammation, infections, and more painful and noticeable acne, according to the American Academy of Dermatology. He says it can also lead to inflammatory hyperpigmentation, or dark marks on the skin. 

    When you pop a pimple, you might inadvertently push bacteria and debris deeper into your pores, worsening acne. The oil and other gunk could also spread, causing more pimples to appear in other areas, says Dr. Annette LaCasse, a dermatologist in Commerce Township, Mich.

    Read More: Why Walking Isn’t Enough When It Comes to Exercise

    “Pushing toward the center of the pimple can often cause the pus beneath the skin to spread further away from the pimple, causing a larger pimple and more inflammation,” says Levine. 

    Plus, bacteria or other germs on your hands can be transferred to the blemish, potentially leading to an infection, the AAD says. 

    “I know people want to get rid of a pimple as soon as they see it, but they have to understand there are consequences to that immediate relief,” LaCasse adds.

    The best way to get rid of pimples 

    Covering blemishes with concealer can help disguise them. But seeing a dermatologist is the safest way to extract pimples, Levine says. 

    Doctors can use sterile instruments to remove blackheads and whiteheads without scarring or inflammation, according to the AAD. They also may inject the bump with a corticosteroid, which helps it heal quickly and minimizes scarring. Another option is an incision and drainage procedure, where they cut open the spot and remove the debris (think: all those doctor’s office pimple-popping videos). 

    As an at-home option, try pimple patches. These are small stickers that you apply to your zits that contain hydrocolloid gel, a wound-healing substance, according to the Cleveland Clinic. You can also dab products containing benzoyl peroxide, glycolic acid, or salicylic acid on the spots. Curtiss says these items often help pimples dry up and go away a little more quickly than they would on their own.

    Read More: What Experts Really Think About Diet Soda

    While dermatologists advise against removing blemishes yourself, they recognize that people are likely going to do it. So knowing the proper technique can help you minimize problems, Levine says.  

    If you must pop a pimple, wash your hands and face first, and then apply ice to reduce pain and inflammation. Wait until the bump forms a whitehead, meaning the pus is near the surface, she adds. “The proper way to pop a pimple involves equal, gentle pressure around the pimple and a slight outward pressure. If no pus comes out with gentle pressure of that nature, then stop trying.”

    You can use the same technique for squeezing blackheads, Levine adds. 

    Why it’s more effective to treat acne—not burst it

    If you frequently have zits that you want to pop, Curtiss suggests treating your acne issue overall. A dermatologist can help you create a plan. 

    Many people can treat acne at home with over-the-counter products. Using a face wash with benzoyl peroxide and applying the retinoid adapalene can help clear up acne, according to AAD. Products with salicylic acid can unclog pores and exfoliate the skin, preventing acne, and azelaic acid can minimize acne-related dark spots.

    If you have acne-prone skin, Levine suggests using oil-free and non-comedogenic skincare products, which won’t clog pores.

    Read More: 6 Compliments That Land Every Time

    See a dermatologist if you’ve tried at-home acne treatments with no improvement for four to six weeks, she says. 

    Doctors will determine what’s causing acne and prescribe the most appropriate treatments, which might include topical and oral retinoids or antibiotics. They might also recommend chemical peels or laser therapy. 

    “My goal for my patients is always to get and keep their skin 100% clear,” Curtiss says. “The best treatments are those that are able to prevent pimples from forming in the first place.” 

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    Erica Sweeney

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  • When Meaningful Work Backfires

    When Meaningful Work Backfires

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    It’s easy to let high stress steal our full attention. Often, high stress leaves us vulnerable to a dysregulated, unproductive state. This means we need reliable resources we can connect to in order to renew and maintain our mental, emotional, and physical energy, and to help us recover from work stressors that, left unchecked, can make us vulnerable to burnout.

    As a burnout researcher, my work has been focused on pinpointing the most reliable and effective resources people can connect to in order to protect themselves from burnout. I’ve conducted hundreds of in-depth interviews with people who experience high stress at work, but they are not burned out. From my research, I found that those who have a deep, lasting connection with their purpose and a sense that they are engaged in meaningful work are significantly less vulnerable to burnout. Yet, while having a high level of engagement with your work can protect you from burnout, being over-engaged in meaningful work can come with some potential risks.

    In fact, some of the people who are at the highest risk of burnout are those who genuinely love their work and who routinely go the extra mile. This is certainly no guarantee of developing burnout, but it’s very important to be aware of the hidden downsides of devoting yourself to meaningful work and to the ways it can potentially backfire.

    Perhaps the most common way is that your work life simply becomes unsustainable. Whether it’s the relentless pace, the emotional or mental intensity, the long work hours, or a scary combination of all three, becoming subsumed in your job without sufficient time to recharge can put you on the fast track to burnout.

    Read More: Why We’re More Exhausted Than Ever

    Researchers have noted a particular vulnerability to burnout in those in the “helping” professions, such as health care workers, social workers, clergy members, counselors, life coaches, and direct care providers. These professionals tend to be deeply purpose-driven and often prioritize the needs of others over their own. Many of them are also vulnerable to a related phenomenon known as empathic distress, a strong aversive response to others’ pain and suffering that arises when you spend a lot of time caring for those who are suffering. Empathic distress leads people to withdraw in an effort to protect themselves, resulting in avoidance, cynicism, and reduced motivation—some of the very same signs of burnout. Much the same vulnerability to burnout exists in individuals who are deeply mission-driven and who prioritize their organization’s needs and goals over their own. Educators, activists, and nonprofit employees are great examples, as are startup founders, entrepreneurs, small-business owners, and changemakers and disruptors of all stripes.

    Take, for instance, Jenn Richey Nicholas, who was working for a top-tier graphic design firm on a very high-profile project that would be seen around the world. She had dreamed of being a graphic designer ever since she was in middle school and always loved the idea of being on a highly talented team where Richey Nicholas and her colleagues shared a passion for design. The firm’s reputation was riding on this project, and it had the potential to be career-defining for the entire team. Everyone was expected to work 120 hours a week or more; many people resorted to sleeping under conference tables and would only go home to shower. Richey Nicholas described how “people were dropping like flies from exhaustion,” and after one colleague passed out several times, he had to be admitted to the ER. “I was terrified I’d be ruined in the industry if I took a break,” she told me. “Fear was the only thing keeping me there.”

    After months of this grueling schedule where Richey Nicholas pushed herself to her physical and mental limits, everything came to a head one day when she went to the rooftop of her office building, stood at the ledge, and thought about jumping. “I just wanted the pain to be over,” Richey Nicholas said. Her vision blurred as she stood there, and she doesn’t remember much more of the episode, except that someone took her back to the office. Incredibly, she managed to go back to work and finish the project. “Walking away was not an option,” she said. When it was finally over, she went home and slept for two weeks.

    Shortly thereafter, she went to London to visit a friend who was also a graphic designer. Richey Nicholas was astonished to see that her friend and her team were working from nine to five—and her friend was astonished to hear what she had just been through. “I gained a lot of perspective on the toxicity I’d been wrapped up in,” she said. “That experience made me lose my sense of self. I felt like my body wasn’t even mine.”

    But now she was awake and aware, and she wasn’t going back. “Since then,” Richey Nicholas told me, “I have built myself and my work ethic around never doing that again.” She left that firm and worked as a designer at other firms for a few years, while dreaming about launching her own business. Today she runs a successful graphic design firm committed to making a positive social and environmental impact in the world, and where mental health and overall well-being are priorities. “We rarely work more than 40 hours a week,” Richey Nicholas said. “We want to be a model for other studios. Our hope is that, one by one, firms like ours will gradually change the toxic culture of this industry.”

    When you love your work and consider it a calling, or if you’re exceptionally purpose-driven and committed, your job will demand a lot of you. You can often find yourself overextended, because you’re so passionate about your cause and care so deeply about improving others’ lives, or you’re overcommitted to your organization’s mission or goals. But without sufficient periods to rest and recharge, the risk is high for exhaustion, depersonalization, and, down the line, a lack of efficacy, as you become increasingly overwhelmed and depleted.

    When work becomes the central focus of our lives (for any reason)—or when our identity gets excessively wrapped up in what we do for a living—we run the risk of making too many personal sacrifices and losing sight of our own self-care, leaving us ripe for burnout.

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    Kandi Wiens

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  • Shōgun is a great war epic that never actually shows us any war

    Shōgun is a great war epic that never actually shows us any war

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    [Ed. note: This post contains spoilers for the end of Shōgun.]

    Just before he’s forced to commit seppuku in the final moments of Shōgun, Yabushige demands to know how Toranaga’s plan to overthrow Ishido will play out. At this moment, Shōgun shows us a glimpse of tens of thousands of soldiers across five armies amassed on a battlefield. The entire series has seemingly been building up to this point — the training of the cannon regiment, Toranaga’s half-brother shifting his alliance, the Regents all signing a declaration of war — and yet just before the battle is set to begin, Ishido is delivered a note letting him know that the heir’s army will abstain from the battlefield. Without the heir’s banner, the other Regents will turn on him before the battle even begins. But this is just Toranaga’s plan; Shōgun never actually shows us any war.

    It’s subversive never to have any war in a historical war epic, with Toranaga’s subversion delaying his impeachment vote (and any declaration of war) until the ninth episode. Most movies or TV shows in the genre set up the narrative to give the viewer a satisfying and violent conclusion to the tension that’s been building, like the final stand in The Return of the King, the faceoff in Braveheart, or even the last stand of The Last Samurai (which is also about a Western military man landing in Japan, and shares some crew with Shōgun). In essence, no matter how brutal and bloody the fight is, an explosive battlefield is the natural climax to the story arc. These movies and shows also often land on one implied conclusion: War, no matter how disgusting it may be, is a justified, even virtuous endeavor.

    But while the war genre often posits a “good side” to root for over the evil one, Shōgun complicates the conception with Toranaga, who spends most of the series plotting in the background toward an alliance with key adversaries rather than preparing to fight them. Toranaga is cunning, ruthless, and willing to sacrifice his closest friends if it means he can avoid an all-out war. His motivations are what make Shōgun such a compelling show — while at the same time forcing audiences to reexamine their expectations of a historical war epic.

    For Toranaga in Shōgun, there’s only one evil side: war itself. In his final speech to Yabushige, Toranaga describes his dream: “A nation without wars. An era of great peace.” Key to his calculus, however, is his willingness to sacrifice those dearest to him to achieve this peace. From the moment Ochiba returned to Osaka, Toranaga had been prepping Mariko (and her thoughts about death) to make a final appeal to gain allegiance from the heir’s army. And, knowing since the pilot that Yabushige was bound to betray him, Toranaga’s orchestration of Mariko’s sacrifice was his personal trolley problem — only in his version, the question is between sacrificing one life or setting 10,000 trolleys against another 10,000 trolleys on the same tracks.

    Photo: Katie Yu/FX

    Blackthorne (Cosmo Jarvis) standing and looking at a zen garden in a still from Shogun

    Photo: Katie Yu/FX

    In other shows, this setup wouldn’t quite work. Audiences are used to war being a mass of bodies hacking and slashing and shooting each other with the idea that sacrifice is necessary and just as long as both parties are armed. Individual deaths of beloved characters, however, are usually framed as the face for the heaps of lost lives. But Mariko walked into Osaka with a plan. With how close she came to committing seppuku, her sacrifice is likely one of the potential outcomes of the plan she discussed with Toranaga. When she willingly absorbs the blast of the bomb through the door, it’s absolutely heart-wrenching for the viewer and Blackthorne. His grief on screen, along with Father Alvito’s and Buntaro’s, is devastating to see unfold in the finale. In most media properties, the audience would walk away wishing the character was saved in time from their terrible fate, forced to be content with the revenge in their name. In Shōgun, we’re asked to accept her decision and not demand a bloodbath as retribution.

    In this light, Toranaga seems ruthlessly Machiavellian, since he seems perfectly fine with innocent death. When Uejiro the gardener removes the rotting pheasant and is put to death by the village as a smokescreen to protect his spy, Toranaga treats Blackthorne’s distress as childish. Similarly, when the Erasmus is sunk at the end of the series, Toranaga routs the whole town of Ajiro, sticking severed heads of fishermen on a sign as punishment for the destruction of the boat — even though it was he, personally, who hired the men who spread gunpowder across the deck of Blackthorne’s beloved ship. Even his son’s graceless death is only audibly acknowledged by Toranaga as a way to buy time and delay the oncoming war.

    Avoiding war seems to be Toranaga’s top priority throughout the series, though he never fully states it outright until his final confrontation with Yabushige. Throughout the show, he declines to share his feelings publicly, instead letting other characters in his council lead discussions — even if he’s manipulating their moves from behind the scenes. When his oldest friend and advisor threatens seppuku, Toranaga stands by his decision to surrender to Osaka, knowing that Hiromatsu’s death will set his battle-averse plans in motion. Even in his final interaction with Yabushige, who demands to know if Toranaga plans to reinstate the shogunate, triggering a return to a single military ruler for all of Japan, he forgoes the chance to monologue: “Why tell a dead man the future?”

    Shōgun is sparing but decisive about the horrors of war that Toranaga wants to avoid. Violence is efficiently brutal in the world of the show. Even in the flashback to Toranaga’s early glory days, Shōgun is careful not to valorize war or his part in it; while his own soldiers brutally behead fallen enemies lying in bloody piles of limbs on the battlefield, a young Toranaga looks on, unwavering in his demeanor. Threatened by the arrival of Ishido’s main man Nebara Jozen in episode 4, Toranaga’s son Nagakado makes the rash decision to unload their newly minted cannon regiment on the interlopers. As the cannons in the distance roar, the camera cuts quickly to Jozen, his men, and their horses being torn to shreds in some of the goriest effects put to television. While there is a fair amount of swordplay skirmishes throughout the series, this cannon demonstration is one of the only depictions we get of mass warfare, and the results are truly terrifying. Amid the viscera, the audience can actually hear the feet of Nagakado’s men squelch in the blood-soaked mud as they creep in to finish everyone off. Compared to the hand-to-hand combat we’ve seen in the woods, where men drop from a single slash or stab, this preview of war is significantly more gruesome, particularly when you add in the full rifle regiments.

    Toranaga (Hiroyuki Sanada) holding up a piece of paper

    Photo: Katie Yu

    Shōgun is careful to avoid the glorious charge into battle, upending the viewer’s relationship to political struggle. When Hiromatsu commits seppuku to protest Toranaga’s surrender to Osaka, he does so to prevent Toranaga’s other generals from sparking their own uprising. Toranaga clearly wants to stop him but can’t, the way Hiromatsu would do anything for him and must. Later, Toranaga reveals that he knew Hiromatsu’s actions would spark Yabushige and Blackthorne to head to Osaka on their own, which allows him to send Mariko with them as part of his true plan. Toranaga’s pained stoicism in this scene is revealing, and the tears in his eyes are the first time viewers see his facade crack. Even if Toranaga carries the weight of every death in service to his cause, he’s still unwavering in his ultimate goal.

    That brings us back to Mariko’s standoff at the Osaka castle gates. As she tries to fight her way forward with her naginata, she’s relentlessly beaten back by Ishido’s men. After her defeat, she declares her intention to commit seppuku publicly for not being able to fulfill Toranaga’s orders, and it’s that moment that primes Ishido to release the Regents and their royal court as hostages — not her actual fight. In her actual fight, just before she picks up her own polearm, we see the pointless death of her armed escorts again and again as Ishido’s men slaughter them. Even when it looks like they may turn the tide, Mariko’s guards are cut down by arrows from men stationed on the castle walls. The battle is over in seconds, ending with one of Toranaga’s men bowing to Mariko while being speared directly through the heart from behind.

    It’s hard to ignore the message of intentional protest by death. For those not directly involved, war — particularly period warfare like Shōgun — tends to be a tragedy that occurs in a faraway place, out of sight and out of mind. Even if her men remain nameless, Mariko’s sacrifice instead places tragedy immediately on the doorstep of Japan’s capital in the most unavoidable way possible. When looking to calculate what the cost of war is, it’s no longer a tally of nameless soldiers dying far away. It’s now the immediate loss of someone everyone in the show — and of course, the audience — holds dear to their hearts.

    And the audience spends the entire last episode dealing with Blackthrone’s grief and acceptance. Shōgun defies the natural story arc by ending with a whimper; it’s in that precise moment of audience discomfort that viewers are forced to reckon with how much they want to see violence play out on screen, and perhaps even contend with how readily they are willing to accept war in real life.

    In a way, Shōgun is both a critique of war and of the media’s portrayal of it. But the show is always clear that every decision demands some sort of sacrifice. “It’s hypocrisy, our lives,” Yabushige states, cliffside, as Toranaga draws his sword to second his seppuku. “All this death and sacrifice from lesser men just to ensure some victory in our names…” Yabushige in this moment exists almost as an analog for the audience, questioning Toranaga’s methods. “If you win, anything is possible,” Toranaga replies, echoing a sentiment uttered by Blackthorne earlier. And winning, Shōgun seems to imply, can happen before war even breaks out.

    Shōgun is now streaming in full on Hulu.

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    Jesse Raub

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  • What Banning Emergency Abortions in Idaho Means for Doctors

    What Banning Emergency Abortions in Idaho Means for Doctors

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    On April 24, the Supreme Court will hear arguments weighing whether Idaho politicians have the power to block doctors from giving emergency medical care to patients experiencing pregnancy complications—a case that will open the door for other states to prohibit emergency reproductive care and worsen medical infrastructure for people across the board. Once again, politicians have set up a case that could have devastating impacts on the ability of doctors to provide–and for pregnant women to receive–essential reproductive health care.

    I’m a family physician who’s practiced medicine in rural Idaho for more than 20 years, where I’ve had the opportunity to guide hundreds of patients through their pregnancies. It’s no exaggeration when I say that my state’s health care system is in crisis, thanks in enormous part to our near-total abortion ban. Now, instead of trying to salvage what’s left, Idaho politicians are looking to hasten our downward spiral, making it even harder for doctors like me to provide care to patients in need. I can only hope that the Court will take into account that it’s not just abortion at stake in this case—it’s the future of emergency room care and medicine altogether.  

    Rural health care has always faced challenges, but in the nearly two years since the overturning of Roe v. Wade, it’s gotten exponentially worse. In Idaho, we’ve lost nearly a quarter of our obstetricians since the state’s abortion ban went into effect—colleagues and friends who got into medicine to help people are being forced out of practicing obstetrics in our state. They realized it was impossible to provide adequate care while under the thumb of politicians more interested in advancing their extremist agenda than protecting the health of their constituents.

    Idaho’s abortion ban makes it a crime for anyone to perform or assist with performing an abortion in nearly all circumstances. The ban does not even include an exception for when a person’s health is at risk—only for when a doctor determines that an abortion is necessary to prevent the pregnant person’s death. Ask any doctor and they’ll tell you that this “exception” leads to more questions than answers.

    Read More: ‘Am I a Felon?’ The Fall of Roe v. Wade Has Permanently Changed the Doctor-Patient Relationship

    Patients need an emergency abortion for a wide range of circumstances, including to resolve a health-threatening miscarriage. But there is no clear-cut legal definition under the ban of what exactly that looks like or when we can intervene, and doctors—operating under the threat of prosecution—have no choice but to err on the side of caution.

    “Can I continue to replace her blood loss fast enough? How many organ systems must be failing? Can a patient be hours away from death before I intervene, or does it have to be minutes?” These are the callous questions doctors are now forced to think through, all the while our patient is counting on us to do the right thing and put their needs first.

    As a result, pregnant patients sometimes make repeated trips to the ER because they’re told time and time again that nothing can be done for them until their complications get more severe. Imagine if someone you love had a 104-degree fever but you were told nothing could be done until it spiked to 106 and your organs were failing. Requiring patients to get right up to the point of no return before administering care is not sound medical policy—it’s naked cruelty, and it’s only going to get worse as long as we allow extremism, not science, to run rampant in our statehouses and trample over our safe system of care.

    It also violates a longstanding federal law—the Emergency Medical Treatment and Labor Act (EMTALA)—that requires hospitals to treat emergencies before they become life-threatening. That’s exactly why the U.S. Department of Justice sued Idaho soon after the state’s abortion ban took effect. The lawsuit argues only that Idaho must allow doctors to provide abortions in medical emergencies when that is the standard stabilizing care, but even that proved too much for state leaders.

    Instead, Idaho politicians fought the DOJ all the way up to the Supreme Court. How the Supreme Court rules will have broad implications that will reverberate throughout the country. If the Court holds that federal law no longer protects pregnant people during emergencies, it will give anti-abortion politicians across the country the green light to deny essential abortion care, push providers to leave states where the choices made with their patients can be second-guessed by prosecutors, and continue this cycle of inhumanity for patients. 

    As we’ve seen in Idaho, policies guided by anti-abortion extremism make health care worse for everyone. This assault on abortion has not ended with abortion—rather, it has extended to more of our rights and health care, with birth control, IVF, prescription drugs, and now emergency medical care all at risk.  

    This must stop. 

    For nearly 40 years, federal law has guaranteed that patients have access to necessary emergency care, including when a pregnancy goes horribly wrong. The Supreme Court must uphold this law and ensure pregnant people continue to get the care they need when they need it most. The health of my patients in West Central Idaho—and millions of other Americans across the country—deserve nothing less.

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    Caitlin Gustafson

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  • What Blocking Emergency Abortions in Idaho Means for Doctors

    What Blocking Emergency Abortions in Idaho Means for Doctors

    [ad_1]

    On April 24, the Supreme Court will hear arguments weighing whether Idaho politicians have the power to block doctors from giving emergency medical care to patients experiencing pregnancy complications—a case that will open the door for other states to prohibit emergency reproductive care and worsen medical infrastructure for people across the board. Once again, politicians have set up a case that could have devastating impacts on the ability of doctors to provide–and for pregnant women to receive–essential reproductive health care.

    I’m a family physician who’s practiced medicine in rural Idaho for more than 20 years, where I’ve had the opportunity to guide hundreds of patients through their pregnancies. It’s no exaggeration when I say that my state’s health care system is in crisis, thanks in enormous part to our near-total abortion ban. Now, instead of trying to salvage what’s left, Idaho politicians are looking to hasten our downward spiral, making it even harder for doctors like me to provide care to patients in need. I can only hope that the Court will take into account that it’s not just abortion at stake in this case—it’s the future of emergency room care and medicine altogether.  

    Rural health care has always faced challenges, but in the nearly two years since the overturning of Roe v. Wade, it’s gotten exponentially worse. In Idaho, we’ve lost nearly a quarter of our obstetricians since the state’s abortion ban went into effect—colleagues and friends who got into medicine to help people are being forced out of practicing obstetrics in our state. They realized it was impossible to provide adequate care while under the thumb of politicians more interested in advancing their extremist agenda than protecting the health of their constituents.

    Idaho’s abortion ban makes it a crime for anyone to perform or assist with performing an abortion in nearly all circumstances. The ban does not even include an exception for when a person’s health is at risk—only for when a doctor determines that an abortion is necessary to prevent the pregnant person’s death. Ask any doctor and they’ll tell you that this “exception” leads to more questions than answers.

    Read More: ‘Am I a Felon?’ The Fall of Roe v. Wade Has Permanently Changed the Doctor-Patient Relationship

    Patients need an emergency abortion for a wide range of circumstances, including to resolve a health-threatening miscarriage. But there is no clear-cut legal definition under the ban of what exactly that looks like or when we can intervene, and doctors—operating under the threat of prosecution—have no choice but to err on the side of caution.

    “Can I continue to replace her blood loss fast enough? How many organ systems must be failing? Can a patient be hours away from death before I intervene, or does it have to be minutes?” These are the callous questions doctors are now forced to think through, all the while our patient is counting on us to do the right thing and put their needs first.

    As a result, pregnant patients sometimes make repeated trips to the ER because they’re told time and time again that nothing can be done for them until their complications get more severe. Imagine if someone you love had a 104-degree fever but you were told nothing could be done until it spiked to 106 and your organs were failing. Requiring patients to get right up to the point of no return before administering care is not sound medical policy—it’s naked cruelty, and it’s only going to get worse as long as we allow extremism, not science, to run rampant in our statehouses and trample over our safe system of care.

    It also violates a longstanding federal law—the Emergency Medical Treatment and Labor Act (EMTALA)—that requires hospitals to treat emergencies before they become life-threatening. That’s exactly why the U.S. Department of Justice sued Idaho soon after the state’s abortion ban took effect. The lawsuit argues only that Idaho must allow doctors to provide abortions in medical emergencies when that is the standard stabilizing care, but even that proved too much for state leaders.

    Instead, Idaho politicians fought the DOJ all the way up to the Supreme Court. How the Supreme Court rules will have broad implications that will reverberate throughout the country. If the Court holds that federal law no longer protects pregnant people during emergencies, it will give anti-abortion politicians across the country the green light to deny essential abortion care, push providers to leave states where the choices made with their patients can be second-guessed by prosecutors, and continue this cycle of inhumanity for patients. 

    As we’ve seen in Idaho, policies guided by anti-abortion extremism make health care worse for everyone. This assault on abortion has not ended with abortion—rather, it has extended to more of our rights and health care, with birth control, IVF, prescription drugs, and now emergency medical care all at risk.  

    This must stop. 

    For nearly 40 years, federal law has guaranteed that patients have access to necessary emergency care, including when a pregnancy goes horribly wrong. The Supreme Court must uphold this law and ensure pregnant people continue to get the care they need when they need it most. The health of my patients in West Central Idaho—and millions of other Americans across the country—deserve nothing less.

    [ad_2]

    Caitlin Gustafson

    Source link