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  • The FDA Keeps Finding Lead in Cinnamon. Here’s What to Know

    The FDA Keeps Finding Lead in Cinnamon. Here’s What to Know

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    U.S. health officials are warning that several types of ground cinnamon sold at certain discount and specialty grocery stores are contaminated with high levels of lead and should be discarded.

    The Food and Drug Administration has issued its third alert this year, adding at least 10 types of packaged ground cinnamon sold at popular outlets including Dollar Tree, Patel Brothers and Eurogrocery stores in several states.

    The FDA has recommended that companies recall the products. In the meantime, consumers should throw away and avoid buying these ground cinnamon products. No illnesses have been reported in connection with these products, the agency said.

    Here’s what you need to know:

    Which brands of cinnamon are affected?

    The FDA issued its latest alert Tuesday, naming these brands of cinnamon: El Chilar, Marcum, SWAD, Supreme Tradition, Compania Indillor Orientale, ALB Flavor, Shahzada, Spice Class, and La Frontera.

    On July 25, the agency issued an alert for El Servidor brand cinnamon. That followed an alert on March 6.

    How much lead was found in the cinnamon?

    Testing by state programs and confirmed by the FDA found levels of lead that ranged from a little over 2 parts per million to about 7 parts per million in most of the spices, the agency said. The El Servidor brand was found to have a lead concentration of 20 parts per million.

    That’s far lower than the 2,000 to 5,000 parts per million detected in ground cinnamon in pouches of WanaBana and other brands of cinnamon apple puree that sickened more than 500 U.S. children starting last year.

    Read More: Why Your Diet Needs More Fermented Pickles

    There is currently no FDA limit for heavy metals in spices. However, the agency has set a limit of 1 part per million of lead in candy likely to be consumed by small children. The American Spice Trade Association, an industry trade group, calls for no more than 2 parts per million of lead in bark spices such as cinnamon.

    How does lead get into cinnamon?

    Many foods, including spices, contain lead from natural sources such as soil and water, said Karen Everstine, technical director for FoodchainID, a company that tracks food supply chains.

    Spices also can accumulate lead from other sources in the environment, such as pollution. Some lead in spices may come from manufacturing, storage or shipping processes.

    In some cases, spices have been mixed with substances, including lead, to boost color or weight, increasing the value of the product.

    How can lead in spices affect health?

    No amount of lead is safe, so it should be avoided, health officials say. Because spices are used in such small amounts, the potential harm of any single use is small, but damage could occur after weeks or months of exposure.

    How can I avoid lead in my spices?

    It can be difficult, if not impossible, to know whether spices on grocery shelves are contaminated with lead or other toxins, Everstine said.

    Read More: Scientists Are Finding Out Just How Toxic Your Stuff Is

    Consumers should buy spices from companies that have publicly said they monitor their sources. They have a vested interest in protecting their brands, she said.

    That can be tough, especially when grocery prices—including spices—remain high. But this is an instance when it might be worth it, she added.

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    JONEL ALECCIA/AP

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  • Do Americans Need Prescriptions for Healthy Food?

    Do Americans Need Prescriptions for Healthy Food?

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    As an internist in the public primary care clinic at Zuckerberg San Francisco General Hospital, Dr. Hilary Seligman often asked her patients about their diets. One conversation that stands out involved a man in his 50s, a longtime patient she had just diagnosed with prediabetes. Asked to describe his meals, he revealed that his daily lunch was a sandwich of Spam between two cinnamon rolls.

    “It really shocked me,” says Seligman. She couldn’t fathom why someone would even put those two foods together until she realized he did it because it was affordable and kept him full until he had enough money to eat again. “Healthier food just costs more,” she adds.

    That pivotal conversation shed light on the harsh realities of food insecurity, fueling Seligman’s passion for health equity and the growing movement known as Food Is Medicine (FIM). The philosophy of FIM is simple: Nutritious food is as critical to health as other medical treatments like prescription drugs and should be included in health care coverage.

    As the director of UC San Francisco’s Food Policy, Health, and Hunger Research Program and the Nutrition and Obesity Policy, Research and Evaluation Network of the U.S. Centers for Disease Control and Prevention, Seligman has played a key role in spearheading policy changes aimed at treating and preventing diet-related chronic illness by improving what people eat. Her initiatives, EatSF and Vouchers 4 Veggies, provide low-income residents who can’t afford nutritious food with “produce prescriptions” to redeem for fruits and vegetables at various outlets in California and outside the state. 

    “From the perspective of the patient, it makes a difference when your doctor prescribes something,” says Seligman, a professor of medicine, and of epidemiology and biostatistics at UCSF. People take it more seriously. In this case, instead of “take this antibiotic for your ear infection,” it’s “take this healthy food to prevent your diabetes.”

    The statistics clearly illustrate the need for this approach. One in eight U.S. households lacks access to affordable and nutritious food, while half of all American adults suffer from chronic diseases linked to their diets such as cardiovascular disease, high blood pressure, or Type 2 diabetes. Each year, these diet-related conditions lead to more than a million deaths in the U.S., exceeding those caused by smoking. These illnesses are also among the country’s largest health care costs, with a price tag of $1.1 trillion annually, which matches what the entire country spends on food itself.

    Read More: Why Your Breakfast Should Start with a Vegetable

    Given the profound health and economic impact of poor nutrition, it’s no surprise that the FIM concept is gaining traction. That’s due to a few key turning points, says Dr. Dariush Mozaffarian, a cardiologist and director of the Food Is Medicine Institute at Tufts University. 

    First, the COVID-19 pandemic drove home the crucial link between diet-related diseases and severe health outcomes, as people with obesity and other nutritional issues often had much tougher battles with the virus. Second, heightened national attention to health disparities, particularly influenced by movements like Black Lives Matter and economic pressures like rising food prices, has further pushed the issue to the forefront. The conversation has also been propelled by the high costs of popular injectable weight loss medications like Ozempic and Wegovy, driving the search for more sustainable health solutions. This collective awareness culminated in the Biden Administration’s 2022 White House Conference on Hunger, Nutrition, and Health, which pledged $8 billion in public and private funds to these causes. In government funding alone, 2023 data from the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP), administered by the U.S. Department of Agriculture, shows a near seven-fold increase in the number of FIM sites and a near twelve-fold increase in participation of these programs.

    One of the movement’s biggest wins came in recent years when FIM programs, including produce prescriptions, were integrated into Medicaid through Section 1115 waivers in 11 states. Additionally, Medicare Advantage has broadly adopted similar coverage, while the departments of Veterans Affairs and the U.S. Indian Health Service are exploring these initiatives through pilot programs.

    How do produce prescriptions work?

    To improve patient health, many organizations are addressing the lack of access and affordability of nutritious foods through innovative collaborations. For example, Brighter Bites, a national nonprofit based in Houston, serves thousands of children and their families across the country through school systems and health care organizations, delivering each of them 20 pounds of fresh fruits and vegetables per week, along with nutrition education. It’s funded by government agencies and partnerships with produce companies, other nonprofits, and philanthropic organizations.

    Among providers, a big player is Kaiser Permanente, which recently committed $50 million to further integrate FIM into its care model. Part of this work includes launching its Food Is Medicine Center of Excellence. The center combines clinical services—from produce prescriptions and medically tailored meals to culinary medicine and nutrition counseling—with new research and partnerships. In one trial in collaboration with Instacart, Kaiser is studying the outcomes of giving Medi-Cal members in Northern and Southern California more choices with grocery stipends that can be used to purchase fresh and frozen produce, legumes, plant-based oils, spices, and other foods from a curated virtual storefront.

    “By building the evidence for how to not only treat but also to prevent these very common conditions, our hope is to improve health—including for our most vulnerable populations—and to lower the cost of care,” says Pamela Schwartz, Kaiser Permanente’s executive director of community health.

    Read MoreWhy Your Diet Needs More Fermented Pickles

    These initiatives align with findings from a 2022 survey that revealed a high level of food and nutrition insecurity among Kaiser Permanente members: A quarter of all members, and nearly half of those on Medicaid, reported struggling to have enough to eat or access to nutritious food. As a result, Kaiser has also been helping members access food assistance through federal programs like SNAP (Supplemental Nutrition Assistance Program), and WIC (Women, Infants and Children).

    Trinadad Cuevas Garcia, a 53-year-old nursery worker in Forest Grove, Ore., knows this firsthand. She faced an ironic twist of fate when she moved to the U.S. from Oaxaca, Mexico, where she once grew her own tomatoes, corn, potatoes, and green beans on her family farm. Despite her farming skills and work in the agriculture industry, she could no longer afford fresh produce and had to subsist on a diet of mostly tortillas, rice, and beans. 

    However, a diagnosis of diabetes in 2021 and a doctor’s referral led Garcia to a produce prescription program at Adelante Mujeres, an Oregon-based nonprofit that supports marginalized Latina women and their families. The program provided her with a monthly budget of $300 to buy fresh produce for her family and to gain access to cooking workshops to learn how to prepare unfamiliar vegetables. Since joining the program, Garcia has embraced a healthier lifestyle, incorporating vegetables like kale, broccoli, and cauliflower into her diet. “I’m so grateful for this program,” says Garcia through a translator, “and I no longer need to restrict myself when buying fresh produce at the market.” Her health has significantly improved as a result; her A1C levels dropped from 7.6 to 6.4, moving her out of the high-risk diabetic category. 

    While access to these life-changing programs is still limited, it is possible thanks to partnerships with organizations like the Rockefeller Foundation, which supports the produce prescription programs at Adelante Mujeres, Brighter Bites, and others as part of the $100 million it earmarked to FIM programs nationally since 2019. “It’s a little bit crazy when you realize that what we eat is the number one driver of poor health in the country, and yet the health care system has so few tools to actually help patients eat better,” says Devon Klatell, vice president of Rockefeller’s food initiatives. 

    The research on FIM programs is also starting to build. In a 2024 review of dozens of studies published in the Journal of the American College of Cardiology, Mozzafarian at Tufts and his co-authors found that these interventions have shown the ability to significantly improve diet, manage chronic diseases like Type 2 diabetes and hypertension, and enhance overall physical and mental health, while also being cost-effective. However, larger, more rigorous studies are still needed, and several such robust experiments are currently underway, including a trial involving high-risk pregnancies in Georgia. 

    What challenges and opportunities lie ahead?

    If food is truly medicine, say experts, interventions like produce prescriptions should become as routine as taking a pill—and become fully integrated into the health care system. That includes better screening for food and nutrition insecurity, expanded public and private coverage, and more providers. It will also require more nutrition education for patients, and training in the field. Currently, U.S. medical schools offer less than 20 hours of nutrition education across four years, which is less than 1% of the total estimated lecture hours.

    It will also require better screening for food insecurity and more innovation to bridge the gap between health care professionals and grocers, some of which is already happening—such as patients getting produce benefits deposited straight onto debit cards to swipe at the grocery store. “We have a system that connects the health care system to the pharmacy in the back of the grocery store, but we don’t have a system to connect the health care system to the healthy foods at the front of the grocery store,” says Seligman.

    In order for healthy eating to be the norm, there also has to be a shift beyond underserved communities, says Shreela Sharma, a professor of epidemiology at the University of Texas’ UTHealth Houston School of Public Health and co-founder of Brighter Bites. “Historically—with smoking, seatbelts—when you shift the social norms, that’s where the sweet spot is.”

    Read More: How to Lower Your Cholesterol Naturally

    In Congress, there’s a significant push to expand federal support for these initiatives, says UCSF’s Seligman. This expansion isn’t just about encouraging healthier eating; it’s also about bolstering farmers and local food systems. “One of the challenges of these programs is that there isn’t a long term, sustainable funding stream outside of health insurance,” she says. “That’s really the cutting edge. Will health insurance pay for this? Because when people don’t eat healthy food, it’s the health system that’s bearing the downstream costs.”

    Food not only underpins our health, but also plays a vital role in our social fabric. Seligman shares a story about a group of socially isolated older adults from the same housing site in San Francisco who decided to spend their EatSF produce vouchers together at a farmers market. They pooled their resources to buy ingredients for a communal meal, which they then cooked and shared. “That’s really important,” says Seligman. “It starts with food, but hopefully food is also an avenue towards better physical and mental health and more connection with one another.”

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    Claire Sibonney

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  • Boar’s Head Recalls More Deli Meat Due to Listeria Outbreak

    Boar’s Head Recalls More Deli Meat Due to Listeria Outbreak

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    The popular deli meat company Boar’s Head is recalling an additional 7 million pounds of ready-to-eat products made at a Virginia plant as an investigation into a deadly outbreak of listeria food poisoning continues, U.S. Agriculture Department officials said Tuesday.

    The new recall includes 71 products made between May 10 and July 29 under the Boar’s Head and Old Country brand names. It follows an earlier recall of more than 200,000 pounds of sliced deli poultry and meat. The new items include meat intended to be sliced at delis as well as some packaged meat and poultry products sold in stores.

    They include liverwurst, ham, beef salami, bologna, and other products made at the firm’s Jarratt, Virginia, plant.

    The recalls are tied to an ongoing outbreak of listeria poisoning that has killed two people and sickened nearly three dozen in 13 states, according to the U.S. Centers for Disease Control and Prevention. Nearly all of those who fell ill have been hospitalized. Illnesses were reported between late May and mid-July.

    The problem was discovered when a liverwurst sample collected by health officials in Maryland tested positive for listeria. Further testing showed that the type of bacteria was the same strain causing illnesses in people.

    Read More: Are Dates Actually That Good for You?

    “Out of an abundance of caution, we decided to immediately and voluntarily expand our recall to include all items produced at the Jarratt facility,” the company said on its website. It has also halted production of ready-to-eat foods at the plant.

    The meat was distributed to stores nationwide, as well as to the Cayman Islands, the Dominican Republic, Mexico, and Panama, Agriculture Department officials said.

    Consumers who have the recalled products in their homes should not eat them and should discard them or return them to stores for a refund, company officials said. Health officials said refrigerators should be thoroughly cleaned and sanitized to prevent contamination of other foods.

    An estimated 1,600 people get listeria food poisoning each year and about 260 die, according to the CDC.

    Listeria infections typically cause fever, muscle aches, and tiredness and may cause stiff neck, confusion, loss of balance, and convulsions. Symptoms can occur quickly or to up to 10 weeks after eating contaminated food. The infections are especially dangerous for people older than 65, those with weakened immune systems, and during pregnancy.

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    JONEL ALECCIA/AP

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  • How to Start—And Stick to—A Breathwork Practice

    How to Start—And Stick to—A Breathwork Practice

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    Ilana Nankin loved being a pre-K teacher, but she and her colleagues often felt stressed by their jobs. So when Nankin noticed a fellow teacher “looking absolutely blissed-out,” she tagged along to the teacher’s new yoga and breathwork class. “I haven’t looked back since,” Nankin says.

    She felt so calmed by the mindful movement and breathing techniques she learned that Nankin brought them into her classroom—and marveled as her students calmed down after a round of “bear belly breathing.” Nankin went on to found a company, Breathe for Change, which brings mindfulness practices to teachers and students in public schools. If breathwork can work for a preschool teacher who was “overwhelmed and overworked, with little to no tools for self-care”—and her toddler students—it can help anyone, she believes. 

    “The most frequent question I’ll get is, ‘How do I start?’” says Nankin. And the answer is easier than you may think. If you can spare a few minutes each day, you have all the time you need to develop a fruitful breathwork routine.

    Ahead, Nankin and other experts share why breathwork matters, how to get started, and simple but effective exercises to try.

    What is breathwork?

    Dr. Sheila Patel, a family physician and chief medical officer of Chopra, defines breathwork as the conscious control of the breath. “When we change the depth and rate of breathing, we can create specific effects on the mind and body,” she says. “When we slow the breath rate, we directly inform the nervous system to shift toward the parasympathetic nervous system, which calms and relaxes us, and is the opposite of the stress response.” By manipulating your breath differently, you can also invigorate and energize yourself. This may sound similar to meditation, but “meditation focuses on cultivating present moment awareness, whereas breathwork focuses on consciously directing the breath to induce a specific outcome,” Nankin says.

    The health benefits of breathwork

    Patel didn’t practice breathwork until adulthood, but she was acquainted with it from a young age. Growing up, many relatives from India would visit her family’s home. “My first introduction to breathwork was hearing snorts and heavy breathing sounds coming from my uncle’s bedroom in the morning,” she says. This brought on fits of laughter for Patel and her sister, until one day they asked their parents what was happening. They explained he was practicing yoga postures and pranayama, which is yogic breathwork, to stay healthy.

    Read More: What’s the Best Skincare Routine?

    Now, Patel maintains a similar practice. “I experienced firsthand how calming the slow-breathing techniques could feel, and I really needed to relax and calm my mind, being a busy doctor, wife, and mother of two young kids,” she says. Given her demanding schedule, she often couldn’t find time to do yoga, but breathwork was more manageable. “Doing five minutes in the morning and five minutes at the end of my day had such profound benefits,” she says. “I was amazed to realize that the simple practice could be so transformational. “

    A large body of research confirms the benefits of slow rhythmic breathing: a lighter mood, reduced feelings of stress, and improved glucose and cortisol levels, says Patel. Some of these findings hold true even after just one session.

    What’s behind the impressive findings? Many of breathwork’s benefits seem to relate to its ability to tamp down your body’s “flight-or-fight” response. “When you are stressed, overwhelmed, or have experienced trauma, your nervous system is activated in the sympathetic state,” says Nankin.That’s when you enter fight-or-flight mode. “Engaging in breathing practices regulates your nervous system and enhances its flexibility, leading to increased comfort, relaxation, and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion,” she says.

    Even though we’re now able to describe the benefits in the language of science, Patel emphasizes that these practices have been done for thousands of years and the benefits have long been known through direct experience. “The practices aren’t new, but we’re learning about them and teaching them in a new way,” she says.

    How to start a breathwork practice, step-by-step

    If you’re an absolute beginner and don’t want to make this your whole identity, experts recommend trying a few easy breathing techniques. You don’t need a fancy meditation cushion or to download any apps. 

    First, note that there is no “right” way to practice breathwork. Kimberly Faith, a breathwork practitioner in Reno, Nev., tells clients who get overwhelmed by how many breathing techniques are available that as long as your exhales are equal to or longer than your inhales, you are calming your nervous system and are on the right track. 

    These three breathwork techniques work well for newbies.

    Box breathing

    Faith calls this popular technique one of the simplest breathwork exercises there is: “Inhale through the nose for a count of four, hold for four, exhale through the mouth for a count of four, hold for four,” she explains. “Doing this several times will relax the nervous system and restore homeostasis to the body.”

    Read More: How to Stop Clenching Your Jaw

    If even this seems like too much for you, Faith recommends trying to become more aware of your breath throughout the day. “Often, when people are stressed, or something triggers them, people stop breathing altogether. They do not even realize it, yet this triggers the sympathetic nervous system to go into overdrive,” she says. “The more we can become aware of our breath, the more we can do something about it.”

    5:2:5 rhythmic breathing

    This breathing technique is one of Patel’s favorites to teach her patients. This can be practiced sitting up or lying down. However, she recommends beginners start lying down, with one hand gently resting on the abdomen. 

    Here’s how it’s done: inhale through the nose for five seconds while feeling your abdomen rising up toward the ceiling. Pause for two seconds, and then exhale through the nose for five seconds while contracting your belly button toward the spine. Patel notes that this practice should be very comfortable, without causing any strain or lightheadedness.

    A 5-step breathwork practice

    Nankin developed this easy exercise in order for beginners to get comfortable with how it feels to pay attention to your breath. She says to approach this exercise (and all types of breathwork) with a non-judgmental attitude. “Start with curiosity, noticing your natural breath for five, 10, or 20 seconds, and the quality of each breath,” she says. “Simply observe without trying to change it.”

    1. Find a comfortable position. Be intentional about your posture and what your body needs. If you’re exhausted, lie down on the floor or couch. If you’re seated, relax your shoulders and lengthen your spine. To energize, stand up, aligning your head, shoulders, hips, and feet.
    2. Connect to your breath. Observe the natural flow of your breath. Focus on each inhale and exhale, allowing your awareness to orient towards your breath.
    3. Connect to your body. Notice sensations arising in your body as you breathe. It could be tingling toes, tension in your lower back or neck, a headache, or even feeling energized. Acknowledge and accept what’s happening in your body.
    4. Connect to your emotions. Notice how you feel as a result of this experience. You might feel calm, relaxed, content, overwhelmed, sad, or joyful.  Give yourself what you need in that moment, treating yourself as you would care for a loved one.
    5. Come back to your space. Begin to move your fingers and your toes. If your eyes are closed, gently open them. Make any final movements that feel good.

    How to commit to a regular breathwork practice

    Do you want to stick to a consistent breathwork practice but fear it will go, well, in one nostril and out the other? Here are five ways to stay the course.

    Pick a technique that feels right for you

    And it may change. Daily. Just because a friend swears by the box breath doesn’t mean that you will. “In this process, it is crucial to really find the right style that works for you,” says Pavel Stuchlik, a breathwork instructor and founder of NOA|AON, an online wellness platform which focuses on breathwork, meditation, and dance. Ask your body, “What is the right flow today?” he suggests. Stuchlik uses different techniques for different situations. “If you need breathwork for sleep, choose practices for sleep. If you need to do breathwork for energy, there’s breathwork for energy.”

    Read More: 8 Eating Habits That Actually Improve Your Sleep

    Set reminders 

    Since breathing is so automatic, Nina Kaiser, a clinical psychologist and founder of Practice San Francisco, says that it’s easy to forget to do these practices. “Setting reminders or habit-stacking with something you do consistently (e.g., picking up your phone, sitting down at your computer, etc.) can be helpful in establishing intentional breathwork as a new habit,” she says.

    Just like building any other habit, Kaiser stresses that it’s easiest to begin by making tiny changes to your routine. “People eager to achieve the benefits of breathwork may be tempted to dive in with complicated, time-consuming, or advanced practices,” she says. “Instead, it’s best to start with small shifts or additions to your current habits.”

    Practice it proactively

    A way to seamlessly wiggle breathwork into your daily life is to practice at the start of the day or as a way to decompress before sleep. You could also try incorporating a 30-second breathing practice throughout the day as a “brain break,” before a meal, or as a transition between activities, she says.

    And deep breathing isn’t only for the tranquil moments. Breathwork is especially vital when the going gets tough. Nankin recommends using it during heightened moments of stress, such as an argument, test, or accident. “Notice how you are feeling. Are you stressed, angry, sad? Pause and engage in a breathing technique to bring yourself back to a calm, regulated state,” she suggests. 

    Don’t breathe too hard 

    One of the most common breathwork mistakes Patel sees is when people strain or try to inhale or exhale to the maximum capacity. When done properly, your inhalations and exhalations should only be at about 75% capacity, says Patel, at a slow rate of about five to seven breaths per minute. “People think it’s about getting more oxygen in your lungs, but true breathwork is not about that. Creating this regular rhythmic and slow breathing synchronizes all the functions in the body regulation of the nervous system,” she says.

    Abandon expectations

    “I should feel calm” or “I should be less stressed” are common expectations Nankin hears from beginners—and when they don’t happen right away, they create anxiety. “The truth is, these practices won’t necessarily lead to immediate outcomes or to the same outcome every time,” says Nankin. “It can take weeks, months, or even years to feel the life-changing effects of breathwork. Be childlike in your experience, and the outcomes will follow. “

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    Perri Ormont Blumberg

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  • The U.S. Will Buy Flu Shots for Farmworkers to Try to Stop Bird Flu

    The U.S. Will Buy Flu Shots for Farmworkers to Try to Stop Bird Flu

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    NEW YORK — The U.S. will pay for flu shots for farmworkers this year, a strategy to prevent bird flu from changing into something more dangerous.

    Dairy and poultry farms are dealing with outbreaks of bird flu, and 13 workers have picked up infections. All cases are mild and are believed to have spread directly from infected animals to people.

    But health officials are worried about what might happen if people are infected with bird flu and seasonal flu at the same time. It’s possible the viruses could swap gene segments, in a process that scientists call reassortment. Bird flu, for example, could gain the ability to spread as easily among people as seasonal flu does.

    To prevent coinfections, the Centers for Disease Control and Prevention on Tuesday said it will spend $5 million to buy seasonal flu shots and get livestock workers vaccinated this fall, working with state and local officials. Another $5 million will be spent to promote the shots.

    “We want to do everything we can to reduce the risk that the virus may change,” said the CDC’s Dr. Nirav Shah.

    Read More: We Are Not Safe from Bird Flu Until We Protect Farmworkers

    Seasonal flu shots do not protect against bird flu. But they might reduce coinfections, he said. The CDC is also discussing the possibility of offering some farmworkers the antiviral medication Tamiflu to prevent getting the flu, Shah said.

    U.S. officials say there are at least 200,000 livestock workers in the country. According to the National Center for Farmworker Health, about a quarter of livestock workers typically get a seasonal flu shot.

    Production of a limited amount of bird flu vaccine for people is underway, but the government is not recommending it for farmworkers. There isn’t the kind of person-to-person spread that would trigger that kind of vaccination campaign, Shah said.

    A bird flu virus has been spreading since 2020 among mammals—including dogs, cats, skunks, bears and even seals and porpoises—in scores of countries. Earlier this year, the virus known as H5N1 was detected in U.S. livestock.

    ___

    AP health writer JoNel Aleccia contributed to this report.

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    Mike Stobbe/AP

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  • Stephen Nedoroscik Wears Glasses Due to Strabismus. Here’s What That Is

    Stephen Nedoroscik Wears Glasses Due to Strabismus. Here’s What That Is

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    Olympian Stephen Nedoroscik—a.k.a. “The Pommel Horse guy”—introduced Americans to more than just a niche sporting event when he helped the U.S. men’s gymnastics team clinch a bronze medal on July 29. He also raised awareness for an eye condition called strabismus, the apparent reason for the now-viral glasses he wears while waiting for his turn to compete, and which he hoisted in the air while celebrating with his team.

    Dr. William Flanary, an ophthalmologist with EyeHealth Northwest in Oregon—best known for the satirical videos he posts as his comedic alter-ego, Dr. Glaucomflecken—posted on X that Nedoroscik’s fame is “possibly the greatest moment for glasses in Olympic history.”

    “Just seeing someone like him on such a huge stage, winning an Olympic medal and unabashedly wearing his glasses…does a lot for making it normal,” Flanary tells TIME.

    Here’s what to know about strabismus.

    What is strabismus?

    Strabismus is the medical term for being cross-eyed, or having eyes that point in different directions. Typically, the brain sorts through information transmitted by each eye to create a cohesive visual picture and assess distance and depth. When there’s misalignment between the eyes, as with strabismus, “you can actually see two images” instead of one, explains Dr. Dean Cestari, director of adult strabismus care at Massachusetts Eye and Ear. This often leads to sight issues like double vision, blurry vision, and light sensitivity, Cestari says.

    Nedoroscik recently told Today that his vision is not clear without his glasses. He has also posted on TikTok about having light sensitivity.

    Read More: What Olympic Athletes Eat to Have All That Energy

    For some people with strabismus, one eye is always the one to turn in, out, up, or down. In other people, however, the turned eye can alternate, according to the American Optometric Association (AOA). The latter is the case for Nedoroscik, who has posted on TikTok about his ability to “switch [his] dominant eye,” a skill that he said at the time he could find little information about.

    (Note to Nedoroscik: Flanary says this ability is fairly common among people with strabismus and is known as “alternating fixation.”) 

    What causes strabismus?

    Babies can be born with strabismus or it can develop later in life. Overall, an estimated 2% to 5% of the population has strabismus.

    Strabismus can occur due to problems with the muscles and nerves that control the eyes, as a side effect of an eye injury or other medical condition, or as a complication from significant far-sightedness, the AOA says. It can also run in families. An estimated 30% of children with strabismus have a family member with a similar diagnosis, the Cleveland Clinic says.

    Nedoroscik has also posted about having coloboma, a condition that leads to missing eye tissue. “Colomba can cause decreased vision or blurry vision, but it can also cause an elongation of the eyeball. Depending on how elongated the eye is, that can result in a strabismus,” Cestari explains.

    How is strabismus treated?

    The earlier strabismus is treated, the better, Flanary says. Kids with untreated strabismus will often learn to “basically turn off vision in [their turned] eye and ignore that eye,” Flanary explains. Over time, that coping mechanism can lead to long-term vision problems in the turned eye, or what is colloquially known as a lazy eye.

    That said, it’s never too late to treat strabismus, says Cestari, who specializes in treating adults. “The most common sentence I hear is, ‘Oh my God, I didn’t know this could be fixed as an adult,’” he says. “It’s absolutely not true” that only kids can be treated.

    Read More: How Much Hair Loss Is Normal for Women?

    Depending on the person and the details of their case, a pair of glasses in the right prescription may be all that’s necessary to straighten vision and address strabismus, Flanary says. But in some cases, according to the Cleveland Clinic, people may also need eye exercises, surgery, medications, or “patching”—purposely covering one eye to strengthen the other.

    Nedoroscik’s glasses have become his much-memed trademark during the Olympics, although he doesn’t wear them when he’s competing. “When I go up on the pommel horse, it’s all about feeling the equipment,” he told Today. I don’t even really see when I’m doing my gymnastics. It’s all in the hands—I can feel everything.”

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    Jamie Ducharme

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  • What’s the Best Skincare Routine?

    What’s the Best Skincare Routine?

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    Walking down the skincare aisle is like sensory overload. There are gels, creams, so-called essences, and serums, so many serums. The products claim to revitalize, exfoliate, hydrate, brighten, soothe, correct—or work anti-aging wonders. What’s a skincare novice to choose?

    “It can be overwhelming for me, as a dermatologist in practice for 25 years, to walk into a Sephora and be surrounded by all the different options,” says Dr. Jessica Wu, who practices cosmetic and clinical dermatology in Beverly Hills, Calif. “There used to be one or two retinoids, or one or two vitamin Cs. Now, there are literally dozens, if not hundreds, of each category. It can be really intimidating.”

    The first step to developing a skincare routine, Wu tells bewildered patients, is understanding your own skin: Is it oily, dry, or normal? To figure that out, wash your face, and then consider how it feels two hours later. “Is it feeling oily? Is it feeling dry and tight, or is it feeling pretty?” she asks. “That gives you a general idea of where you fall in that spectrum.”

    From there, you can design a routine that requires only two to three steps at the start and end of the day. We asked experts which five products to prioritize—and when and how to apply them

    A gentle cleanser

    Washing your face for 60 seconds with a gentle cleanser every morning and night is a terrific way to reset your skin. You’ll say good riddance to dirt, makeup, sweat, oil that built up over night, dead skin cells, and other impurities. “Even if your house is very clean, there could still be dust that falls on your skin or mites living in your pillow,” Wu says. “If you have animals, they could be licking your face, or kids could be touching your face.”

    If you have dry skin, look for a creamy cleanser, she advises. If you’re oily, opt for a gel or foaming cleanser, because they’ll help break up the oils. Alexis Pfropper, an esthetician who owns ästhetik spa and skincare in Punta Gorda, Fla., likes to remind people that cleanser isn’t meant to have a stripping effect. “We want to clean it, but not overstrip it to the point where you get that squeaky-clean feeling,” she says. “That’s actually a little inflammation starting to happen, because your face is now so dry, and the pH is thrown off the skin.”

    Read More: How Much Do You Actually Need to Shower?

    Pfropper suggests looking for a cleanser that contains hyaluronic acid, vitamin E oil, and glycerin, all of which help hydrate the skin. Avoid fragrances, sulfates, parabens, and alcohol, which could be irritating, she says.

    Moisturizer

    Especially as we age, our skin gets drier because we’re losing water—and that’s one reason why moisturizing is so essential. “It can be really important to repair that skin barrier, so bacteria and yeast don’t cause a problem,” says Dr. Leah Ansell, an assistant professor of dermatology at Columbia University who practices in Rye, N.Y. “Plus, a moisturizer can just make your skin look and feel good.”

    Most people benefit from using a gentle moisturizer that doesn’t have added scents or a ton of extra ingredients. Ian Michael Crumm, an esthetician in New York, suggests those with oily skin opt for a water cream moisturizer, which is lightweight; people who run dry might benefit from a rich moisturizer that has a thicker texture. You can apply it to your face, neck, chest, ears, under your eyes, your hands—anywhere prone to dryness.

    Vitamin C serum

    Vitamin C is a powerhouse antioxidant that helps protect your skin from particles called free radicals that are created by UV rays. Exposure can break down the skin’s collagen production, while leading to signs of aging, like winkles, dark spots, fine lines, and saggy skin. “Our skin is bombarded by these free-radical particles, and we want to protect its collagen from being unnecessarily or prematurely broken down,” Wu says. “That way, we can keep the skin looking fresh and smooth and youthful.”

    Read More: Why You Should Never Pop a Zit

    You can apply vitamin C every morning, Wu says, right after you wash your face. Squeeze a few drops onto your palm or directly onto your face, and then gently massage it into your skin. You can even put some on your chest, she adds.

    When you’re shopping for a vitamin C serum, look for one that includes vitamin E, which is another antioxidant, Wu suggests—the combination is stronger than just vitamin C alone. Ideally, it should be sold in an opaque container with a pump. “Vitamin C is very fragile,” Wu says. “If it’s in a jar, you open it and it gets exposed [to light and air], and it breaks down. Just like a bottle of champagne or a bottle of soda—when you open it, it goes flat.”

    Sunscreen

    Here’s a familiar but essential addition to any skincare routine: sunscreen. Everyone should get in the habit of using it 365 days of the year, starting at a young age, Ansell says. While it’s especially important in the spring and summer, it’s possible to get sun damage any time of year, she points out. Even if you think you’re not going to spend a lot of time outside, you might still be at risk. Side and rear windows in cars, for example, protect against UVB rays, which cause sunburn, but not against all UVA rays, which are linked to wrinkles, skin aging, and other damage. “A lot of dermatologists see that people have more brown spots and a lot more wrinkles on the left side of their face,” Ansell says, and that’s because they’re not wearing sunscreen while driving.

    Read More: What’s the Best Kind of Sunscreen?

    Opt for a broad-spectrum sunscreen that’s SPF 30 to 50, Wu advises. (Going much higher than that doesn’t offer additional protection, she adds.) If you have sensitive skin, look for mineral sunscreen instead of a chemical version, she says—it’s less likely to be irritating. And keep in mind that you need to reapply sunscreen at least every two hours, or more often if you’ve been swimming or sweatily exercising.

    Retinoids

    Retinoids are derived from vitamin A, and they can help keep your skin looking youthful. The overarching term refers to retinol (which you can buy over the counter) as well as a variety of products that require a prescription. Among them: tretinoin (which treats acne and hyperpigmentation) and tazarotene (which works against acne, psoriasis, and sun-damaged skin). While people tend to use the word “retinol” to describe any and all retinoids, “that’s like calling all alcohol beer,” Wu says.

    So which do you need? Most people do well with retinol, but some people—like those with severe acne or other skin conditions—benefit from more powerful prescription retinoids. Ask your dermatologist which is best for you. In general, if you’re testing a retinoid for the first time or have dry or sensitive skin, it’s best to start with retinol—it tends to be less drying and often contains hydrating ingredients, Wu says. Apply a thin layer to your face before you go to bed (it can be broken down by the sun), but only every other night for about a month. Some people find it irritating, so it’s best to ease in slowly.

    Almost any adult can benefit from retinol, experts say, though people who are pregnant or breastfeeding are generally advised to avoid using the product. You should also skip it if you have a sunburn or broken, already-irritated skin. And it’s important to note that retinol can make your skin slightly more sensitive to the sun. “Retinoids help stimulate new collagen and also unclog pores, and they help push the dead skin cell layers off the skin,” Wu says. “In doing so, you may sunburn more quickly, because you have less layers of skin protecting you. That’s why we tell people to be sure to use some protection if you’re going to be using a retinol.”

    What’s the best order in which to apply these products?

    Order matters when you’re applying skincare products. Here’s the step-by-step routine experts suggest following:

    In the morning

    1. Wash your face with cleanser and softly pat it dry.
    2. Apply vitamin C serum.
    3. Moisturize your face.
    4. Apply sunscreen.

    In the evening

    1. Wash your face with cleanser as soon as you get home—it’s probably dirty from the day.
    2. Before you go to bed, make sure your skin is dry, and then apply your retinoid. (“Medication always goes first,” Ansell says. “You want that closest to your skin.”)
    3. Moisturize your skin to help lock the retinol in.

    How quickly will you see results?

    You won’t notice a payoff from your skincare routine immediately, Ansell cautions—but that doesn’t mean it’s not working. The earliest you might see results is after about four weeks. “Your skin should feel better—the texture is going to be smoother,” she says. If you’re dealing with discoloration, you probably won’t notice any improvement for two to three months. “It’s really the long-term benefits of a skincare routine that are where you see all the results,” she says. “It takes months, and even years, but it’s a really good thing to do for your skin.”

    Read More: How Much Hair Loss Is Normal for Women?

    Enlisting a professional’s help

    If you’re dealing with an issue like acne, eczema, or rosacea, consult with your dermatologist before starting a new skincare routine. Or, if you have fairly normal skin, consider scheduling an appointment with a licensed esthetician. Many offer in-person as well as virtual consults, Crumm says, and it’s smart to come prepared with a list of what products you use and when, as well as how much you’re willing to spend on a new routine. Your esthetician will ask about your skin goals—a more even complexion? Looking dewey?—and then develop a step-by-step plan “around your personal preferences, capabilities, and budget,” he says.

    Regardless of what products you gravitate toward, keep in mind that it’s never too late to start a skincare routine. Experts recommend thinking of it as an investment in yourself. “For so long, skincare was a vanity thing, and it’s not,” Pfropper says. “It’s OK to take 5 minutes out of your day to moisturize and apply sunscreen and serums.”

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    Angela Haupt

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  • Tongue Tie May Be Overdiagnosed in Babies

    Tongue Tie May Be Overdiagnosed in Babies

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    NEW YORK — Tongue-tie—a condition in infants that can affect breastfeeding—may be overdiagnosed in the U.S. and too often treated with unnecessary surgery, a prominent doctors’ group said Monday.

    The American Academy of Pediatrics is the latest, and largest, medical society to sound an alarm about the increasing use of scissors or lasers to cut away some infants’ tongue tissue when breastfeeding is difficult.

    “It’s almost an epidemic,” said Dr. Maya Bunik, a Colorado-based co-author of the report.

    Experts say there isn’t a good count of how many infants each year are being treated for tongue-tie with surgery, though Bunik believes the annual tally may exceed 100,000. Research suggests many of those treatments are not necessary, she added.

    The academy’s new report encourages pediatricians and other medical professionals to consider nonsurgical options to address breastfeeding problems. The report cites a study that suggests less than half of the kids with the characteristics of tongue-tie actually have difficulty breastfeeding.

    Read More: To Address the Teen Mental Health Crisis, Look to School Nurses

    Ankyloglossia, or “tongue-tie,” occurs when an infant is born with a tight or short band of tissue that tethers the bottom of the tongue’s tip to the floor of the mouth. The condition can make it hard for the infant to extend and lift their tongue to grasp a nipple and draw milk—which in turn can be painful for the mother.

    Doctors say it’s critical to get breastfeeding on track in the first three to four weeks, and surveys indicate most parents want to breastfeed, so it’s natural that they want a quick solution to a problem, Bunik said.

    Ankyloglossia diagnoses have been increasing worldwide, though there is no uniform diagnostic criteria for this condition and no consensus on how to treat it. One common approach is to cut the tissue with scissors, but dentists increasingly are using lasers to vaporize the tissue—some charging $800 or more.

    But the procedures can cause pain and sore mouths, potentially deterring babies from trying to breastfeed, Bunik said.

    “The practice (of treating tongue-tie) got to be very common without a lot of good data,” said Wisconsin pediatrician Dr. Jennifer Thomas, who also co-authored the report.

    The report also recommends lactation experts, pediatricians, and surgeons and other medical professionals work with parents to evaluate possible reasons for breastfeeding challenges and make the best treatment decision.

    The American Academy of Pediatrics, which has 67,000 members who specialize in treating children, started working on the report in 2015 after some pediatricians began to notice that an increasing number of patients were going to dentists to get treatment for tongue-tie, Thomas said. Pediatricians were finding out after the surgeries.

    Read More: Healthy Activities Save Kids’ Lives. Why Are They So Hard to Find?

    At least two other medical groups have issued statements about tongue-tie. In 2020, the American Academy of Otolaryngology-Head and Neck Surgery issued a consensus statement in which member physicians said they believe tongue-tie is being overdiagnosed in some places and that there isn’t sufficient evidence to support claims that using lasers is superior to other techniques.

    A year later, the Academy of Breastfeeding Medicine, an international group, issued a position called for more research into tongue-tie treatment and stressed that decisions “require a high level of clinical skill, judgment, and discernment.”

    The American Dental Association didn’t directly respond to The Associated Press’ questions about the new report. It sent a statement saying the organization agrees with a 2022 policy statement by the American Academy of Pediatric Dentistry, which noted not all children with ankyloglossia need surgical intervention and that a team-based approach with other specialists can aid in treatment planning.

    Haley Brown saw a lactation consultant two years ago after her son Shiloh, who was born prematurely, had trouble nursing. But as months passed and the situation didn’t improve, Brown turned to a Denver dentist she heard about on social media The dentist diagnosed Shiloh with tongue-tie and also lip-tie, in which the tissue inside the upper lip is too tight. Shiloh underwent a short laser procedure that cost $750.

    Breastfeeding improved immediately. “Things just seemed a little easier for him,” said Brown, 33, of Englewood, Colorado.

    Brown later had another baby, and another lactation consultant told her that a scissors snip could have been less involved and just as effective. Brown said the laser treatment worked for Shiloh, but added: “I probably should have consulted with my pediatrician before I went straight to the dentist.”

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    Mike Stobbe/AP

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  • Blood Tests for Alzheimer’s May Be Coming to Your Doctor’s Office

    Blood Tests for Alzheimer’s May Be Coming to Your Doctor’s Office

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    WASHINGTON — New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday—but some appear to work far better than others.

    It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs—buildup of a sticky protein called beta-amyloid—with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.

    Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.

    “What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”

    Demand for earlier Alzheimer’s diagnosis is increasing

    More than 6 million people in the United States and millions more around the world have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.

    New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.

    Read More: A New Alzheimer’s Drug May Be the Most Effective One Yet

    Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.

    “I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.

    New study suggests blood tests for Alzheimer’s can be simpler and faster

    Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices—especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.

    In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.

    Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73%—but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.

    Which blood tests for Alzheimer’s work best?

    There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.

    Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.

    Read More: Changing Your Diet and Lifestyle May Slow Down Alzheimer’s

    Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.

    That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.

    Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.

    Who should use blood tests for Alzheimer’s?

    Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.

    For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.

    Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.

    The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family—unless it’s part of enrollment in research studies, Schindler stressed.

    That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.

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    LAURAN NEERGAARD/AP

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  • The Link Between a Mother’s Lupus and a Child’s Autism

    The Link Between a Mother’s Lupus and a Child’s Autism

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    At the turn of the 21st century, the prevalence of autism spectrum disorder among American children was roughly 1 in 150. That’s according to data collected by the Autism and Developmental Disabilities Monitoring Network of the U.S. Centers for Disease Control and Prevention. A decade later, in 2010, the prevalence had risen to 1 in 68 children. By 2020, it had climbed again—to 1 in 36 children. “The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent decades, supporting the claim of an autism epidemic,” wrote the authors of a 2020 study in the journal Brain Sciences.

    The precise cause and extent of that epidemic are contested. Some researchers have observed that the diagnostic criteria for ASD have evolved during that time—stretching and broadening to include a wider array of conditions. And so part of the rise in diagnoses, they argue, is likely attributable to dilating conceptions and a deeper understanding of autism. Still, the increasing prevalence of ASD diagnoses has spurred greater scientific interest in the underlying causes of the disorder. That work has revealed a possible connection between ASD and autoimmune conditions, including systemic lupus erythematosus (SLE).

    “For quite a while, there’s been a link between maternal autoimmune diseases and risk for having a child with autism,” says Paul Ashwood, a professor of medical microbiology and immunology at the University of California, Davis and the MIND Institute, which focuses on autism and other neurodevelopmental conditions. He mentions work based on nationwide data collected over a period of many years from mothers and their offspring in Denmark. That research found that prenatal exposure to a number of different maternal autoimmune diseases, including both lupus and rheumatoid arthritis, was associated with an increased risk for an eventual autism diagnosis.

    Since then, more research has firmed up the apparent association, and also found evidence of a broader connection between a pregnant woman’s immune system and the risk of an offspring with autism. “What we’ve been looking at a lot more recently is how anything that generates a maternal immune response could be linked to autism risk,” Ashwood says.

    Read More: The Most Exciting New Advancements in Managing and Treating Lupus

    Antibodies and the developing brain

    In response to a threat, such as a virus or other pathogen, the immune system produces protein antibodies that are intended to neutralize or eliminate the danger. But among people with autoimmune conditions such as systemic lupus erythematosus, the immune system produces antibodies that attack the body’s own healthy proteins or tissues. These are called autoantibodies.

    In a 2015 study in the journal Arthritis and Rheumatology, a group of Canadian researchers found that children born to women with systemic lupus erythematosus were nearly twice as likely to develop autism as children of women who did not have SLE. Furthermore, the children of mothers with SLE tended to be diagnosed with autism at a younger age than those of mothers without SLE. 

    “In-utero exposures to maternal antibodies and cytokines [proteins that regulate the growth of immune system cells] are important risk factors for ASD,” the authors of that study wrote. Women with SLE “display high levels of autoantibodies and cytokines,” which have been shown in animal models to alter fetal brain development and induce behavioral anomalies in offspring, they added.

    “Maternal antibodies, including autoantibodies, start crossing the placenta barrier around day 100 of gestation, and we know that this can affect the developing fetus,” says Judy Van de Water, professor of medicine and associate director of biological sciences at the University of California, Davis and the MIND Institute. “One of the things we’re looking at is how these autoantibodies or other aspects of the mother’s immune response could affect neurodevelopment.”

    Some research has already found that maternal autoantibodies related to SLE may lead to the development of heart conditions and also blood and liver abnormalities in a developing fetus. Van de Water and her colleagues are examining whether and how other autoantibodies may similarly affect fetal brain development. “Several of the proteins that these autoantibodies target are really highly expressed in the developing brain, and not the mature brain,” she says. This may create unique exposure risks for a developing fetus.

    Read More: How Changing Your Diet Could Have a Major Impact on Managing Lupus Symptoms

    The immune-autism link

    Apart from lupus, several other maternal autoimmune disorders, including rheumatoid arthritis, have been tied to an increased risk for having children with autism. The same is true of immune-related conditions such as asthma and allergies. Van de Water and other researchers are now taking a broad look at how a pregnant woman’s immune system activity may affect the fetal brain. “Anything that impacts maternal immune homeostasis or the balance of the immune response in the mother could impact neurodevelopment in the child,” she says. “So we’re looking at different immune systems responses—what the response is, how intense the response is, the makeup of inflammatory markers—and their relationships to autism.” 

    An autoimmune condition like lupus is one source of a heightened maternal immune response, but Van de Water says that, under the right conditions, just about anything that triggers an immune reaction could potentially affect neurodevelopment in ways that contribute to autism. “We’re looking at a lot of different maternal immune activations or perturbations—whether from an existing condition or illness, or something that happens during pregnancy,” she says. 

    In particular, experts highlight the role that inflammatory cytokines may play in autism risk. “The way to think about cytokines in the fetal environment is that they can potentially act in a dose response manner—just as too much is bad, then too little is also bad, but there is this goldilocks level that you need to have for appropriate growth,” Ashwood says. “If there’s some kind of immune condition or inflammatory response that leads to the constant production and release of these cytokines, those could cross the placental barrier and affect fetal development.” 

    In the brain, for example, the presence of cytokines “could affect neuron growth, neuron proliferation, the connection of neurons to other neurons, synapse formation, neuronal migration, and all sorts of processes that are necessary to build an interconnected network as the brain grows,” he explains. “Having those systems slightly off-kilter can potentially affect the trajectory of neurodevelopment.”

    Lupus and other autoimmune disorders are one potential source of cytokine imbalance. But Van de Water says that obesity is another inflammation-related condition—and a far more common one than lupus—that could produce the sort of immune activity that contributes to autism. “Obesity has a major inflammatory component attached to it,” she says. “We just published a paper looking at this, and it turns out that the biggest maternal risk factor for autism was not any autoimmune disease, but asthma and allergies coupled with obesity. You put these two together with obesity and he risk was significantly greater.”

    Another potential connection between a mother’s immune activity and her offspring’s autism risk is the microbiome—the community of bacteria that inhabit the gut. Some research has found that the metabolites produced by a mother’s gut bacteria can affect the neurodevelopment of the fetus. Furthermore, there’s evidence that infections, metabolic stress (such as obesity), and other immune-related events can lead to maternal microbiome imbalances that, potentially, could raise her offspring’s risk for autism. 

    On top of this, there’s evidence that people with autism share some distinct microbiome characteristics, and that gut-related symptoms—diarrhea, constipation, and abdominal pain in particular—are common comorbidities among people with autism. “There’s a lot of interest right now in the microbiome —how it’s formed, the way it nourishes the body, and how it shapes the activity of the immune system,” Ashwood says. There’s also been much recent interest in the so-called “gut-brain connection,” and science has established that the gut’s microbiota influence brain connectivity and functioning.

    It’s not certain yet, but it’s possible that maternal autoimmune disorders and other immune-related perturbations could directly or indirectly affect the microbiome of the fetus in ways that contribute to the development of autism.

    Read More: What to Know About Complementary Treatments for Lupus

    A multifaceted disease

    While there are several plausible mechanisms that could tie autoimmune disorders to autism, experts say this is likely only one small part of the autism equation. “It’s worth remembering that autoimmunity in the general populace is pretty low,” Ashwood says. Also, research on the link between maternal lupus and autism has found that while the risks are elevated, women with the autoimmune condition were still at low overall risk for having a child with autism.

    Apart from maternal immune conditions, there’s growing evidence of the role that genetics play in a person’s risk for autism. “More than 100 genes are known to confer risk, and 1,000 or more may ultimately be identified,” wrote David Amaral, a distinguished professor at the University of California, Davis and the MIND Institute, in a 2017 paper on the causes of autism. He goes on to explain that, most likely, a mix of genetic and environmental factors contribute to the development of autism. “It seems clear at this point,” he writes, “that when all is said and done, we will find that autism has multiple causes that occur in diverse combinations.”

    Van de Water likewise emphasizes this point. Autism spectrum disorder is a diverse and multifaceted condition, and its underlying causes are likely equally complex. Lupus and other immune-related conditions may be a piece of the puzzle, but they’re just one of many. “Anyone who tells you they know the cause of autism doesn’t know autism very well. There are many layers to it,” Van de Water says. “There seems to be a relationship between the mother’s immune activity and autism, but we don’t have all the answers yet.” 

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    Markham Heid

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  • How to Keep Pets Cool in the Heat

    How to Keep Pets Cool in the Heat

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    PHOENIX — As much of the world swelters, it’s not just people who need help with the dog days of summer. Pet owners have to consider how to both shield and cool down furry family members as intense—at times deadly—heat waves become more common.

    “It’s really important to remember that if it’s hot outside for you, it’s even hotter for your pets,” says Dr. Sandra Faeh, American Veterinary Medical Association president. A dog’s breed, weight and chronic health issues also matter. “There’s not one specific temperature that we can say, `this is the right temperature to go outside,’ because they’re all different.”

    In the U.S, over 180 million people, or 63% of households, have at least one pet, according to an American Pet Products Association report. Pet-related spending is projected to be over $150 billion this year, yet a lot of pooch parents aren’t accustomed to changing routines or buying items for hot weather. This summer’s heat is making that more normal.

    Simple safety steps

    Of course, the surest strategy against high temperatures is to take pets out in the morning and evening, Faeh advises. If you must take them out during the day, be quick and stick to shade, grass and dirt. Pavement can be a scorcher on paws.

    “We often think that their paws are thicker, they’re not as susceptible to the heat, but they are. They can blister, they can hurt,” Faeh said.

    One paw-sitive measure: Faeh says dog booties made with a thick fabric can help with hot surfaces. Dogs just need time to get the hang of walking in them.

    Pets can also suffer sunburns, which can manifest as lighter pigment on the nose, or around the face on short-hair breeds. Veterinarians can prescribe special sunscreen.

    Read More: Why Sweat and Heat Make Your Skin So Sensitive

    Providing relief even after brief sun exposure is as important as sun protection. Cooling mats and small fans can help. And besides giving dogs water, you can wet their bodies with cool water. But not too cold, Faeh warns.

    “If they get cold too quickly, their vessels constrict and then they have a harder time cooling off,” she said.

    In a power blackout, Faeh suggests putting pets in a cooler part of the home like a basement or a windowless room. Keep fresh water on hand and any blinds or curtains closed.

    Signs to look for if a dog is experiencing heat-related stress or heatstroke include restlessness, excessive panting, drooling and even vomiting. Cats show distress through open-mouth breathing. In any of these scenarios, contact a veterinarian immediately, Faeh advises.

    The importance of accessorizing

    There’s a wide array of pet accessories and devices available to help beat the heat, says Pete Scott, American Pet Products Association president. But some markets have been caught off-guard by the higher temperatures.

    “You don’t think of Connecticut as being 100 degrees,” said Scott, who is based in Stamford. “You’ve got to be vigilant and be prepared. Like if it’s a week out when they say a heat wave is coming, everybody stocks up on bottled water. But they don’t also stock up for their pets.”

    Besides booties, protective gear can mean a sun visor and doggy sunglasses or goggles, if your pet will wear them.

    David Escalante started Kaykos Dog Shades out of his San Francisco Bay Area home in 2016 after putting a makeshift pair of sunglasses on his family’s pit bull. Now, Escalante, his father and brother hand-make every pair in his San Jose garage. They have sold nearly 15,000 in the last three years.

    Read More: What to Wear When It’s Really Hot Outside

    Each pair has a drawstring, nose bridge rest and lenses that he says protect against ultraviolet light rays.

    “We try to push … to let people know, ‘Hey, you know, think about your dog’s eyes now that you’re out and it’s super bright,” said Escalante, who sells more during heat waves.

    Other helpful tools include cooling collars and elevated dog beds that help with airflow, Scott says. You can also feed Fido chilled goodies like canine-friendly gelato, pup-sicles and ice cream mixes.

    “When it’s hot, we all like a little frozen treat. So do dogs, so do cats,” Scott said.

    Indoor playtime

    Another solution is an indoor dog park. Spencer Mak and his wife, Lauren, have operated two Mak Pack Dog Training & Boarding facilities in suburban Phoenix since 2020. The 10,000-square-foot Chandler location includes an indoor dog park with agility exercises, climbing obstacles and a bounce house. They offer a $10 drop-in rate and a $49 monthly membership.

    At its busiest, the indoor area has accommodated as many as 100 dogs. In June, when temperatures spiked, Mak saw 520 admissions compared to 300 in May—a nearly 75% jump.

    He’s currently working on building an indoor doggy pool with ramps and floats.

    And ugh, the car…

    Summertime also sees cases of people leaving or forgetting pets in hot cars. The temperature inside a vehicle can surpass the outside very quickly.

    “It is so much better to just leave them at home and know that they’re gonna be wagging their tail and giving you kisses when you walk in the door,” Faeh says.

    Some vehicles come with dashboard alerts if a child or pet is still in the back. There are also backseat car alarms on the market. But ultimately, “it always comes down to the human that owns the pet,” Scott says.

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    Terry Tang/AP

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  • The Shingles Vaccine May Help Delay Dementia

    The Shingles Vaccine May Help Delay Dementia

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    GSK Plc’s shingles vaccine was linked to a longer delay in dementia onset than a competing shot, a finding that suggests superior protective powers against one of the world’s most threatening conditions.

    People who received the Shingrix vaccine lived an average of 164 days longer without a dementia diagnosis than those who got Merck & Co.’s Zostavax, according to a study published Thursday in the Nature Medicine journal. The Merck vaccine was linked to lower dementia risk in a study last year.

    More than 55 million people worldwide have dementia, the seventh leading cause of death among older people globally. While recently approved drugs like Eisai Co.’s Leqembi and Kisunla from Eli Lilly & Co. can help slow the progress of Alzheimer’s disease—one of the most common dementia forms—there is no cure.

    Read More: Changing Your Diet and Lifestyle May Slow Down Alzheimer’s

    “The next question is how does vaccination exert this dementia protection effect?” said Rob Howard, a professor of old age psychiatry at University College London who wasn’t involved in the study. It could be through reducing levels of the virus, or by affecting some mechanism of the disease itself, he said.

    The study, conducted by scientists at the University of Oxford, included data from more than 200,000 people in the U.S. who had received one of the shots over the past decade. About half received Zostavax between October 2014 and September 2017, while others received Shingrix between November 2017 and October 2020. Zostavax, a live vaccine, has been largely discontinued in the U.S. in favor of Shingrix, a recombinant shot.

    Read More: A Blood Test for Alzheimer’s Disease Is Almost Here

    The researchers followed subjects for six years after they received shots, comparing the prevalence of dementia diagnoses in both groups. The Shingrix shot delayed dementia longer in women than men. An earlier study of Zostavax found little impact on dementia in men at all.

    The efficacy appears to be comparable to that seen in the new drugs for Alzheimer’s, said Andrew Doig, a professor of biochemistry at the University of Manchester. More studies might show whether there’s benefit in giving the shingles vaccine at younger ages, he said.

    The findings should prompt further research about how exactly the protection could arise and should be confirmed in a large-scale, randomized control trial, the authors wrote.

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    Kimberley Mannion and Tim Loh/Bloomberg

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  • A Twice-Yearly Shot Prevents HIV, Study Finds

    A Twice-Yearly Shot Prevents HIV, Study Finds

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    CAPE TOWN, South Africa — Twice-yearly shots used to treat AIDS were 100% effective in preventing new infections in women, according to study results published Wednesday.

    There were no infections in the young women and girls that got the shots in a study of about 5,000 in South Africa and Uganda, researchers reported. In a group given daily prevention pills, roughly 2% ended up catching HIV from infected sex partners.

    “To see this level of protection is stunning,” said Salim Abdool Karim of the injections. He is director of an AIDS research center in Durban, South Africa, who was not part of the research.

    The shots made by U.S. drugmaker Gilead and sold as Sunlenca are approved in the U.S., Canada, Europe and elsewhere, but only as a treatment for HIV. The company said it is waiting for results of testing in men before seeking permission to use it to protect against infection.

    Read More: How Depression Can Affect Dental Hygiene

    The results in women were published Wednesday in the New England Journal of Medicine and discussed at an AIDS conference in Munich. Gilead paid for the study and some of the researchers are company employees. Because of the surprisingly encouraging results, the study was stopped early and all participants were offered the shots, also known as lenacapavir.

    While there are other ways to prevent HIV infection, like condoms or daily pills, consistent use has been a problem in Africa. In the new study, only about 30% of participants given Gilead’s Truvada or Descovy prevention pills actually took them—and that figure dropped over time.

    The prospect of a twice-a-year shot is “quite revolutionary news” for our patients, said Thandeka Nkosi, who helped run the Gilead research at the Desmond Tutu Health Foundation in Masiphumelele, South Africa. “It gives participants a choice and it just eliminates the whole stigma around taking pills” to prevent HIV.

    Experts working to stop the spread of AIDS are excited about the Sunlenca shots but are concerned Gilead hasn’t yet agreed on an affordable price for those who need them the most. The company said it would pursue a “voluntary licensing program,” suggesting that only a select number of generic producers would be allowed to make them.

    “Gilead has a tool that could change the trajectory of the HIV epidemic,” said Winnie Byanyima, executive director of the Geneva-based U.N. AIDS agency.

    Read More: Why It Took So Long to Finally Get an RSV Vaccine

    She said her organization urged Gilead to share Sunlenca’s patent with a U.N.-backed program that negotiates broad contracts allowing generic drugmakers to make cheap versions of drugs for poorer countries worldwide. As an HIV treatment, the drug costs more than $40,000 a year in the U.S., although what individuals pay varies.

    Dr. Helen Bygrave of Doctors Without Borders said in a statement that the injections could “reverse the epidemic if it is made available in the countries with the highest rate of new infections.” She urged Gilead to publish a price for Sunlenca that would be affordable for all countries.

    In a statement last month, Gilead said it was too early to say how much Sunlenca would cost for prevention in poorer countries. Dr. Jared Baeten, Gilead’s senior vice president of clinical development, said the company was already talking to generics manufacturers and understood how “deeply important it is that we move at speed.”

    Another HIV prevention shot, Apretude, which is given every two months, is approved in some countries, including in Africa. It sells for about $180 per patient per year, which is still too pricey for most developing countries.

    Byanyima said the people who need long-lasting protection the most include women and girls who are victims of domestic violence and gay men in countries where same-sex relationships are criminalized. According to UNAIDS, 46% of new HIV infections globally in 2022 were in women and girls, who were three times more likely to get HIV than males in Africa.

    Byanyima compared the news about Sunlenca to the discovery decades ago of AIDS drugs that could turn HIV infection from a death sentence into a chronic illness. Back then, South African President Nelson Mandela suspended patents to allow wider access to the drugs; the price later dropped from about $10,000 per patient per year to about $50.

    Read More: Dengue Is Rising in the U.S. Here’s How to Protect Yourself

    Olwethu Kemele, a health worker at the Desmond Tutu Health Foundation, predicted the shots could boost the number of people coming in for HIV prevention and slow the virus’ spread. She said young women often hide the pills to avoid questions from boyfriends and family members. “It makes it hard for the girls to continue,” she said.

    In a report on the state of the global epidemic released this week, UNAIDS said that fewer people were infected with HIV in 2023 than at any point since the late 1980s. Globally, HIV infects about 1.3 million people every year and kills more than 600,000, mainly in Africa. While significant progress has been made in Africa, HIV infections are rising in Eastern Europe, Latin America and the Middle East.

    In other research presented at the AIDS conference, Andrew Hill of the University of Liverpool and colleagues estimated that once production of Sunlenca is expanded to treat 10 million people, the price should fall to about $40 per treatment. He said it was critical that health authorities get access to Sunlenca as soon as possible.

    “This is about as close as you can get to an HIV vaccine,” he said.

    ___

    Cheng reported from London.

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    MARIA CHENG and GERALD IMRAY/AP

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  • Can Food Really Change Your Hormones?

    Can Food Really Change Your Hormones?

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    Dr. Taraneh Nazem, a reproductive endocrinologist and infertility specialist for RMA of New York, recently watched a TikTok video claiming that eating raw cacao daily could completely balance your hormones and cure PMS. “The creator made sweeping statements without any scientific backing, and the comment section was filled with people eager to try it—despite cacao’s known potential to cause insomnia and anxiety if consumed in large quantities,” says Nazem.

    Social-media is rife with posts like this, pushing superfoods and supplements to boost your hormonal health and improve your low energy, poor sleep, bad acne, and so many other ills in the process. “Every day, another influencer on TikTok claims that superfoods can change our hormonal balance,” says Dr. Caroline Messer, an endocrinologist with Northwell Health at Lenox Hill Hospital in New York City. The myths that especially irk Messer: apple cider vinegar helps women with PCOS, green tea is the secret to better insulin sensitivity, and butter supports healthy estrogen levels.

    Do you even need to “balance your hormones,” as many on social-media tout in their hashtags? Experts share what foods can—and can’t—do for your hormonal health.

    The connection between diet and your hormones

    The foods you eat can affect your hormone production and secretion by creating small changes throughout your gut, says Perri Halperin, a registered dietitian who is a clinical nutrition coordinator at Mount Sinai Hospital. Some foods also contain hormones or compounds that are similar to or imitate them. (For example, soy contains phytoestrogen, which mimics estrogen.)

    But a person’s big-picture way of eating—not any single food included in their diet—is what can truly affect hormonal health, experts agree. “An unhealthy diet high in processed foods and saturated fats can lead to conditions like metabolic syndrome, diabetes, and polycystic ovary syndrome [PCOS],” says Messer. That’s because a diet high in sweets, dairy, refined grains, red meat, and processed foods can raise estrogen levels and promote insulin resistance due to higher body fat, she explains. Research has linked a Western diet with high estrogen in women, low testosterone in men, insulin abnormalities, and imbalanced cortisol levels.

    Read More: You Don’t Need to Balance Your Hormones

    It’s also possible to have hormone-based medical issues that can be helped by a dietary overhaul. Kaytee Hadley, a functional dietitian in Richmond, Va., recently worked with a young woman experiencing unpleasant gut symptoms along with irregular cycles, PMS, and ovarian cysts, which would rupture regularly and cause excruciating pain. “It was clear she had hormonal imbalances,” says Hadley. After running a few tests, it was also determined that she had nutritional deficiencies and poor gut health exacerbating these issues.

    Hadley had the client focus on a “food-first approach” by adding more nourishment and gut-friendly foods, addressing her vitamin deficiencies, and developing a consistent eating schedule with foods she enjoyed. “In less than six months, she had no more symptoms of PMS or cysts, her acne cleared up, her cycles became more regular, she had more energy, and her bloating and gas were completely gone,” says Hadley.

    But this success story doesn’t apply to the average person—and no “magic” superfood touted on TikTok can have these effects. It wasn’t, say, the beans or tofu she started eating more regularly that “cured” her sex hormone imbalances, but sweeping lifestyle changes that focused on a healthy diet, exercise, stress-reduction techniques, and improving her sleep, Hadley says.

    Read More: 8 Eating Habits That Actually Improve Your Sleep

    “While a single food won’t address the underlying cause of hormonal imbalances, nutrients are important building blocks for hormones and affect their production, transportation and elimination,” says Hadley. “If you aren’t getting the necessary vitamins, minerals and macronutrients, making positive long-term changes to your diet can help to optimize thyroid, stress and sex hormones.”

    Others echo that outlook. Making lifestyle changes for the long haul can significantly improve hormonal issues. “But a teaspoon of apple cider vinegar or a cup of green tea won’t fix everything,” Messer says.

    “This kind of misinformation can lead to unmet expectations and potential health issues,” says Nazem.

    Hormonal health is often more about what you don’t eat

    Consider testosterone, a sex hormone made from cholesterol. Some studies suggest that healthy sources of cholesterol such as eggs and avocados can support testosterone production, says Dr. Alex Robles, a reproductive endocrinologist at Columbia University Fertility Center. Other nutrients important for testosterone production include zinc, magnesium, and vitamin D.

    But eating foods rich in these nutrients “likely won’t cause a massive boost to your testosterone levels,” says Robles. “Rather, the lack of these nutrients (or being deficient in them) can negatively affect your body’s ability to produce certain hormones.” (You may see on social media that zinc deficiencies are linked to low testosterone, but such deficiencies are uncommon in the U.S., where people regularly consume zinc from sources like poultry, beans, oats, eggs, and nuts.)

    Read More: What Alcohol Does to the Gut

    With testosterone and many other hormones, maintaining the right levels is more about what you don’t eat—too many processed foods, refined carbohydrates, and saturated fats, and alcohol—rather than putting a health halo on any one food.

    What foods can help your hormones?

    Most people do not need to stress about “balancing” their hormones through food or supplements. Your body does that complicated task for you, says Halperin.  “The truth is, [hormones] are incredibly complex, individualized, and they fluctuate,” she says. There’s no “magic bullet” that will create optimal hormonal health.

    Messer agrees. While it’s true that foods can impact our metabolic health, our bodies are “pretty resilient,” says Messer, and individual food choices don’t usually create drastic hormonal changes. Eating a well-rounded diet rich in whole foods will cover your bases. 

    However, certain foods can sometimes slightly influence your hormones. Here’s how.

    Thyroid hormones

    Thyroid hormones regulate energy levels, temperature, weight, and metabolism. Called triiodothyronine (T3) and thyroxine (T4), they are also involved in skin, hair, and nail growth.

    “Chances are your thyroid and its hormones are working just fine, unless you have a diagnosed thyroid condition like hypo- or hyperthyroidism, for which you should consult a doctor for medication managed treatment,” says Halperin.

    Foods that may help thyroid health

    Including foods rich in minerals such as iron, selenium, zinc, and iodine in your diet may be beneficial for thyroid health. These include shellfish such as shrimp and oysters, seaweed, Brazil nuts (which are particularly rich in selenium), and fortified foods like iodized salt, cereals, and dairy products. 

    Cortisol

    The body releases cortisol when it’s physically or emotionally stressed (earning its reputation as the “stress hormone.”) Cortisol normally peaks in the morning to help you wake up and declines throughout the day so you can fall asleep at night. When this natural rhythm is disrupted, people tend to become fatigued, gain weight, and get sick more often. 

    As with most hormones, to optimize cortisol levels, dietitians recommend eating a balanced diet and not restricting food intake, as severe calorie restriction may increase cortisol levels. (This is because not getting adequate energy from food and calories is stressful for your body.)

    Read More: Should I Take Supplements to Sleep? What Experts Think

    Another thing to note: When we’re stressed, our bodies use up certain vitamins and minerals faster. “Focusing on magnesium and B vitamins during these times is especially important for helping your body combat stress and rebalance cortisol,” says Hadley. As long as your doctor or dietitian isn’t recommending you take these supplements, the best way to get those is through a balanced diet.

    Foods that may lower cortisol levels

    Oily fish rich in omega-3 fatty acids, such as mackerel, may help lower cortisol levels. That in turn can decrease cortisol-sensitive symptoms like fatigue.  

    Some studies have also shown that other omega-3 rich foods like avocado oil and dark chocolate may support healthy cortisol levels. Decreasing added sugar—by cutting out soda, for example—is also key for healthy cortisol levels.

    Read More: For Better Well-Being, Just Breathe

    Recently, a study showed that following a Mediterranean style diet lowers cortisol levels. In general, adhering to a plant-filled, nutrient-rich diet may keep cortisol in check. An ultra-processed diet composed of refined carbohydrates and sugary beverages can lead to a constant release of insulin, which can result in insulin resistance, weight gain, and inflammation. Because of this blood-sugar roller coaster, you can end up boosting cortisol, which Dr. Simran Malhotra, an internal medicine and lifestyle medicine physician in Bethesda, Md., says may worsen the vicious cycle of eating highly palatable but nutrient-depleted foods.

    Melatonin

    Often called the “sleep hormone,” melatonin promotes a proper sleep-wake cycle. “Healthy habits, like giving yourself time to wind down and not drinking caffeine or alcohol before bed, can increase melatonin production,” says Halperin. As with other hormones, what you avoid may impact levels as much as what you consume.

    Foods that may help produce melatonin

    Some studies suggest that tart cherry juice may increase melatonin levels, beneficially impacting both sleep duration and quality. And tryptophan is an amino acid that supports the production of melatonin. Tryptophan-rich foods include turkey, tuna, and quinoa. 

    Serotonin

    Scientists have discovered a close link between the stomach and the mind known as the gut-brain axis, a two-way communication system between the central nervous system and the enteric nervous system in our gut. Research indicates that 95% of the body’s serotonin—the so-called “happy” hormone that plays a key role in mood—is produced in the gut. 

    Foods that may boost serotonin levels

    Tryptophan is a key protein building block used to make serotonin. “Meats such as turkey are rich in tryptophan, but our bodies struggle to convert it to serotonin due to competing amino acids,” says Malhotra. Scientists have found that high-carbohydrate meals help by triggering insulin, which aids your muscles absorbing the competing amino acids; this makes it easier for the tryptophan to cross into the brain and boost serotonin levels, she explains. “That’s why a high animal-protein diet can limit serotonin production, whereas tryptophan-rich whole-plant foods such as oats, walnuts, pumpkin seeds, tofu, spinach, and dark chocolate (more than 70% cacao) can boost serotonin levels and promote feelings of calm,” explains Malhotra.

    What about “fertility” diets for women?

    Sex hormones like estrogen, progesterone, and testosterone impact fertility for men and women in different amounts. On social media, the so-called “fertility diet” is presented as a way for couples (especially women) who are trying to conceive to improve their chances. Experts like Nazem believe that while some aspects of these diets are rooted in scientific evidence, others are exaggerated or lack sufficient scientific evidence. “It’s essential to approach such diets with a critical mindset and understand that individual health and fertility depend on a complex interplay of various factors,” she says.

    While there’s no one-size-fits-all approach to eating to optimize fertility, reproductive endocrinologists—doctors who specialize in hormonal health as it relates to fertility—tend to endorse eating a fiber-rich, whole foods diet. Sound familiar? That’s because it’s the same research-backed eating approach science says is best to promote overall health, such as through a Mediterranean or plant-based diet.

    Read More: The Silent Shame of Male Infertility

    One key reason these diets are so healthy is because they emphasize fiber. “Fiber from fruits, vegetables, beans, and whole grains not only helps to keep you regular, but it is also important for maintaining healthy estrogen levels,” says Hadley—a sex hormone that can negatively affect fertility if it’s too high. The nutrient acts like a broom to sweep excess estrogen out of the body through bowel movements. Large-scale, longitudinal studies have also shown that women who eat more fiber have a reduced risk of breast cancer. 

    Nazem counsels female patients to focus on foods rich in antioxidants, healthy fats and folate to support hormone balance and improve egg quality. “Avocados, nuts, seeds, leafy greens and whole grains are excellent choices,” she says. She’s also a fan of flax seeds and cruciferous vegetables such as broccoli, cabbage, and cauliflower; they all contain phytoestrogen, which can improve estrogen metabolism.

    The bottom line 

    For Hadley, the key takeaway is that making nutrition changes for the sake of your hormones should only be done based on your body’s unique needs. “While there are foundational strategies that anyone can implement, knowing what’s going on with your hormones will allow you to take a more individualized approach and address those imbalances specifically,” she says.

    The body is incredibly smart and likes to maintain equilibrium, so unless you have a diagnosed hormone condition, Halperin says there is a good chance your hormone levels are where they need to be. “Small dips or spikes in hormone levels can cause unpleasant symptoms like difficulty losing weight or sleeping, but can generally be managed through a balanced diet, regularly scheduled meals and snacks, weight maintenance, adequate sleep, and stress management,” she says. “If you’re living your best life, but still not feeling your best, your actual best bet is to get checked out by your doctor or RD, versus believing what you see and hear on social media.”

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    Perri Ormont Blumberg

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  • How to Tell If You’re Clenching Your Jaw—And How to Stop

    How to Tell If You’re Clenching Your Jaw—And How to Stop

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    When Dr. Priya Mistry asks people if they clench their jaws, they usually say no—yet she can see clear signs suggesting otherwise. So now, she words the question differently: Are they aware of their jaw-clenching tendencies? “That makes them stop and think,” says Mistry, a dentist in Vancouver, Wash., who specializes in jaw disorders.

    If her patients still say no, Mistry coaches them to pay special attention to what they do when they’re stressed. “When you’re focused at work, or when you’re stuck in traffic, really monitor where your teeth are,” she says. “Are they together? Are they apart? Because if you’re not talking to anyone—you’re just sitting in your car—your lips should be together and your teeth should be apart. They should not be touching. Our teeth aren’t meant to be in contact all day.”

    Mistry estimates that “the majority” of her patients engage in some type of bruxism, which is the umbrella term for jaw clenching and teeth grinding. While the behaviors often overlap, grinding refers to shifting your jaw side to side or forward and backward, as though you’re mashing something down. Clenching is squeezing your top and bottom jaw together and tightening the jaw muscles. You might do it while you’re awake or asleep—which means that it’s possible you’re completely unaware of the habit.

    We asked dental experts what causes jaw clenching, how it affects oral health, and what to do to break the habit.

    What causes jaw clenching?

    Emotions like stress, anger, and anxiety play a significant role in jaw clenching. Think about it: When you’re really stressed or tense, you likely squeeze your fists together or notice your entire body has tightened, says Dr. Karin Grinbaum, an orthodontist with smiles + grins in New York City. Your jaw muscles coil up in the same way. After the COVID-19 pandemic, Grinbaum noticed a sharp increase in clenching-related damage, which she attributed to those years’ high stress levels. “Patients we didn’t see for two years came back, and they had extreme wear and tear on their teeth,” she says. “It was a big difference.”

    Read More: Why You’re Grinding Your Teeth—And How to Stop

    There are other culprits, too. Alcohol abuse, caffeine, and nicotine can all increase jaw muscle activity, says Dr. Steven Katz, an endodontist in Beachwood, Ohio, and specialist member of the American Association of Endodontists. (If you’ve ever needed a root canal, it was probably performed by an endodontist.) That’s because they’re all stimulants that can trigger muscle activity, including jaw clenching. “If you tend to drink coffee, you know that a lot of people get real energy from it,” he says. “They’ll start clenching their jaw and put stress on the muscles.” Certain medications, like selective serotonin reuptake inhibitors, can also cause clenching, he adds.

    So can sleep disorders. Research suggests that people with sleep apnea, for example, clench their jaws more overnight than those without the disorder. That relationship suggests that treating sleep apnea could improve clenching tendencies, the study authors concluded. “When a diagnosis is made, a lot of times dentists are interacting with physicians, and they take a two-pronged approach,” Katz says. “They’ll address both the sleep disorder and the jaw disorder at the same time,” which will ideally lead to sounder, clench-free snoozing.

    The health consequences of jaw clenching

    People who clench overnight often wake up with intense pain around their face, by their ears, or on the back of their neck. They might complain about frequent headaches. “When you clench, you’re stretching all the muscles—even your neck muscles,” Grinbaum says. “People go to a chiropractor, and they don’t know what’s going on. Then we find out it’s because they’re clenching.”

    How does that lightbulb moment happen? Sometimes, people’s partners tell them they can feel—or even hear—them squeezing their jaw muscles, Grinbaum says. Or, you might find out at a dental check-up that you have flattened and worn tooth surfaces, or even microfractures in your teeth caused by repeatedly exerting pressure on the enamel. “Eventually, the teeth that are biting together most forcefully will weaken—and suddenly you bite into something and your tooth cracks, and you’re like, ‘What the heck?’” Mistry says. You might need a new filling or crown to protect it. As Mistry says, “Cracks in teeth are just like cracks in windshields—they spread over time.”

    Read More: How Depression Can Affect Dental Hygiene

    Chronic clenching can also lead to receding gums—which increases tooth sensitivity—as well as cracked roots that require extraction, and, in some cases, limited ability to open the jaw. That’s why it’s so important to get an early diagnosis. “If you’re a clencher, you should protect your teeth at any early stage,” Grinbaum says. “Don’t wait until you start breaking your teeth. People say, ‘Oh, I’m fine, I don’t wake up with pain.’ Then years go by and they see their dentist, and they’ve already broken down so much of their teeth.” Addressing the problem early, she stresses, helps minimize risks and improve long-term outcomes.

    How to stop clenching your jaw

    Jaw clenching is a difficult habit to break, experts acknowledge, especially because you might not even realize you’re doing it. But it’s possible to overcome. Start with these tips:

    Practice mindfulness

    The more relaxed you are, the less likely you’ll be to clench your jaw. If you’re focused on what’s in front of you, your body will release tension—so make it a point to engage in calming activities. “It could be meditation, it could be yoga, it could be just not watching TV before you go to bed,” Grinbaum says. Deep breathing is another science-backed way to reduce stress and, by extension, cut back on clenching. Any time you notice yourself clenching, summon your favorite mindfulness technique.

    Read More: How to Be Mindful if You Hate Meditating

    Ensure your bite is even

    A misaligned bite can increase the likelihood that you clench your jaw. “People tend to clench because their bite doesn’t feel even, and they don’t know what to do,” Grinbaum says. “So they squeeze down or grind.” Ask your dentist if that’s at the root of your problems; if so, you’ll likely be referred to an orthodontist for treatment like Invisalign or braces. “It’s not a guarantee that you’ll stop clenching or grinding, but it can ease the symptoms,” she says.

    Get fitted for a night guard

    Night guards are one of the best solutions for clenching, Katz says. Rather than buying one off the shelf at the store, get fitted for a customized guard; your dentist will make an impression of your teeth and design the mouthguard so it’s specific to the way you bite. “It helps keep your teeth apart,” he says. “You’ve got this appliance in between,” acting as a cushion. While you might not completely stop clenching, you’ll likely find that it reduces the urge. Plus, over time, you’ll wear away the night guard’s hard plastic instead of your teeth.

    Train yourself with the timer method

    This is one of Mistry’s favorite ways to combat daytime clenching. For one week, set a timer on your phone that goes off every 20 minutes, she suggests. When you hear it dinging, check and see if you’re clenching your teeth. If you are, “You can either put your hand over your heart, take a deep breath, and tell yourself to stop, or you can snap your wrist with a rubber band,” she says. The latter is “the mean way to do it—negative reinforcement.” During the second week, adjust the timer so it goes off every 30 minutes, and when you enter the third week, change it to every 40 minutes, and so on. “By the time you get to every hour, you’ve pretty much trained yourself to stop clenching,” she says.

    Consider muscle relaxers or botox

    If your clenching is particularly severe, you might be prescribed a muscle relaxant that reduces muscle spasms in your face and jaw. “Just as you would expect, it relaxes the muscles of the jaw,” Katz says. And research suggests that when Botox is injected into the muscles that move the jaw, people clench less frequently and experience less pain than they did beforehand. Both are potential options to ask your doctor about.

    Experiment with jaw-clenching exercises

    Dr. Ryan Doyle, a dentist in Boise, Idaho, recommends several jaw exercises to help relieve his patients’ tension and clenching. First, he says, gently slide your lower jaw forward and hold for 10 seconds, then release. Repeat 10 times; doing so helps loosen the jaw muscles. Another option: Put your tongue on the roof of your mouth for 10 to 15 seconds to relax your jaw, and then release. Do 10 reps, Doyle advises.

    The key to jaw-clenching exercises, he adds, is doing them regularly, at least two to three times every day. “Be gentle and go slowly,” he says. It can take weeks of consistency to retrain your jaw muscles, but many of Doyle’s patients report significant improvements in just a month. “The good news is these techniques are simple, free, and can have lasting benefits,” he says.

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    Angela Haupt

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  • 11 Things to Say When Someone Dies Besides ‘I’m Sorry’

    11 Things to Say When Someone Dies Besides ‘I’m Sorry’

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    It’s hard to summon any words when someone dies—let alone the right ones. That’s why so many of us let the sympathy cards do the talking. “As a society, we’re uncomfortable with death and grief. We’re not very open to talking about it,” says Katie Cosgrove, a death doula and grief coach in Buffalo, N.Y. Plus, “I think a lot of people, myself included, feel like words aren’t enough to comfort somebody,” which makes it challenging to figure out how to articulate our condolences.

    Though it may be the first thing that springs to mind, “I’m sorry” isn’t always the best way to go. It implies responsibility in some way—and simply isn’t as comforting or empathetic as other ways of showing support. Cosgrove also advises steering clear of the age-old cliché that “time heals all wounds.” “That’s what everybody said to me when my dad passed, and it’s just not true,” she says. “Grief doesn’t ever go away. It shifts and changes, but it doesn’t leave us.”

    We asked Cosgrove and other experts who specialize in grief to share what they’ve found works best when talking to someone who lost a loved one.

    “I can’t imagine how hard this is for you, and I’m sending you all my strength and love.”

    One of the worst things to tell someone who’s grieving is that you know exactly what they’re going through. Even if you’ve also lost a loved one—maybe you’re a widow consoling someone who has newly obtained that title—every loss is unique. Instead, Cosgrove suggests flipping the sentiment over and making it clear that you can’t imagine what it’s like to be in their shoes. “You’re validating their feelings,” she says. “Even if you knew that person really well, you didn’t know them the way your friend or family member knew them,” and it’s impossible to grasp how the loss is really landing for them.

    “Please accept my condolences.”

    It sounds simple, right? Maybe even generic. Yet the sentiment works well when you’re talking to someone you don’t know well, or when you’re too surprised by the bad news to string any other words together, says Elizabeth Schandelmeier, a grief therapist in Pittsburgh. “It’s preferable to saying ‘I’m sorry,’ because it doesn’t put the bereaved person in the position of having to console you by saying it’s OK,” she points out. “Or, if they’re angry in the moment, [it keeps them] from snapping back that you don’t need to be sorry because it wasn’t your fault.”

    “Your husband was a wonderful person. I have this cherished memory of him when [explain a thoughtful memory].”

    When people tell Cosgrove they’re going to a wake or a funeral and don’t know what to say, she encourages them to share a story. “I can tell you from personal experience that stories about people I’ve lost and never heard before are like little nuggets of gold,” she says. “It’s a beautiful way to cherish their memory and show that you really loved them.” If you don’t have a story of your own, you could invite your friend to share one of their favorite memories if they feel up to it. There’s sometimes a misconception that talking about the deceased will be too painful—when, in fact, the opposite is often true.

    Read More: 10 Ways to Respond to Someone’s Bad News

    “Is it OK if I stop by in a few days with lunch? I know the kids are involved in a lot of activities. Do you need any help getting them to games?”

    Acts of service can be invaluable, especially in the early days of grief, when someone’s energy is zapped. “They’re having to tend to so many things—taking something off their plate not only says, ‘I’m here for you and I’m supporting you,’ but it truly helps reduce the burden on them,” says Whitney Menarcheck, a licensed professional counselor in Pittsburgh who specializes in grief. “That may give them time to focus on the flower arrangements or take a nap.” The more specific your offer, the better; having to think about what kind of help to ask for might dissuade someone from asking at all.

    Read More: 7 Things to Say When Someone Gaslights You

    “I’m holding space for you in my heart.”

    People aren’t always in the habit of telling others that they’re “holding space” for them, Cosgrove acknowledges. Yet she finds it’s a powerful way to convey that, while you can’t make their pain better, you will be present with them as they navigate through it. That’s why this is one of her go-to expressions when talking to the bereaved. “It’s a simple way to let the person know you’re thinking of them, their experience is both unique and universal, and that dealing with loss is incredibly hard,” she says.

    “I’ll always remember their smile [or laugh].”

    This is a powerful way to memorialize someone’s physical presence—and reinforce to their loved ones that they won’t be forgotten. You might describe the mischievous twinkle in their eyes when they told a joke, or the pink streaks they dyed in their hair. “Grief can be very surreal,” Cosgrove says. “We’re scared of losing that person, or forgetting them, so knowing what somebody else out in the world is going to remember is really helpful.”

    “I know a lot of people don’t know what to do when someone dies by suicide, and that can leave the person who’s grieving feeling alone. I’m here for you.”

    Menarcheck uses the term “disenfranchised grief” to describe loss that tends to be minimized or misunderstood—like when someone dies by suicide or because of an overdose, or when the bereaved had a complicated relationship with the deceased. She recalls that once, when she checked in with a friend whose ex-husband had died, the woman replied: “Why does everyone think that just because we weren’t married anymore, I don’t care that he’s dead?” That speaks to the importance of always reaching out and letting your friends know you’re thinking of them, no matter the circumstances of the loss.

    “Do you want my help, or do you want me to just listen?”

    Sometimes without even realizing it, we slip into advice mode—trying to help fix the unfixable. That’s not always what someone needs. The most valuable thing you can do might be lending an ear. If your friend asks whether they’ve already told you a story about the person they’re grieving, “You can say yes, but that you’d love to hear it again,” Schandelmeier says.

    “Is it OK if I give you a hug right now?”

    Always respect personal space: Not everyone wants to be pulled into an embrace or have their hand patted, even or especially when they’re grieving. If it’s typical for you to hug when you see each other, you’re probably fine—but if you want to throw your arms around a second cousin you last saw two decades ago, it’s best to ask first. “What gives you comfort doesn’t always give others comfort,” Menarcheck points out. “If they say no, just be like, ‘Well, I’m thinking of you,’ and don’t take it personally.”

    Read More: Taylor Swift Is Embracing the 5 Stages of Grief. Should You?

    “Hey, I know Sunday mornings were a special routine for you and your dad. Just thinking about you.”

    Maybe your friend and her dad went for a walk together every Sunday morning. On the first—or second or third or 13th—Sunday after his death, check in to remind her you’re there for her. The same advice applies to birthdays, anniversaries, and other special occasions. The key is not making any assumptions about how your friend might be feeling, Menarcheck advises. (“You must be so devastated today!”) “It gives the person an opportunity to respond and say, ‘Wow, thanks. I’ve been struggling,’” she notes. “Or they may say, ‘I was just thinking about this really funny thing that happened between me and my dad.” Allow your friend’s response to direct where the conversation goes from there.

    “I was watching the Cubs play, and I remember your son really loved them. It made me smile thinking about it.”

    No matter how much time has passed since someone died, bring them up when you feel moved to do so. You were shopping and saw a Hawaiian shirt they would have loved? Heard their favorite song on the radio? Say it. “People who die become elephants in the room,” Menarcheck says. “But all we want to do sometimes is talk about them. We want to laugh about them, we want to talk about what drove us nuts about them, and we want them to continue existing through our memories and stories.”

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    Angela Haupt

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  • What Olympic Athletes Eat to Have All That Energy

    What Olympic Athletes Eat to Have All That Energy

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    The athletes selected to compete at the most elite level must be extremely regimented to get there. That includes paying close attention to nutrition. We asked eight Olympic athletes—including track-and-field, cycling, and volleyball stars—what they eat to fuel their bodies.

    Helen Maroulis

    Helen Maroulis, left, wrestles Jacarra Winchester in the Women’s Freestyle 57kg Championship Finals of the Olympic Wrestling Team Trials on Park, Pa. on April, 20, 2024.Gregory Fisher—Icon Sportswire/Getty Images

    Helen Maroulis is the first U.S. female wrestler to qualify for three Summer Games—and, at 32, the oldest female wrestler to ever compete in an Olympics. Nutrition plays an important role in her success, she says, especially given that she has to make a certain weight (125 pounds) to compete in her class. She’s also had serious brain injuries following concussions she suffered on the mat, and has learned how important the right food choices are for brain health. “My three rules are I have to eat well, I have to sleep well, and training has to be good,” she says. “I don’t compromise on those.”

    When Maroulis is in training, she aims to eat about 1,500 calories a day. She could easily eat salads and chocolate for every meal, so she has to be intentional about getting enough protein. For breakfast, she might have a four-egg omelet and some broccolini with ghee, garlic, salt, and pepper. She generally has two snacks a day: sliced apples and almond butter, or a keto sugar-free organic zucchini bread she makes with almond flour. (“It’s on the expensive side,” she says, “but it definitely brings the carbs down.”) If she hasn’t meal-prepped lunch and dinner, she’ll cook a steak and sweet potatoes, or have healthy spring rolls with shrimp. On super busy days, “I’ll just grab a handful of spinach and eat it plain with some eggs and chicken,” she says.

    Hydration matters, too: Maroulis usually has a protein shake after a training session, and lately, she’s been craving what her coach calls “healthy Sprite.” She makes it with a SodaStream: “It’s just lemon and some organic fruit sweetener, and it tastes like Sprite,” she says.

    Mitchell Saron

    HUNGARY-BUDAPEST-FENCING-MEN'S SABRE WORLD CUP-TEAM FINAL
    Mitchell Saron, left, and Park Sangwon compete during the team final at the Men’s Sabre World Cup in Budapest, Hungary, on March 24, 2024.Attila Volgyi—Xinhua/Getty Images

    Fencer Mitchell Saron, 23, got “super into nutrition” last summer as a way to optimize his athletic performance. He and a handful of friends discovered an “animal-based” style of eating—similar to the keto diet—had blown up on TikTok, so they decided to start following it. They now send each other photos of their daily meals via a group chat that’s grown to include about 15 people.

    Saron—who will compete in men’s saber in his first-ever Olympics—focuses on eating grass-fed meat (like beef, lamb, and venison), wild-caught fish, fermented veggies, organic fruit, raw honey and maple syrup, and pasture-raised eggs. He cooks his meals in raw and unsalted grass-fed butter, beef tallow, ghee, or virgin coconut oil. He doesn’t drink alcohol, instead adding salt-based, sugar-free electrolytes to his water. “The biggest change I’ve had is that I think about what my food is eating,” he says. “I don’t want to be eating food that’s at a farm, or in a warehouse, getting fed awful things.” He credits the shift with boosting his energy levels and clearing brain fog. “I just feel great all the time, and I can train longer and harder,” he says.

    Your Guide to the Paris Olympics

    Saron doesn’t count calories, but he does keep an eye on protein, aiming for 160 to 180 grams a day. One of his favorite meals is grass-fed rib eye. “I get out a nice wooden cutting board—I like to cut it very pretty,” he says. He’ll dice up mango or kiwi, and have sauerkraut or another fermented veggie, like kimchi, on the side. For dessert, he enjoys grass-fed Greek yogurt, sometimes mixed with grass-fed collagen protein powder. Or he might pair 100% cacao powder with frozen blueberries and raspberries—a tasty dish topped with raw honey and coconut flakes.

    Taryn Kloth and Kristen Nuss

    Beach Volleyball World Cup - Women's Match Between USA and Canada
    Kristen Nuss and Taryn Kloth compete during the Beach Volleyball World Cup Women’s match on Oct. 11, 2023.Essene Hernandez— Eyepix Group/Future Publishing/Getty Images

    Taryn Kloth and Kristen Nuss have been playing beach volleyball together since they were in college—and now, they’re headed to their first Summer Games. Though the Baton Rouge roommates have always taken nutrition seriously, they didn’t go all in until the pandemic hit in 2020, and they suddenly had time to dedicate to tracking their intake and figuring out what their bodies needed. The answer? Lots of protein, carbs, and proper hydration.

    Kloth, 27, enjoys starting the day with an English muffin topped with eggs, avocado, and turkey or ham. Breakfast is her favorite meal of the day, so for lunch, she might make an open-face quesadilla with eggs, plus an apple she dips in lactose-free Greek yogurt. (She finds she feels best when she omits lactose.) She has a protein bar before practice if she feels like she needs more fuel, and when she gets home, she chops up Russet potatoes. “I cut them in slices, and then I put them in the oven, and they come out like potato chips,” she says. She’ll probably have another veggie, like roasted cauliflower, on the side, plus some protein. For dessert, she enlists her Ninja CREAMi. “It turns everything into a Dairy Queen frosty,” she says. “I put a protein shake in there”—she likes Core Power’s lactose-free chocolate—“and it turns into ice cream.”

    Read More: 8 Eating Habits That Actually Improve Your Sleep

    Meanwhile, Nuss, 26, usually has a piece of toast, scrambled eggs, and salsa for breakfast. She also enjoys mixing an avocado with Good Culture 2% Cottage Cheese. For lunch, she’ll dig into a quesadilla with scrambled eggs, avocado, and fat-free cheddar cheese with turkey or ham, plus Greek yogurt mixed with PB2 powdered peanut butter. She enjoys meal-prepping dinners—she gets a lot of ideas from Stealth Health on Instagram—and often has queso chicken mac ‘n cheese made with cottage cheese. For dessert, she can’t resist a Gatsby Sea Salt Extra Dark Bar. “I’ll eat three little squares as a sweet treat, and it’s absolutely delicious,” she says.

    Meghan Musnicki

    World Rowing Cup II 2023
    Meghan Musnicki, right, competes with Alison Rusher, left, in the Women’s Pair during the second rowing World Cup regatta on Lake Varese in Varese, Italy on June 16, 2023.Mattia Ozbot—Getty Images

    On any given day, rower Meghan Musnicki spends four to six hours on the water or lifting weights in the gym. “Nutrition, and energy in general, is hugely important for our performance,” the four-time Olympian says. “Our bodies are our main tool, so it’s very important for us to make sure we’re giving it what it needs. You wouldn’t put diesel in your gasoline engine and expect it to work.”

    Musnicki, 41, doesn’t count calories, but she’s had tests done to measure her resting metabolic rate—which is how many calories she’d need to maintain her weight if she didn’t expend any energy. That number is around 2,000. Once she factors in how much she burns while working out, a dietitian calculated that she has to consume between 3,500 and 4,500 calories per day to maintain her weight.

    Read More: How Much Water Should You Drink When It’s Hot Outside?

    Most of the time, Musnicki prioritizes nutrient-dense, low-processed foods, like lean protein, fruits, vegetables, and carbs. Though carbs sometimes get a bad rap, they’re a “huge energy source” for endurance athletes, she points out. She also loves chocolate, and when she’s in an intense training cycle, she’ll sometimes reach for a high-calorie treat. “If I need to get in an extra 400 calories, ice cream is not out of the question.”

    On training days, Musnicki leaves home at 6:15 a.m. and needs to make sure she has enough fuel to last for two hours. A typical breakfast is oatmeal with fruit, Greek yogurt, pistachios, and honey. “That covers all my bases in terms of carbs, proteins, fats—staying power,” she says. During practice, she’ll have an applesauce packet or a fruit snack for a hit of energy. Once she gets off the water, she has “second breakfast,” which is her favorite meal of the day. She usually opts for an egg sandwich, and perhaps some more yogurt. At lunch, she’ll have grilled chicken breast, vegetables, and rice, and once she heads to her afternoon training session, she’ll down another healthy snack on the water. For dinner, Musnicki enjoys entrees like chicken sausage and chicken breast—or a veggie pizza with red sauce made on her “bougie” wood-fired pizza oven.

    Masai Russell

    2024 U.S. Olympic Team Trials - Track & Field - Day 8
    Masai Russell looks on after competing in the first round of the women’s 100 meter hurdles on Day Eight of the 2024 U.S. Olympic Team Track and Field Trials in Eugene, Ore. on June 28, 2024.Patrick Smith—Getty Images

    First-time Olympian Masai Russell—who will compete in the 100M hurdles on the U.S.’s track and field team—describes eating well as the most important part of her training regimen. “You can put all the work in, you can get all the rest, but if your body doesn’t have the proper nutrition, it’s not going to be able to operate at its most optimal form,” she says. “I won’t be fueled to do what I need to do at the track if I’m not eating a lot.”

    Russell, 24, who talks to a nutritionist every month, starts the day at 8 a.m. with carbs and protein, like two to three eggs, two pieces of bacon, a hash brown, and a green smoothie. That provides the energy dose she needs to feel prepared for the day—and for four hours at the track. Practice usually starts at 1 or 2 pm, and beforehand, Russell has a light lunch, like an acai bowl with fruit, granola, and honey. After practice, she chugs an Evolve plant-based protein shake to make sure she’s maintaining muscle. “I’ve learned that drinking protein shakes post-practice actually helps me to not feel as sore the next day,” she says. Dinner might be a Chipotle bowl or burrito with brown rice, black beans, chicken, corn, light sour cream, light tomato, and a little cheese. If she gets hungry again after that, she’ll have some fruit: “Something sweet, but not candy—something that’s more natural and fresh.”

    Russell makes sure to stay hydrated throughout the day, but plain water doesn’t always cut it. Especially when it’s hot outside, she says, it’s essential to get enough electrolytes. “When I’m training, I like to go for a Gatorade for carbs and sugar,” she says. “I also do a sports packet of Pedialyte to keep my muscles hydrated and elastic.” That keeps her feeling healthy and ready to compete.

    Josh Kerr

    Microplus UK Athletics Championships
    Josh Kerr take an early lead in the 800m during the Microplus UK Athletics Championships in Manchester, England, on June 30, 2024.MI News/NurPhoto/Getty Images

    Taking control of his nutrition has helped Josh Kerr unlock “amazing results,” says the middle-distance runner, 26, who competes for Great Britain. He works closely with a nutritionist and chef who design a daily menu for him that prioritizes macronutrients. “It’s probably one of the biggest, last steps I’ve taken into being the athlete I am today,” he says.

    Kerr aims for 110 to 140 daily grams of protein, 85 to 100 grams of fat, 350 to 400 grams of carbs pre-workout, and 200 to 300 grams of carbs when he’s recovering from a training session. He starts workout days with gluten-free pancakes, blueberries, raspberries, and plain Greek yogurt, paired with coffee and electrolyte tablets dunked in water. (Kerr is an ambassador for NOW Foods, which makes the tabs.) He undergoes regular sweat testing, which helps his team understand how much salt is in his sweat, and how many electrolytes he needs that day. Having some first thing in the morning is a great way to “kickstart the day,” he’s found.

    Read More: 7 Things to Say When Someone Gaslights You

    At the start of warm-ups, Kerr might have three CLIF BLOKS Energy Chews—low-calorie cubes that provide a swift dose of energizing carbs. Post-training, when he needs to feed his muscles, he’ll have 25 grams of unflavored whey protein isolate powder mixed into water with 70 grams of electrolyte powder, and then for lunch, a chicken breast sandwich on sourdough bread, topped with half an avocado and two tablespoons of Primal Kitchen mayo. Later, he’ll snack on a beef stick and string cheese, and for dinner, he might dig into barbacoa tacos. 

    Chloé Dygert

    13rd Gent-Wevelgem in Flanders Fields 2024 - Women's Elite
    Chloé Dygert competes during the 13rd Gent-Wevelgem in Flanders Fields 2024, Women’s Elite a 171.2km one day race from Ieper to Wevelgem, Belgium on March 24, 2024.Luc Claessen—Getty Images

    Cyclist Chloé Dygert might not know how many calories she eats every day—but she can tell you exactly what’s on Crumbl Cookies’ weekly menu. “Every Sunday, they put out their flavors for the week,” she says of the gourmet cookie chain. “I always go for the chocolate chip, but they’ve also had Everything Bagel. That was probably my favorite.”

    Dygert, who’s doubling up during the Summer Games—she’ll compete in both track cycling and road cycling—jokes that her diet isn’t a great representation of what it takes to excel in the sport. Her friends often tease her: “How can you win, and you don’t eat right?” What she’s doing works for her, she tells them.

    The 27-year-old cyclist usually has muesli for breakfast; she fills her bowl with almond milk and lets it soak, and then adds a honeycrisp or pink lady apple, plus a couple scoops of plain Chobani Greek yogurt. If she’s training, she’ll take along a few snacks, like a fig bar, energy gel (carbs in liquid form), or a cookie. Carbs are essential, she notes—she aims for 90 grams per hour of workout. For lunch, she might have a Mexican bowl; for dinner, she’ll wolf down a whole pizza (maybe DiGiorno’s stuffed-crust pie, smothered with cheese and sausage) or a burrito. As an evening snack, she’ll have another plain yogurt, this time paired with granola. The night before a tough workout, she often downs four cookies or 10 Starbucks cake pops. “The next day, I’m on fire,” she says with a laugh.

    Read More: What’s the Best Pillow Setup for Sleep?

    On race days, Dygert’s meals are scheduled by her team. “They say, ‘OK, the race starts at 1—you guys wake up, have a big breakfast, and then three hours before the race, you’re going to have another little breakfast, so you’re not hungry,’” she says. “Two or three hours beforehand is probably a good benchmark to give yourself enough time to let everything settle.” Afterwards, she guzzles a sugary drink, like a Fanta soda. She also makes it a point to have protein and carbs within 30 minutes to an hour to help her body recover and get a head start on fuel for the next day.

    As Dygert heads to the Olympic Village, she’s looking forward to all the different types of food available to athletes: “They have all different cuisines, and a salad bar and fruit bar,” she says. But, as you may have guessed based on her favorite snacks, “What I feel the best on is definitely Mexican and Italian—pizza and rice bowls.” It very well might power her trip back to the podium at this year’s Games.

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    Angela Haupt

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  • COVID-19 Can Leave a Lasting Mark on the Brain—Especially for Older People

    COVID-19 Can Leave a Lasting Mark on the Brain—Especially for Older People

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    COVID-19 no longer poses the urgent public-health threat it once did. But recent research points to a good reason to keep the virus in mind: it could leave a lasting stamp on yours.

    Studies suggest that COVID-19 is associated with possibly long-lasting changes to the brain, potentially contributing to cognitive problems like brain fog, mental fatigue, and memory loss, as well as neurological and mental-health issues. The virus seems able to damage blood vessels and support cells in the brain and may kickstart changes to the immune system that also affect brain function, says Dr. Wes Ely, co-director of the Center for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Center.

    What does that mean for the average person as the virus once again circulates widely?

    Many people of all ages recover just fine, mentally and physically, after a COVID-19 case. But lingering cognitive effects are a real risk, particularly for older people, Ely says. Older adults are more likely to experience severe COVID-19, which has long been linked to a higher risk of long-term complications. And they may have had preexisting cognitive issues that become worse after infection.

    “They don’t have as far to fall before they experience a clinical awareness that they’re having problems,” Ely says. Research has shown that a COVID-19 case can accelerate mental decline in older adults with dementia.

    Read More: The Isolation of Having Long COVID as Society Moves On

    The virus may also raise the chances of developing dementia for the first time, suggests a research review of 11 previous studies that was posted online in February before being peer-reviewed. Adults older than 60 who survived COVID-19 had a significantly higher risk of developing dementia a year later, compared to similar-aged people who hadn’t had a respiratory infection. Cognitive impairment was almost twice as likely among people who’d had COVID-19 compared to an uninfected control group.

    Dan Shan, co-author of the study and a former junior researcher at Columbia University, wrote in an email that more research is required to confirm whether the virus is directly causing dementia, but his team is “pretty confident” there’s a connection.

    This link may not be unique to the virus that causes COVID-19. “Numerous studies have shown that respiratory infections like the flu can lead to greater risks of cognitive deficits or dementia,” Shan wrote. “However, these findings haven’t captured public attention as much as COVID-19.”

    Read More: You’ve Heard of Long COVID. Long Flu Is a Health Risk, Too

    Age may be an important risk factor for cognitive issues, but younger people shouldn’t feel immune from COVID-19’s effects, either. Ely says there are “people in their 30s and 40s [who] have neurocognitive deficits that look like mild dementia.”

    A large study published in the New England Journal of Medicine in February backs up that warning. It suggests that COVID-19 can hinder cognitive performance among adults of all ages, even those who ostensibly recover fully.

    In that study, more than 100,000 adults in the U.K. took tests meant to measure cognitive skills. When the researchers compared people who’d had COVID-19 with demographically similar people who’d never had a confirmed case, they found that the COVID-19 survivors, on average, performed worse “across the board, but particularly on measures of memory function, executive function—for example your ability to decision-make and plan—and reasoning,” says study co-author Adam Hampshire, a professor of cognitive and computational neuroscience at King’s College London.

    Read More: Scientists Are Just Beginning to Understand COVID-19’s Effect On the Brain

    The study didn’t measure differences in individual participants’ performance pre- and post-COVID, and the results don’t necessarily mean that every single person who catches COVID-19 will experience cognitive decline, Hampshire says. But, when looking at the study group as a whole, there were clear differences between those who’d had COVID-19 and those who hadn’t. The results equated to about a three-IQ-point deficit among people who recovered completely from COVID-19 versus those who’d never had it. Among people with unresolved Long COVID symptoms and those who’d been admitted to the ICU, the deficits jumped to six and nine IQ points, respectively.

    But there are some reasons for optimism. In the study, cognitive differences were not as pronounced among people who’d gotten vaccinated multiple times, nor those who got COVID-19 later in the pandemic—which suggests risks may be lower now than they were in 2020.

    Read More: What’s the Risk of Getting Long COVID in 2024?

    The researchers also didn’t find a dramatic difference between people who’d been infected once versus multiple times. (Other studies, however, have found that repeat infections carry compounding risks of brain complications, as well as other serious health problems.) And people who had Long COVID symptoms but eventually got better “performed at the same [cognitive] level as people who had shorter-duration symptoms,” which suggests some effects of Long COVID may be reversible, Hampshire says.

    The data on COVID-19 and cognition are worrying, but more research is required to fully assess the virus’ long-term effects. “These relationships need to be observed over a longer period, potentially 5-10 years, to fully understand the impact of COVID-19 on the development of new-onset dementia, a condition that progresses slowly,” Shan wrote.

    Research on if and how COVID-related brain damage can be reversed is ongoing and provides reason for hope, Ely says. But for now, the cognitive risks of COVID-19 are yet another reason to stay up-to-date on vaccines and avoid infection if at all possible.

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    Jamie Ducharme

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  • 8 Eating Habits That Actually Improve Your Sleep

    8 Eating Habits That Actually Improve Your Sleep

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    About 1 in 3 Americans say they’re sleep deprived, and these deficits are linked to serious illnesses like heart disease, stroke, diabetes, cancer, and depression. Certain patterns of eating could lead to more nightly rest, translating into healthier, more satisfying lives.

    Good sleep also stabilizes the body’s hunger hormones for less impulsive snacking the next day. “It’s a cycle,” says Marie-Pierre St-Onge, an associate professor of nutrition and director of Columbia University’s Irving Medical Center of Excellence for Sleep and Circadian Research. “If you eat better, you’ll sleep better and be more refreshed. And that helps you make better decisions for your diet.”

    Here’s what to eat for better sleep.

    Have tryptophan the right way

    Key to improving nighttime rest is picking an eating regimen with plenty of compounds that promote sleep. This doesn’t come down to any one food or ingredient. “It’s more of a holistic profile with various helpful components,” St-Onge says.

    One of those is tryptophan, a building block of protein. The body doesn’t make any of it. Rather, we get tryptophan from food: yes, turkey, but also fish, eggs, yogurt, and nuts like walnuts, among other examples. Once eaten, tryptophan passes from the blood into the brain and becomes melatonin, the hormone that triggers sleepiness for nighttime shuteye.

    There’s a hiccup, though: not much tryptophan enters the brain if other substances are competing to get in. But when we pair foods that have tryptophan with healthy carbohydrates, such as lentils or fruits, the cells throughout our bodies gobble up the competitors, clearing tryptophan’s path.

    “We need tryptophan in combination with carbohydrate-rich foods,” says Arman Arab, a postdoctoral fellow at Harvard Medical School who specializes in nutrition.

    The Mediterranean diet is one regimen loaded with both tryptophan and healthy carbs—those with plenty of fiber. Like carbs, nutrients such as zinc, B vitamins, and magnesium play key roles in converting tryptophan into melatonin for better sleep, and the Mediterranean diet delivers each of these components. Spinach, barley, and whole wheat are great mates for tryptophan-rich foods. Arab recently found that people who follow the Mediterranean diet have better sleep quality and less insomnia. St-Onge has researched similar associations.

    Avoid foods that cause inflammation

    An ideal diet leaves out foods with substances that could spoil your slumber. They include less healthy carbs like low-fiber, high-sugar cereals, bagels, and fruit juices. People who eat unhealthy carbs tend to wake up more frequently overnight, according to St-Onge’s research. 

    When frequently consumed, foods high in saturated fats (for instance, beef and chicken with the skin) also contribute to sleep problems

    A common denominator between unhealthy carbs and saturated fats is that they both produce inflammation across the body, an issue linked to lower sleep quality and duration, Arab says. A diet packed with these foods may also lead to excess weight gain, which can cause sleep apnea and pressure on the diaphragm, further disrupting sleep.

    Read More: Should I Take Supplements to Sleep? What Experts Think

    People can use the Dietary Inflammatory Index to score their daily consumption of inflammatory foods. Scores improve with plenty of healthy, unsaturated fats, like the ones in salmon, nuts, and seeds. These foods are anti-inflammatory and prevalent in the Mediterranean diet—another reason this diet promotes sleep. 

    Having a wide variety of fruits and vegetables is optimal, says Erica Jansen, an assistant professor of nutritional epidemiology at the University of Michigan. The diversity can “spread out exposure to any one toxicant” such as pesticides or heavy metals—which may disrupt sleep—and it ensures plenty of polyphenols and micronutrients that support sleep partly by lowering inflammation. Jansen found that when women increased their daily fruit and vegetable consumption by three servings, they dramatically improved their sleep quality and insomnia symptoms.

    Try other approaches with sleep “superfoods”

    Although the Mediterranean regimen is backed by the most research, other approaches could be just as beneficial if they offer the same sleep-promoting nutrients and compounds. Aim for diets with many vegetables, lower-sugar fruits, plant-based proteins, and unsaturated fats. “Such patterns probably influence sleep in the same way” as the Mediterranean approach, St-Onge says.

    These strategies include the USDA’s Healthy Eating Index and the Dietary Approaches to Stop Hypertension diet, or DASH. Arab didn’t find a strong link between DASH and having fewer insomnia symptoms, but some other research suggests it’s helpful. The Chinese Healthy Eating Index, another eating pattern with many sleep-supportive ingredients, is also associated with good sleep.

    Some effects differ across individuals, so plug-and-play items to find what boosts your sleep, even if they’re not staples of a particular diet. A line of research points to Montmorency tart cherry juice, for example. It’s full of melatonin, as are kiwis, nutritional yeast, pumpkin seeds, edamame, tofu, and dairy products. 

    Many ingredients high in fiber can also be found beyond the Mediterranean diet. These sleep-promoting foods include black beans, split peas, sweet potatoes, chia seeds, and flaxseeds.

    Start eating early, stop eating early

    Like most things in life, timing matters. Research shows that having meals too close to bedtime can hinder sleep. It’s important to wrap up eating for the day a few hours before turning in for the night. 

    This final meal could feature a plant-based protein such as tofu—which is filling, contains tryptophan, and keeps inflammation low—and a healthy carb like chickpeas to support tryptophan’s passage into the brain. Time it 2-4 hours before bed; that’s how long it takes for tryptophan levels in the body to peak. 

    Foods that are heavy or have too much sugar or spice, when eaten before bed, are especially likely to cause bloating, blood sugar spikes, and a night of tossing and turning, Jansen says.

    Sleep is also disturbed at the other extreme: being really hungry at bedtime. To avoid this scenario, get a headstart on nutrition in the morning. “Wherever we look, individuals who have breakfast, sleep better,” St-Onge says. Keep the same timing each day as much as possible, Jansen adds. “Maintaining a consistent pattern is really important for sleep.”

    Try the liquid loophole

    There is an exception to the rule about wrapping up nutrition several hours before bed. Pouring through this loophole could be some of your favorite liquids. The research isn’t conclusive, but a variety of teas, such as chamomile and lemon balm, have relaxing compounds that seem to improve sleep, at least for some “super responders,” St-Onge says. Low-fat milk, rich in tryptophan, may help as well. “There’s no harm in trying them” about an hour before bedtime; they’re absorbed faster than food.

    Melatonin supplements are another matter. While these pills may help with occasional bouts of insomnia or jet lag, even small doses “go beyond what’s needed for sleep,” an excess that may cause health problems with regular use, Jansen explains.  

    Feed your gut bugs

    Food affects the bacteria in the digestive tract, known as the microbiome, and the right bacteria may help reduce inflammation. In theory, “If we can improve our microbiota, it could reduce inflammation in the body and lead to better sleep,” Arab says. 

    Some early research suggests that certain gut bacteria play a role in converting tryptophan into sleep hormones. A study in 2022 found that mice given prebiotics had more rapid-eye movement and other relaxing forms of sleep. According to a recent research review, consuming prebiotics and probiotics improves sleep quality in humans. 

    Instead of probiotic supplements, though, eating yogurt, kimchi, and other fermented foods will support the microbiome as part of a natural, healthy diet. More research is needed on “sleepbiotics,” whether pills or food, to know their effect on slumber, Jansen says.

    Be consistent

    People who follow these dietary patterns regularly have better sleep outcomes than those who merely dabble in them, several studies show. Whichever sleep-promoting diet you choose, stick with it. For the biggest improvements in sleep, “make sure you have a healthy diet day in, day out,” St-Onge says. “Give it a week or two” before expecting to see benefits.

    Have a vegetable before breakfast

    The relationship between food and sleep goes both ways. Just as a healthy diet with sleep-promoting compounds leads to better sleep, better sleep leads to healthier food choices. By the same token, less sleep changes hunger hormones for worse decisions. “After sleeping poorly, you should be extra vigilant about a healthy diet to get back on track,” St-Onge says.

    Jansen is a good example. With her one-year-old interrupting sleep, “I keep in mind that, because I was up all night, I’ll crave more energy-dense foods,” she says. “So I try not to give in to that.”

    She also has a healthy breakfast to “get off on a good nutritional foot.” A related strategy when sleep-deprived is to begin the day with a veggie starter. When people have a salad or other vegetable before a carb-heavy breakfast, their appetites and blood sugar tend to be more stable the rest of the day. This could prevent a cycle of several nights of bad sleep and poor nutrition. “You can break the cycle,” St-Onge says.

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    Matt Fuchs

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  • Why You Get Your Best Ideas in the Shower

    Why You Get Your Best Ideas in the Shower

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    I have long since gotten out of the habit of writing down my best ideas in felt-tip pen. Felt-tip ink runs, after all, and half of the time I have a brainstorm to record I am dripping wet. That’s because more often than not I have dashed straight from the shower. I am not remotely alone in finding the shower a wonderful place to be wildly creative.

    Social media is rife with groups dedicated to sharing so-called “shower thoughts.” “One of my favorites on Reddit is ‘People often talk about how every snowflake is unique, but every potato is unique, too, and nobody talks about that,’” says Zachary Irving, assistant professor of philosophy and cognitive science at the University of Virginia.

    What is it about the shower that brings out the Eureka! in us? And what is it about similar, seemingly mindless things—walking, working out, doing the dishes—that affect us the same way?

    Irving has made it something of a life mission to explore the question of how to induce states of creative mind-wandering. “I describe this [kind of thought] as unguided or unconstrained attentional thinking,” he says. “Your brain codes that it doesn’t need you to engage in detail, it doesn’t need your perceptual attention or motor attention, and that allows your mind to have this random kind of movement.”

    A moderately engaging activity like a shower provides the perfect environment. Go too boring—think sitting in a chair and staring into middle-distance—and you’ll be too unstimulated to be creative.

    “When we’re super, super-bored, we seek stimulation,” says Irving. “So we just stop our mind from wandering by, say, checking our phone. That’s not going to lead to the kind of creativity we need.”

    The power of the shower

    The proper balance between engagement and disengagement is turbocharged in the shower. John Kounios, professor of psychology at Drexel University and co-author of the book The Eureka Factor: Aha Moments, Creative Insight, and the Brain, thinks he knows why. In the shower we are on-task—washing, shampooing, shaving, in a familiar and purposeful sequence—but we’re also cut off from the world. “There’s sensory restriction,” Kounios says. “There’s white noise and you really can’t see too much.” There’s a tactile component to a shower too. The temperature of the water, Kounios points out, is more or less the same as the temperature of the body, so there is nothing too cold or too hot to draw you out of the literal immersion of the experience.

    Shower thoughts and related mind-wandering are part of what Kounios calls a “brain blink.” In one 2004 paper in the journal PLoS Biology, Kounios and his colleagues studied people’s brains with functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), while the people worked on a kind of puzzle known as a remote association test, in which subjects are given three words and have to come up with a fourth word that connects them all. (The words “loser,” ”throat,” and “spot,” for example, could all be connected by the word “sore,” which precedes them in common phrases.)

    Read More: How Often Do You Actually Need to Shower?

    There are two ways to solve the problem. The more plodding way is the co-called analytical approach in which people can take things word by word, by pairing “crab,” for example, with “cake,” and seeing if that word also works with “pine” and “sauce”—which it doesn’t. (The correct word in this case would be “apple.”) In the alternative, the technique known as the insight insight approach could work too—just rolling the words around in your head until the solution presents itself.

    There’s no doubt which approach is more satisfying: The answer achieved by insight with its happy Aha! is just a lot more fun (and creative).

    In Kounios’ study, people were instructed to solve the problems and then push a button indicating whether they’d come up with the answer by analysis or insight. In the insight case, the brain scans showed that in the second before the answer was reached, there was a burst of alpha waves in the right occipital cortex, which processes vision. Alpha waves actually suppress brain activity, but when they occur in the occipital cortex, they’re a very good thing.

    Consider the way we often close our eyes or look at the floor or the ceiling when we’re trying to solve a problem—effectively shutting out distracting stimuli that get in the way of the work. The alpha burst does the same in the brain without our having to move or close our eyes, clearing the cognitive decks to help us reach the right solution. “For an instant before you have an insight,” Kounios says, “you’re less aware of your environment.”

    Showering causes just that kind of brain blink to happen in a sort of open-ended way—but showering is by no means the only or even best way to achieve it. “Each person may have something that works for them,” Kounios says, “whether it’s walking the dog or gardening or whatever. It should be something that has low demands, not no demands.”

    Here are other ways to benefit from “shower thoughts” on dry land. 

    Have a rest

    Jonathan Schooler, a professor of psychological and brain sciences at the University of California, Santa Barbara, has looked into the shower-thought phenomenon and points to the “hypnagogic state,” the zone just between sleep and wakefulness, as being especially fertile ground for insights. Thomas Edison and Salvador Dali, he says, made it a habit to nap sitting up with objects in their hands, so that when they dozed off, the objects would drop, waking them up and allowing them to snag any insights before they vanished. 

    Read More: How to Take the Perfect Nap

    But it’s not necessary to deny yourself your rest; deep sleep can yield its own creative dividends. There is something real about sleeping on a problem, with thoughts and ideas having a chance to consolidate overnight and become clearer and sharper the next day. Here too the shower can come into play. “Oftentimes we’re showering in the morning,” Schooler says. “So we can be the beneficiary of whatever incubation and consolidation process took place during sleep.”

    Take a walk

    Walking semi-mindlessly has also been shown to have this effect. “Plato and Aristotle were [part of] the peripatetic school,” says Schooler, “because they did their philosophizing while walking.” He points to at least one study showing that being pushed in a wheelchair did not have the same effect on creativity, suggesting that it is something about the physical experience of the walk, as opposed to simply seeing the landscape go by, that has the salutary effect.

    Turn off your phone

    There is, Irving says, a “spontaneity deficit” in modern culture, with our phones becoming a barrier to creative mind-wandering. To get the most out of your mind during whatever activity you choose, shut the phone off or at least silence the ringer and the buzzer.

    Turn off your worry

    To the greatest degree possible, allow creativity time to be a vacation from problem-solving. The problems will be there when you emerge from your reverie; address them then. “Mind-wandering should not devolve into rumination,” says Kounios.

    Forget the agenda 

    The best mind-wandering has no goal. If you go into a session of free-associating with any kind of purpose, well, that association is a lot less free. 

    Be happy

    A cheery state is not always easy to summon up on demand, but if you start your shower or walk or workout with a memory of, say, the best vacation you ever had, you’re likelier to find the creative spark, says Kounios.

    Immerse yourself in nature and art

    Both are known to help the mind unmoor itself, says Schooler.

    Ask yourself questions

    Make them undemanding, free-floating ones—like what was your happiest day, what was your most surprising day. Those kinds of questions, says Schooler, are likely to promote the productive, generative form of mind-wandering he calls “mind-wondering.”

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    Jeffrey Kluger

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