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More Olive Oil May Bring Longer Life

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People who consume more than 1/2 a tablespoon of olive oil a day are less likely to die from heart disease, cancer, neurodegenerative diseases like Alzheimer’s or lung disease.

Does CBD Oil Help With Schizophrenia?

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Scientists are studying CBD oil for schizophrenia and dozens of other health conditions. Here’s what to know if you have schizophrenia and are thinking of trying CBD.

CBD Oil and Breast Cancer

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CBD oil can’t treat or cure breast cancer, but it may ease side effects of treatment like pain, anxiety, insomnia, nausea, and vomiting. Here’s what to know about using CBD oil for breast cancer.

Former WebMD Editor Kristy Hammam Dies

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The cause of her death was triple-negative breast cancer. She was 50 years old. Hammam retired from a 22 year career at WebMD in June of 2021, after losing much of her eyesight to chemotherapy.

Amputees Lost in the COVID-19 Shuffle

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Amid COVID-19 restrictions, amputees say they’ve struggled to get the care they depend on to survive and thrive. Members of disadvantaged communities may have had it even worse.

FDA, CDC Authorize Pfizer Boosters for 16- and 17-year-olds

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The FDA said it was basing its emergency authorization of boosters for 16 and 17 year olds on data from 200 individuals who were ages 18 to 55 years of age when they received a booster dose. They are requiring Pfizer to collect data on safety in post-authorization studies.

Patients Can Experience Burnout Too

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Although the primary focus of clinical burnout has been health care professionals — with good reason — a new model suggests adding the patient could improve chronic condition outcomes.

A Pandemic Page-Turner

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Talking about dread diseases might not be your idea of fun holiday conversation, but Lydia Kang, MD, co-author of Patient Zero: A Curious History of the World’s Worst Diseases, thinks it should be.

This Thanksgiving, Enjoy the Turkey But Hold the GERD

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Most of us have occasional periods of reflux and the heartburn that can result, but with GERD, it happens two or more times a week. Roughly 60 million Americans have heartburn at least once a month, and as many as 15 million experience it daily.

COVID-19 Variant Sparks U.K. Travel Restrictions

covid immunity

A highly transmissible coronavirus variant detected in the United Kingdom has prompted Prime Minister Boris Johnson to shut down parts of the country, triggering other nations to impose travel and shipping restrictions.

Letter from the Editor: Love your mind

Fairy lights are gracing the shop windows and Michael Bublé is dominating the airwaves with his rendition of “Winter Wonderland.” The holiday season is well and truly in full swing.
A woman deep in thought after reading a book
Taking some time for yourself can do wonders for easing holiday stress.

“Are you all set for the holidays?”

I’ve been asked this question three times this week — a classic example of festive chitchat in the United Kingdom. The short answer? No.

With fewer than 4 weeks to go, I’ve purchased a total of three gifts, including one box of candy that will undoubtedly be opened prior to its intended date of consumption and will need to be replaced.

There was once a time when I would have become stressed if I had failed to purchase and wrap all my gifts by the first week of December. Simply the thought of the abundance of social events I’d need to attend would have made me anxious.

In recent years, however, I’ve learned to better deal with the stresses that accompany the festive season. My tips include going for a stroll or taking 5 minutes of “me time” to listen to a favorite song or treat myself to some cocoa.

Earlier this month, Medical News Today explored some stress-busting strategies in an article that reveals seven ways to protect mental well-being during the holidays.

My personal favorite? “Don’t be afraid to say no.” I can vouch for this one. These days, I attend social events that I want to attend, and my mental well-being (and wallet) are much better off for it.

I asked the MNT team what they do to alleviate holiday stress.

“It helps to identify the aspects of the holiday season that I enjoy the most and to focus on those,” one news writer commented.

“I try to carry on exercising, as it’s good thinking and head-clearing time for me, and it makes me feel better,” said one of our copy editors, who added, “It’s really easy to let that slide over the holidays!”

“I watch ‘Die Hard’ to get in the festive mood and relax,” said our production coordinator, opening up the great office debate as to whether “Die Hard” is really a holiday movie.

Do you have any tips for protecting your mental well-being this festive season? Get in touch! We’d love to hear them.

Maybe there’s a health topic you’d like us to cover before the end of the year? Reach out to us on Facebook or Twitter.

Speaking of health topics, which articles caught your eye this month? You were interested in learning what exercises can help to increase lung capacity, as well as the benefits of soaking your feet in vinegar.

You also wanted to discover the best foods for increasing low testosterone and whether blue waffle disease is a real medical condition.

As for our news content this November, brain health was a popular topic. You were interested in our coverage of new research that suggests that a low-protein, high-carb diet may benefit the brain.

Our article on a study investigating how coffee protects the brain also piqued your curiosity, as did our coverage of new research that sheds light on how cannabis affects the brain.

You’ll hear more from me and the rest of the MNT team next month.

Until then, I’ll leave you with this quote, which may prompt you to take some time out when holiday stress strikes:

Almost everything will work again if you unplug it for a few minutes, including you.”

Anne Lamott

We wish you a joyful and healthful December!

Honor signature

Honor Whiteman, Managing Editor

Regular exercise can keep the body decades younger

In a new study involving people over 70 who have exercised regularly for years, scientists discovered that the participants’ hearts, lungs, and muscles were in equivalent shape to those of people in their 40s.
woman on bicycle
Regular exercise could help keep the body young, new research shows.

Researchers from the Human Performance Laboratory at Ball State University in Muncie, IN recently assessed the physical condition of people in their 70s who have been exercising regularly for decades.

The team compared the health measurements of these participants with those of their more sedentary peers and with the measurements of healthy people in their 20s.

Specifically, the investigators measured heart and lung capacity, as well as muscle fitness. They have published their findings in the Journal of Applied Physiology.

‘Exercise wins’ is the take-home message. We saw that people who exercise regularly year after year have better overall health. These 75-year-olds — men and women — have similar cardiovascular health to a 40–45-year-old.”

Lead researcher Scott Trappe, director of the Human Performance Laboratory

Leisure exercise can keep you young

The researchers worked with three types of participants: seven women and 21 men in their 70s who exercised regularly, 10 women and 10 men in their 70s who led sedentary lifestyles, and 10 women and 10 men in their 20s, who were all healthy and who exercised regularly.

Participants in the first category reported having exercised throughout their lives, and they described enjoying frequent physical activity on a leisurely basis. Each of these participants worked out, on average, 5 days per week for a combined total of about 7 hours.

At one stage, the investigators sought to determine the participants’ aerobic endurance by evaluating their VO2 max measurements. This assesses the maximum amount of oxygen that an individual can use during bouts of intense aerobic exercise. The researchers did so by asking the participants to cycle on indoor bikes.

The marker is important because, as the team explains, VO2 max tends to decline by approximately 10 percent every 10 years after a person reaches the age of 30, and this reduction corresponds to an increased risk of disease.

The researchers also performed muscle biopsies on the participants to assess the formation and distribution of small blood vessels in the muscles and to evaluate aerobic enzyme activity, which drives the metabolism of oxygen at the cellular level.

At another stage of the study, the team split the male participants into two groups: the performance group, which trained to compete, and the fitness group, which exercised for leisure.

They found that “For some of the variables, the performance group had some metrics that were superior to the fitness people, and cardiovascular capacity was one of those,” as Trappe notes.

“But things like muscle health and capillaries to support blood flow, they were equivalent between the two groups. Higher intensity didn’t necessarily take them to a higher place,” he adds.

The researchers suggest that the health measurements of the physically active participants in their 70s look like those of healthy people decades younger and that these benefits seem to apply to women and men alike.

30–45 minutes of exercise per day

The team notes that the older participants belong to a generation that received a lot of encouragement to take up sports.

“What was really interesting about this study is: These folks came out of the exercise-boom generation, which really started in the 1970s, when running and tennis became popular [for] the masses,” Trapp states.

The 1970s, the lead researcher explains, was also the decade in which women were permitted to join in more competitive sports, thanks to new federal laws adopted in the United States. “You did have some interesting things that happened back in that era,” he notes, referring to the adoption of Title IX of the Education Amendments Act of 1972.

This law states that “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.”

Thanks to this type of legislative change, Trappe says, researchers have been able to recruit female participants who practice sports at competitive levels.

But he emphasizes that it is not necessary to be competitive to reap the benefits of exercise.

“If you want to put 30–45 minutes of walking in one day, the amount of health benefit you are going to get from that is going to be significant and substantial,” Trappe says.

“Will it equal the person training for competitive performances? No. But, it will outdo the couch potato. In basic terms, 30–45 minutes of any type of exercise a day is beneficial,” he stresses.

Regular exercise can keep the body decades younger

In a new study involving people over 70 who have exercised regularly for years, scientists discovered that the participants’ hearts, lungs, and muscles were in equivalent shape to those of people in their 40s.
woman on bicycle
Regular exercise could help keep the body young, new research shows.

Researchers from the Human Performance Laboratory at Ball State University in Muncie, IN recently assessed the physical condition of people in their 70s who have been exercising regularly for decades.

The team compared the health measurements of these participants with those of their more sedentary peers and with the measurements of healthy people in their 20s.

Specifically, the investigators measured heart and lung capacity, as well as muscle fitness. They have published their findings in the Journal of Applied Physiology.

‘Exercise wins’ is the take-home message. We saw that people who exercise regularly year after year have better overall health. These 75-year-olds — men and women — have similar cardiovascular health to a 40–45-year-old.”

Lead researcher Scott Trappe, director of the Human Performance Laboratory

Leisure exercise can keep you young

The researchers worked with three types of participants: seven women and 21 men in their 70s who exercised regularly, 10 women and 10 men in their 70s who led sedentary lifestyles, and 10 women and 10 men in their 20s, who were all healthy and who exercised regularly.

Participants in the first category reported having exercised throughout their lives, and they described enjoying frequent physical activity on a leisurely basis. Each of these participants worked out, on average, 5 days per week for a combined total of about 7 hours.

At one stage, the investigators sought to determine the participants’ aerobic endurance by evaluating their VO2 max measurements. This assesses the maximum amount of oxygen that an individual can use during bouts of intense aerobic exercise. The researchers did so by asking the participants to cycle on indoor bikes.

The marker is important because, as the team explains, VO2 max tends to decline by approximately 10 percent every 10 years after a person reaches the age of 30, and this reduction corresponds to an increased risk of disease.

The researchers also performed muscle biopsies on the participants to assess the formation and distribution of small blood vessels in the muscles and to evaluate aerobic enzyme activity, which drives the metabolism of oxygen at the cellular level.

At another stage of the study, the team split the male participants into two groups: the performance group, which trained to compete, and the fitness group, which exercised for leisure.

They found that “For some of the variables, the performance group had some metrics that were superior to the fitness people, and cardiovascular capacity was one of those,” as Trappe notes.

“But things like muscle health and capillaries to support blood flow, they were equivalent between the two groups. Higher intensity didn’t necessarily take them to a higher place,” he adds.

The researchers suggest that the health measurements of the physically active participants in their 70s look like those of healthy people decades younger and that these benefits seem to apply to women and men alike.

30–45 minutes of exercise per day

The team notes that the older participants belong to a generation that received a lot of encouragement to take up sports.

“What was really interesting about this study is: These folks came out of the exercise-boom generation, which really started in the 1970s, when running and tennis became popular [for] the masses,” Trapp states.

The 1970s, the lead researcher explains, was also the decade in which women were permitted to join in more competitive sports, thanks to new federal laws adopted in the United States. “You did have some interesting things that happened back in that era,” he notes, referring to the adoption of Title IX of the Education Amendments Act of 1972.

This law states that “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.”

Thanks to this type of legislative change, Trappe says, researchers have been able to recruit female participants who practice sports at competitive levels.

But he emphasizes that it is not necessary to be competitive to reap the benefits of exercise.

“If you want to put 30–45 minutes of walking in one day, the amount of health benefit you are going to get from that is going to be significant and substantial,” Trappe says.

“Will it equal the person training for competitive performances? No. But, it will outdo the couch potato. In basic terms, 30–45 minutes of any type of exercise a day is beneficial,” he stresses.

What are the benefits of cherry juice?

Cherry juice is a popular drink with links to several health benefits, including boosting the immune system, improving memory, and aiding sleep. However, few scientific studies back up these claims.

There are different varieties of cherry, but manufacturers typically make cherry juice using a tart or sour variety such as Montmorency, or sweeter black cherries. Black cherries contain more sugar and more carbohydrates. The nutritional content of the two types is otherwise similar.

A 1-cup serving of unsweetened tart cherry juice typically contains:

Some claim that drinking cherry juice can help people sleep better, give the immune system a boost, and help people recover after a workout.

Benefits of cherry juice

Cherry juice in a glass
The possible benefits of cherry juice include fewer gout symptoms, improved vision, and a stronger immune system.

Dark red, purple, and blue fruits and vegetables contain anthocyanins.

These are pigments that give these fruits and vegetables their color. Cherries contain anthocyanins.

Anthocyanins have potential health benefits, but a lot more research is needed to determine whether they are good for health.

Read on for more information about some of the alleged health benefits of drinking cherry juice.

1. Fewer gout symptoms

Gout is a type of arthritis that usually affects one joint at a time. It causes pain, swelling, and redness. A person may sometimes have flares, which is when they experience worsened symptoms, and remission, which is when their symptoms are mild or totally absent.

One 2012 study looked at 633 people with gout and revealed that those who ate cherries or cherry extract had a lower risk of repeated gout attacks. The researchers thought that this could be due to the anthocyanins in the fruit.

2. Antioxidants

Anthocyanins are antioxidants. Antioxidants are substances that may be able to stop or slow down some types of damage to cells. Particles called free radicals cause this damage.

The creation of free radicals occurs when a person eats or exercises. They can come from the environment, including as a result of air pollution. Free radicals trigger cell damage, which is a risk factor for diseases such as cancer and diabetes.

Fruits and vegetables contain antioxidants, and a healthful diet should include lots of fruits and vegetables. However, there is no proven link between antioxidants and disease prevention.

3. A stronger immune system

Anthocyanins from natural sources may have antimicrobial properties. This means that they can kill small organisms called microbes, such as bacteria that cause disease.

Some research has suggested that the anthocyanins in cherries could help fight bacteria. This could help support the immune system by fighting off minor illnesses such as colds.

More research is necessary to determine whether or not anthocyanins in cherry juice may benefit the immune system.

4. Improved vision

Anthocyanins similar to those present in cherries may benefit people who have glaucoma. Glaucoma is a buildup of fluid pressure inside the eye that can cause vision loss.

Some research looked at people who had received treatment with anthocyanins for glaucoma. Some people showed improvement in their vision after this treatment.

5. Fewer osteoarthritis symptoms

Osteoarthritis is a common form of arthritis that causes pain and stiffness in the joints. One method that healthcare professionals use to test stiffness, pain, and a range of physical movements is called the Western Ontario and McMaster Universities osteoarthritis (WOMAC) index.

A small 2013 study found slightly improved WOMAC scores for people who had consumed cherry juice for the 6 weeks of the study. This was in comparison with receiving a placebo, but the difference was not significant. It is important to note that a corporation that makes and sells cherry juice funded this research.

6. Better recovery after exercise

After a significant amount of exercise, some people experience inflammation in their airways.

A small study looked at people who had run a marathon. It found that drinking cherry juice helped prevent symptoms of inflammation.

7. Better short-term memory

One small study from 2017 looked at the possible benefits of drinking cherry juice to older adults with mild dementia.

Those who drank cherry juice every day for 12 weeks showed minor improvements in their short-term memory.

8. Improved sleep

For adults who have insomnia, cherry juice may help with quality of sleep and length of sleep time. Cherry juice can raise the amount of melatonin in the body. Melatonin is a molecule that helps maintain normal sleep.

The basis for this theory is a small study that scientists conducted over a short period.

How to obtain cherry juice

Cherries in a bowl on a table
Homemade cherry juice is a healthful alternative to processed juices.

Making cherry juice can be a cheaper, more healthful alternative to buying juice. Like other fruit juices, manufacturers often add sugar or sweeteners to cherry juice.

By following these steps, a person can make cherry juice at home using a food processor:

  • Wash and stem fresh cherries.
  • Combine 1 cup of cherries with one-quarter of a cup of water, scaling up as needed.
  • Blend in a food processor until cherries come just loose from the pits.
  • Sieve into a bottle or jar.
  • Drink within 5 days.

If buying cherry juice, look for an unsweetened version without any extra additives. Health food stores may be more likely to stock cherry juice without additives.

All fruit juice contains natural sugars. A person should be aware that drinking a lot of fruit juice could add too much sugar to the diet.

Manufacturers often label juice as either from concentrate or not from concentrate. Makers of cherry juice from concentrate will pulp the cherries and remove the water. They then usually freeze the juice for transportation, then put the water back in before the juice becomes commercially available.

They may sometimes add sugar or sweeteners to the water, which can make it a less healthful choice. This is not always the case, however. Juice from concentrate with no added sugar is no less healthful than juice that is not from concentrate.

Summary

Much more research is necessary to draw firm conclusions about the possible benefits of cherry juice. Currently, there is not enough evidence to suggest that cherry juice has any significant benefits to health.

As part of a balanced diet, drinking cherry juice can be a good way to include a portion of fruit. Making it at home or choosing an option without added sugar is a healthful choice.

Hot baths reduce inflammation, improve glucose metabolism

According to new research, a hot bath could have effects that extend way beyond mental relaxation. According to the authors, regular hot baths might reduce inflammation and improve metabolism.
Hot bath
The list of health benefits associated with hot baths keeps growing.

Over recent years, hot baths, saunas, and other so-called passive heating therapies have received growing attention from scientists.

Scientists now believe they offer some potential benefits, including improved vascular function and sleep.

Because hot baths are low cost and unlikely to cause significant side effects, understanding any benefits that a hot bath might have could be a quick win for medical science.

Recently, researchers set out to understand whether hot bath immersion could have an impact on metabolic disorders, such as diabetes.

Almost 20 years ago, a paper concluded that hot water immersion of individuals with type 2 diabetes enhanced insulin sensitivity. However, it is still unclear how this might occur.

In the most recent study, the researchers dug a little deeper into the mechanisms at work. They theorized that the influence of a hot bath over glucose metabolism might revolve around the inflammatory response.

Inflammation and insulin resistance

There is some evidence that chronic, low-level inflammation increases insulin resistance. In other words, inflammation reduces a cell’s ability to respond to insulin, potentially contributing to the development of diabetes.

Conversely, exercise has been shown to reduce inflammation and improve insulin sensitivity — meaning that the body has better control over glucose levels.

Although doctors often recommend exercise to reduce the risk of developing metabolic disorders, not everyone can exercise — perhaps due to health conditions or physical capacity. It is, therefore, essential to find alternative ways to improve insulin sensitivity for these people.

Exercise, as with other physical stressors, sparks a brief inflammatory response, followed by a more extended anti-inflammatory response. The researchers wanted to see if a different type of physical stressor — a hot bath — might have a similar effect on the immune system.

For this study, the researchers investigated the impact of a hot bath on overweight, mostly sedentary men. The findings were published recently in the Journal of Applied Physiology.

Hot bath intervention

Each participant immersed themselves in a water bath set at 102°F (39°C) for 1 hour. Scientists took blood just before and after the bath, and then 2 hours later.

Also, the researchers charted the participants’ blood pressure, body temperature, and heart rate every 15 minutes.

Over the following 2 weeks, the participants had a further 10 hot water immersions.

The researchers found that a single hot water immersion caused a spike of interleukin — a marker of inflammation. Similarly, there was an increase in nitric oxide (NO) production.

The spike in NO is important because it causes blood vessels to relax, lowering blood pressure. NO also improves glucose intake into tissues, and scientists think it has anti-inflammatory properties.

As expected, the 2-week intervention saw a reduction in fasting blood sugar and inflammation. In the same way that exercise influences inflammation, the researchers saw an initial increase followed by a long-term decrease in inflammation.

The authors conclude:

[Hot-water immersion may] improve aspects of the inflammatory profile and enhance glucose metabolism in sedentary, overweight males.”

The researchers also write that it “might have implications for improving metabolic health in populations unable to meet the current physical activity recommendations.”

It is important to note that the people who took part in the study did report some discomfort. This was either due to the length of time that they were required to stay in the bath or the high temperature. Future research might investigate whether shorter periods or lower temperatures might have similar benefits.

Of course, hot baths alone cannot treat metabolic disorders, but they may be a simple, cost-effective intervention that can run alongside other treatments.

What is asthma?

Asthma is a chronic disease of the airways in the lungs. It can occur in people of all ages, and there are several different types. Controlling the condition is vital for avoiding attacks. Read on to learn more.

Treatments for atopic dermatitis (eczema)

People may find their atopic dermatitis, or eczema, challenging to treat. However, there are many treatments and home remedies that can reduce itching, cracked skin, inflammation, and infections.

Atopic dermatitis is a skin condition that affects around 30 percent of people in the United States, most of whom are children and adolescents. A person with eczema will typically experience patches of dry, itchy skin that may crack, bleed, or become infected.

This article looks at treatments and home remedies for atopic dermatitis, as well as some tips for coping, possible treatments for babies, and when to see a doctor.

Treatments for atopic dermatitis

Moisturizers can help prevent and treat eczema flares.
Moisturizers can help prevent and treat eczema flares.

There is currently no cure for eczema, but many people will find that it improves as they get older. Treatments aim to help a person manage the symptoms of their eczema.

According to a study paper published in the journal Trials, “The foundation of all treatment is the regular use of leave-on emollients to preserve and restore moisture to the skin.”

Treatments for eczema typically fall into two categories:

  • moisturizers to relieve dryness and itching
  • anti-inflammatories to reduce swelling, itching, and redness

People usually apply moisturizers and anti-inflammatories directly to the skin as creams or ointments. It is possible to take some anti-inflammatories orally.

The following list describes some common treatments for atopic dermatitis:

Medications

A doctor may prescribe medicated creams or oral medication to hydrate the skin, reduce itching, and relieve inflammation. Medications include:

  • corticosteroid creams to relieve itching and inflammation
  • corticosteroid tablets, which are for short-term use only, to relieve itching and inflammation
  • topical calcineurin inhibitors, which suppress inflammation to reduce symptoms
  • antihistamines, which some scientists believe can reduce the severe itching that atopic dermatitis causes

People can buy milder steroids, such as hydrocortisone, over the counter at drug stores.

Wet-wrap therapy

Research shows that wet-wrap therapy can help improve eczema symptoms by increasing the moisture of a person’s skin.

After bathing and moisturizing, wrap wet strips of fabric or gauze around the eczema-affected areas. Doing this helps keep the skin hydrated and increases the action of medicated creams and moisturizers. Do not use wet wraps over prescribed corticosteroid creams unless a doctor has advised this.

Place a dry layer over the wet layer to prevent it from drying out. People can leave the wraps on for several hours or overnight.

Phototherapy

People with severe eczema may benefit from ultraviolet (UV) light therapy. An estimated 70 percent of people with eczema see an improvement in their symptoms after undergoing phototherapy.

During phototherapy, a doctor or dermatologist will shine a UVB light on either the whole body or just the affected areas. This light helps reduce itchiness and inflammation, and it encourages the body to create vitamin D. It may also help the skin fight bacteria to prevent infection.

Home remedies for atopic dermatitis

Certain home remedies can help relieve the symptoms of atopic dermatitis, though people should talk to their doctor to find out the best course of treatment for their symptoms.

The following home remedies can help reduce the symptoms of atopic dermatitis:

Natural moisturizers

Coconut oil in bowl with halved coconut behind
Coconut oil is a popular home remedy for dry skin.

Some natural products can help lock in moisture and relieve itchiness. According to the National Eczema Association, common home remedies that evidence has shown to be effective in adults include:

  • Coconut oil. Apply virgin or cold-pressed coconut oil directly to eczema to moisturize the area and reduce bacteria. Use it once or twice per day on damp skin.
  • Sunflower oil. Sunflower oil may help improve the skin’s protective barrier and reduce inflammation. Apply it twice a day.
  • Cardiospermum. Cardiospermum is a plant extract that can reduce inflammation, itchiness, and bacteria on the skin.

Bathing

Bathing every day is essential for eczema as it helps keep the skin hydrated and prevents infection. People can also try different kinds of bath for eczema, including:

  • bath-oil baths
  • oatmeal baths
  • baking soda baths
  • bleach baths
  • vinegar baths

Always use moisturizer on affected areas of skin within 3 minutes of getting out of the bath to stop the skin from drying out.

Tips for coping

People can adopt various methods of skin care to help reduce the symptoms of their eczema. These might include:

  • avoiding scratching the affected areas, which helps reduce inflammation
  • taking antihistamines to reduce itchiness further
  • avoiding wool, which can irritate the skin
  • avoiding strong soaps and detergents and products that contain scents, dyes, or fragrances
  • minimizing contact with water when washing objects, such as dishes, by hand
  • avoiding scrubbing dry skin for too long
  • washing with lukewarm water

Eczema can affect a person’s mental health, which may lead to symptoms of depression, anxiety, and stress. Caregivers should be aware of these possible mental health issues, as well as any physical health issues, in relation to a child’s eczema.

Likewise, an adult may find that speaking to medical professionals, friends, and family members helps them cope better with any mental health issues relating to their eczema.

Treatment for babies

Baby lying down in blanket with woman putting cream on their face
Applying moisturizer regularly can help prevent a baby with eczema from scratching.

According to the National Institutes of Health (NIH), eczema usually develops when a baby is 3–6 months old.

There is little clear evidence about whether eczema in babies is preventable. Some research suggests that exclusive breastfeeding for 6 months may reduce eczema in infants who are at high risk, but the evidence is not conclusive.

Infants may make their eczema worse, as they can find it more difficult to avoid scratching.

Treatment for eczema in infants and babies is similar to that which adults use, with the focus being on the application of moisturizing creams or ointments and anti-inflammatories that reduce the urge to scratch.

Ensure that a baby’s room is not too warm at night as sweat can make the symptoms of eczema worse.

Treating children with eczema can be difficult and time-consuming. According to a study published in the Journal of Advanced Nursing, speaking to children about the difficulties of treating eczema and developing strategies to make the process easier may help them ease into regular treatment routines.

Although there is no cure for eczema, most children who have this condition will outgrow it by adulthood. Eczema disappears within 10 years in 80 percent of children and within 20 years in 95 percent.

When to see a doctor

A person can often manage their eczema at home by using over-the-counter moisturizers and avoiding triggers. However, a person may need to see a doctor if complications occur.

Bacterial, viral, and fungal skin infections are common complications of eczema. This is because the skin of people with eczema lacks the proteins that fight infections.

Bacterial infections can make the symptoms of eczema worse.

People with eczema may be more prone to fungal infections, such as yeast infections. They are also more likely to get viral skin infections, such as eczema herpeticum, which can occur if they come into contact with the herpes simplex virus that causes cold sores.

People with eczema should look out for the following signs of skin infection:

  • eczema suddenly becoming worse
  • areas of the skin weeping
  • a raised temperature
  • flu-like symptoms

Once they have identified it, doctors can treat all forms of infection. They may prescribe antibacterial, antifungal, or antiviral medication. In rare instances of viral infection, a person may need to go to the hospital.

Outlook

Most people will grow out of eczema, but it can return or develop in some adults. Those with eczema often find that it is an ongoing disease that gets better or worse over time.

Treatment options for atopic dermatitis include topical creams, oral medication, wet wraps, phototherapy, and special baths. These treatments can reduce itchiness and dry skin and lower the risk of skin infections.

There is no cure for atopic dermatitis, but treatments, home remedies, and coping tips can help relieve the symptoms. Some of these may even increase the amount of time that the disease stays in remission.

What to know about anxiety

Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a medical disorder.

Anxiety disorders form a category of mental health diagnoses that lead to excessive nervousness, fear, apprehension, and worry

These disorders alter how a person processes emotions and behave, also causing physical symptoms. Mild anxiety might be vague and unsettling, while severe anxiety may seriously affect day-to-day living.

Anxiety disorders affect 40 million people in the United States. It is the most common group of mental illnesses in the country. However, only 36.9 percent of people with an anxiety disorder receive treatment.

What is anxiety?

anxiety
Disproportionate reactions of tension and worry characterize anxiety.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Knowing the difference between normal feelings of anxiety and an anxiety disorder requiring medical attention can help a person identify and treat the condition.

In this article, we look at the differences between anxiety and anxiety disorder, the different types of anxiety, and the available treatment options.

When does anxiety need treatment?

While anxiety can cause distress, it is not always a medical condition.

Anxiety

When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival.

Since the earliest days of humanity, the approach of predators and incoming danger sets off alarms in the body and allows evasive action. These alarms become noticeable in the form of a raised heartbeat, sweating, and increased sensitivity to surroundings.

The danger causes a rush of adrenalin, a hormone and chemical messenger in the brain, which in turn triggers these anxious reactions in a process called the “fight-or-flight’ response. This prepares humans to physically confront or flee any potential threats to safety.

For many people, running from larger animals and imminent danger is a less pressing concern than it would have been for early humans. Anxieties now revolve around work, money, family life, health, and other crucial issues that demand a person’s attention without necessarily requiring the ‘fight-or-flight’ reaction.

The nervous feeling before an important life event or during a difficult situation is a natural echo of the original ‘fight-or-flight’ reaction. It can still be essential to survival – anxiety about being hit by a car when crossing the street, for example, means that a person will instinctively look both ways to avoid danger.

Anxiety disorders

The duration or severity of an anxious feeling can sometimes be out of proportion to the original trigger, or stressor. Physical symptoms, such as increased blood pressure and nausea, may also develop. These responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as “having recurring intrusive thoughts or concerns.” Once anxiety reaches the stage of a disorder, it can interfere with daily function.

Symptoms

While a number of different diagnoses constitute anxiety disorders, the symptoms of generalized anxiety disorder (GAD) will often include the following:

  • restlessness, and a feeling of being “on-edge”
  • uncontrollable feelings of worry
  • increased irritability
  • concentration difficulties
  • sleep difficulties, such as problems in falling or staying asleep

While these symptoms might be normal to experience in daily life, people with GAD will experience them to persistent or extreme levels. GAD may present as vague, unsettling worry or a more severe anxiety that disrupts day-to-day living.

For information on the symptoms of other diagnoses under the umbrella of anxiety disorders, follow the links in the “Types” section below.

Types

panic disorder
Panic disorder is a type of anxiety disorder.

The Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) classifies anxiety disorders into several main types.

In previous editions of DSM, anxiety disorders included obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), as well as acute stress disorder. However, the manual now no longer groups these mental health difficulties under anxiety.

Anxiety disorders now include the following diagnoses.

Generalized anxiety disorder: This is a chronic disorder involving excessive, long-lasting anxiety and worries about nonspecific life events, objects, and situations. GAD is the most common anxiety disorder, and people with the disorder are not always able to identify the cause of their anxiety.

Panic disorder: Brief or sudden attacks of intense terror and apprehension characterize panic disorder. These attacks can lead to shaking, confusion, dizziness, nausea, and breathing difficulties. Panic attacks tend to occur and escalate rapidly, peaking after 10 minutes. However, a panic attack might last for hours.

Panic disorders usually occur after frightening experiences or prolonged stress but may also occur without a trigger. An individual experiencing a panic attack may misinterpret it as a life-threatening illness, and may make drastic changes in behavior to avoid future attacks.

Click here to learn more about panic disorder and panic attacks.

Specific phobia: This is an irrational fear and avoidance of a particular object or situation. Phobias are not like other anxiety disorders, as they relate to a specific cause.

A person with a phobia might acknowledge a fear as illogical or extreme but remain unable to control feelings anxiety around the trigger. Triggers for a phobia range from situations and animals to everyday objects.

Click here to learn more about phobias and how they develop.

Agoraphobia: This is a fear and avoidance of places, events, or situations from which it may be difficult to escape or in which help would not be available if a person becomes trapped. People often misunderstand this condition as a phobia of open spaces and the outdoors, but it is not so simple. A person with agoraphobia may have a fear of leaving home or using elevators and public transport.

Click here to learn about agoraphobia, an often-misunderstood psychological disorder.

Selective mutism: This is a form of anxiety that some children experience, in which they are not able to speak in certain places or contexts, such as school, even though they may have excellent verbal communication skills around familiar people. It may be an extreme form of social phobia.

Social anxiety disorder, or social phobia: This is a fear of negative judgment from others in social situations or of public embarrassment. Social anxiety disorder includes a range of feelings, such as stage fright, a fear of intimacy, and anxiety around humiliation and rejection.

This disorder can cause people to avoid public situations and human contact to the point that everyday living is rendered extremely difficult.

Click here to learn all you need to know about social anxiety disorder.

Separation anxiety disorder: High levels of anxiety after separation from a person or place that provides feelings of security or safety characterize separation anxiety disorder. Separation might sometimes result in panic symptoms.

Learn all about separation anxiety by clicking here.

Causes

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.

Possible causes include:

  • environmental stressors, such as difficulties at work, relationship problems, or family issues
  • genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves
  • medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery
  • brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain
  • withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes

To learn more about the causes and diagnosis of anxiety disorders, click here.

Treatment

Treatments will consist of a combination of psychotherapy, behavioral therapy, and medication.

Alcohol dependence, depression, or other conditions can sometimes have such a strong effect on mental well-being that treating an anxiety disorder must wait until any underlying conditions are brought under control.

Self-treatment

yoga for anxiety
Yoga can reduce the effects of an anxiety disorder.

In some cases, a person can treat an anxiety disorder at home without clinical supervision. However, this may not be effective for severe or long-term anxiety disorders.

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:

  • Stress management: Learning to manage stress can help limit potential triggers. Organize any upcoming pressures and deadlines, compile lists to make daunting tasks more manageable, and commit to taking time off from study or work.
  • Relaxation techniques: Simple activities can help soothe the mental and physical signs of anxiety. These techniques include meditation, deep breathing exercises, long baths, resting in the dark, and yoga.
  • Exercises to replace negative thoughts with positive ones: Make a list of the negative thoughts that might be cycling as a result of anxiety, and write down another list next to it containing positive, believable thoughts to replace them. Creating a mental image of successfully facing and conquering a specific fear can also provide benefits if anxiety symptoms relate to a specific cause, such as in a phobia.
  • Support network: Talk with familiar people who are supportive, such as a family member or friend. Support group services may also be available in the local area and online.
  • Exercise: Physical exertion can improve self-image and release chemicals in the brain that trigger positive feelings.

Counseling

A standard way of treating anxiety is psychological counseling. This can include cognitive-behavioral therapy (CBT), psychotherapy, or a combination of therapies.

CBT

This type of psychotherapy aims to recognize and change harmful thought patterns that form the foundation of anxious and troublesome feelings. In the process, practitioners of CBT hope to limit distorted thinking and change the way people react to objects or situations that trigger anxiety.

For example, a psychotherapist providing CBT for panic disorder will try to reinforce the fact that panic attacks are not really heart attacks. Exposure to fears and triggers can be a part of CBT. This encourages people to confront their fears and helps reduce sensitivity to their usual triggers of anxiety.

Medications

A person can support anxiety management with several types of medication.

Medicines that might control some of the physical and mental symptoms include antidepressants, benzodiazepines, tricyclics, and beta-blockers.

Benzodiazepines: A doctor may prescribe these for certain people with anxiety, but they can be highly addictive. These drugs tend to have few side effects except for drowsiness and possible dependence. Diazepam, or Valium, is an example of a commonly prescribed benzodiazepine.

Antidepressants: These commonly help with anxiety, even though they also target depression. People often use serotonin reuptake inhibitors (SSRI), which have fewer side effects than older antidepressants but are likely to cause jitters, nausea, and sexual dysfunction when treatment begins.

Other antidepressants include fluoxetine, or Prozac, and citalopram, or Celexa.

Tricyclics: This is a class of drugs older than SSRIs that provide benefits for most anxiety disorders other than OCD. These drugs might cause side effects, including dizziness, drowsiness, dry mouth, and weight gain. Imipramine and clomipramine are two examples of tricyclics.

Additional drugs a person might use to treat anxiety include:

  • monoamine oxidase inhibitors (MAOIs)
  • beta-blockers
  • buspirone

Seek medical advice if the adverse effects of any prescribed medications become severe.

Prevention

There are ways to reduce the risk of anxiety disorders. Remember that anxious feelings are a natural factor of daily life, and experiencing them does not always indicate the presence of a mental health disorder.

Take the following steps to help moderate anxious emotions:

  • Reduce intake of caffeine, tea, cola, and chocolate.
  • Before using over-the-counter (OTC) or herbal remedies, check with a doctor or pharmacist for any chemicals that may make anxiety symptoms worse.
  • Maintain a healthy diet.
  • Keep a regular sleep pattern.
  • Avoid alcohol, cannabis, and other recreational drugs.

Takeaway

Anxiety itself is not a medical condition but a natural emotion that is vital for survival when an individual finds themselves facing danger.

An anxiety disorder develops when this reaction becomes exaggerated or out-of-proportion to the trigger that causes it. There are several types of anxiety disorder, including panic disorder, phobias, and social anxiety.

Treatment involves a combination of different types of therapy, medication, and counseling, alongside self-help measures.

An active lifestyle with a balanced diet can help keep anxious emotions within healthy limits.

Q:

How do I know when my anxious emotions have started to occur out of proportion with their trigger?

A:

The clearest indication that anxiety is becoming problematic may be finding it increasingly difficult to do things that the person used to do relatively easily.

This may mean talking in front of a group of people, going to the grocery, separating from a loved one or caregiver, or riding in an elevator. If anxiety starts to get in the way, it is definitely time to reach out.

Dillon Browne, PhD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

What causes anxiety?

Anxiety disorders occur when a person regularly feels disproportionate levels of distress, worry, or fear over an emotional trigger. Identifying the reason behind a presentation of anxiety can be the key to successful treatment.

To assist diagnosis, the conditions under the umbrella of anxiety disorders have certain characteristics that set them apart from normal feelings of anxiety. A wide variety of factors can contribute to anxiety disorders.

This article explores the different causes of anxiety disorders and the criteria a doctor or psychologist would use to reach a diagnosis.

Causes

stress anxiety cause
Stress around work or school can lead to an anxiety disorder.

Anxiety disorders have a complicated network of causes, including:

  • Environmental factors: Elements in the environment around an individual can increase anxiety. Stress from a personal relationship, job, school, or financial predicament can contribute greatly to anxiety disorders. Even low oxygen levels in high-altitude areas can add to anxiety symptoms.
  • Genetics: People who have family members with an anxiety disorder are more likely to have one themselves.
  • Medical factors: Other medical conditions can lead to an anxiety disorder, such as the side effects of medication, symptoms of a disease, or stress from a serious underlying medical condition that may not directly trigger the changes seen in anxiety disorder but might be causing significant lifestyle adjustments, pain, or restricted movement.
  • Brain chemistry: Stressful or traumatic experiences and genetic factors can alter brain structure and function to react more vigorously to triggers that would not previously have caused anxiety. Psychologists and neurologists define many anxiety and mood disorders as disruptions to hormones and electrical signals in the brain.
  • Use of or withdrawal from an illicit substance: The stress of day-to-day living combined with any of the above might serve as key contributors to an anxiety disorder.

Sometimes, stressful events occur as the result of a third party, such as an employer or partner, but anxious feelings might emerge from people telling themselves the worst will happen. An anxiety disorder may develop without any external stimuli whatsoever.

Disproportionate anxiety can result from a combination of one or more of the above causes.

For example, a person may respond to stress at work by drinking more alcohol or taking illicit substances, increasing anxiety levels and the risk of further complications.

Diagnosis

anxiety diagnosis
A person must meet all criteria of an anxiety disorder to qualify for a diagnosis.

A mental health professional can diagnose anxiety and identify the possible causes.

The physician will take a thorough medical and personal history, perform a physical examination, and order laboratory tests if needed. These tests may provide useful information about a medical condition that may be causing anxiety symptoms.

To receive a diagnosis of generalized anxiety disorder (GAD), a person must:

  • experience excessive worry and anxiety about several different events or activities on more days than not for at least six months
  • have difficulties controlling worry
  • have at least three anxiety symptoms on more days than not in the last six months

To identify the condition, a doctor will look for one of the following anxiety symptoms:

  • restlessness
  • fatigue
  • irritability
  • muscle tension
  • difficulty sleeping
  • difficulty concentrating

A doctor must be able to note that symptoms are interfering with daily life, perhaps causing absence from work or school.

Takeaway

A range of factors can work together to cause an anxiety disorder.

People with anxiety disorders regularly have a genetic predisposition towards them, and physical factors, such as an imbalance of hormones and chemical messengers in areas of the brain, also play an important role. However, environmental factors, including stress and traumatic life events, can also impact the scale of an emotional reaction to a trigger.

Withdrawal from alcohol or an illicit substance can also contribute to anxiety.

A doctor will recognize and diagnose an anxiety disorder by noting excessive worry, difficulties managing worrying emotions, and the presence of at least three symptoms of anxiety on more days than not over the last 6 months that have been severe enough to interfere with daily living.

These symptoms include restlessness, fatigue, and irritability, as well as muscle tension and difficulties with sleep and concentration.

Q:

I feel anxiety symptoms every day that do not seem to link to a specific cause or trigger. What should I do?

A:

Make an appointment with a professional. Often, we are unable to see the patterns in our own lives that are apparent to others, especially professionals with experience in this area.

Dillon Browne, PhD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Why you probably have microplastics in your poop

Two recently published studies underline how pervasive plastic is on our planet. One finds it hiding in table salt, and the other finds it in stool samples. The question is, how will it impact health?
Plastic bottles on end
Microplastics are everywhere, but does it matter?

Most of us know that planet Earth has a problem with plastic — namely, there is way too much of it, and it will not go away.

From the middle of the 20th century onward, humans have increased plastic production drastically.

In 1950, we produced around 350,000 metric tons. By 2016, that figure had skyrocketed to 335 million metric tons.

By some estimates, 4.8–12.7 million metric tons of plastic entered the ocean in 2010. Researchers are still working out exactly how this impacts the sea, the creatures that live in it, and, ultimately, human beings.

What are microplastics?

Unlike organic compounds that will slowly rot away, plastic breaks down into ever smaller pieces of plastic.

This slow dismantling means that there is a full spectrum of sizes available. Some plastic pieces are the right size to choke a large fish, while some are the right size to fit into the gills of a tiny fish.

Other pieces are small enough to float through the air and be taken in as we breathe, while others are so small that they can pass through the membranes in our lungs and intestines.

When a plastic piece is smaller than 5 millimeters across, it is a microplastic. Manufacturers create some microplastics for use in industrial processes, whereas the breakdown of larger plastics can create other microplastics.

Plastic stools

A new study from the Medical University of Vienna in Austria and the Environment Agency Austria has investigated microplastic infiltration into the human body.

The team presented its results at the 26th United European Gastroenterology Week, which is the largest gastroenterology meeting in Europe, held this year in Vienna.

The scientists investigated stool samples from eight people from a range of geographical locations: Finland, Italy, Japan, the Netherlands, Poland, Russia, the United Kingdom, and Austria.

For 1 week, each participant kept a food diary, then specialists took a stool sample. The scientists assessed the samples for the presence of 10 types of plastic using testing techniques recently developed at the Environment Agency Austria.

Incredibly, they found microplastics in every single one of the stool samples that they tested.

The investigators found up to nine different plastics in each individual; they measured 50–500 micrometers. They saw polypropylene and polyethylene terephthalate most commonly. On average, they found 20 microplastic particles for every 10 grams of stool.

Though this was just a small-scale pilot study, this is still a concerning finding. “This is the first study of its kind and confirms what we have long suspected, that plastics ultimately reach the human gut,” explains Dr. Philip Schwabl, who presented the findings earlier this week.

Of particular concern is what this means to us, and especially patients with gastrointestinal diseases.”

Dr. Philip Schwabl

He adds, “While the highest plastic concentrations in animal studies have been found in the gut, the smallest microplastic particles are capable of entering the bloodstream, lymphatic system, and may even reach the liver.”

While it seems clear that microplastics have infiltrated many of us, it will take much more research before we understand exactly how much damage this might be doing.

As Dr. Schwabl says, “Now that we have the first evidence for microplastics inside humans, we need further research to understand what this means for human health.”

Salt of the earth

The second study of interest appears in the journal Environmental Science and Technology. Older work had measured the presence of plastic in table salt, but it could not ascertain where in the world the salt originated.

The latest study assessed the plastic content of 39 table salts, including 28 brands of sea salt from 16 regions on six continents.

The scientists found plastic in 25 of the 28 samples of sea salt (almost 90 percent), with particularly high levels present in sea salt originating in Asia. This matches up with previous findings indicating that Asia is a particular hotspot for plastic pollution.

Plastic is all around us, but these two studies really drive that fact home. The next question is what does this mean for our health? This will take a lot longer to investigate and understand.

Researchers have carried out few studies into the health implications of microplastics, and those that have been done have generally focused on animals or cell cultures in a laboratory. A study published in 2017, for instance, explored the metabolic effects of feeding mice microplastics.

The scientists found that they built up in the liver, kidney, and gut. Overall, they concluded that “MPs [microplastics] exposure could cause disruptions to energy and lipid metabolism, induce oxidative stress, and include neurotoxic responses.”

It will be some time before there is definitive proof that microplastics can damage health. One of the major difficulties in studying microplastics’ effects on our body is the lack of a control population. No one, it seems, can avoid ingesting plastic on a regular basis.

Can people with diabetes eat potatoes?

People with diabetes need to be aware of their carbohydrate intake. Although potatoes are a starchy vegetable, it is still possible for a person with diabetes to enjoy them as part of a healthful diet.

When a person eats, the body converts the carbohydrates and sugars into a simple sugar called glucose, which enters the bloodstream and raises sugar levels. This impact on blood sugar levels makes it essential for people with diabetes to monitor the number of carbohydrates that they consume.

Potatoes are a starchy vegetable, which means that they contain a lot of carbohydrates and can raise a person’s blood sugar levels.

In this article, we examine whether people with diabetes can eat potatoes. We also cover which types of potato are better, the best ways to prepare and cook potatoes, and general dietary tips for people with diabetes.

Potatoes and diabetes

man peeling a potato
People with diabetes need to be mindful of the number of carbohydrates they consume.

The American Diabetes Association (ADA) recommend eating starchy vegetables, such as potatoes, as part of a healthful diet.

It is a common misconception that people with diabetes need to avoid all potatoes and other starchy foods.

The reason for this misconception is that starchy foods are high in carbohydrates and tend to have a high glycemic index (GI).

GI is a useful system for ranking foods from 0 to 100 according to their potential to raise blood sugar levels. Foods with a high GI raise blood sugar more than those with a low GI. According to the ADA:

  • low GI foods have a GI of 55 or less
  • medium GI foods have a GI of 56 to 69
  • high GI foods have a GI of 70 or more

Only eating foods with a low or medium GI can help a person control their blood sugar levels. While some varieties of potato do have a high GI, other factors can balance this out, including the portion size and method of preparation.

The ADA recommend combining a high GI food with low GI foods to help balance a meal. They also state that portion size is key to enjoying starchy foods as part of a healthful meal plan.

Another consideration is the cooking method. Deep or shallow frying potatoes in certain oils and fats, such as animal fats, can make them high in saturated and trans fats, which can increase the risk of heart disease. Fats are also high in calories, which may be a consideration for people trying to maintain a healthy weight.

The best way to prepare potatoes is to boil or steam them. Both boiled and steamed potatoes are rich in vitamins, minerals, and fiber but very low in fat, sugar, and salt.

Considerations when eating potatoes

Potatoes are starchy vegetables, which means that they have a high GI and raise blood sugar levels. However, people with diabetes can eat them in smaller portion sizes.

It is best to eat potatoes as part of a balanced, healthful meal. Other meal components, such as low GI foods, fiber, lean protein, and healthful fats, can help balance a meal out.

Eating high-fiber foods is beneficial as these help control blood sugar levels and increase the feeling of fullness. Low GI foods can include other non-starchy vegetables.

Best type of potatoes for diabetes?

Sweet potatoes are one of the best types of potato for people with diabetes as they are low GI and contain more fiber than white potatoes. Sweet potatoes are also a good source of calcium and vitamin A.

Carisma potatoes, a variety of white potato, are another lower GI option. Russet potatoes are high GI, so it is best to eat them in small quantities.

Preparing and cooking potatoes

young woman boiling potatoes
Boiling is a healthful method of cooking potatoes.

The preparation and cooking methods that a person uses can affect both the GI and the nutritional content of potatoes.

For instance, whole potatoes have a lower GI than mashed or diced potatoes.

Allowing potatoes to cool slightly before eating them can also be beneficial. Cooking a potato makes the starch more digestible, which raises the GI. After cooling, the potato becomes less digestible again, which may lower the GI.

The most healthful way to cook potatoes is to boil, steam, or microwave them without adding any other ingredients. Preparing potatoes in this way will ensure that they are very low in sugar, salt, and fat.

Keeping the skins of the potatoes on can provide additional fiber. Also, up to 50 percent of the phenolic compounds in potatoes are present in the skin and attached flesh. Phenolic compounds have antioxidant properties that may be beneficial to health.

What about other potato dishes?

Some potato dishes are more suitable than others for people with diabetes.

For example, a potato salad can be a good option as the potatoes are whole. However, other ingredients, such as mayonnaise, should be low-fat with no added sugar. People can try this potato salad recipe, which uses low-fat mayonnaise and light sour cream to reduce the fat content.

Any recipes that use mashed or crushed potato, such as potato pasta, are less appropriate for people with diabetes. Processing the potato in this way increases its GI and the potential impact that it has on a person’s blood sugar levels.

It is also best to avoid fried potatoes as frying them increases their calorie and fat content.

General dietary tips for diabetes

mum and young daughter preparing a salad
A healthful diet should include plenty of nutrient-rich vegetables.

Meal planning is a valuable tool for people with diabetes as it can help them optimize meal timings and serving sizes of each food. A doctor or dietitian can offer dietary advice and help with meal planning.

General dietary tips include eating more non-starchy vegetables and filling half of the plate with nutrient-rich vegetables, such as:

  • broccoli
  • carrots
  • cauliflower
  • peppers
  • spinach and other leafy greens
  • tomatoes

Starchy and lean protein options should fill no more than a quarter of the plate. It is advisable to trim excess fat off cuts of meat to lower their saturated fat content.

The ADA’s “Create Your Plate” is a free online tool that can help people with diabetes plan a balanced meal with appropriate portion sizes.

Carbohydrate counting can also be a helpful technique for managing diabetes. Counting the total carbohydrate content of foods and meals will give a better indication of how they may affect a person’s blood sugar levels than GI.

Summary

Potatoes are a starchy vegetable, which means that they are rich in carbohydrate and can raise a person’s blood sugar levels. However, potatoes are a good source of vitamins, minerals, and fiber, and people with diabetes can enjoy them as part of a healthful diet.

Eating non-starchy foods alongside moderate portions of whole potatoes can balance out their GI. Cooking potatoes by boiling or steaming them with no added ingredients will also ensure that they are low in fat, salt, and sugar.

What is rheumatoid arthritis?

Rheumatoid arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.

Rheumatoid arthritis (RA) usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.

Common symptoms include stiff joints, especially upon getting up in the mornings or after sitting down for a while. Some people often experience fatigue and a general feeling of being unwell.

The Rheumatoid Arthritis Support Network estimate that RA affects up to 1 percent of the world’s population and over 1.3 million people in America.

What is rheumatoid arthritis?

Rheumatoid arthritis knee
Rheumatoid arthritis causes pain, redness, and swelling in the joints and a feeling of generally being unwell.

RA is an autoimmune disease. It is also a systemic disease, which means it affects the whole body.

It occurs when a person’s immune system mistakes the body’s healthy tissues for foreign invaders.

As the immune system responds, inflammation occurs in the target tissue or organ.

In the case of RA, this can be the joints, lungs, eyes, and heart.

Symptoms

Symptoms of RA include:

  • pain, swelling, and stiffness in more than one joint
  • symmetrical joint involvement
  • joint deformity
  • unsteadiness when walking
  • a general feeling of being unwell
  • fever
  • loss of function and mobility
  • weight loss
  • weakness

According to the Centers for Disease Control and Prevention (CDC), the symptoms usually affect the same joints on both sides of the body

Symptoms tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe.

Causes

Nobody knows what causes the immune system to malfunction.

Some people appear to have genetic factors that make it more likely. One theory is that bacteria or a virus triggers RA in people who have this genetic feature.

In RA, the immune system’s antibodies attack the synovium, which is the smooth lining of a joint. When this happens, pain and inflammation result.

Inflammation causes the synovium to thicken. Eventually, if left untreated, it can invade and destroy cartilage — the connective tissue that cushions the ends of the bones.

The tendons and ligaments that hold the joint together can also weaken and stretch. The joint eventually loses its shape and configuration. The damage can be severe.

Risk factors

The CDC note that people with a higher risk of developing RA may include those who:

  • are aged 60 years or above
  • are female
  • have specific genetic traits
  • have never given birth
  • have obesity
  • smoke tobacco or whose parents smoked when they were children

Complications

People with RA have a higher risk of some other conditions, including:

People who have obesity with RA also have a higher risk of diabetes and high blood pressure.

The joint damage that occurs with RA can make it difficult to perform daily activities. RA can also be unpredictable. Often, a person does not know when a flare will happen.

This uncertainty can lead to:

There is also a higher risk of developing the following conditions:

Carpal tunnel syndrome: This is a type of nerve damage that stems from compression and irritation of a nerve in the wrist. Symptoms include aching, numbness, and tingling in the fingers, thumb, and part of the hand.

Inflammation: This can affect the lungs, heart, blood vessels, eyes and other parts of the body.

Tendon rupture: Inflammation in the tendons can lead to rupture, especially on the backs of the fingers.

Cervical myelopathy: Dislocation of the joints in the neck or cervical spine can add pressure to the spinal cord. This can result in decreased mobility and pain on movement. As RA progresses, the risk of cervical myelopathy increases.

Vasculitis: Inflammation of the blood vessels can cause them to weaken, thicken, narrow and scar. This can affect blood flow to tissues and organ function may be affected.

Susceptibility to infections: There is a higher risk of developing colds, flu, pneumonia, and other diseases, especially if the person is taking immunosuppressant medications to manage RA. People with RA should ensure their vaccinations, such as flu jabs, are up-to-date.

Diagnosis

In its early stages, it may be difficult for a doctor to diagnose RA as it can resemble other conditions. However, early diagnosis and treatment are essential to slow the progression of the disease.

The CDC recommend diagnosis and an effective treatment strategy to begin within 6 months of the onset of symptoms.

A doctor will look at the person’s clinical signs of inflammation and ask how long they have been there and how severe the symptoms are. They will also carry out a physical examination to check for any swelling, or functional limitations, or deformity.

They may recommend some tests.

Blood tests

Erythrocyte sedimentation rate (ESR or sed rate): This test assesses levels of inflammation in the body. It measures how fast red blood cells in a test tube separate from blood serum over a set period. If the red blood cells settle quickly as sediment, inflammation levels are high. This test is not specific for RA and is a useful test for other inflammatory conditions or infections.

C-reactive protein (CRP): The liver produces CRP. A higher CRP level suggests that there is inflammation in the body. This test is not specific for RA and CRP can occur in other inflammatory conditions or infection.

Anemia: Many people with RA also have anemia. Anemia happens when there are too few red blood cells in the blood. Red blood cells carry oxygen to the tissues and organs of the body.

Rheumatoid factor: If an antibody known as rheumatoid factor is present in the blood, it can indicate that RA is present. However, not everyone with RA tests positive for this factor.

Imaging scans and X-rays

An X-ray or MRI of a joint can help a doctor identify what type of arthritis is present and monitor the progress of RA over time.

Diagnostic criteria

In 2010, the American College of Rheumatology recommended the following criteria for diagnosing RA:

  • swelling is present in at least one joint, and it does not have another cause
  • results from at least one blood test indicate the presence of RA
  • symptoms have been present for at least 6 weeks

Conditions with similar symptoms

The doctor will need to distinguish RA from other conditions with similar symptoms, such as:

  • gout
  • osteoarthritis
  • lupus
  • psoriatic arthritis

Treatment

Pain relief medication
Pain relief and other types of medication can reduce symptoms.

If a person receives a diagnosis of RA, the doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.

There is currently no cure for RA, but treatment can help to:

  • reduce inflammation to the joints
  • relieve pain
  • minimize any loss of function caused by pain, joint damage, or deformity
  • slow down or prevent damage to the joints

Options include medications, physical therapy, occupational therapy, counseling, and surgery.

Medications

Some drugs can help to relieve symptoms and slow disease progression.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These are available over-the-counter from pharmacies. Examples include Advil, Motrin, and Aleve. Long-term use and high doses can lead to side effects, such as bruising, gastric ulcers, high blood pressure, and kidney and liver problems.

Corticosteroids: These medications reduce pain and inflammation and may play a role in slowing down joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.

Corticosteroids can help with acute symptoms or short-term flare-ups. Long-term use of corticosteroids can have serious side effects. These include cataracts, osteoporosis, glaucoma, diabetes mellitus, and obesity.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with the overactive immune system. A person usually takes a DMARD for life.

It is most effective if a person uses it in the early stages, but it can take from 4 to 6 months to fully experience the benefits.

Some people may have to try different types of DMARD before finding the most suitable one.

Examples include leflunomide (Arava), methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and hydroxychloroquine (Plaquenil).

Side effects can include liver damage and immune-related problems, such as bone marrow suppression, and a higher risk of severe lung infections.

Other types of immunosuppressants include cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan).

Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors)

The human body produces tumor necrosis factor-alpha (TNF-alpha), an inflammatory substance.

TNF-alpha inhibitors prevent inflammation. They can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.

Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).

Possible side effects include:

  • a higher risk of infection
  • blood disorders
  • congestive heart failure
  • demyelinating diseases, involving an erosion of the myelin sheath that normally protects nerve fibers
  • lymphoma

Occupational therapy

An occupational therapist can help the individual learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints.

For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.

Surgery

If medication and physical therapy do not help, a doctor may recommend surgery to:

  • repair damaged joints
  • correct deformities
  • reduce pain

The following procedures are possible:

  • Arthroplasty: In a total joint replacement, the surgeon removes the damaged parts and inserts a metal and plastic prosthesis, or artificial joint.
  • Tendon repair: If tendons have loosened or ruptured around the joint, surgery may help restore them.
  • Synovectomy: This procedure involves removal of the synovium if it is inflamed and causing pain.
  • Arthrodesis: The surgeon will fuse a bone or joint to decrease pain and realign or stabilize the joint.

Home remedies

A number of strategies can help a person to manage RA.

Rest

When a flare-up occurs, the person should rest as much as possible. Over-exerting swollen and painful joints can make the symptoms worse.

Exercise

During times of remission, when symptoms are mild, the individual should exercise regularly to boost their general health and mobility and to strengthen the muscles around the joint.

The best exercises are those that do not strain the joints, such as swimming.

Diet

Following a varied diet with plenty of fresh fruits and vegetable can help a person to feel better and maintain a healthy weight.

Applying heat or cold

Tense and painful muscles may benefit from the application of heat.

Try:

  • taking a 15-minute hot bath or shower
  • applying a hot pack or an electric heating pad, set at the lowest setting

Cold treatment can dull pain and reduce muscle spasms, but people with poor circulation or numbness should not use cold remedies.

Examples include:

  • cold packs or ice in a cloth, but never put ice directly on the skin
  • soaking the affected joint in cold water

Some might prefer to do both:

  1. Place the joints in warm water for a few minutes, then dip them in cold water for 1 minute.
  2. Repeat for about half an hour.
  3. Finish up with a warm soak.

Relaxation

Finding ways to relieve mental stress may help control pain. Examples include meditation, guided imagery, deep breathing, and muscle relaxation.

Complementary therapies

Massage to relieve the pain of RA
Massage may be one way to relieve the pain of RA.

Some people with RA use the following, but there is little scientific evidence to confirm that they work:

Prevention

It may not be possible to prevent RA, but the CDC suggest the following:

Takeaway

RA is a painful and chronic condition that can cause joint damage and make it difficult for a person to carry out their daily tasks.

Anyone who experiences pain and swelling in two or more joints should see a doctor, as early treatment can reduce the risk of long-term problems.

What is rheumatoid arthritis?

Rheumatoid arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.

Rheumatoid arthritis (RA) usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.

Common symptoms include stiff joints, especially upon getting up in the mornings or after sitting down for a while. Some people often experience fatigue and a general feeling of being unwell.

The Rheumatoid Arthritis Support Network estimate that RA affects up to 1 percent of the world’s population and over 1.3 million people in America.

What is rheumatoid arthritis?

Rheumatoid arthritis knee
Rheumatoid arthritis causes pain, redness, and swelling in the joints and a feeling of generally being unwell.

RA is an autoimmune disease. It is also a systemic disease, which means it affects the whole body.

It occurs when a person’s immune system mistakes the body’s healthy tissues for foreign invaders.

As the immune system responds, inflammation occurs in the target tissue or organ.

In the case of RA, this can be the joints, lungs, eyes, and heart.

Symptoms

Symptoms of RA include:

  • pain, swelling, and stiffness in more than one joint
  • symmetrical joint involvement
  • joint deformity
  • unsteadiness when walking
  • a general feeling of being unwell
  • fever
  • loss of function and mobility
  • weight loss
  • weakness

According to the Centers for Disease Control and Prevention (CDC), the symptoms usually affect the same joints on both sides of the body

Symptoms tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe.

Causes

Nobody knows what causes the immune system to malfunction.

Some people appear to have genetic factors that make it more likely. One theory is that bacteria or a virus triggers RA in people who have this genetic feature.

In RA, the immune system’s antibodies attack the synovium, which is the smooth lining of a joint. When this happens, pain and inflammation result.

Inflammation causes the synovium to thicken. Eventually, if left untreated, it can invade and destroy cartilage — the connective tissue that cushions the ends of the bones.

The tendons and ligaments that hold the joint together can also weaken and stretch. The joint eventually loses its shape and configuration. The damage can be severe.

Risk factors

The CDC note that people with a higher risk of developing RA may include those who:

  • are aged 60 years or above
  • are female
  • have specific genetic traits
  • have never given birth
  • have obesity
  • smoke tobacco or whose parents smoked when they were children

Complications

People with RA have a higher risk of some other conditions, including:

People who have obesity with RA also have a higher risk of diabetes and high blood pressure.

The joint damage that occurs with RA can make it difficult to perform daily activities. RA can also be unpredictable. Often, a person does not know when a flare will happen.

This uncertainty can lead to:

There is also a higher risk of developing the following conditions:

Carpal tunnel syndrome: This is a type of nerve damage that stems from compression and irritation of a nerve in the wrist. Symptoms include aching, numbness, and tingling in the fingers, thumb, and part of the hand.

Inflammation: This can affect the lungs, heart, blood vessels, eyes and other parts of the body.

Tendon rupture: Inflammation in the tendons can lead to rupture, especially on the backs of the fingers.

Cervical myelopathy: Dislocation of the joints in the neck or cervical spine can add pressure to the spinal cord. This can result in decreased mobility and pain on movement. As RA progresses, the risk of cervical myelopathy increases.

Vasculitis: Inflammation of the blood vessels can cause them to weaken, thicken, narrow and scar. This can affect blood flow to tissues and organ function may be affected.

Susceptibility to infections: There is a higher risk of developing colds, flu, pneumonia, and other diseases, especially if the person is taking immunosuppressant medications to manage RA. People with RA should ensure their vaccinations, such as flu jabs, are up-to-date.

Diagnosis

In its early stages, it may be difficult for a doctor to diagnose RA as it can resemble other conditions. However, early diagnosis and treatment are essential to slow the progression of the disease.

The CDC recommend diagnosis and an effective treatment strategy to begin within 6 months of the onset of symptoms.

A doctor will look at the person’s clinical signs of inflammation and ask how long they have been there and how severe the symptoms are. They will also carry out a physical examination to check for any swelling, or functional limitations, or deformity.

They may recommend some tests.

Blood tests

Erythrocyte sedimentation rate (ESR or sed rate): This test assesses levels of inflammation in the body. It measures how fast red blood cells in a test tube separate from blood serum over a set period. If the red blood cells settle quickly as sediment, inflammation levels are high. This test is not specific for RA and is a useful test for other inflammatory conditions or infections.

C-reactive protein (CRP): The liver produces CRP. A higher CRP level suggests that there is inflammation in the body. This test is not specific for RA and CRP can occur in other inflammatory conditions or infection.

Anemia: Many people with RA also have anemia. Anemia happens when there are too few red blood cells in the blood. Red blood cells carry oxygen to the tissues and organs of the body.

Rheumatoid factor: If an antibody known as rheumatoid factor is present in the blood, it can indicate that RA is present. However, not everyone with RA tests positive for this factor.

Imaging scans and X-rays

An X-ray or MRI of a joint can help a doctor identify what type of arthritis is present and monitor the progress of RA over time.

Diagnostic criteria

In 2010, the American College of Rheumatology recommended the following criteria for diagnosing RA:

  • swelling is present in at least one joint, and it does not have another cause
  • results from at least one blood test indicate the presence of RA
  • symptoms have been present for at least 6 weeks

Conditions with similar symptoms

The doctor will need to distinguish RA from other conditions with similar symptoms, such as:

  • gout
  • osteoarthritis
  • lupus
  • psoriatic arthritis

Treatment

Pain relief medication
Pain relief and other types of medication can reduce symptoms.

If a person receives a diagnosis of RA, the doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.

There is currently no cure for RA, but treatment can help to:

  • reduce inflammation to the joints
  • relieve pain
  • minimize any loss of function caused by pain, joint damage, or deformity
  • slow down or prevent damage to the joints

Options include medications, physical therapy, occupational therapy, counseling, and surgery.

Medications

Some drugs can help to relieve symptoms and slow disease progression.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These are available over-the-counter from pharmacies. Examples include Advil, Motrin, and Aleve. Long-term use and high doses can lead to side effects, such as bruising, gastric ulcers, high blood pressure, and kidney and liver problems.

Corticosteroids: These medications reduce pain and inflammation and may play a role in slowing down joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.

Corticosteroids can help with acute symptoms or short-term flare-ups. Long-term use of corticosteroids can have serious side effects. These include cataracts, osteoporosis, glaucoma, diabetes mellitus, and obesity.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with the overactive immune system. A person usually takes a DMARD for life.

It is most effective if a person uses it in the early stages, but it can take from 4 to 6 months to fully experience the benefits.

Some people may have to try different types of DMARD before finding the most suitable one.

Examples include leflunomide (Arava), methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and hydroxychloroquine (Plaquenil).

Side effects can include liver damage and immune-related problems, such as bone marrow suppression, and a higher risk of severe lung infections.

Other types of immunosuppressants include cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan).

Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors)

The human body produces tumor necrosis factor-alpha (TNF-alpha), an inflammatory substance.

TNF-alpha inhibitors prevent inflammation. They can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.

Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).

Possible side effects include:

  • a higher risk of infection
  • blood disorders
  • congestive heart failure
  • demyelinating diseases, involving an erosion of the myelin sheath that normally protects nerve fibers
  • lymphoma

Occupational therapy

An occupational therapist can help the individual learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints.

For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.

Surgery

If medication and physical therapy do not help, a doctor may recommend surgery to:

  • repair damaged joints
  • correct deformities
  • reduce pain

The following procedures are possible:

  • Arthroplasty: In a total joint replacement, the surgeon removes the damaged parts and inserts a metal and plastic prosthesis, or artificial joint.
  • Tendon repair: If tendons have loosened or ruptured around the joint, surgery may help restore them.
  • Synovectomy: This procedure involves removal of the synovium if it is inflamed and causing pain.
  • Arthrodesis: The surgeon will fuse a bone or joint to decrease pain and realign or stabilize the joint.

Home remedies

A number of strategies can help a person to manage RA.

Rest

When a flare-up occurs, the person should rest as much as possible. Over-exerting swollen and painful joints can make the symptoms worse.

Exercise

During times of remission, when symptoms are mild, the individual should exercise regularly to boost their general health and mobility and to strengthen the muscles around the joint.

The best exercises are those that do not strain the joints, such as swimming.

Diet

Following a varied diet with plenty of fresh fruits and vegetable can help a person to feel better and maintain a healthy weight.

Applying heat or cold

Tense and painful muscles may benefit from the application of heat.

Try:

  • taking a 15-minute hot bath or shower
  • applying a hot pack or an electric heating pad, set at the lowest setting

Cold treatment can dull pain and reduce muscle spasms, but people with poor circulation or numbness should not use cold remedies.

Examples include:

  • cold packs or ice in a cloth, but never put ice directly on the skin
  • soaking the affected joint in cold water

Some might prefer to do both:

  1. Place the joints in warm water for a few minutes, then dip them in cold water for 1 minute.
  2. Repeat for about half an hour.
  3. Finish up with a warm soak.

Relaxation

Finding ways to relieve mental stress may help control pain. Examples include meditation, guided imagery, deep breathing, and muscle relaxation.

Complementary therapies

Massage to relieve the pain of RA
Massage may be one way to relieve the pain of RA.

Some people with RA use the following, but there is little scientific evidence to confirm that they work:

Prevention

It may not be possible to prevent RA, but the CDC suggest the following:

Takeaway

RA is a painful and chronic condition that can cause joint damage and make it difficult for a person to carry out their daily tasks.

Anyone who experiences pain and swelling in two or more joints should see a doctor, as early treatment can reduce the risk of long-term problems.

Diabetes: Surprising new role of fat revealed

A new study, published in the journal Cell Metabolism, challenges the current understanding of what causes diabetes. The findings may lead to new therapies.
fat cell
New research finds that the PKCɛ enzyme affects the health of fat cells, shown here.

More than two decades ago, researchers suggested that the action of an enzyme called protein kinase C epsilon (PKCɛ) in the liver may cause diabetes. This enzyme, the researchers posited, inhibits the activity of insulin by acting on insulin receptors.

Since then, other studies have shown that knocking out the PKCɛ gene in mice protected the rodents from glucose intolerance and insulin resistance when they ate a high-fat diet.

However, the precise location where this enzyme activated remained unclear. Now, a new study — led by Carsten Schmitz-Peiffer, an associate professor at the Garvan Institute of Medical Research in Darlinghurst, Australia — suggests that the liver is not responsible for activating the enzyme and spreading its harmful effects. Instead, fat tissue throughout the body is the culprit.

Obesity is a known risk factor for type 2 diabetes, and the current study adds to the mounting research that unravels the connection between body fat and the risk of developing the metabolic condition.

Additionally, the new study may lead to novel strategies of disrupting the activity of PKCɛ, ultimately leading to new treatments.

‘Acting from fat tissue to worsen’ diabetes

Schmitz-Peiffer and colleagues fed mice a high-fat diet, thus inducing symptoms of type 2 diabetes, such as glucose intolerance and insulin resistance, in the animals. Insulin resistance occurs when the liver no longer reacts to insulin, the hormone secreted by the pancreas.

Then, the researchers knocked out the gene responsible for PKCɛ in the liver, or the gene responsible for PKCɛ in the entire adipose tissue of the mice, and compared the results.

Schmitz-Peiffer reports on the findings, saying: “The big surprise was that when we removed PKCε production specifically in the liver — the mice were not protected.”

“For over a decade,” continues the lead author, “it’s been assumed that PKCε is acting directly in the liver — by that logic, these mice should have been protected against diabetes.”

“We were so surprised by this, that we thought we had developed our mice incorrectly. We confirmed the removal and tested it in several different ways, but they still become glucose intolerant when given a [high-fat diet].”

“What we found,” explains Schmitz-Peiffer, “is that if we removed PKCε production solely from fat tissue, the mice were protected from becoming glucose intolerant, similar to when we removed PKCε from the entire animal.”

So PKCε isn’t progressing diabetes from the liver, but in fact, it is acting from fat tissue to worsen the disease.”

Carsten Schmitz-Peiffer

How PKCɛ affects fat cells

To determine the precise way in which PKCε affects fat tissue, the researchers examined how the enzyme affected the shape and size of the fat cells.

“Under the microscope, the fat cells looked very different,” reports Schmitz-Peiffer. “In [high-fat diet]-fed mice with PKCε removed from the fat tissue, we saw mostly small, healthy fat cells.”

“And in [high-fat diet]-fed mice with PKCε intact — which are glucose intolerant — we saw more of the unhealthy, engorged fat cells, that tend to have less access to oxygen and become inflamed.”

This suggests to the researchers that adipose tissue may have a much more far-reaching effect on metabolic health than previously believed.

“We know that fat tissue is a lot more than just an inert mass for storing fat,” says Schmitz-Peiffer.
“[I]t’s a very dynamic organ, it sends many messages and releases factors that communicate with the rest of the body, including the liver.”

“If PKCε is changing the nature of fat and affecting the overall health of fat cells, it’s changing the types of messages it sends and factors it releases — which could be acting on the liver and possibly other organs to interfere with glucose metabolism.”

The researchers plan to develop a drug which, when taken orally, might be able to interfere with PKCε.

These results give us an even better idea about how to target PKCε to develop the most effective treatments possible. And therapeutically targeting PKCε would be a new possible approach for diabetes treatment.”

Carsten Schmitz-Peiffer

How to make a heating pad at home

Using a heating pad can help ease aches and pains, and reduce stiffness in the muscles and joints. This is one way to provide heat therapy, or thermotherapy.

Many people use heating pads to reduce neck pain, back pain, muscle aches, symptoms of arthritis, and menstrual cramps.

In this article, we describe three ways to make a heating pad at home. We also explore how heat can help relieve a variety of symptoms.

3 ways to make a homemade heating pad

Many stores sell heating pads, but they are easy to make at home.

To make a heating pad, use:

1. A wet dishcloth

Place a wet dishcloth in a freezer bag and heat it in a microwave. First, make sure that the bag is microwave safe.

Wrap the hot pack in a towel and place it on the affected area for 15–20 minutes at a time.

2. An oven-heated towel

Towels can be used for homemade heating pads.
A person can use a towel to make a homemade heating pad.

People can use this method to make a larger heating pad.

First, place a damp, folded towel in an oven set to 300°F (149°C). Leave the towel in the oven for 5–10 minutes. The right timing will depend on the thickness of the towel.

Once it is warm, wrap the towel in a thinner, dry cloth and place it on the affected area for 15–20 minutes.

3. An old sock

People can make reusable heating pads out of fabric or an old sock. It is also possible to use these as cold compresses by freezing rather than heating them.

Take an old, clean sock and fill it three-quarters full with uncooked rice, corn barley, or oatmeal. Tie or sew it shut and heat it in the microwave for 1–2 minutes.

To prevent burns, always test a heating pad on the inside of the arm before applying it to the affected area. It should feel comfortably warm, but not hot.

How heating pads work

Applying a heating pad can help ease pain in joints, muscles, and soft tissues. This is a form of heat therapy, or thermotherapy.

Heat increases the blood flow to the affected area, relaxing the muscles and helping to reduce stiffness in the joints.

Thermotherapy can help ease:

  • back pain
  • neck pain
  • menstrual cramps
  • migraine symptoms
  • pain following an injury
  • arthritis pain

During the healing process, increased blood circulation brings more oxygen to the injured cells. Oxygen accelerates the healing of tissues.

Heating pads are a popular method of thermotherapy. A hot bath or shower may also help.

Risks

Heating pads can pose a burn risk for people with diabetes.
Heating pads can pose a burn risk for people with diabetes.

Do not use heat therapy in the immediate aftermath of an injury. This is the inflammatory phase of healing, and heat could cause more swelling and tissue injury. Immediately after an injury, a cold compress can help reduce swelling.

Young children and elderly adults should not use heating pads.

Also, people with heat sensitivity issues should not use any form of thermotherapy. This includes people with neuropathy that results from diabetes or other conditions. They may not be able to feel a burn right away.

Women who are pregnant should not apply heating pads to the abdomen or pelvic area. They should also avoid hot tubs and bathing or showering in very hot water.

Takeaway

Heating pads can provide heat therapy, or thermotherapy. Many stores sell heating pads, but they are easy to make at home.

A homemade heating pad can ease pain from conditions such as arthritis, as well as back pain, neck pain, and menstrual cramps. Using a heating pad can also speed healing after a muscle injury.

Use any heating pad with caution, as it can burn the skin.

Seed oils are better for cholesterol than olive oil

An analysis of data from dozens of studies reveals that replacing saturated fat in the diet with unsaturated fat reduces low-density lipoprotein cholesterol. In addition, of the unsaturated fats, seed oils such as sunflower have the strongest effect.
Sunflower
Is olive oil or seed oil, such as sunflower, more healthful?

Dr. Lukas Schwingshackl — from the German Institute of Human Nutrition Potsdam-Rehbruecke — led the new study.

This study was the first to carry out an analysis that allows the impact of several oils and solid fats on blood lipids to be assessed in a single model.

Many have compared the effect of replacing a food rich in saturated fat, such as butter or lard, with one rich in unsaturated fat, such as plant-based olive oil and sunflower. However, the evidence makes it difficult to find out which of the many plant-derived oils have the greatest benefit.

To this end, Dr. Schwingshackl and team used a statistical technique called network meta-analysis, which is gaining ground in health research as a way to glean evidence from enormous amounts of data through the use of “direct and indirect comparisons.”

Network meta-analysis

Investigators use network meta-analysis to find answers that could otherwise only be addressed in “giant studies” that compare the effect of many different interventions on a single result.

“The beauty of this method,” Dr. Schwingshackl explains, “is that you can compare a lot of different interventions simultaneously.”

The end result, he adds, is that “you can say” which of the oils is best for the “specific outcome.”

The method, for instance, allows a comparison of butter with sunflower oil to be inferred indirectly by analyzing the results of two trials: one that tested butter against olive oil directly, and another that tested sunflower against olive oil directly.

The new findings feature in a paper that is now published in the Journal of Lipid Research.

A modifiable cardiovascular risk factor

According to the World Health Organization (WHO), heart disease and stroke are the biggest killers worldwide and have been so for 15 years. In 2016, 15.2 million people died because of these cardiovascular diseases.

In their study background, the investigators explain that dyslipidemia, or abnormal blood levels of lipids such as cholesterol, is a major cardiovascular risk factor that people can modify.

“It is well-established,” they point out, that replacing saturated fatty acids with either mono- or polyunsaturated fatty acids reduces low-density lipoprotein (LDL) cholesterol, the “bad kind,” which is a “strong risk factor” for cardiovascular disease.

For their network meta-analysis, they searched databases going back to 1980 for studies that had compared the effect of different types of dietary fats on blood lipids.

The researchers found 55 studies that matched their criteria for inclusion. These had assessed the impact on blood levels of various lipids of consuming the “same amount of calories” from two or more types of solid fats or oils over a minimum of 3 weeks.

Their analysis compared the effect of 13 oils and solid fats: safflower oil, sunflower oil, rapeseed oil, flaxseed oil, olive oil, hempseed oil, corn oil, coconut oil, palm oil, soybean oil, butter, beef fat, and lard.

Seed oils were the ‘best performers’

Dr. Schwingshackl reports that the “best performers” were safflower oil, sunflower oil, rapeseed oil, and flaxseed oil. In contrast, “solid fats like butter and lard are the worst choice for LDL,” he adds.

He and his colleagues point out that their approach has limitations, and that these should be borne in mind when interpreting the results. For one, they focused on lipid levels and not disease outcomes.

“This is not a hard clinical outcome,” Dr. Schwingshackl goes on to warn. “LDL is a causal risk factor for coronary heart disease, but it’s not coronary heart disease.”

In addition, the authors feel that the method was not robust enough to pick a “winner” from the list of seed oils.

The fact that the oils that showed greatest benefit on LDL cholesterol levels were not necessarily the ones that showed a similar impact on other types of lipid, such as HDL cholesterol and triglycerides, also complicated matters.

Nevertheless, as it would be almost impossible to carry out a trial in which people are required to consume just one type of dietary fat for several years, such methods offer the next best thing.

Some people from Mediterranean countries probably are not so happy with this result, because they would prefer to see olive oil at the top. But this is not the case.”

Dr. Lukas Schwingshackl

What to know about radiation dermatitis

Radiation dermatitis is one of the side effects of cancer treatment radiotherapy that people experience most often.

Also known as radiodermatitis, it happens when radiation therapy damages the outer layers of a person’s skin.

An estimated 95 percent of people who receive radiation therapy will have some form of radiation dermatitis, including redness, skin dryness, or skin peeling.

This article will explore radiation dermatitis, including what causes it, and how people can ease the symptoms at home.

What is radiation dermatitis?

Radiation dermatitis. Image credit: CDC/ Robert E. Sumpter, 1967
Radiotherapy may cause radiation dermatitis.
Image credit: CDC/ Robert E. Sumpter, 1967

Radiation dermatitis is a common side effect of radiotherapy, which is one of the most frequently used treatments for cancer.

Radiation dermatitis can vary in severity. Some people will experience mild redness and itchiness, while others may suffer painful, broken skin that is prone to infection.

The effects of radiation dermatitis typically arise within a few days or weeks of starting radiotherapy, depending on the dose of radiation, and a person’s skin sensitivity.

The symptoms only appear on the areas of skin that doctors had to expose to the radiation.

Symptoms of radiation dermatitis

Symptoms of radiation dermatitis include:

  • skin redness or pinkness, known as erythema
  • skin swelling, or edema
  • dry, peeling skin, called dry desquamation
  • skin that thins and weakens called moist desquamation
  • blisters or skin ulcers

The severity of radiation dermatitis varies between people and radiation doses in the following grades:

  • Grade 1, faint redness and skin peeling
  • Grade 2, moderate redness and swelling, skin thinning in the skin folds
  • Grade 3, skin thinning more than 1.5 centimeters across, not just on the skin folds, plus severe swelling
  • Grade 4, death of skin cells and deep skin ulcers

Sometimes, these effects can also develop weeks or years after radiotherapy has finished. This is called radiation recall.

In severe cases, the symptoms can restrict movement in the affected limb, which can interfere with day-to-day activities. People may find it difficult to wear clothes on the sensitized areas.

Causes

Person undergoing radiation therapy wearing mask on face.
Radiation therapy can destroy cancer cells.

Radiation therapy is when doctors use high-energy waves, such as X-rays, or gamma rays, to destroy or damage the cancer cells. These rays make tiny breaks in the DNA inside the cells, stopping it from growing and dividing.

During the treatment, doctors also unavoidably expose normal cells that are near the cancer cells to the radiation. This includes skin cells, and the damage causes radiation dermatitis.

In most cases, the cells will recover and return to normal after the course of radiotherapy has finished.

Risk factors

The likelihood of developing radiation dermatitis during radiotherapy depends on several things. These are called risk factors.

People have a higher chance of skin problems if they are:

  • older
  • malnourished
  • a smoker
  • have overlapping skinfolds
  • have poor skin strength before radiation therapy
  • obese
  • undergoing chemotherapy also
  • have another health condition, such as diabetes or kidney failure

Genetics also play a role, meaning some people are more susceptible to radiation dermatitis than others.

The type of radiotherapy someone has, as well as how and to which part of the body doctors deliver it, can also make a difference.

People are more likely to get radiation dermatitis if their treatment involves the following:

  • high doses of radiotherapy
  • radiotherapy on a large area of the body
  • radiotherapy over a long period of time

Radiation to the head, neck, breast, chest wall, the vulva or near the anus is more likely to cause radiation dermatitis.

Home treatment

Person putting moisturizer lotion on their hands
Gentle lotions and moisturizers may ease the symptoms of radiation dermatitis.

The American Cancer Society offer advice to people suffering from mild skin problems, during cancer treatment.

If the skin is dry, it may be red, rough and flaky, or cracked or bleeding. In this case, the organization recommend:

  • putting mineral or baby oil in bath water or applying it to damp skin after a shower
  • washing with cool or warm water
  • avoiding any scrubbing of the skin while washing
  • using an alcohol-free moisturizer twice a day
  • avoiding colognes or after-shaves that contain alcohol
  • using an electric razor
  • drinking lots of fluids

If the skin is itchy, a number of soothing methods are worth trying. These include:

  • applying calamine lotion or witch hazel
  • bathing in warm water
  • adding baking soda, bath oil, or a mesh bag of oatmeal to bath water
  • using a mild, unscented soap
  • using baking soda instead of deodorant
  • avoiding alcohol-based skin products
  • drinking plenty of fluids
  • getting plenty of rest

It is essential for people to resist the urge to scratch itchy skin, as this can lead to sores and scarring. Calm the itch by wrapping a bag of crushed ice in a damp towel, and holding it on the itchy skin.

Other top tips include:

  • keeping nails clean and short to prevent scratching
  • wearing clean fabric gloves
  • gently rubbing the skin instead of scratching so as not to break the surface
  • wearing loose, soft clothing

Medical treatment

While people can care for mild skin irritations at home, it is important for them to speak to their cancer care team if they experience any of the following:

  • itching that does not go away after 2 or more days
  • very rough, painful skin
  • yellowish skin
  • tea-colored urine
  • open or bleeding skin
  • a rash that gets worse after using creams or ointments
  • blisters, bright red skin, or crusts on the skin
  • signs of infection, such as pus or tenderness near broken skin

If itching is stopping someone from sleeping, their healthcare team may prescribe medications to ease the sensation.

If the skin irritation is accompanied by hives, which are itchy white or red welts on the skin, shortness of breath or swelling of the throat or face, it could be an allergic reaction. This reaction requires emergency medical attention.

Outlook

Radiation dermatitis is a common side effect of radiotherapy, which can damage skin cells as it fights cancer cells. Symptoms include redness, skin peeling, and ulceration. It usually begins to resolve after treatment ends. In some cases, it can appear years after radiotherapy has finished.

People can treat the symptoms of radiation dermatitis at home using soothing skincare routines. Healthcare teams may also provide creams and other treatments.

How does RA affect different parts of the body?

People feel the primary symptoms of rheumatoid arthritis in their joints. However, this condition can also affect many other parts of the body, including the eyes, lungs, and heart.

Rheumatoid arthritis (RA) causes a person’s immune system to mistakenly attack healthy tissue. When left untreated, RA can have wide-ranging effects.

Along with the joints, RA can affect many of the body’s organs, including the heart, eyes, and brain, as well as the skeleton. Medication for RA can also cause side effects across the body.

In this article, we look at RA’s diverse range of impacts. We also discuss the long-term effects of RA on the body and the likely outcomes.

Which body parts are affected by RA?

RA is an autoimmune disease. Doctors also classify it as a systemic disease because of the extensive changes it can make to different parts of the body.

Effects on the body of rheumatoid arthritis infographic
Image credit: Stephen Kelly, 2018

The joints

RA can affect any joint in the body, and it commonly develops in the fingers, hands, and feet.

The condition can also affect joints in the:

  • neck and its vertebrae
  • spine
  • knees
  • ankles
  • hips
  • shoulders

RA primarily targets the lining of the joints, called the synovium. The condition causes the synovium to become inflamed and swollen.

When the lining of a joint swells, it can lead to stiffness, pain, and a loss of mobility. People often experience joint pain and stiffness in the mornings, and this can be one of the first signs of RA.

The skeleton

The joints contain cartilage, which prevents the bones from rubbing together. Over time, inflammation from RA can cause the cartilage to break down.

If the bones rub against one another, it can permanently damage the joint. This is a significant cause of pain and stiffness in people with advanced RA.

Rheumatoid arthritis can also cause the bones to lose density, becoming thinner and more brittle. This increases the risk of breaks and fractures.

The skin

In as many as 20 percent of people with RA, rheumatoid nodules form near the joints. These are small, firm bumps made of inflammatory tissue.

Rheumatoid nodules develop under the skin, over bony areas. While they are often painless and are generally not a cause for concern, they can cause discomfort if a person places pressure on them, such as when kneeling.

RA can also cause inflammation in the skin, sometimes leading to:

  • red patches
  • swelling
  • ulcers or lesions

When RA affects the skin, a person may notice symptoms ranging from harmless red dots to ulcers on the legs or under the nails.

They may also notice that wounds heal more slowly than usual. Many factors can cause longer healing times in people with RA, including vasculitis, or inflammation of the small blood vessels in the skin.

Some RA medications can also cause skin rashes.

The mouth

People with RA are more likely than others to experience dry mouth, or xerostomia.

Having RA increases a person’s risk of developing Sjogren’s syndrome, which causes dryness in the eyes and mouth. Like RA, Sjogren’s syndrome is an inflammatory autoimmune disorder.

RA can also cause saliva ducts to narrow or close, leading to an uncomfortable feeling of dryness in the mouth and difficulty eating and swallowing.

Chronic dry mouth can also contribute to gingivitis and tooth decay.

The eyes

RA can also cause inflammation in the eyes, as well as dry eye syndrome, which can lead to ongoing irritation and eventually damage the cornea.

The effects of RA on the eyes can include:

  • keratitis sicca, or dry eye syndrome
  • scleritis, or inflammation of the whites of the eyes
  • uveitis, or inflammation of the inner eye
  • retinal vascular occlusion, or blocked blood vessels in the eye
  • glaucoma, which damages the optic nerve
  • cataracts, which results from inflammation in the optic lens

The lungs

In around 80 percent of people, RA affects the lungs. The effects are usually not severe enough to cause symptoms. However, prolonged inflammation in the lungs can lead to pulmonary fibrosis, which can cause scarring and breathing difficulties.

Rheumatoid nodules can also form in the lungs, though these are not usually a cause for concern.

Some RA medications can make the immune system less effective. This can make people more vulnerable to respiratory infections, including pneumonia and tuberculosis.

The heart

Inflammation from RA can damage the heart and blood vessels. In some cases, the consequences are life-threatening.

RA can cause the following complications:

  • Anemia: Unchecked inflammation can lead to iron-deficiency anemia. This refers to a low level of red blood cells, and it can cause headaches and fatigue.
  • Atherosclerosis: Chronic inflammation can damage the walls of the blood vessels. This can cause the body to absorb more cholesterol, which can cause plaque to build up inside the arteries. The medical term for this is atherosclerosis.
  • Heart attack or stroke: If plaque builds up and blocks an artery or another blood vessel, a heart attack or stroke can result.
  • Pericarditis: RA can cause inflammation in the lining of the heart (the pericardium), and this can lead to chest pain.

The nerves

RA causes inflammation and swelling, which can compress the nerves in the area. When this occurs, a person may notice numbness or tingling in the hands or feet.

When RA develops in the wrist, it can lead to carpal tunnel syndrome. This occurs when inflamed tissue in the wrist squeezes a nerve that extends from the forearm.

The feet

Rheumatoid arthritis in the feet
RA can develop in the joints of the toes.

If RA affects the feet, it can limit a person’s mobility. Because the feet bear the entire weight of the body, the pain from RA can become severe.

The condition often develops in the joints of the toes and, less commonly, the ankles.

RA in the feet can also lead to:

  • Inflamed bursae: These fluid-filled sacs often appear on the balls of the feet and can cause chronic pain.
  • Nodules: These small, firm lumps can form on the pad of the heel, the Achilles tendon, and other bony areas.
  • Corns and calluses: These patches of hard, thick skin tend to develop as the shape of the foot changes. They can lead to ulcers if a person does not receive treatment.
  • Nerve compression: When RA damages a joint, this can compress the surrounding nerves and cause numbness and tingling.
  • Circulation problems: Inflammation in the blood vessels and joint damage can block the flow of blood to the feet. The feet or toes may become numb easily or develop a bluish tinge.

The mind and brain

Many people with RA may experience psychological or neural symptoms, including:

  • brain fog
  • depression
  • cognitive issues
  • changes in behavior

These symptoms may arise:

  • as side effects of medication
  • as a result of body-wide inflammation
  • when damage to the bones in the joints leads to a compression of nearby nerves

The kidneys and liver

Prescription medications for RA can cause complications, including liver and kidney damage. This can result from long-term use of painkillers or anti-inflammatory medications.

Long-term effects of rheumatoid arthritis

Rheumatoid arthritis is a progressive disease. This means that if a person does not receive treatment, the symptoms usually get worse.

Over time, a person may notice symptoms in other joints or parts of the body. Or, existing symptoms may grow more severe.

RA causes inflammation in one or more joints. This can cause the cartilage in the joints to wear away. As a result, the bones may rub together and eventually start to erode, causing permanent damage.

Medications can slow the progression of the disorder. In more advanced cases, surgery or joint replacements can help.

RA can be unpredictable. In the long term, people with RA may notice:

  • changes in the severity and frequency of symptoms
  • periods in which symptoms flare up, which can become more or less frequent
  • periods of remission that vary in length

When RA progresses, a person experiences more frequent symptoms, and pain often grows worse.

Below are common indications that RA is progressing:

  • pain and swelling increasing
  • pain and swelling occurring more regularly
  • other symptoms arising more frequently and lasting for longer periods
  • symptoms appearing in new areas
  • blood tests recording higher levels of rheumatoid factor

If a person notices new symptoms, or if symptoms worsen or appear more frequently, they should contact a doctor.

People with progressive RA often benefit from a tailored treatment plan. The doctor will build this according to the person’s symptoms and history. Treatment can also involve specialists in different areas.

Outlook

Every person with RA has a different experience. Fortunately, many treatments and therapies are available, and a person often benefits from a combination of these. For some people, surgery can also help.

Typically, a doctor will monitor any changes in the condition with testing that may involve blood work or imaging.

Treatment will focus on minimizing pain, slowing the progression of RA, and optimizing a person’s mobility.

Cardiovascular disease: Study finds best drugs for prevention

A large cohort study has identified which treatment combinations work best for people with high blood pressure who are at risk of heart disease. Taking both blood pressure drugs and statins might be the best choice, the researchers find.
organizer with different pills
Which treatments work best for preventing cardiovascular events?

Researchers from the William Harvey Research Institute at Queen Mary University London in the United Kingdom have recently made public the results of a large long-term study that looked at the efficiency of different treatments in keeping cardiovascular disease at bay.

A combination of blood pressure-lowering drugs and statins (which are drugs that help regulate cholesterol levels) show the best results, the experts explain.

They presented the study’s results at the European Society of Cardiology annual congress, held in Munich, Germany, and they featured them in a dedicated paper now published in The Lancet.

“Patients in their mid-60s with high blood pressure were less likely to die from heart disease or stroke by age 75–80 if they had taken both calcium channel blocker-based blood pressure lowering treatment and a statin,” explains Dr. Ajay Gupta.

Best preventive approach against stroke?

The scientists derived their results from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study, which continued the work started by the original ASCOT.

In the new study, the investigators followed 8,580 U.K. participants who were initially recruited in 1998–2000. All of the participants had high blood pressure at baseline, as well as several risk factors for developing cardiovascular disease.

The original ASCOT study had three main aims; first, to test which of two approaches to treatment — a traditional or an innovative one — would work best for preventing heart attacks.

To do so, the team gave some participants the innovative therapy, which consisted of amlodipine and, if necessary, perindopril. These are two specialized drugs that aim to lower blood pressure.

The other participants all took the traditional treatment of atenolol (another blood pressure drug), and bendroflumethiazide (which is a diuretic used to treat hypertension), to which potassium was added on a case-by-case basis.

Since the novel approach proved effective in preventing strokes and premature death after a median period of 5.5. years, the researchers stopped the trial at that point.

The ASCOT study’s second aim was to see whether people with high blood pressure who also took statins would be any more shielded against the development of coronary heart disease. The team gave this new treatment to those with hypertension and average cholesterol levels (under 6.5 millimoles per liter).

On the basis of a randomized allocation, these participants took either atorvastatin or a placebo for 3.3 years. Once more, the trial was so successful in preventing heart attacks and strokes that it ended early.

Finally, the ASCOT study also aimed to assess the overall effectiveness of the two therapies for blood pressure in individuals with hypertension and high cholesterol (reading over 6.5 millimoles per liter).

The researchers did not give statins to this group of participants over the 5.5 years during which they were involved in the study.

‘These results are remarkable’

Based on the ASCOT data, Dr. Gupta and team were able to assess the effectiveness of the various treatment combinations in the long-term.

They found that the study participants who had taken amlodipine and perindopril for 5.5 years had a 29 percent lower likelihood of having died due to a stroke 10 years later, compared with the participants who followed the traditional therapy for blood pressure.

Moreover, participants with average cholesterol levels at baseline who took a statin during the trial had a 15 percent lower risk of death due to heart disease and stroke after 16 years, compared with those who only took a placebo.

Also, the participants with high cholesterol at baseline who took their usual cholesterol-lowering treatment as well as the innovative blood pressure therapy saw 21 percent fewer deaths due to cardiovascular disease over 10 years.

These results are remarkable. We have previously shown that statins confer long-term survival benefits after trials have stopped, but this is the first time it has been found with a blood pressure treatment.”

Study co-author Prof. Peter Sever

Prof. Mark Caulfield, the director of the William Harvey Research Institute, also emphasizes the importance of the study’s findings for preventive medicine.

“This study confirms the importance of lowering blood pressure and cholesterol to prevent disabling and life-shortening cardiovascular disease,” he notes.

Best exercises for rheumatoid arthritis pain

For people with rheumatoid arthritis (RA), exercise can be hugely beneficial for relieving pain and joint stiffness. Exercising and stretching can be particularly helpful during a flare.

People with RA who exercise may find that they have less pain that those who do not. Exercise can reduce painful symptoms, improve joint function and flexibility, increase range of motion, and boost mood.

It is best to seek medical advice before starting any exercise program and to work with a doctor and a physical therapist to develop a tailored exercise plan.

Best exercises for RA pain

The following types of exercise may help relieve the pain, joint stiffness, and other symptoms that RA can cause:

1. Stretching

Seniors walking in a park which is an exercise for ra pain
Walking can help with joint health.

Stretching can help improve flexibility, reduce stiffness, and increase range of motion. Stretching daily, ideally in the morning, is important for relieving RA symptoms.

The ideal stretching routine will be different for each person and will depend on which joints are affected and what symptoms occur. However, stretches often involve slowly and gently moving the joints of the knees, hands, and elbows.

A typical stretching routine may consist of:

  • Warming up by walking in place or pumping the arms while sitting or standing for 3–5 minutes.
  • Holding each stretch for 10–20 seconds before releasing it.
  • Repeating each stretch 2–3 times. Using a yoga strap may help people maintain proper form while stretching.

Many people will find it beneficial to work with a physical therapist who understands RA to learn the correct way to perform the stretches that meet their personal needs.

2. Walking

Walking is a low-impact form of exercise that can help with aerobic conditioning, heart and joint health, and mood.

It is essential to wear proper shoes and stay hydrated, even if the walking is not strenuous. It is often sensible to walk slowly initially and then increase the pace when possible.

3. Flowing movements, such as tai chi and yoga

Both tai chi and yoga combine deep breathing, flowing movements, gentle poses, and meditation. They increase flexibility, balance, and range of motion while also reducing stress.

It is possible to buy DVDs of tai chi or yoga workouts that are specifically for people with RA.

4. Pilates

Pilates is a low-impact activity that stabilizes the joints and strengthens the muscles around them. People new to Pilates should begin with a routine that uses a mat rather than a machine to build muscle strength safely.

5. Water exercises

Water helps support body weight, which means that water exercises do not impact heavily on the joints.

Swimming, water aerobics, and other gentle water exercises can increase flexibility, range of motion, strength, and aerobic conditioning. They can also reduce joint stress and stiffness.

6. Cycling

As RA increases the risk of cardiovascular disease, it is vital to keep the heart as healthy as possible. Riding a stationary bike can be a safe way to get the joints moving and improve cardiovascular fitness.

In addition to improving aerobic conditioning, cycling can reduce stiffness, increase range of motion and leg strength, and build endurance.

7. Strength training

Strengthening the muscles around the affected joints can help increase strength while reducing pain and other RA symptoms.

Using a resistance band is one of the best ways to challenge the body and build muscle over time. A physical therapist who works with people with RA should be able to offer guidance on suitable exercises.

8. Hand exercises

RA can sometimes lead to limited use of the hands. Bending the wrists up and down, slowly curling the fingers, spreading the fingers wide on a table, and squeezing a stress ball can all help increase strength and flexibility in the hands.

9. Gardening

As well as being a form of exercise, gardening offers the benefit of improving mood. People should be gentle with their body, work slowly, and avoid overstraining the muscles and joints.

Tips for exercising with RA

The tips below may improve safety and comfort when exercising with RA:

Be consistent

People need to exercise consistently to achieve meaningful results. It is important to keep at it and practice regularly. Some days may be less comfortable than others, but it is possible to adjust the intensity accordingly.

Accessorize for comfort and protection

Yoga mat being rolled out
Use a slip-resistant yoga mat to reduce the risk of injury.

The following methods can help people exercise more comfortably with less risk of injury:

  • Choosing proper shoes that provide the right protection and balance.
  • Using a slip-resistant yoga mat.
  • Wearing comfortable clothes that wick sweat away quickly.

Listening to music can provide motivation and help pass time when exercising.

Seek variety

RA symptoms can vary daily, and they tend to come in waves. People often experience flares and periods of remission.

Doing a variety of exercises and mixing up the daily routine can help people avoid overworking one set of muscles or particular joints.

For example, a person doing morning stretches each day may choose to add strength training twice a week, a water workout once a week, and yoga or tai chi twice a week, symptoms permitting. This variety should prevent any overuse injuries, which can aggravate symptoms and counter the benefits of the exercise.

Adjust exercises according to symptoms

On days when symptoms are more severe, people can reduce the intensity of the exercise. For example, they could place a resistance band around the forearms instead of holding it in the hands.

Alternatively, they can try a different type of exercise or exercise for a shorter time.

On days when cycling or swimming seems too much, switching this type of activity to a leisurely stroll or some stretching will still be beneficial.

Listen to the body

It is important for people with RA to remain as physically active as possible. However, it is equally crucial to avoid discomfort or injuries.

It is vital to choose the right pace and listen to the body. If exercise causes discomfort or a flare, it is best to reduce the session. For example, do 10 minutes instead of 30. People should also take time off when necessary.

Pay attention to small things

Most exercises focus on large muscle groups. It is essential to make time for smaller parts of the body, such as the hands and fingers. Creating a daily routine out of these focused exercises can help.

Work with a physical therapist

Working with a physical therapist who specializes in RA can be helpful in developing a safe and appropriate exercise routine. This collaboration can be particularly beneficial for people with a new RA diagnosis or those who are experiencing a severe flare.

Exercises to avoid

People with RA should avoid strenuous exercise or any exercises that cause pain. These may include high-impact exercises that put excessive strain on the joints.

However, there are no specific exercises that everyone with RA should avoid. Each person is different, and an activity that causes pain for one person may not have the same effect on another person.

What is right for someone will depend on their situation and health condition. However, everyone is likely to benefit from paying close attention to their body and working with a doctor or physical therapist for guidance.

Outlook

Exercise is usually very helpful for people with RA. It offers a range of benefits, which include relieving symptoms, improving joint function, building strength, increasing flexibility, helping daily functioning, improving aerobic fitness, and boosting mood. It can reduce RA flares and make the symptoms of this condition easier to manage.

It is a good idea to work with a doctor and physical therapist to develop a personalized exercise program for the best possible results.

Can you take Aleve and Tylenol together?

Aleve is the brand name for over-the-counter naproxen, and Tylenol is the brand name for acetaminophen. Most people can take the two medications together.

Doctors and pharmacists may recommend Tylenol or Aleve to reduce fevers or mild to moderate pain, such as that caused by:

If the pain is moderate or severe, a person may wonder if it is safe and effective to take both types of pain medication together.

Is it safe to take Aleve and Tylenol together?

Aleve and tylenol
Taking Aleve and Tylenol at the same time is safe.

Yes, Aleve and Tylenol are generally safe to take at the same time. However, taking them at different times is often more effective.

A person could start, for example, by taking Tylenol in the morning. The pain may return before the next scheduled dose, depending on the strength of the Tylenol. At the first sign of pain, a person could take Aleve and continue to alternate the two as necessary.

Staggering the medications can help to extend the relief from pain.

If instead, a person takes both at the same time, the combined pain relief may wear off before it is safe to take the next doses.

There are other ways to alternate the medications effectively.

For example, a person may take either Tylenol or Aleve every day to help control aches and pains from arthritis. If new pain arises, they could take the other drug as needed.

Or, if the pain is severe, taking regular doses of Tylenol may not provide relief. A person may decide to add regular doses of Aleve. The combination may work better than either drug alone.

How does Aleve work?

Aleve is an anti-inflammatory drug. As inflammation decreases, a person usually experiences less pain.

Naproxen sodium is the active ingredient in Aleve. Naproxen sodium belongs to the class of nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs reduce the chemicals that cause inflammation.

How does Tylenol work?

The active ingredient in Tylenol is acetaminophen, which blocks pain signals in the brain.

Acetaminophen is an analgesic and antipyretic. It inhibits the pain sensors in the nervous system, and it can also reduce fevers.

However, researchers still do not fully understand how acetaminophen blocks pain signals.

Dosage

Aleve and tylenol dosage
Doctors recommend starting off with the smallest dose of a drug, as this reduces the risk of side effects.

Healthcare professionals usually suggest starting off with the smallest dosage of a drug. If the symptoms persist, they then recommend increasing the dosage or adding another medication.

Starting off with the lowest effective dosage reduces the risk of side effects.

Doctors generally recommend taking different dosages of Aleve and Tylenol. The same is true for other drugs that contain naproxen or acetaminophen.

The recommended dosage of Aleve, for adults, is one pill every 8–12 hours. However, this depends on the strength of the medication.

A person can usually take acetaminophen-based pain relievers like Tylenol more frequently.

Tylenol generally comes in 325 milligram (mg), 500 mg, or 650 mg pills. Citing the product’s labeling, Harvard Medical School reports that a healthy adult can take Tylenol in any of the following doses:

  • 1 or 2 325 mg pills every 4–6 hours, taking no more than 8–10 pills per day
  • 1 or 2 500 mg pills every 4–6 hours, taking no more than 6 pills per day
  • 1 or 2 650 mg extended release pills every 8 hours, taking no more than 4–6 pills per day

Interactions

Taking Tylenol and Aleve together will not cause any drug interactions.

If a person takes either medication regularly, it may be a good idea to use the other when additional pain arises.

If either Aleve or Tylenol is insufficient to relieve pain, a person may benefit from adding a staggered dosage of the other medication.

Anyone experiencing ongoing pain should speak with their doctor about the best treatment options.

Considerations and risks

Aleve and tylenol ingredients
Reading drug labels is essential, as they list potential side effects or complications.

Both Aleve and Tylenol can cause side effects.

Read the labeling of these products carefully to understand the correct dosage and potential complications. When in doubt, it is important to speak with a doctor.

Acetaminophen is a very common ingredient in over-the-counter medications, such as cough and cold medicines. If a person takes multiple products that contain the drug, they may accidentally overdose. The most common result of an acetaminophen overdose is liver damage.

Naproxen-based pain medication can also be harmful if a person does not take it as directed. The most common side effects are allergic reactions and bleeding in the stomach.

Takeaway

The medical community considers it generally safe to take Tylenol and Aleve at the same time.

However, alternating doses of Aleve and Tylenol can extend the relief from pain. A person can take one as the other starts to wear off.

A person should only take the recommended doses of these medications. Also, do not take Aleve or Tylenol for more than 10 days at a time.

Anyone with questions about these medications should speak to a doctor or pharmacist.

Why a low-carb diet may not be so good for you

A large-scale, two-part study now published in The Lancet Public Health journal examines the effects of high, moderate, and low carbohydrate intake on mortality risk.
woman saying no to carbs
The results of a new study could make you think twice before turning down carbs.

As more and more people are concerned with losing weight, the prevalence of the low-carb diet is increasing.

However, new research points out that both too much carbohydrate and too little in our diet may be a cause for concern.

Also, according to the new research, if you must choose between two types of low-carb diet, you should choose the one that replaces carbs with plant-derived proteins and fats.

Such diets may help prolong life — unlike the diets that replace carbs with animal proteins and fat.

Dr. Sara Seidelmann, who is a clinical and research fellow in cardiovascular medicine at Brigham and Women’s Hospital in Boston, MA, led the research.

According to her, “Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy.

“However, our data suggest that animal-based low-carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall lifespan and should be discouraged.”

Instead, if one chooses to follow a low-carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy aging in the long-term.”

Dr. Sara Seidelmann

Studying carbohydrate intake and mortality

Dr. Seidelmann and colleagues explain the motivation for their research. Previous studies, they say, have suggested that low-carb diets are good for weight loss and metabolic health.

However, these findings referred only to the short term. The long-term effect of a low consumption of carbs on mortality risk has not garnered enough attention in the research community, and the studies that have examined the matter yielded conflicting results.

Also, studies have not yet looked at the fat and protein sources in these low-carb diets, and their impact on mortality risk.

To remedy this, the researchers studied over 15,400 people, aged 45–64, who registered in the Atherosclerosis Risk in Communities study in 1987–1989.

The male study participants reported an intake of 600–4200 kilocalories per day, on average, while the females said that they consumed 500–3600 kilocaleries per day.

The participants answered questions about their dietary habits both at the beginning of the study and 6 years later, at follow-up. The questionnaire asked about what types of food and drink the participants consumed, in what portions, and with what frequency.

Then, the scientists analyzed the link between overall carbohydrate consumption and mortality from any cause.

In the second stage of the study, the team conducted a meta-analysis of cohort studies that summed up over 430,000 people from across the world.

Moderate-carb, plant-based diet may be ideal

The first part of the study revealed that both a low intake of carbs (less than 40 percent of the total energy intake coming from carbs) and a high intake (or over 70 percent) correlated with a higher risk of premature mortality.

By comparison, a moderate carb intake of 50–55 percent of the total energy was found to correlate with 4 more years of life expectancy, compared with people who consumed too little carbohydrate.

The second part of the study reinforced these findings and found that replacing carbs with animal proteins in a low-carb diet correlated with a higher risk of mortality than consuming carbs in moderation.

“Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate,” says study co-author Walter Willett, a professor of epidemiology and nutrition at the Harvard T. H. Chan School of Public Health in Boston, MA.

Senior study author Dr. Scott Solomon, a professor of medicine at Harvard Medical School, weighs in on the findings.

“This work,” he says, “provides the most comprehensive study of carbohydrate intake that has been done to date, and helps us better understand the relationship between the specific components of diet and long-term health.”

While a randomized trial has not been performed to compare the longer-term effects of different types of low-carbohydrate diets, these data suggest that shifting towards a more plant-based consumption is likely to help attenuate major morbid disease.”

Dr. Scott Solomon

Is it safe to drink alcohol while taking Lexapro?

Lexapro is the brand name of a drug called escitalopram, which doctors prescribe to treat depression and anxiety. Medical practitioners consider Lexapro to be safe and effective for these conditions. However, they do not recommend that people drink alcohol while taking Lexapro.

Lexapro belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Serotonin is a chemical messenger or neurotransmitter that affects mood. SSRIs help to restore the natural balance of serotonin in the brain.

Doctors consider SSRIs to be one of the safest types of antidepressants. However, some people taking Lexapro may experience one or more of the following side effects:

In this article, we look at the risks of drinking alcohol while taking Lexapro or other antidepressants, including how alcohol may worsen their side effects.

Can you drink alcohol while taking Lexapro?

Lexapro and alcohol
Doctors advise against drinking alcohol while taking Lexapro.

Doctors usually do not recommend drinking alcohol while taking Lexapro or any other antidepressant. This guidance is because alcohol can make depression worse and can counteract the benefits of a person taking antidepressants.

People who drink alcohol while taking Lexapro may feel more depressed or anxious, and these symptoms may then become more challenging to treat.

This worsening scenario is potentially dangerous as it can lead to some people having an increase in suicidal thoughts.

Drinking alcohol may also worsen some of the side effects of Lexapro or other antidepressants, including drowsiness and dizziness. This is because alcohol can also cause these side effects.

Doctors also strongly recommend that people do not stop taking Lexapro or any other antidepressant to drink alcohol. Antidepressants require steady daily doses to work and stopping abruptly can cause withdrawal issues, such as:

  • flu-like symptoms
  • pins and needles
  • nausea and vomiting
  • headaches
  • irritability
  • nightmares

Is any amount of alcohol safe while taking Lexapro?

Alcohol can negatively impact the treatment of depression even when someone consumes it in moderation.

For people who are taking an SSRI antidepressant, such as Lexapro, and who are at low risk of alcohol use disorder, it may be safe to have a small amount of alcohol occasionally.

However, a person should always talk to their doctor before having any alcohol if they are also taking Lexapro or any other medicines.

In general, doctors consider drinking in moderation to be no more than:

  • one alcoholic drink per day for women
  • two alcoholic drinks per day for men

Guidelines in the United States consider one drink to be:

  • 12 ounces (oz) of 5 percent alcohol by volume (ABV) beer
  • 5 oz of a 12 percent ABV wine
  • 1.5 oz of a 40 percent ABV whiskey

Doctors recommend that people who wish to drink alcohol while taking antidepressants should drink slowly and have the alcohol with food.

Alcohol can also interfere with other any other drugs a person may be taking, including many other-the-counter (OTC) medications. Some OTC treatments, such as cough syrups, also contain small amounts of alcohol. A person should always inform their doctor of all the medications they are taking.

General effects of alcohol on mental health issues

Lexapro and alcohol use with depression
Drinking alcohol can worsen the symptoms of depression and anxiety.

Alcohol can affect the body in many ways. While it can temporarily relax a person and improve their mood, it can have serious effects on mental health in the longer-term and can worsen symptoms of depression and anxiety.

Alcohol can disrupt the natural chemical balance of the brain and can interfere with the central nervous system. Excessive alcohol consumption can:

  • increase the risk of accidents and injuries
  • make a person violent or aggressive
  • cause mood swings
  • affect memory and concentration
  • cause slurred speech
  • impair coordination and reaction time
  • lead to respiratory difficulties

In the longer-term, alcohol can cause depression and anxiety and increase the risk of self-harm and suicide.

Excessive alcohol consumption can also lead to alcohol use disorder. People with depression are at greater risk than others of developing alcohol use disorder.

Developing alcohol use disorder can affect a person’s relationships and cause social problems, such as unemployment, divorce, and homelessness.

Long-term alcohol use can also increase the risk of chronic health conditions, including:

Outlook

Lexapro is a safe and effective treatment for depression and anxiety. However, doctors strongly recommend that people avoid drinking while taking antidepressants. Alcohol can worsen symptoms of depression and anxiety and can increase the side effects of antidepressants.

Anyone who wishes to drink alcohol while taking Lexapro or any other medication should speak to their doctor first.

Could beef jerky contribute to manic episodes?

Manic episodes usually occur as part of a mood disorder known as bipolar disorder, characterized by swings between opposite moods: feeling extremely “high” (mania) or feeling very “low” (depression).
beef jerky
Does eating beef jerky and other processed meats contribute to manic episodes in people who are at risk?

During a manic phase, a person experiences a state of intense emotional arousal.

They may feel euphoric and over-energetic, and this can result in hyperactivity and insomnia, as well as lead to risky behaviors.

This manic state can last from 1 week to several months, and though it is typically characteristic of bipolar disorder, it is also encountered in other conditions, such as schizoaffective disorder.

A recent study reported that the treatment of bipolar disorder costs the United States healthcare system an estimated $25 billion per year. Also, the symptoms associated with this condition can seriously affect individuals’ quality of life.

For these reasons, researchers are always on the lookout for modifiable lifestyle factors, such as diet, that may be able to influence the onset or severity of symptoms, since such factors can be fairly easily acted upon.

Recently, researchers from the Johns Hopkins University School of Medicine in Baltimore, MD, have been able to isolate one dietary factor that appears to be linked to the onset of manic episodes: eating processed meats, such as salami or beef jerky.

They report their findings in the journal Molecular Psychiatry.

Processed meats linked to mania

The first clues were identified by Dr. Robert Yolken and his team, who analyzed data regarding the health and diet of 1,101 participants aged 18 to 65, collected in 2007–2017, as part of an ongoing study. Some of these participants had a history of psychiatric conditions, while others did not.

As those with pre-existing psychiatric conditions had been recruited from among patients receiving assistance in the Sheppard Pratt Health System in Baltimore, the researchers were able to assess information regarding their dietary habits prior to hospital admission.

To the scientists’ surprise, they found that, of the participants who had been hospitalized due to a manic episode, the likelihood that they had a history of consuming processed meats was about 3.5 times higher than that of the healthy participants.

But, a history of eating processed meats was not linked to either bipolar disorder or schizoaffective disorder in individuals who were not admitted to hospital due to a manic episode.

Also, no other types of food had a significant link to the two disorders, or to the onset of a manic phase.

“We looked at a number of different dietary exposures,” says Dr. Yolken, “and cured meat really stood out. It wasn’t just that people with mania have an abnormal diet.”

What makes processed meats harmful?

But why processed meats, in particular? The research team hypothesized that this may be due to a highly controversial ingredient used in industrial meat processing and curing processes: nitrates.

Research has linked nitrates with the onset of neurodegenerative diseases such as Alzheimer’s, so the investigators involved with the new study thought it plausible that they might contribute to mania, as well.

In order to test this idea, Dr. Yolken collaborated with Kellie Tamashiro, Dr. Seva Khambadkone — both from Johns Hopkins — and other scientists to explore the effects of dietary nitrates in a rat model.

First, the scientists divided the rats into two groups: one that was to receive their regular food, and another that was to be fed store-bought beef jerky (containing nitrates) every other day, alongside the normal food.

Soon, the researchers noticed that they were on the right path, as the rats that had received the extra piece of beef jerky began to show signs of hyperactivity, as well as irregular sleeping patterns, within only 2 weeks from the start of their special diet.

The team’s next step was to “commission” a batch of beef jerky that had been prepared using more natural methods, without the added nitrates.

The scientists repeated the initial experiment in a slightly altered version: some rats were fed their regular diets plus some extra store-bought jerky prepared with nitrates, while others were given their regular food plus the nitrate-free beef jerky. A third group (the controls) remained on their regular diet.

Again, they saw that the rats that had eaten the store-bought beef jerky had symptoms similar to those of mania.

However, the ones that had eaten nitrate-free beef behaved similarly to the rats in the control group.

A key ‘environmental player?’

Dr. Yolken and team conducted a last experiment, in which they added nitrates directly to the chow in quantities that would be consistent with the amount of nitrates that a person would be expected to ingest normally in a day from store-bought meats.

“We tried to make sure,” notes Dr. Yolken, that “the amount of nitrate used in the experiment was in the range of what people might reasonably be eating.”

Some rats were fed the nitrate-enriched chow, while others ate their regular food. This was done so that, later, the researchers would be able to study the animals’ gut bacteria and look out for any changes in the bacterial populations of the rats that had ingested nitrates.

Dr. Yolken and colleagues did reveal that the animals that had been fed a nitrate-enriched diet had different bacterial strains in their guts, compared with their control group counterparts.

They also saw altered molecular pathways in the brains of the rats on the nitrate-enriched diet, and these changes mirror the ones seen in the brains of people diagnosed with bipolar disorder.

It’s clear that mania is a complex neuropsychiatric state, and that both genetic vulnerabilities and environmental factors are likely involved in the emergence and severity of bipolar disorder and associated manic episodes.”

Dr. Seva Khambadkone

“Our results suggest,” Dr. Khambadkone goes on to explain, “that nitrated cured meat could be one environmental player in mediating mania.”

The findings of this study do not necessarily indicate a causal relationship between dietary factors and the onset of manic episode, and more research is needed to understand the potential mechanisms at play.

Still, the authors believe that they add to the increasing amount of evidence indicating the impact of gut health on brain activity and psychiatric well-being.

How to cope with a depressive episode

A depressive episode in the context of a major depressive disorder is a period characterized by low mood and other depression symptoms that lasts for 2 weeks or more. When experiencing a depressive episode, a person can try to make changes to their thoughts and behaviors to help improve their mood.

Symptoms of a depressive episode can persist for several weeks or months at a time. Less commonly, depressive episodes last for over a year.

According to the Anxiety and Depression Association of America, approximately 16.1 million adults in the United States experienced at least one major depressive episode in 2015.

Read on to learn more about the symptoms of a depressive episode and 12 tips for coping with one.

Symptoms

man in bed with a depressive episode
Symptoms of a depressive episode may include anxiety, frustration, feeling hopeless, fatigue, and a loss of interest in things once enjoyed.

Symptoms of a depressive episode are more extreme than normal periods of low mood and may include:

  • feeling sad, hopeless, or helpless
  • feeling guilty or worthless
  • anxiety
  • irritability or frustration
  • fatigue or low energy
  • restlessness
  • changes in appetite or weight
  • loss of interest in things once enjoyed, including hobbies and socializing
  • trouble concentrating or remembering
  • changes in sleep patterns
  • moving or talking more slowly than usual
  • loss of interest in living, thoughts of death or suicide, or attempting suicide
  • aches or pains that do not have an obvious physical cause

For a diagnosis of depression, people must experience several of these symptoms for most of the day, almost every day, for at least 2 weeks.

Twelve tips for dealing with a depressive episode

Tackling depression as soon as symptoms develop can help people recover more quickly. Even those who have experienced depression for a long time might find that making changes to the way they think and behave improves their mood.

The following tips may help people deal with a depressive episode:

1. Track triggers and symptoms

Keeping track of moods and symptoms might help a person understand what triggers a depressive episode. Spotting the signs of depression early on may help them avoid a full-blown depressive episode.

Use a diary to log important events, changes to daily routines, and moods. Rate moods on a scale of 1 to 10 to help identify which events or activities cause specific responses. See a doctor if symptoms persist for 14 days or more.

2. Stay calm

Identifying the onset of a depressive episode can be scary. Feeling panicked or anxious is an understandable reaction to the initial symptoms of depression. However, these reactions may contribute to low mood and worsen other symptoms, such as loss of appetite and disrupted sleep.

Instead, focus on staying calm. Remember that depression is treatable and the feelings will not last forever.

Anyone who has experienced depressive episodes before should remind themselves that they can overcome these feelings again. They should focus on their strengths and on what they have learned from previous depressive episodes.

Self-help techniques, such as meditation, mindfulness, and breathing exercises can help a person learn to look at problems in a different way and promote a sense of calmness. Self-help books and phone and online counseling courses are available.

3. Understand and accept depression

Learning more about depression can help people deal with the condition. Depression is a widespread and genuine mental health disorder. It is not a sign of weakness or a personal shortcoming.

Accepting that a depressive episode may occur from time to time might help people deal with it when it does. Remember, it is possible to manage symptoms with treatments, such as lifestyle changes, medication, and therapy.

4. Separate yourself from the depression

A condition does not define a person; they are not their illness. When depression symptoms begin, some people find it helpful to repeat: “I am not depression, I just have depression.”

A person should remind themselves of all the other aspects of themselves. They may also be a parent, sibling, friend, spouse, neighbor, and colleague. Each person has their own strengths, abilities, and positive qualities that make them who they are.

5. Recognize the importance of self-care

Self-care is essential for good physical and mental health. Self-care activities are any actions that help people look after their wellbeing.

Self-care means taking time to relax, recharge, and connect with the self and others. It also means saying no to others when overwhelmed and taking space to calm and soothe oneself.

Basic self-care activities include eating a healthful diet, engaging in creative activities, and taking a soothing bath. But any action that enhances mental, emotional, and physical health can be considered a self-care activity.

6. Breathe deeply and relax the muscles

woman deep breathing and meditating at work
Inhaling and exhaling slowly has psychological benefits.

Deep breathing techniques are an effective way to calm anxiety and soothe the body’s stress response. Slowly inhaling and exhaling has physical and psychological benefits, especially when done on a daily basis.

Anyone can practice deep breathing, whether in the car, at work, or in the grocery store. Plenty of smartphone apps offer guided deep breathing activities, and many are free to download.

Progressive muscle relaxation is another helpful tool for those experiencing depression and anxiety. It involves tensing and relaxing the muscles in the body to reduce stress. Again, many smartphone apps offer guided progressive muscle relaxation exercises.

We have reviewed some meditation apps that can help with depression and anxiety.

7. Challenge negative thoughts

Cognitive behavioral therapy (CBT) is an effective therapy for those with depression and other mood disorders. CBT proposes that a person’s thoughts, rather than their life situations, affect their mood.

CBT involves changing negative thoughts into more balanced ones to alter feelings and behaviors. A qualified therapist can offer CBT sessions, but it is also possible to challenge negative thoughts without seeing a therapist.

Firstly, notice how often negative thoughts arise and what these thoughts say. These may include “I am not good enough,” or “I am a failure.” Then, challenge those thoughts and replace them with more positive statements, such as “I did my best” and “I am enough.”

8. Practice mindfulness

Take some time every day to be mindful and appreciate the present moment. This may mean noticing the warmth of sunlight on the skin when walking to work, or the taste and texture of a crisp, sweet apple at lunchtime.

Mindfulness allows people to fully experience the moment they are in, not worrying about the future or dwelling on the past.

Research suggests that regular periods of mindfulness can reduce symptoms of depression and improve the negative responses that some people with chronic or recurrent depression have to low mood.

9. Make a bedtime routine

Sleep can have a huge impact on mood and mental health. A lack of sleep can contribute to symptoms of depression, and depression can interfere with sleep. To combat these effects, try to go to bed and get up at the same time each day, even at weekends.

Establish a nightly routine. Start winding down from 8 pm. Sip chamomile tea, read a book, or take a warm bath. Avoid screen time and caffeine. It may also be helpful to write in a journal before bed, especially for those whose racing thoughts keep them up.

10. Exercise

Exercise is extremely beneficial for people with depression. It releases chemicals called endorphins that improve mood. An analysis of 25 studies on exercise and depression reports that exercise has a “large and significant effect” on symptoms of depression.

11. Avoid alcohol

Alcohol is a depressant, and alcohol use can trigger episodes of depression or make existing episodes worse. Alcohol can also interact with some medications for depression and anxiety.

12. Record the positives

Often, depressive episodes can leave people focusing on the negatives and discounting the positives. To counteract this, keep a positivity journal or gratitude journal. This type of journal helps to build self-esteem.

Before bed, write down three good things from the day. Positives include regular meditation, going for a walk, eating a healthful meal, and so much more.

Asking for help

Mother and daughter chatting over coffee
Asking for help is an important step in dealing with a depressive episode.

Dealing with depression can be daunting, but no one has to do it alone. One of the most important steps in dealing with a depressive episode is asking for help.

Seek help from:

  • Family and friends. People experiencing depression should consider telling family and friends how they are feeling, and asking for support where they need it.
  • A doctor. It is essential to speak to a doctor who can make a diagnosis and recommend treatments. Research suggests that tailoring early treatment to the individual offers the best possible outcomes.
  • A therapist. Talking to a counselor or psychotherapist can be beneficial. Talk therapy can help address low moods and negative thoughts. A therapist can also teach coping skills to help people deal with future depressive episodes.
  • Support groups. Look for a local support group for people with depression. It can be beneficial to talk to others who are experiencing the same thing.

Support lines and crisis hotlines are another way that people with depression can reach out to others. Save important numbers to a cell phone, so they are easily accessible in times of need.

Helpful numbers in U.S. include:

Support groups and helplines similar to these are also available in other countries.

Types of depression

Major depressive disorder is the most common form of depression. Other types of depression have similar symptoms and can also cause depressive episodes. These include:

  • Persistent depressive disorder lasts for a minimum of 2 years. During this period, symptoms may vary in severity but are always present. Approximately 1.5 percent of adults in the U.S. may experience persistent depressive disorder in any one year.
  • Psychotic depression causes symptoms of psychosis as well as severe depression. A person may experience delusions and hallucinations. Approximately 4 in every 1,000 people may develop psychotic depression.
  • Bipolar disorder is a mood disorder similar to major depressive disorder. Someone with bipolar disorder may also experience periods of extreme highs, called mania or hypomania. According to the National Institute of Mental Health (NIMH), approximately 2.8 percent of adults in the U.S. might develop bipolar disorder each year.
  • Postpartum depression causes major depression symptoms during pregnancy or after delivery. This condition affects nearly 15 percent of new mothers and typically requires treatment.
  • Seasonal affective disorder (SAD) causes symptoms of depression during the winter months. According to the American Academy of Family Physicians, between 4 and 6 percent of people are estimated to have SAD, while another 10 to 20 percent have a milder form of the disorder.

Possible triggers

Depression is a complex condition with many possible causes. Even though a person may be more susceptible to depression than someone else, they usually only experience a depressive episode when a stressful event triggers the condition.

Possible triggers include:

  • changes in daily routines
  • disrupted sleep
  • poor eating habits
  • stress at work, home, or school
  • feeling isolated, alone, or unloved
  • living with abuse or mistreatment
  • medical problems, such as Alzheimer’s disease, stroke, or erectile dysfunction
  • some medications, including certain antibiotics and blood pressure drugs
  • a significant life event, such as a bereavement or divorce
  • a traumatic incident, such as a car accident or sexual assault

However, it is important to note that not every depressive episode will have an obvious or identifiable trigger.

What is lisinopril?

Important warnings

  • Angioedema (swelling): This drug can cause abrupt swelling of your face, arms, legs, lips, tongue, throat, and intestines. This can be fatal. Tell your doctor right away if you have swelling or abdominal pain. You’ll be taken off of this drug and possibly given medication to reduce your swelling. Swelling can happen at any time while you’re taking this drug. Your risk may be higher if you have a history of angioedema.
  • Hypotension (low blood pressure): This drug can cause low blood pressure, especially during the first few days of taking it. Tell your doctor if you feel lightheaded, dizzy, or like you’re going to faint. You may be more likely to have low blood pressure if you:
    • aren’t drinking enough fluids
    • are sweating heavily
    • have diarrhea or are vomiting
    • have heart failure
    • are on dialysis
    • take diuretics
  • Persistent cough: This drug may cause a persistent cough. This cough will go away once you stop taking the medication.

What is lisinopril?

Lisinopril oral tablet is a prescription drug that’s available as the brand-name drugs Prinivil and Zestril. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Why it’s used

This drug is used to treat high blood pressure and heart failure. It’s also used to improve your chance of survival after a heart attack.

This drug may be used as part of a combination therapy. That means you may need to take it with other drugs.

How it works

This drug belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors.

A class of drugs is a group of medications that work in a similar way. They have a similar chemical structure and are often used to treat similar conditions.

This drug relaxes the blood vessels in your body. This reduces stress on your heart and lowers your blood pressure.

Lisinopril side effects

Lisinopril oral tablet does not cause drowsiness. However, it may cause low blood pressure. This can make you feel faint or dizzy. You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you. Lisinopril can also have other side effects.

More common side effects

The most common side effects that occur with lisinopril include:

  • headache
  • dizziness
  • persistent cough
  • low blood pressure
  • chest pain

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have any of these serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

  • hypersensitivity (allergic) reaction. Symptoms include:
    • swelling of your face, lips, tongue, or throat
    • trouble breathing
    • trouble swallowing
    • stomach (abdomen) pain with or without nausea or vomiting
  • kidney problems. Symptoms include:
    • tiredness
    • swelling, especially of your hands, feet, or ankles
    • shortness of breath
    • weight gain
  • liver failure. Symptoms include:
    • yellowing of your skin and the whites of your eyes
    • elevated liver enzymes
    • stomach pain
    • nausea and vomiting
  • high potassium levels. This drug can cause dangerously high potassium. This can lead to arrhythmia (heart rate or rhythm problems). Your risk may be higher if you have kidney disease or diabetes, or if you’re taking other drugs that increase potassium levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Lisinopril may interact with other medications

Lisinopril oral tablet can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or cause the drugs that you take to not work as well.

To help prevent interactions, your doctor should manage all of your medications carefully. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with lisinopril are listed below.

Blood pressure drugs

Taking certain blood pressure drugs with lisinopril increases your risk for low blood pressure, high blood potassium, and kidney problems including kidney failure. These drugs include:

  • angiotensin receptor blockers (ARB). Examples include:
    • candesartan (Atacand, Atacand HCT)
    • eprosartan (Teveten)
    • irbesartan (Avapro, Avalide)
    • losartan (Cozaar, Hyzaar)
    • olmesartan (Benicar, Benicar HCT, Tribenzor, Azor)
    • telmisartan (Micardis, Micardis HCT, Twynsta)
    • valsartan (Diovan, Diovan HCT, Exforge, Exforge HCT)
    • azilsartan (Edarbi, Edarbyclor)
  • angiotensin-converting enzyme (ACE) inhibitors. Examples include:
    • benazepril (Lotensin, Lotrel, Lotensin HCT)
    • captopril
    • enalapril (Vasotec, Epaned)
    • fosinopril (Monopril)
    • lisinopril (Prinivil, Zestril, Prinzide, Zestoretic)
    • moexipril (Uniretic)
    • perindopril (Aceon)
    • quinapril (Accupril, Accuretic)
    • ramipril (Altace)
    • trandolapril (Mavik, Tarka)
  • renin inhibitors:
    • aliskiren (Tekturna, Tekturna HCT)

Diabetes drugs

Taking diabetes drugs with lisinopril can lower your blood sugar level too much. These drugs include:

  • insulins
  • oral diabetes drugs

Water pills (diuretics)

Taking water pills with lisinopril can make your blood pressure too low. These drugs include:

  • hydrochlorothiazide
  • chlorthalidone
  • furosemide
  • bumetanide

Potassium supplements and potassium-sparing diuretics

Taking potassium supplements or potassium-sparing diuretics with lisinopril can increase potassium in your body. These drugs include:

  • spironolactone
  • amiloride
  • triamterene

Mood stabilizer drugs

Lisinopril can increase the effects of lithium. This means that you may have more side effects.

Pain drugs

Taking certain pain drugs with lisinopril can decrease your kidney function. These drugs include:

Neprilysin inhibitors

These drugs are used to treat heart failure. They should not be used with enalapril. Do not use enalapril within 36 hours of switching to or from a neprilysin inhibitor. Using these drugs together raises your risk of sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines (angioedema).

An example of this drug class includes:

  • sacubitril

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Lisinopril warnings

Allergy warning

This drug can cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Call 911 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

The use of drinks that contain alcohol can increase the blood pressure-lowering effects of lisinopril. This may cause you to feel dizzy or faint. If you drink alcohol, talk to your doctor.

Warnings for people with certain health conditions

For people with kidney disease: If you have kidney disease or are on dialysis, you have a higher risk of getting certain serious side effects from this drug. Your doctor will monitor your kidney function and adjust your medication as needed. Your doctor should start you on a lower dose of this drug.

For people with diabetes: This drug can affect your blood sugar levels. Your doctor may need to change your dose of your diabetes medicines. Your doctor will tell you how often to test your blood sugar levels.

Warnings for other groups

For pregnant women: This drug is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

For women who are breastfeeding: It isn’t known if this drug passes into breast milk. If it does, it may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

For children: This medicine hasn’t been studied and shouldn’t be used in children younger than 6 years.

How to take lisinopril

This dosage information is for lisinopril oral tablet. All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: lisinopril

  • Form: Oral tablet
  • Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg

Brand: Prinivil

  • Form: Oral tablet
  • Strengths: 5 mg, 10 mg, 20 mg

Brand: Zestril

  • Form: Oral tablet
  • Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg

Dosage for hypertension

Adult dosage (ages 18–64 years)

  • starting dose: 10 mg taken by mouth once per day
  • usual dose: 20–40 mg taken once per day
  • maximum dose: 80 mg taken once per day

Child dosage (ages 6–17 years)

  • starting dose: 0.07 mg/kg of body weight taken by mouth once per day
  • dose adjustments will be based on your blood pressure response.
  • maximum dose: 0.61 mg/kg, up to 40 mg, once per day

Child dosage (ages 0–5 years)

This medicine hasn’t been studied and shouldn’t be used in children younger than 6 years.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Dosage for heart failure

Adult dosage (ages 18–64 years)

  • starting dose: 5 mg taken by mouth once per day
  • maximum dose: 40 mg taken once per day

Child dosage (ages 0–17 years)

This medicine hasn’t been studied and shouldn’t be used in children younger than 18 years for heart failure.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Dosage for acute myocardial infarction (heart attack)

Adult dosage (ages 18–64 years)

  • starting dose: 5 mg taken by mouth within the first 24 hours of when symptoms of heart attack start. Your doctor will give you another 5 mg after another 24 hours.
  • usual dose: 10 mg given 48 hours after heart attack. Then 10 mg taken once per day for at least 6 weeks.

Child dosage (ages 6–17 years)

This medicine hasn’t been studied and shouldn’t be used in children younger than 18 years for improving survival after a heart attack.

Child dosage (ages 0–5 years)

This medicine hasn’t been studied and shouldn’t be used in children younger than 6 years.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Special considerations

  • Heart failure: If you have low blood sodium levels, your starting dose may be 2.5 mg taken once per day.
  • Improving survival after a heart attack: If you have low blood pressure, your starting dose may be 2.5 mg for the first 3 days after having a heart attack.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Lisinopril oral tablet is used for long-term treatment. This drug comes with serious risks if you don’t take it as prescribed.

If you don’t take it at all: If you don’t take it at all, your blood pressure will stay high. This will raise your risk for a heart attack and stroke.

If you stop taking it suddenly: If you stop taking this drug suddenly, your blood pressure may spike. This can cause anxiety, sweating, and a fast heart rate.

If you don’t take it on schedule: You may not feel any different, but your blood pressure may not be controlled. This can put you at higher risk for heart attack and stroke.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could result in toxic side effects.

If you take too much: If you take too much of this drug, you may have a drop in blood pressure. This may cause you to faint. If you think you’ve taken too much of the drug, act right away. Call your doctor or local Poison Control Center, or go to the nearest emergency room.

How to tell this drug is working: Your doctor will monitor your blood pressure and other symptoms of your condition to tell if this drug is working for you. You also may be able to tell this drug is working if you check your blood pressure and it’s lower.

Important considerations for taking this drug

Keep these considerations in mind if your doctor prescribes lisinopril oral tablet for you.

General

This drug should be taken around the same time every day.You can crush or cut the tablet.

Storage

  • Keep it from 59°F (20°C) to 86°F (25°C).
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport security staff the pharmacy prescription label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.

Self-management

Your doctor may ask you to check your blood pressure at home. To do this, you’ll need to purchase a home blood pressure monitor. These are available at most pharmacies. You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

Clinical monitoring

Before starting and during your treatment with this drug, your doctor may check the following to tell if this drug is working or is safe for you:

  • blood pressure
  • liver function
  • kidney function
  • blood potassium

Hidden costs

You may need to buy a blood pressure monitor to check your blood pressure at home.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Signs of alcohol withdrawal syndrome

Alcohol withdrawal syndrome is the group of symptoms that can develop when someone with alcohol use disorder suddenly stops drinking.

Alcohol use disorder was formerly known as alcohol addiction or alcoholism. If a person regularly drinks too much alcohol, their body may become dependent on the substance.

Alcohol is a depressant. Alcohol use disorder or drinking heavily over an extended period can change a person’s brain chemistry due to the continued exposure to the chemicals in alcohol.

Chronic alcohol use can cause complex changes in their brain, including to the neurotransmitters dopamine and gamma-aminobutyric acid (GABA), which affect excitement and a person’s sense of reward.

The production of these neurotransmitters is affected when a person stops or significantly reduces alcohol intake. The brain has to readjust, which leads to withdrawal symptoms.

Symptoms

Alcohol withdrawal syndrome causes anxiety
Symptoms of alcohol withdrawal include nausea, anxiety, and a fast heart rate.

People with alcohol withdrawal syndrome can have a wide variety of symptoms, depending on how much alcohol they drank, their body type, sex, age, and any underlying medical conditions.

Common symptoms of alcohol withdrawal syndrome include:

Less frequently, people can develop severe symptoms of alcohol withdrawal syndrome. Severe symptoms are called delirium tremens or DTs.

Symptoms of DTs include:

  • severe tremors
  • elevated blood pressure
  • hallucinations, usually visual
  • extreme disorientation
  • seizures
  • raised body temperature

The DTs can be life-threatening. In extreme cases, the brain can have problems regulating breathing and circulation.

Drastic changes in blood pressure and heart rate can also develop, which may lead to a stroke or heart attack.

Alcohol withdrawal syndrome vs. a hangover

While some of the symptoms of alcohol withdrawal syndrome are similar to a hangover, they are not the same condition. Alcohol withdrawal syndrome and a hangover have different causes.

A hangover occurs when a person drinks too much alcohol at one time. Alcohol withdrawal syndrome occurs when a person with alcohol use disorder stops or suddenly decreases their alcohol intake.

Too much alcohol can irritate the stomach lining, cause dehydration, and lead to an inflammatory response in the body. As the alcohol wears off, these effects lead to common hangover symptoms, such as headache, nausea, and fatigue.

Alcohol withdrawal syndrome is different. If a person has alcohol use disorder, their body gets used to a certain amount of alcohol in their system.

The continued use of alcohol causes changes in the central nervous system and neurotransmitter production in the brain. When the supply of alcohol is suddenly stopped or decreased, withdrawal symptoms can develop.

When to see a doctor

Alcohol withdrawal syndrome can lead to hospital
It is important to detox from alcohol under the supervision of a doctor.

Anyone that thinks they are dependent on alcohol should consider speaking to a doctor.

Alcohol use disorder can lead to various physical and mental health conditions. However, treatment is available and can be highly effective.

For those trying to detox from alcohol, it is vital to do so under the supervision of a doctor, as the withdrawal symptoms may be severe.

Diagnosis

A doctor can often diagnose alcohol withdrawal syndrome by taking a person’s medical history and doing a physical exam.

The doctor may ask for evidence that there has been a decrease in alcohol use after regular heavy use.

They may also do a blood test called a toxicology screen to measure the amount of alcohol in a person’s system. Blood tests and imaging tests can show if organs, such as the liver, have been affected by a person’s intake of alcohol.

Treatment

Treatment options for alcohol withdrawal syndrome typically involve supportive care to ease the effect of the symptoms.

Doctors usually use a type of drug called benzodiazepines to reduce alcohol withdrawal symptoms.

Heavy alcohol use also depletes the body of vital electrolytes and vitamins, such as folate, magnesium, and thiamine. So, treatment may also include electrolyte corrections and multivitamin fluids.

The American Society of Addiction Medicine has goals for detoxification from alcohol or drugs. The purpose of treating alcohol use disorder is to:

  • Make the withdrawal process safe for the person and help them live alcohol-free.
  • Protect a person’s dignity during the withdrawal process and treat them humanely.
  • Prepare a person for ongoing treatment for alcohol dependence.

Detox process

Drinking in moderation can prevent alcohol withdrawal syndrome
Drinking in moderation is the best way to prevent alcohol withdrawal syndrome.

When a person is detoxing from alcohol, the symptoms may begin anywhere from 6 hours to a few days after their last drink.

Symptoms may gradually worsen over the course of 2 or 3 days.

Most symptoms reduce after about 5 days. In some cases, mild symptoms can continue for several weeks. Although some people choose to detox at home, it is safer to seek help when detoxing.

Symptoms can become severe, and it can be difficult to predict which people will develop life-threatening symptoms.

Anyone who is having severe symptoms of alcohol withdrawal syndrome, such as seizures, hallucinations, or prolonged vomiting needs immediate medical treatment.

People with severe symptoms remain in the hospital for part or all of the detox process so a doctor can closely monitor their blood pressure, breathing, and heart rate and provide medications to ease the process.

Prevention

The most effective way to prevent alcohol withdrawal syndrome is to avoid drinking or drinking only in moderation.

Moderate drinking is officially defined as 1 drink or less per day for women and 2 drinks or less per day for men. However, if a person already has alcohol use disorder, they can help prevent some of the withdrawal symptoms by speaking to a doctor about safe withdrawal.

Risk factors for alcohol use disorder include a family history of problems with alcohol, depression and other mental health conditions, and genetic factors.

For those who think they may have alcohol use disorder or may be dependent on alcohol, seeking help is essential.

What is the difference between heatstroke and heat exhaustion?

Heatstroke and heat exhaustion are illnesses caused by exposure to extreme heat. If left untreated, heat exhaustion can progress into heatstroke, which may be life-threatening.

According to the Centers for Disease Control and Prevention (CDC), above-average temperatures or unusually humid weather kills more than 600 people in the United States each year.

As temperatures rise, it is important to know how to avoid heat-related illnesses. Learn about the symptoms and treatments of heatstroke and heat exhaustion below.

What are heatstroke and heat exhaustion?

These conditions both result from overexposure to extremely hot weather. However, only heatstroke can cause damage to the body’s systems.

Heatstroke

man in the sun holding wet cloth to neck
Without treatment, heat exhaustion can develop into heatstroke.

Heatstroke, also called sunstroke, is the most serious heat-related illness. It occurs when the body’s temperature is 104ºF or higher, and it is a life-threatening medical emergency.

If not treated immediately, heatstroke can damage multiple organs and systems, including the:

  • brain and nervous system
  • circulatory system
  • lungs
  • liver
  • kidneys
  • digestive tract
  • muscles

Heat exhaustion

Heat exhaustion is less serious than heatstroke. Anyone who suspects that they have heat exhaustion should immediately rest and rehydrate. If symptoms do not improve, seek medical attention to prevent heatstroke.

Symptoms

Symptoms of heat exhaustion and heatstroke may develop quickly or over several days. They can cause significant distress, and muscle cramping often occurs first.

Heat exhaustion can lead to:

  • muscle cramping
  • a rapid, weak pulse
  • a general sense of weakness
  • nausea or vomiting
  • excessive sweating
  • cold, clammy skin
  • dizziness and sometimes fainting
  • dark-colored urine
  • headaches

Heatstroke may begin with symptoms of heat exhaustion. It can be life-threatening, and symptoms may rapidly worsen, to include:

  • a temperature of 104ºF or higher
  • hot, dry skin
  • a racing heartbeat
  • confusion
  • agitation
  • slurred speech
  • seizures
  • loss of consciousness
  • coma

There are two types of heatstroke: exertional and non-exertional.

Non-exertional heatstroke occurs in those who cannot adapt well to increasingly hot temperatures. Older adults, people with chronic illnesses, and infants are often affected.

A person typically experiences this type of heatstroke when they are indoors without air conditioning, and they may not be engaging in any physical activity. It can take several days of high temperatures for non-exertional heatstroke to occur, and it is common during extreme heat waves.

Exertional heatstroke occurs in people whose bodies can no longer adapt to rising temperatures while exercising or working. This condition can develop within a few hours, and it usually affects people who are spending time outdoors.

Spending time in closed cars puts small children and pets at high risk of heatstroke. The CDC estimate that when the temperature outdoors is 80ºF, the temperature inside a closed car rises to 109ºF within 20 minutes. The hotter it is outside, the faster the temperature rises inside a vehicle.

When to see a doctor

Anyone experiencing any symptoms of heatstroke should seek emergency medical attention.

If a person suspects that they have heat exhaustion, they should try to reverse the condition by moving into a cooler environment, resting, staying hydrated, and changing into cooler clothes.

If symptoms get worse or do not improve within 1 hour, seek immediate medical care.

A doctor will likely be able to diagnose a heat-related illness based on symptoms. They may also perform tests to check for potential complications.

For example, a doctor may test for:

  • muscle damage
  • dehydration, often with a urine sample or blood test
  • heart and lung damage, possibly using imaging
  • circulatory system problems
  • a lack of kidney or liver function

Treatment

man drinking glass of water in front of electric fan
Using an electric fan and drinking water will help a person with heat exhaustion to cool down.

Anyone who suspects that they have heat exhaustion should immediately take steps to cool down. These can include:

  • moving to a shady location
  • removing one or more articles of clothing
  • resting out of the sun
  • turning on a fan or the air conditioning
  • running cool water over the skin or applying cool, wet towels to the body
  • drinking fluids such as water and sports drinks

If a person vomits or feels nauseous, seek medical attention.

If a person exhibits any symptom of heatstroke, contact emergency services immediately. To treat it, a doctor may:

  • apply ice packs to the neck, armpits, and groin
  • spray cool mists
  • support any injured organ systems
  • use a specialized cooling blanket
  • administer intravenous fluids that promote cooling and hydration

Risk factors

Certain factors can make a person more likely to experience heat exhaustion or heatstroke. These include:

  • being overweight or obese
  • having a significant disability
  • having a sunburn
  • being younger than 13 or older than 65
  • using some prescription medications for heart conditions or high blood pressure, particularly diuretics
  • experiencing sudden changes in temperature, such as by traveling from a cold to a hot climate
  • spending time outdoors in extreme heat, or indoors without a way to cool down

Prevention

female hiker sitting on a bench in the shade sniffing a flower
Spending time in the shade will help to prevent heat exhaustion.

When temperatures rise, it is important to know how to prevent heat-related illnesses. The goal is to keep the body cool.

The following strategies can help:

  • staying indoors during the hottest part of the day
  • trying to stay in the shade when outdoors
  • drinking an extra 2–4 cups of water every hour while exposed to high temperatures
  • taking frequent breaks when working or exercising outdoors on hot days
  • wearing loose, light-colored clothing
  • using cooler water for showers and baths
  • wearing a wide-brimmed hat to shield the face from the sun
  • avoiding drinks that dehydrate, including those with caffeine or alcohol
  • wearing breathable fabrics like cotton, rather than synthetic blends
  • spending part of the day in an air-conditioned place, such as a mall, library, or movie theater

No one should remain alone in a parked car in extremely hot weather. Doing so could be especially dangerous for children and people aged 65 and older.

Outlook

With appropriate, timely treatment, a person can fully recover from heat-related illnesses.

Recognizing symptoms of heat exhaustion and taking steps to cool down can prevent the condition from developing into heatstroke.

If left untreated, heatstroke can result in serious complications or death. When a person receives the right treatment early enough, they can fully recover from heatstroke.

Even on the hottest days, these illnesses can usually be prevented by planning and taking precautions.

What causes a bump on the bottom of the foot?

A bump on the bottom of the foot may cause a person discomfort or pain when walking. There are a variety of conditions that may cause bumps on the feet, some of which require medical treatment.

This article explores the various causes of a bump on the bottom of the foot and how a person can treat each cause.

Causes

A bump on the bottom of the foot may be caused by:

1. Uneven weight distribution

bump on the bottom of the foot person holding their foot squeezing pain in sole of foot while seated.
If certain bones in the foot are misaligned, it may cause uneven weight distribution.

Sometimes, the long bones behind the toes (metatarsals) become misaligned. This affects the way weight is distributed across the ball of the foot as a person walks.

Uneven weight distribution in the foot means some areas absorb more pressure than others. These may cause calluses to form on the ball of the foot.

Bumps caused by uneven weight distribution tend to occur in people with diabetes.

If a person with diabetes develops lumps or calluses on their feet, they should monitor them carefully and speak to a doctor. If left untreated, these lumps can cause ulcers.

Foot ulceration is the most common lower-extremity complication for people with diabetes.

2. Limited movement of the big toe joint

If a person’s big toe joint does not move correctly when they walk, an excessive force is applied to the bottom of their big toe.

A callus may develop under their big toe and the bone may become enlarged.

3. Plantar fibromas

Plantar fibromas are nodular masses that can form in the arch of a person’s foot.

These non-cancerous tumors form in the plantar fascia, which is the ligament in the arch of the foot.

Researchers are unsure why some people get plantar fibromas, but risk factors include tendon damage, a medication called Dilantin, and genetics.

4. Dyshidrotic eczema

Dyshidrotic eczema may cause bumps on the bottom of the foot that are itchy and filled with fluid.

Doctors do not know what causes this type of eczema, but it has been linked to allergies and stress. Dyshidrotic eczema can also cause skin that is:

  • flakey
  • cracked
  • painful to touch

5. Plantar warts

Plantar warts may form on the bottom of a person’s foot if they have human papillomavirus (HPV). These small, fleshy bumps may be tender to walk on. They usually heal without treatment.

6. Bursitis

Bursitis is an inflammation of the natural cushions between bones and soft tissue. Caused by excess friction or injury, bursitis may cause a bump on the bottom of the foot.

7. Cysts

Cysts are fluid-filled sacs that form with no accompanying symptoms. Cysts are normally benign (harmless). Cysts can develop anywhere on the body, including on the bottom of a person’s foot.

8. Synovial sarcoma

A synovial sarcoma is a type of soft-tissue sarcoma (cancer) that appears as a lump or swelling. It may affect the bottom of the foot and can also cause pain or numbness.

Sarcomas are harmful and may spread to other areas of the body if left untreated.

The American Cancer Society estimate that 13,040 Americans will receive a diagnosis of soft-tissue sarcoma in 2018.

9. Haglund’s deformity

Haglund’s deformity is a bump on the back of the foot or heel that forms under the Achilles tendon. It is often confused with Achilles tendonitis.

When the bump rubs against a person’s shoes, it may cause pain and irritation.

Diagnosis

If a person has a bump on the bottom of their foot that does not go away after a few days or is causing pain or discomfort, they should speak to their doctor.

The doctor can examine the feet and ask questions about a person’s medical history to determine the cause.

Once the doctor has diagnosed the cause, the doctor can recommend the best course of treatment.

Treatment

Doctor feeling skin on bottom of patient's foot.
Treatment will be recommended based on the cause diagnosed.

Treatment for a bump on the bottom of the foot varies depending on the cause.

Treatments for each cause are explored below:

Limited movement of the big toe joint

A doctor may recommend functional foot orthosis for someone with limited movement of their big toe joint.

This treatment helps to restore normal movement in the joint. Once the joint can move properly, it relieves the pressure under the big toe, and a person can treat the callus.

Uneven weight distribution

A molded insole or orthotic can help treat bumps caused by uneven weight distribution. This helps to remove the pressure from the balls of the feet. Orthotic insoles are available for purchase online.

Plantar fibromas

Foot orthotics may relieve pressure from the arch of the foot (plantar fascia) and help reduce the size of the nodules.

It is also possible to remove the mass surgically. However, to ensure the plantar fibromas do not come back, it may be necessary to remove most of the plantar fascia.

A person may need to wear orthotics after surgery. A range of orthotic products is available for purchase online.

Dyshidrotic eczema

A doctor may prescribe corticosteroids or antihistamines for dyshidrotic eczema. Reducing stress may also help treat dyshidrotic eczema.

Plantar warts

Plantar warts do not usually need treatment. However, if they bleed, change color, or cause noticeable discomfort, a person should speak to their doctor. The doctor can determine whether they should be removed.

There are many ways to remove warts. A 2006 study notes that cryotherapy, which involves using liquid nitrogen to remove the wart, has the highest quality of clinical evidence to support its effectiveness.

Bursitis

People can treat bursitis with:

  • rest
  • anti-inflammatory medications
  • ice

If the condition does not improve, a doctor may recommend corticosteroids and physical therapy. Surgery may be needed in severe cases.

Cysts

A doctor can drain cysts using a sterile needle. For more significant cysts, surgery may be needed. Unlike blisters, it is not a good idea to try to drain a cyst at home.

Synovial sarcoma

A synovial sarcoma is malignant and always requires medical treatment. A surgeon can also remove it using surgery. A person may also need chemotherapy or radiotherapy to help recovery.

Haglund’s deformity

A person can often treat Haglund’s deformity with home remedies, such as:

  • wearing open back shoes
  • taking anti-inflammatory medications
  • icing the area to reduce inflammation

If home remedies are not effective, the following treatments are available:

Surgery is also an option if other treatments are not effective.

Takeaway

There are several different causes of a bump on the bottom of the foot. Understanding these helps a person determine why they have one and take the best course of action.

It is always a good idea to speak to a doctor to get a proper diagnosis. A doctor can recommend an appropriate treatment and steps a person can take to prevent bumps from occurring in the future.

What causes a bump on the bottom of the foot?

A bump on the bottom of the foot may cause a person discomfort or pain when walking. There are a variety of conditions that may cause bumps on the feet, some of which require medical treatment.

This article explores the various causes of a bump on the bottom of the foot and how a person can treat each cause.

Causes

A bump on the bottom of the foot may be caused by:

1. Uneven weight distribution

bump on the bottom of the foot person holding their foot squeezing pain in sole of foot while seated.
If certain bones in the foot are misaligned, it may cause uneven weight distribution.

Sometimes, the long bones behind the toes (metatarsals) become misaligned. This affects the way weight is distributed across the ball of the foot as a person walks.

Uneven weight distribution in the foot means some areas absorb more pressure than others. These may cause calluses to form on the ball of the foot.

Bumps caused by uneven weight distribution tend to occur in people with diabetes.

If a person with diabetes develops lumps or calluses on their feet, they should monitor them carefully and speak to a doctor. If left untreated, these lumps can cause ulcers.

Foot ulceration is the most common lower-extremity complication for people with diabetes.

2. Limited movement of the big toe joint

If a person’s big toe joint does not move correctly when they walk, an excessive force is applied to the bottom of their big toe.

A callus may develop under their big toe and the bone may become enlarged.

3. Plantar fibromas

Plantar fibromas are nodular masses that can form in the arch of a person’s foot.

These non-cancerous tumors form in the plantar fascia, which is the ligament in the arch of the foot.

Researchers are unsure why some people get plantar fibromas, but risk factors include tendon damage, a medication called Dilantin, and genetics.

4. Dyshidrotic eczema

Dyshidrotic eczema may cause bumps on the bottom of the foot that are itchy and filled with fluid.

Doctors do not know what causes this type of eczema, but it has been linked to allergies and stress. Dyshidrotic eczema can also cause skin that is:

  • flakey
  • cracked
  • painful to touch

5. Plantar warts

Plantar warts may form on the bottom of a person’s foot if they have human papillomavirus (HPV). These small, fleshy bumps may be tender to walk on. They usually heal without treatment.

6. Bursitis

Bursitis is an inflammation of the natural cushions between bones and soft tissue. Caused by excess friction or injury, bursitis may cause a bump on the bottom of the foot.

7. Cysts

Cysts are fluid-filled sacs that form with no accompanying symptoms. Cysts are normally benign (harmless). Cysts can develop anywhere on the body, including on the bottom of a person’s foot.

8. Synovial sarcoma

A synovial sarcoma is a type of soft-tissue sarcoma (cancer) that appears as a lump or swelling. It may affect the bottom of the foot and can also cause pain or numbness.

Sarcomas are harmful and may spread to other areas of the body if left untreated.

The American Cancer Society estimate that 13,040 Americans will receive a diagnosis of soft-tissue sarcoma in 2018.

9. Haglund’s deformity

Haglund’s deformity is a bump on the back of the foot or heel that forms under the Achilles tendon. It is often confused with Achilles tendonitis.

When the bump rubs against a person’s shoes, it may cause pain and irritation.

Diagnosis

If a person has a bump on the bottom of their foot that does not go away after a few days or is causing pain or discomfort, they should speak to their doctor.

The doctor can examine the feet and ask questions about a person’s medical history to determine the cause.

Once the doctor has diagnosed the cause, the doctor can recommend the best course of treatment.

Treatment

Doctor feeling skin on bottom of patient's foot.
Treatment will be recommended based on the cause diagnosed.

Treatment for a bump on the bottom of the foot varies depending on the cause.

Treatments for each cause are explored below:

Limited movement of the big toe joint

A doctor may recommend functional foot orthosis for someone with limited movement of their big toe joint.

This treatment helps to restore normal movement in the joint. Once the joint can move properly, it relieves the pressure under the big toe, and a person can treat the callus.

Uneven weight distribution

A molded insole or orthotic can help treat bumps caused by uneven weight distribution. This helps to remove the pressure from the balls of the feet. Orthotic insoles are available for purchase online.

Plantar fibromas

Foot orthotics may relieve pressure from the arch of the foot (plantar fascia) and help reduce the size of the nodules.

It is also possible to remove the mass surgically. However, to ensure the plantar fibromas do not come back, it may be necessary to remove most of the plantar fascia.

A person may need to wear orthotics after surgery. A range of orthotic products is available for purchase online.

Dyshidrotic eczema

A doctor may prescribe corticosteroids or antihistamines for dyshidrotic eczema. Reducing stress may also help treat dyshidrotic eczema.

Plantar warts

Plantar warts do not usually need treatment. However, if they bleed, change color, or cause noticeable discomfort, a person should speak to their doctor. The doctor can determine whether they should be removed.

There are many ways to remove warts. A 2006 study notes that cryotherapy, which involves using liquid nitrogen to remove the wart, has the highest quality of clinical evidence to support its effectiveness.

Bursitis

People can treat bursitis with:

  • rest
  • anti-inflammatory medications
  • ice

If the condition does not improve, a doctor may recommend corticosteroids and physical therapy. Surgery may be needed in severe cases.

Cysts

A doctor can drain cysts using a sterile needle. For more significant cysts, surgery may be needed. Unlike blisters, it is not a good idea to try to drain a cyst at home.

Synovial sarcoma

A synovial sarcoma is malignant and always requires medical treatment. A surgeon can also remove it using surgery. A person may also need chemotherapy or radiotherapy to help recovery.

Haglund’s deformity

A person can often treat Haglund’s deformity with home remedies, such as:

  • wearing open back shoes
  • taking anti-inflammatory medications
  • icing the area to reduce inflammation

If home remedies are not effective, the following treatments are available:

Surgery is also an option if other treatments are not effective.

Takeaway

There are several different causes of a bump on the bottom of the foot. Understanding these helps a person determine why they have one and take the best course of action.

It is always a good idea to speak to a doctor to get a proper diagnosis. A doctor can recommend an appropriate treatment and steps a person can take to prevent bumps from occurring in the future.

ZINBRYTA (daclizumab beta) – Voluntary Withdrawal in Canada due to Risk of Encephalitis

ZINBRYTA (daclizumab beta) – Voluntary Withdrawal in Canada due to Risk of Encephalitis

Report a Concern

Starting date:

March 16, 2018

Posting date:

March 16, 2018

Type of communication:

Dear Healthcare Professional Letter

Subcategory:

Biologic/vaccine

Source of recall:

Health Canada

Issue:

Important Safety Information, Product withdrawal

Audience:

Healthcare Professionals

Identification number:

RA-66214

· Issue

· Who is affected

· Report health or safety concerns

Audience

Healthcare professionals involved in dispensing and administration of ZINBRYTA including multiple sclerosis (MS) specialists, neurologists, pharmacists, pharmacies, MS societies and MS patient support/advocacy groups.

Key messages

  • Following reports of serious inflammatory brain disorders, including immune-mediated encephalitis and meningoencephalitis, the manufacturer has decided to voluntarily withdraw ZINBRYTA from the Canadian market. The withdrawal is to be completed by April 30, 2018.
  • No new patients can be started on or be prescribed ZINBRYTA.
  • All treating healthcare professionals are advised to immediately contact patients in their care who have been prescribed ZINBRYTA, and to initiate alternative treatment options as soon as medically appropriate.
  • Given ZINBRYTA’s potential for liver injury, patients discontinuing the product should have serum transaminase levels and total bilirubin levels monitored monthly, for 6 months after receiving their last dose of ZINBRYTA.
  • Healthcare professionals should inform their patients that adverse drug reactions may also occur up to 6 months after discontinuation and to contact their physician immediately if any new symptoms such as prolonged fever, severe headache, tiredness, jaundice, nausea or vomiting occur.
  • ZINBRYTA will not be available through Health Canada’s Special Access Program.

Issue

Cases of immune-mediated encephalitis and meningoencephalitis, some with fatal outcomes, have been reported in patients treated with ZINBRYTA. No cases have been reported in Canada.

Products affected

ZINBRYTA (daclizumab beta)

Background information

In Canada, ZINBRYTA was authorized for marketing under controlled distribution for the treatment of adult patients with active relapsing remitting multiple sclerosis (RRMS) who have had an inadequate response to, or who are unable to tolerate 1 or more therapies indicated for the treatment of this condition. As of February 28, 2018, over 8,000 patients have been treated with ZINBRYTA worldwide. In Canada, as of March 5, 2018, 30 patients have been treated with ZINBRYTA, of which 10 received the drug in clinical trials.

The European Medicines Agency (EMA) has recommended the immediate suspension of the marketing authorization and recall of ZINBRYTA following 12 reports of serious inflammatory brain disorders worldwide, including encephalitis and meningoencephalitis, some of which were fatal.

In parallel, the company has initiated a global voluntary withdrawal of ZINBRYTA from the market.

A preliminary review of the available evidence by the EMA indicates that immune reactions observed in the reported cases may be linked to the use of ZINBRYTA. ZINBRYTA may also be linked to severe immune reactions affecting several other organs.

Who is affected

Information for consumers

ZINBRYTA is a prescription medicine used to treat adults with active relapsing remitting forms of multiple sclerosis who have tried 1 or more multiple sclerosis medicines that have not been effective.

The company is removing ZINBRYTA from the market worldwide as cases of fatal inflammation of the brain have been reported in persons who had been prescribed ZINBRYTA. Patients who are being treated with ZINBRYTA should immediately contact their healthcare professional to discuss their treatment options since ZINBRYTA will no longer be available anywhere in the world.

Patients should let their healthcare professional know immediately if they experience symptoms such as persistent high temperature, severe headache, nausea (feeling sick), tiredness, yellowing of the skin or eyes and vomiting. These could be signs of a reaction to ZINBRYTA.


Regular blood tests are required for 6 months after stopping treatment, to check for possible side effects that may occur after stopping ZINBRYTA. Patients are advised to maintain their Patient Alert Card during treatment, for 6 months after stopping treatment or until they are advised to do so by their treating physician.

Patients in clinical trials should contact their treating physicians.

Information for healthcare professionals

Healthcare professionals are reminded:

  • A withdrawal of ZINBRYTA will take place from pharmacies across Canada.
  • Do not start new patients on ZINBRYTA.
  • Contact patients under your care, who are currently being treated with ZINBRYTA to discuss alternative treatments.
  • Monitor patients at least monthly and more frequently as clinically indicated for 6 months after the last dose of ZINBRYTA.
  • Advise patients to immediately report symptoms of liver injury such as prolonged fever, severe headache, tiredness, jaundice, nausea or vomiting. These reactions can occur for 6 months after treatment has been stopped.

Action taken by Health Canada

Following Biogen’s completion of the voluntary withdrawal by April 30th 2018, Health Canada will discontinue the marketing authorization for ZINBRYTA and will not make it available through Health Canada’s Special Access Program. Health Canada is communicating this important safety information to healthcare professionals and to the public through its MedEffect™ Canada website.

Report health or safety concerns

Managing marketed health product-related side effects depends on healthcare professionals and consumers reporting them. Any case of encephalitis, severe cutaneous adverse reactions, drug-induced liver injury, autoimmune reactions affecting 1 or more organs, or other serious or unexpected side effects in patients receiving ZINBRYTA should be reported to Biogen Canada Inc. or Health Canada.

Biogen Canada Inc.
90 Burnhamthorpe Road W, Suite 1100
Mississauga, Ontario
Canada L5B 3C3
Email: canmed
Tel: 905-804-1444

ZINBRYTA Biogen ONE Support Program at 1-855-676-6300.

You can report any suspected adverse reactions associated with the use of health products to Health Canada by:

  • Calling toll-free at 1-866-234-2345; or
  • Visiting MedEffect Canada’s Web page on Adverse Reaction Reporting for information on how to report online, by mail or by fax.

For other health product inquiries related to this communication, contact Health Canada at:

Marketed Health Products Directorate
E-mail: mhpd_dpsc.public
Telephone: 613-954-6522
Fax: 613-952-7738

Mihaela Vlaicu, MD
Country Medical Lead
Biogen Canada

For more information

The manufacturer advised Health Canada of the risk associated with this health product. Health Canada supports the actions taken by the manufacturer and as such a risk assessment was not required and a Summary Safety Review was not prepared.

Alysena birth control tablets – an update from Health Canada

Chipped pills in additional packages of Alysena 21 and 28 birth control pills

Starting date:

March 8, 2018

Posting date:

March 8, 2018

Type of communication:

Advisory

Subcategory:

Drugs

Source of recall:

Health Canada

Issue:

Quality

Audience:

General Public, Healthcare Professionals

Identification number:

RA-66158

· Issue

· Products affected

· What you should do

· Who is affected

· What industry professionals should do

· Background

· Media enquiries

· Public enquiries

· What Health Canada is doing

· Images

Issue

Further to a recent advisory about the recall of one lot of Alysena 28 birth control pills because of chipped pills, Health Canada is informing Canadians that all lots of both Alysena 21 and Alysena 28 may have chipped pills. Health Canada is reminding women to always check their pills carefully before taking them.

Alysena 21 and Alysena 28 are prescription drugs used to prevent pregnancy as well as to treat acne (in women 14 or more years of age). Alysena 21 contains 21 “active” pink pills, while Alysena 28 contains 21 “active” pink pills and 7 “inactive” white pills.

Products affected

Alysena 21 (DIN 02387875) and Alysena 28 (DIN 02387883)

What you should do

  • Check your pills before and after taking them out of the blister package. Do not consume a pink pill if it looks unusual (for example, it is chipped, has jagged edges or is broken). Examine both sides of each pill thoroughly before taking it. It may not be immediately obvious from looking at the blister package that there is a problem with the pills, since the underside of the pill cannot be seen while in the blister pack.
  • If you find a chipped pink pill, take the next unchipped pink pill. Do not miss a dose as this may result in pregnancy. Return any packages with chipped pills to your pharmacy for a replacement package. Packages with no chipped pills do not need to be returned.
  • If you have no unchipped pink pills left, then return the package to your pharmacy as soon as possible for a replacement package. Use a non-hormonal method of birth control (such as condoms, spermicidal foam or gel) until you can obtain a replacement package, and contact your health care provider for medical advice.
  • Talk to a health care professional if you have questions or concerns about your birth control product, including about missed doses and alternatives.
  • Report adverse events to health products to Health Canada by calling toll-free at 1 866 234 2345, or by reporting online, by mail or by fax.
  • Report complaints about health products to Health Canada by calling toll-free at 1 800 267 9675, or complete an online complaint form.

Who is affected

  • Women who are currently taking Alysena 21 or 28
  • Health professionals who dispense the product

What industry professionals should do

Additional information for pharmacists:

  • Check each blister pack of Alysena 21 and Alysena 28 before dispensing it to make sure the pills look as they should.
  • Report any unusual pills to the company (Apotex Inc.) and to Health Canada.

Background

Apotex Inc. voluntarily recalled one lot of Alysena 28 (lot LF10133A) on February 9th, 2018 as a precaution while it determined the scope and nature of the issue.

Apotex Inc. has put in place measures to address the manufacturing issue and is conducting additional visual inspections of the product before release. Based on a thorough assessment of all available information, Health Canada considers these measures, along with patients visually checking the pills and not taking pink pills that are chipped (and not missing a dose), adequate to address the issue at this time.

Media enquiries

Health Canada
613-957-2983

Public enquiries

613-957-2991
1-866-225-0709

What Health Canada is doing

Health Canada will continue to monitor this issue and will take necessary action, including informing Canadians as appropriate.

How to clear the diabetes clutter

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If your medicine cabinet is busting at the seams with diabetes supplies, it may be time to get better organized. Have a look at these practical tips.

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Five ways to make ringing stop after a concert

Long exposure to loud noises, such as attending a concert with no ear protection, can damage the delicate structures within the ear. This can cause a ringing in the ears, known as tinnitus.

Tinnitus can be bothersome, as the sound can make hearing difficult and interrupt daily life. Tinnitus after a concert is usually temporary and should subside within a few days.

However, damage to the structures in the ear may be permanent, so it is important to take steps to prevent further hearing loss.

How does noise damage occur?

band and crowd at concert<!--mce:protected %0A-->
Attending loud concerts without any ear protection may result in ringing in the ears.

Loud noises can damage tiny hair cells in the inner ear. These hair cells vibrate in response to noise and send a message to the brain. Once destroyed, the cells do not grow back.

Scientists think that damage to these cells causes the brain to misinterpret the signal it receives, so it makes up a sound instead. This is what causes a person to hear ringing in their ears after a concert, even when the room is silent.

Some live music can be extremely loud. Any exposure to sounds at or above 85 decibels (dB) can cause noise-induced hearing loss.

For reference, the volume of a typical conversation is about 60 dB. The level of noise from heavy city traffic is around 85 dB. Concerts are usually well over this 85 dB level.

While the average concert-goer may experience symptoms that only last a couple of hours, anyone listening to live music regularly may start to experience tinnitus for more extended periods of time if they do not take steps to treat or prevent the damage.

Five home remedies

There is a variety of ways to help ease ringing in the ears, including:

1. Reduce exposure to loud sounds

young woman listening to music through headphones
Listening to soft music through over-ear headphones may help distract from the ears ringing.

While the ears can often recover from damage, it is still important to reduce exposure to loud sounds when experiencing tinnitus.

This may mean talking quietly, avoiding loud bars or events, and avoiding in-ear headphones. Watching television or listening to the radio at lower volumes than usual may also help the ears recover.

2. Distraction

Sometimes, a person only notices ringing in the ears when there are no other sounds to compete with it. In these cases, it may help to distract the ears from the ringing by listening to soft music or an engaging podcast.

Meditation and yoga may also help take the focus off of the ringing. These techniques may also help reduce stress, which is sometimes a contributing factor to tinnitus.

3. White noise

If the ringing causes trouble sleeping, it may help to use some gentle white noise to distract the brain from focusing on the sound.

Some people find the hum of a room fan is enough to allow them to sleep. Others prefer the sounds of ocean waves or the static from a television to help them sleep.

4. Head tapping

Another method to help reduce or eliminate ringing in the ears after a concert is a type of head tapping.

Head tapping involves a few simple steps:

  • Place the palms over the ears, resting the fingers at the base of the skull in the back of the head.
  • Keeping the ears covered with the palms, raise the index fingers up and tap the back of the head. This should produce a sound inside the head that is similar to the tap of a drum.
  • Gently tap the head around 50 times.
  • Repeat the process a few times each day as needed for relief.

5. Reducing alcohol and caffeine

People with ringing in their ears after a concert are often told to stop drinking alcohol and caffeine. While there is little scientific evidence to back up this claim, some people may find that reducing the amount of caffeine or alcohol they drink could help reduce their symptoms.

When to see a doctor

If the ringing in the ears does not go away after a day or so, it may be time to see a doctor. It is possible that something other than the concert is causing the tinnitus.

Numerous things could influence ringing in the ears, and doctors will want to check the most likely culprits. During the appointment, a doctor will likely do a physical exam of the ear canal.

In some cases, excess earwax or a foreign object can get stuck inside the ear and cause tinnitus. Doctors may also check for signs of an ear infection, ask about the person’s stress levels, and ask about any medications they take.

Tinnitus influenced by any of these factors should clear up once the underlying condition is treated.

In cases of chronic tinnitus, doctors can recommend hearing devices or medications to help ease some of the symptoms.

Prevention

Hearing ringing in the ears after a concert is a sign of hearing damage, which may be permanent. Taking preventative measures is crucial to avoid noise-induced hearing loss.

Earplugs

man at music festival using ear plugs
Wearing earplugs at concerts can help prevent noise-induced hearing loss.

Foam earplugs are available at many pharmacies or grocery stores, and many music venues even provide them to guests.

There are even companies that make custom earplugs to help reduce the loudness of the sound of a concert without affecting the quality of the sound.

In an emergency, clean paper napkins that are balled up and gently positioned in the outer ear may help muffle the loud sounds of a concert.

Seating

When buying tickets for a concert, it may help to pay attention to where the speakers will be located in the venue. Booking seats further away from the speakers may help reduce the amount of sound reaching the ear.

Taking breaks

Continuous loud noise only puts the ear at more risk for tinnitus. Taking regular breaks at a concert to go outside for fresh air or visit the bathroom may help give the ears a break.

Outlook

People experiencing ringing in their ears after a concert do not need to panic, as the symptoms will likely start to fade within a few hours.

Home remedies can often help speed up the process, and a trip to the doctor may uncover any underlying cause in cases of persistent tinnitus.

While experiencing temporary tinnitus after exposure to loud music is not an immediate cause for concern, the damage done to a person’s hearing may add up over time.

Many of the causes of tinnitus are preventable, such as visiting concerts or playing music too loud in headphones, so it is important to take steps to prevent noise-induced hearing loss.

[Tc-99m]-Disofenin (2017-09-22)

Affected products

[Tc-99m]-Disofenin

Reason

The sterility may be out of specification in the affected lot.

Depth of distribution

3 Hospitals located in Hamilton, Ontario, Canada

Affected products

[Tc-99m]-Disofenin

DIN, NPN, DIN-HIM

No market authorization

Dosage form

Liquid

Strength

0.31 GBq

Lot or serial number

M-170830DISO-1

Companies
Recalling Firm
Centre for Probe Development and Commercialization (CPDC)
1280 Main St. W. NRB-A316
Hamilton
L8S 4K1
Ontario
CANADA
Marketing Authorization Holder
Not Applicable