Take a Break: Create Luminaries and lanterns

Midsummer Night’s Eve isn’t far off so now is a good time to make lanterns and luminaries. It’s a great way to reuse tissue paper, milk cartons, beads, paper bags and whatever else you have on hand. Of course, luminaries can be as simple as paper lunch bags, filled with 2” of sand, kitty litter or gravel, sufficient to weigh down the bag and secure space for a Tea light. However, you can dress up the bags by cutting out shapes and designs or even gluing pieces of a paper doily to them. Below are some videos to help inspire you.

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life with Chronic Conditions: CBD Oil

Does it seem like everywhere you turn there are stores, friends and articles promoting cannabidiol (CBD)? 

In the last few weeks I had a friend ask if it would be good for his arthritis because his pharmacist friend said it helped him. Others have told me it had done wonders for their dogs.

CVS is now carrying CBD products (creams, sprays and lotions) from Curaleaf Holdings in 800 stores in eight states (Alabama, California, Colorado, Illinois, Indiana, Kentucky, Maryland and Tennessee). Walgreens is following CVS’s lead and will sell CBD infused products in 1,500 stores in nine states (Oregon, Colorado, New Mexico, Kentucky, Tennessee, Vermont, South Carolina, Illinois and Indiana).

Even the New York Times Magazine ran an article a few weeks ago Can CBD Really Do All That? How one molecule from the cannabis plant came to be seen as a therapeutic cure-all.  

The FDA held its first public hearing on CBD to help to better regulate CBD products this past week. The take home message from the hearing appears to be the public wants CBD products and too many manufacturers are delivering shoddy goods.  5 Take aways From the FDA’s Hearings on CBD.

So is there science to back up the hype?

What is CBD?

The second most active ingredients of cannabis (marijuana), it is derived from the hemp plant and it does not cause a “high.” CBD can have no more than 0.3% THC (tetrahydrocannabinol the active ingredient in cannabis), while medical marijuana oil may contain up to 5%.

In the late 19^th century, cannabis was an important component of British and American physicians’ pharmacopoeia. It’s suspected that the cannabis of this era, and the tinctures made from them, probably contained much more CBD than modern varieties.

Are there proven health benefits?

CBD has been shown to treat some severe childhood epilepsy syndromes. The FDA has approved the first cannabis derived drug for this condition, Epidiolex, which contains CBD.

A double-blind placebo-controlled study published on May 21, 2019 in the American Journal of Psychiatry demonstrated that Epidiolex can reduce cue-induced craving in individuals that had been former heroin users. Furthermore, in these individuals, the drug reduced reports of anxiety, and blood levels of cortisol, a hormone known to increase under conditions of stress and anxiety.

Zynebra Pharmaceuticals recently tested a topical CBD product for osteoarthritis knee pain with mixed results. The Phase 2 clinical study did not meet its primary endpoint of reducing the average pain score, although there were some indications it improved function and reduced pain severity.

A small clinical trial of CBD for Crohn’s disease in Israel in 2017 was also negative, finding “CBD was safe but had no beneficial effects.”

A recent review of studies on CBD oil and other forms of cannabis for the management of neurologic disorders was more positive, finding “there is strongest evidence to indicate benefits in treatment of spasticity and neuropathic pain in multiple sclerosis.”

Animal studies suggest that CBD might be beneficial for some conditions including pain, inflammation, arthritis and anxiety. Note that there is a big difference between animal studies and clinical trials on humans. Some organizations and promoters of CBD refer to “studies” without noting these involved animals. This is the case for Does CBD Oil Really Help Treat Arthritis Pain? April 14, 2019 from the Rheumatoid Arthritis Support Network   

There is a growing body of scientific literature critically assessing the validity of animal experimentation and raises important concerns about its reliability and predictive value for human outcomes and for understanding human physiology. In short, just because it worked in an animal model doesn’t mean it will be equally successful in humans.

However, there are studies underway where CBD is being evaluated for a range of conditions including: addiction, Parkinson’s Disease, schizophrenia, diabetes, MS, autism, cancer, graft-host disease, anxiety and more.

If you are wondering how one product could be such a miracle cure, the author of the recent NY Times Magazine article asked the same question.

How could one family of molecules help so many maladies? The most obvious response is that they might not; all this research is preliminary and might not pan out. But scientists often propose a counter-explanation: Many chronic disorders, even though they seem distinct, are characterized by dysfunction in the same few pathways. Inflammation and oxidative stress, for example, occur in schizophrenia, metabolic disorders, heart disease and other ailments..... There are other examples of a single drug being able to help meliorate a variety of conditions. We know aspirin as a treatment for fever and headache, for example, but in low doses it is also used to reduce the risks of stroke, heart attack and pre-eclampsia in pregnant mothers; it even figures as an adjunct treatment for schizophrenia. Aspirin has its own downsides — an elevated risk of bleeding, for instance — but like CBD, its broad utility may be partly explained by its anti-inflammatory effects. New York Times

Risks?

Though it's often well-tolerated, CBD can cause side effects, such as dry mouth, diarrhea, reduced appetite, drowsiness, difficulty with sleep, weight loss, stomach pain or discomfort, drooling or excessive saliva, problems with walking and fatigue.

CBD can also interact with other medications, primarily those that are changed or broken down by the liver. Medline lists a number of drugs that can interact with CBD including: blood thinners, codeine, Paxil, ibuprofen, Celebrex, Elavil, Prevacid, Valium Priolosec, testosterone, Allegra, morphine and various other drugs, plus possibly caffeine, nicotine, vitamins and nutrional supplements

In addition there are legal issues in some states, but most importantly is the quality control of the product itself. In 2015, the FDA found that many CBD labeled products, actually contained very little CBD. Two years later, a study published in JAMA documented that in 84 products sold online, 26% had less CBD than advertised and 43% had more. As noted above, this was a major issue discussed at yesterday's FDA hearing on CBD.

A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication, which means it’s not regulated by the FDA. In addition to not knowing therapeutic doses for various conditions, it’s difficult to know exactly how much CBD you are actually getting in a product and if there are additives that could be problematic.

Legality

The 2018 Farm Bill was signed into law in December 2018, effectively legalizing hemp at the federal level by removing it from the federal list of controlled substances and classifying it as an agricultural commodity. As a result, CBD from hemp is legal nationwide at the federal level.

Just this week the Transportation Security Administration has changed its cannabis policy to allow passengers to travel with Epidiolex, the FDA version of CBD that is used to treat epilepsy in children, as well as some CBD oil, "as long as it is produced within the regulations defined by the law" under the 2018 Farm Bill, which legalized hemp and hemp derivatives. The TSA's new rules still ban other forms of marijuana, including CBD oils that have THC, and cannabis-infused products that are still illegal under federal law.

All 50 states have laws legalizing CBD with varying degrees of restriction. You will need to do the research to see how it applies to the state you live in.

Considering CBD?

Be aware that wild claims, such as an effective cancer treatment, are just plain bogus. While more research is needed in humans, there are indications that CBD may be a useful treatment for managing anxiety, insomnia and chronic pain. That said, science needs to be the driving force behind new treatments, not a marketing campaign. People with chronic conditions are often targeted by marketers, so buyer be ware.

Before trying CBD, it’s imperative that you talk to your medical provider in order to understand drug interactions with current treatment regiments. Talk with them about dosing and the most reliable source possible for purchasing CBD. Finally, there are CBD clinical trials that are open and seeking patients. Check https://clinicaltrials.gov to see if you qualify.

Further Reading

Cannabidiol (CBD)-What we Know and What we Don’t. Harvard Health Publishing

Cab CBD Really Do All That? How one molecule from the cannabis plant came to be seen as a therapeutic cure-all. New York Times Magazine May 12, 2019

CBD: The next weapon in the war against opioid addiction?

A Reality Check for CBD Oil from Pain News Network

Take a Break: Create a Spa/Zen Space

 Ideally it would be a room, but it can also be a sun porch, backyard patio, or the corner of bedroom, where you can create your “moment of Zen”. Include yoga mat, blankets, soft music, soothing sounds, simple furniture and soft lighting. Make sure it’s free of distractions such as phones, tablets and computers. Add things like:

• Aromatherapy-scents of lavender or chamomile are relaxing. Use essential oils

• Water feature-These are easy to create but a sound machine can duplicate the sound of the ocean or rain falling

• Elements of nature-Use only natural textures for things like blankets.  A wooden bowl full of pebbles is restful on the eyes and you can use the stones for gentle self-massage. Art can reflect various aspects of nature. A noise machine to duplicate whispering winds and other sounds can be very soothing. Plants have a very calming effect and provide oxygen

• Candles-Use soy or beeswax

• Hide the electronics-If your TV room is going to double as your spa space, find a way to hide the TV (cabinet, screen)

• Include a Zen Garden: Make your own. Use a shallow container, such as a bowl or tray. Fill it with fine sand- playground sand is fine or check your local craft store or even local gardening center.  Select an odd number of small polished stones for the garden. A tiny rake can be found at hobby and craft shops, should be placed by the side of the garden so you can rake different patterns. You can also make your own rake with dowels. In a pinch, use a small fork.

The view outside a window can be enhanced with bird feeders as well as shrubs and flowers that attract bees and birds.

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Life with Chronic Conditions: What Sunscreen Should I use?

May is  Skin Cancer Awareness Month and the Environmental Working Group (EWG) has recently released its annual guide to  sunscreens. They report that two-thirds of the more than 1,300 sunscreens on the market either don’t provide enough protection or contain ingredients that are especially worrisome — such as oxybenzone, which may have hormone-disrupting qualities dangerous for kids.

There has also been a lot in the news lately about how sunscreen can end up in a wearer’s blood. The US Food and Drug Administration recently reported that the chemicals are present at much higher levels than current government health rules permits. Before you panic and decide not to use sunscreen, recognize that the volunteers in this study put on two times as much sunscreen as people usually apply in everyday use.  JAMA Network

Practice Safe Sun

Using common sense can help reduce risks of a burn and the increased risk of skin cancer. So before discussing what to look for in a sunscreen, make sure you follow the basics:

- Avoid getting burned by covering up

- Stay in the shade

- Plan your day so you avoid being out in midday sun when UV radiation is the highest.

- Don’t forget the sunglasses

Be mindful that certain medications may make you more sensitive to the sun, so be sure to talk to your medical provider and/or pharmacist about your medications and sun sensitivity.

Picking the right sunscreen for you

• Avoid any skin or lip product whose label includes retinyl palmitate, retinol or vitamin A.

• Avoid oxybenzone, a synthetic estrogen that penetrates the skin and can disrupt the hormone system. Other chemicals identified by the FDA for more research include avobenzone, ecamsule and octocrylene. 

• Don’t combine sunscreen with repellent

• Don’t use sprays

• Apply cream often

• Don’t use old sunscreen. If there is no expiration date on the sunscreen you just purchased, write the date you bought it on the bottle. Sunscreens are required to retain their original strength for at least three years.

• Look for products with

-       zinc oxide, 3 percent avobenzone or Mexoryl SX. They protect skin from harmful UVA radiation.

-       SPF between 15 and 50+

• Check your sunscreen with the EWG sunscreen database.  You don’t have to spend a lot of money for a product that will have an excellent EWG rating. For example, Equate Baby Zinc, available from Walmart for about $5, has an excellent rating from EWG.

• Because of skin sensitivity, particularly if you are on medications, test any new product on a small patch of skin.

• If you use a dermatologist, check with them about recommendations that work for your skin.

Take a Break: Watch Terrific Graduation Speeches

It’s graduation time and lots of speeches are being given. Some are funny, some are poignant. Some feature celebrities and some are students. There are the classics such as: 

                                                            J.K. Rowling

                                              Steve Jobs at Stanford

                                             Solzhenitsyn’s Address at Harvard

Check out your alma mater or one of the many lists of “top graduation speeches”

 Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Journal Watch May 2019

CHRONIC PAIN

Prevalence of Arthritis 22.8 Percent in U.S. Adults in 2017: The prevalence of arthritis was 22.8 percent in U.S. adults in 2017, with statewide variation in prevalence and in the prevalence of severe joint pain and physical inactivity among those with arthritis, according to research published in the May 3 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Adults with arthritis in southeastern states have highest prevalence of severe joint pain, physical inactivity.

Does insulin resistance cause fibromyalgia? Researchers were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance. This discovery could dramatically alter the way that chronic pain can be identified and managed. Plos One

Are Herbal Products Effective for Treating Neuropathic Pain? According to the results of a recent review, there is “insufficient” evidence to conclude that either nutmeg or St John’s wort are effective in helping treat pain in neuropathic conditions.

COMPLEMENTARY & ALTERNATIVE MEDICINE

Mindfulness smoking-cessation app can change the brain: Researchers have found that a mindfulness-based smartphone app designed to help people stop smoking was effective at reducing study participants' self-reported daily cigarette consumption. And those who reduced their cigarette consumption the most also showed decreased reactivity to smoking-related images in a brain region known to be activated when someone experiences a craving. Neuropsychopharmacology 

Clinicians could prescribe fitness apps to help cancer survivor's exercise: Fitness apps could be prescribed by clinicians to help patients recovering from cancer increase their physical activity levels, new research in the Journal of Cancer Survivorship reports.

Legal marijuana reduces chronic pain, but increases injuries and car accidents: The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco. In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized. BMJ Open

Health Professionals Supportive of Medicinal Cannabis: Health professionals are generally supportive of medicinal cannabis use but report a lack of knowledge about its use, according to a review published online May 6 in PLOS ONE. 

FDA ACTION

• Recalled six tattoo inks as they are contaminated with bacteria and could lead to infection that poses a serious health risk

• Approves Venetoclax for Chronic Lymphocytic Leukemia

• Warns against the use of unapproved or unauthorized devices for diabetes management, including continuous glucose monitoring systems, insulin pumps and automated insulin dosing systems

• Approved Fragmin (dalteparin sodium) injection, for subcutaneous use, to reduce the recurrence of symptomatic venous thromboembolism (VTE) in pediatric patients one month of age and older

• Sent warning letters to five companies who produce products labeled as homeopathic for significant violations of current good manufacturing practice (CGMP) regulations

• Approved Vyndaqel (tafamidis meglumine) and Vyndamax (tafamidis) capsules for the treatment of the heart disease (cardiomyopathy) caused by transthyretin mediated amyloidosis (ATTR-CM) in adults.

• Authorized the marketing of new tobacco products manufactured by Philip Morris Products S.A. for the IQOS “Tobacco Heating System” – an electronic device that heats tobacco-filled sticks wrapped in paper to generate a nicotine-containing aerosol. The FDA has placed stringent marketing restrictions on the products in an effort to prevent youth access and exposure.

• Approved Mavyret (glecaprevir and pibrentasvir) tablets to treat all six genotypes of hepatitis C virus (HCV) in children ages 12 to 17

• Requiring a new boxed warning – the agency’s most prominent warning – on certain prescription insomnia drugs to better ensure patients and their health care professionals have the information they need when considering use of these medicines. The new warnings will be required for eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist).

• Approved a device, called Xvivo Perfusion System with Steen Solution Perfusate, that can temporarily ventilate, oxygenate, and pump (perfuse) preservation solution through lungs that were initially thought to be unacceptable for transplant

• Launched  a new education campaign to help Americans understand the important role they play in removing and properly disposing of unused prescription opioids from their homes

• Permitted marketing of the first medical device to treat attention deficit hyperactivity disorder (ADHD)

PREVENTION

Morning exercise can improve decision-making across the day in older adults: A study of older Australians has found a morning bout of moderate-intensity exercise improves cognitive performance like decision-making across the day compared to prolonged sitting without exercise. It also shows that a morning bout of exercise combined with brief walking breaks to frequently disrupt sitting throughout an eight-hour day can boost short-term memory compared to uninterrupted sitting, according to the study. British Journal of Sports Medicine

Stressed at work and trouble sleeping? It's more serious than you think: Work stress and impaired sleep are linked to a threefold higher risk of cardiovascular death in employees with hypertension. That's the finding of research published today in the European Journal of Preventive Cardiology

Chronic insomnia and memory problems: A direct link is established: Chronic insomnia disorder, which affects approximately 10 percent of adults, has a direct negative impact on cognitive function of people aged 45 and over, independent of the effect of other health issues. Canadian Longitudinal Study on Aging

Healthy Lifestyle Recommended for Reducing Dementia Risk: Guidelines emphasizing adoption of a healthy lifestyle for reducing the risk for cognitive decline and dementia have been developed by the World Health Organization. Adults who use tobacco should be offered interventions for tobacco cessation, and interventions should be offered to reduce or cease hazardous or harmful drinking. For adults with normal cognition and mild cognitive impairment, a Mediterranean-like diet may be recommended for reducing the risk for cognitive decline and/or dementia. A healthy balanced diet based on WHO recommendations should be recommended to all adults. Vitamins B and E, polyunsaturated fatty acids, and multicomplex supplementation should not be recommended for reducing cognitive decline and/or dementia risk. Interventions for overweight and/or obesity may be offered.

Regular crosswords and number puzzles linked to sharper brain in later life: Older adults who regularly take part in word and number puzzles have sharper brains, according to the largest online study to date.  The more regularly adults aged 50 and over played puzzles such as crosswords and Sudoku, the better their brain function, according to research in more than 19,000 participants. The findings emerge from two linked papers published today (May 16th) in the International Journal of Geriatric Psychiatry. 

Working Memory Affected by Sleep and Mood: Two linked medical studies on age-related working memory decline show surprisingly strong inverse and direct relationships with mood and sleep quality. For the mind to work at its best — especially among the elderly — it’s important to ensure one has good sleep quality and be in a good mood, which generally means freedom from depression. Journal of the International Neuropsychological Society

Moderate/Vigorous Exercise Attenuates Risks of Sitting: Moderate-to-vigorous physical activity (MVPA) equivalent to meeting current recommendations attenuates the association of sitting with all-cause and cardiovascular disease (CVD) mortality, according to a study published online April 22 in the Journal of the American College of Cardiology. 

Women Who Exercise Still More At Risk Of Depression Than Men: Researchers from the University of Michigan in Ann Arbor claimed exercise reduces the risk of depression but such manifestation differs for men and women. They tested whether exercise can alleviate depression caused by disturbed sleep, but they only found it effective in male participants. The findings were contradictory to previous research. According to the principal investigator Weiyun Chen, few women in the study participated in the high-intensity exercise and their conditions did not improve after the test. The previous study used in assessing the effects of exercise on depression showed that low-to-moderate intensity workouts may be an effective solution for depression. Vigorous physical activity done frequently also resulted in the growth of nerve cells. Journal of American College Health  

NUTRITION/SUPPLEMENTS/VITAMINS

A spoonful of peppermint helps the meal go down: When treated with peppermint oil, 63 percent of patients with disorders of the esophagus that cause difficulty swallowing and non-cardiac chest pain reported feeling much or slightly better, report researchers. Eighty-three percent of patients with spastic disorders of the esophagus reported feeling better. Peppermint is an attractive first-line treatment because it has few side effects and can be taken as needed by patients. Digestive Diseases and Sciences 

Walnuts may help lower blood pressure for those at risk of heart disease: When combined with a diet low in saturated fats, eating walnuts may help lower blood pressure in people at risk for cardiovascular disease. Journal of the American Heart Association

Habitual Glucosamine Use Linked to Reduced Risk for CVD Events: Habitual use of glucosamine supplements is associated with a reduced risk for cardiovascular disease (CVD) events-CVD death, coronary heart disease and stroke- , according to a study published online May 14 in The BMJ. 

Low Fat Dietary Pattern Cuts Breast Cancer Deaths: A low-fat dietary intervention is associated with reductions in deaths after breast cancer and deaths from breast cancer among postmenopausal women after long-term follow-up, according to a study scheduled to be presented at the annual meeting of the American Society for Clinical Oncology.

Does sunscreen compromise vitamin D levels? Maybe not Sunscreen can reduce the sun's adverse effects, but there are concerns that it might inhibit the body's production of vitamin D. In a new study, however, investigators recorded an increase of vitamin D in participants during a week of cloudless weather, with very high UV index, even when sunscreens were used properly and prevented sunburn. British Journal of Dermatology 

How Much Coffee is too Much for the Heart: People who frequently drank six or more cups of coffee per day — the scientists defined one cup as containing around 75 milligrams of caffeine — had a modest increase in cardiovascular disease risk. The American Journal of Clinical Nutrition 

Processed foods lead to weight gain, but it's about more than calories: In the first study of its kind, scientists have shown that eating ultra-processed foods leads to weight gain in human volunteers in as little as 2 weeks. Cell Metabolism

Is There Evidence to Support Kombucha Health Claims in Humans? According to the results of a systematic review, there is a lack of evidence supporting the potential health benefits of kombucha, a fermented tea beverage, in humans.

TREATMENT

rTMS Improves Memory in Younger and Older Adults: Magnetic stimulation of the brain improves working memory, offering a new potential avenue of therapy for individuals living with Alzheimer's disease and other forms of dementia, according to new research from the Duke University School of Medicine. Plos One

Combination therapy advisable for bowel disorder IBS: The more abnormalities in intestinal and brain function that IBS sufferers have, the more severe their symptoms of this functional bowel disorder, and the more adversely their everyday life is affected. This is shown by a Sahlgrenska Academy study indicating that patients with IBS should get treatments for different abnormalities simultaneously, to improve both bowel function and signaling from the brain to the gut. Gastroenterology 

Thyroid Hormones Not Endorsed for Subclinical Hypothyroidism: The researchers found that thyroid hormones consistently demonstrated no clinically relevant benefits for quality of life or thyroid-related symptoms, including depressive symptoms, fatigue, and body mass index, for adults with SCH (moderate- to high-quality evidence). Thyroid hormones seem to have little or no effect on cardiovascular events or mortality (low-quality evidence); only one trial measured harms, with few events at two-year follow-up. Based on these findings, the guideline panel issued a strong recommendation against thyroid hormones in adults with SCH. The recommendation does not apply to women trying to get pregnant or patients with thyroid stimulating hormone levels >20 mIU/L and may not apply to young adults or patients with severe symptoms. The BMJ

Risks, Benefits of Long-Term Drug Therapy for Osteoporosis Reviewed: Long-term osteoporosis drug therapy (ODT) reduces fracture risk in women but may increase risk for rare adverse events, and research gaps surround use of long-term drug therapies for osteoporotic fracture prevention, according to a review and position paper published online April 23 in the Annals of Internal Medicine. 

Sleeping Pill Use Tied to Greater Need for BP Meds in Older Adults: Consumption of sleeping pills is linked to a subsequent increase in the number of antihypertensive drugs taken among older adults, according to a study published online March 25 in Geriatrics & Gerontology International. "'Sleeping pill use' might be an indicator of future needs of antihypertensive treatment and a warning indicator to investigate underlying sleep disorders or unhealthy lifestyles," the authors write.

The Generic Drugs You're Taking May Not Be As Safe Or Effective As You Think: Often health insurance plans require patients to switch to generics as a way of controlling costs. But journalist Katherine Eban warns that some of these medications might not be as safe, or effective, as we think.  Eban has covered the pharmaceutical industry for more than 10 years. She notes that most of the generic medicines being sold in the U.S. are manufactured overseas, mostly in India and China. The U.S. Food and Drug Administration states that it holds foreign plants to the same standards as U.S. drugmakers, but Eban's new book, Bottle of Lies, challenges that notion. She writes that the FDA often announces its overseas inspections weeks in advance, which allows plants where generic drugs are made the chance to fabricate data and results. Eban advises consumers to research who manufactures their generics and look up any problems that regulators have found out about them. But some consumers may find they are not allowed by their health plan to switch to alternatives, because of cost. NPR 

Brain network activity can improve in epilepsy patients after surgery: Successful epilepsy surgery can improve brain connectivity similar to patterns seen in people without epilepsy.  Neurosurgery 

Blood pressure drug shows no benefit in Parkinson's disease: A study of a blood pressure drug does not show any benefit for people with Parkinson's disease. The drug isradipine had shown promise in small, early studies and hopes were high that this could be the first drug to slow the progression of the disease. American Academy of Neurology's 71st Annual Meeting

CAREGIVING

Teaching happiness to dementia caregivers reduces their depression, anxiety: Caring for family members with dementia -- which is on the rise in the US -- causes significant emotional and physical stress that increases caregivers' risk of depression, anxiety and death. A new method of coping with that stress by teaching people how to focus on positive emotions reduced their anxiety and depression after six weeks, reports a new national study. It also resulted in better self-reported physical health and positive attitudes toward caregiving.  Skills taught to participants in the study:

1. Recognizing a positive event each day

2. Savoring that positive event and logging it in a journal or telling someone about it

3. Starting a daily gratitude journal

4. Listing a personal strength each day and noting how you used this strength recently

5. Setting an attainable goal each day and noting your progress

6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed

7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day

8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath

Health Psychology

Mindfulness may help decrease stress in caregivers of veterans: Caregivers of veterans who engaged in mindfulness-based cognitive therapy found it relieved stress, anxiety and worry, according to a new study. Mindfulness

OTHER

Two-Thirds of Sunscreens Fail Safety Tests: Nearly two-thirds of sunscreens that were analyzed failed safety tests proposed by the U.S. Food and Drug Administration, the Environmental Working Group said Wednesday. The findings are included in the nonprofit consumer advocacy group's latest edition of its annual Guide to Sunscreens, CNN reported. The group analyzed the ingredients and performance of more than 1,300 sunscreen products with sun protection factor (SPF). Of those, 750 are marketed as beach and sport sunscreens. The total sample size is just a small portion of the more than 12,000 sunscreen products the FDA says are available in the United States. Experts suggest that consumers look for products with zinc oxide and titanium dioxide, which studies show are not absorbed into the skin.CNN

Doctors Aware of Patient Difficulties Affording Medical Care: Physicians are aware of patients' difficulty with affording medical care and consider out-of-pocket costs in their decision making, according to an article published in a supplement to the May 7 issue of the Annals of Internal Medicine. 

Prices Will Soon Be Included in TV Drug Ads: Regulations will require companies to disclose prices of meds costing more than $35 for a month's supply . AP  

Appendix removal associated with development of Parkinson's disease: Patients who had their appendix removed were more likely to develop Parkinson's disease than those whose appendix remained in place, according to the largest study to address the relationship between the two conditions. The retrospective study involving more than 62 million patient records from 26 health systems. Digestive Disease Week 

Chronic kidney disease epidemic in agricultural workers: High heat, toxins: A mysterious epidemic of chronic kidney disease among agricultural workers and manual laborers may be caused by a combination of increasingly hot temperatures, toxins and infections, according to researchers.  NEJM

Life with Chronic Conditions: Intermittent fasting

Recently my brother told me he was “intermittent fasting” as a way to control his pre diabetes. So far, it was working very well for him and he had no problem adhering to the schedule.

In college, I found that if I ate only one large meal in the middle of the day, I not only kept weight off but I felt good. With the passing years, pregnancy and nursing, I definitely got out of that habit, but more recently gastric reflux has me finishing dinner by 7pm or earlier. So the combination of my brother’s and my experiences, made me take a closer look at the various articles I was coming across on IF (intermittent fasting).

A lot of the research has been done on animal models and looks very promising, but does it hold true for humans? Is it different for men and women? What about people with chronic conditions?

 For centuries cultures and religions have included fasting, such as Ramadan for Muslims, Lent for Catholics and Yom Kippur for Jews. Buddhist and Hindus also have fast days scheduled throughout the year.  In hunter/gatherer cultures, it would be feast of famine. The change, with year round food availability, as well as “snack” foods, appears to play a part in the high levels of diabetes among Native Americans.

Broadly speaking IF falls into two categories:

a) Alternate Day Fasting: Switching between days you eat more (feast) and others less (fast). There are lots of variations on this with the most popular appearing to be 5:2, where you fast for two non-consecutive days every week.

b) Restricted Eating Window: Instead of restricting what you eat, you restrict the hours you eat. Most popular is the 16/8 method. You fast for 16 hours and eat for 8.

Research is slow in catching up with the hype, but there are indications that IF does help with weight loss, anti aging, diabetes risk reduction cholesterol etc. In fact, the science of fasting has been focused more on disease prevention and longevity then weight loss.

A German study found that while IF does cause weight loss, it doesn’t appear to have an advantage over conventional weight loss diets. American Journal of Clinical Nutrition  Another study of 88 obese women found that they lost more weight and improved their health by using IF while following a strictly controlled diet. However, this was only a 10-week study. Obesity 

There is some research that indicates that IF may help reverse type 2 diabetes, while some animal studies say it might increase the risk.

Interestingly, the study that has shown promise in reversing memory loss associated with Alzheimer’s disease, implemented a 36-point program targeting life styles. One of these was fasting 12 hours between dinner and breakfast. Reversal of Cognitive Decline. 

Researchers at Johns Hopkins School of Medicine have found that intermittent fasting—limiting caloric intake at least two days a week—can help improve neural connections in the hippocampus while protecting neurons against the accumulation of amyloid plaques, a protein prevalent in people with Alzheimer’s disease. “Fasting is a challenge to your brain, and we think that your brain reacts by activating adaptive stress responses that help it cope with disease,” says Mattson. “From an evolutionary perspective, it makes sense your brain should be functioning well when you haven’t been able to obtain food for a while.” Johns Hopkins Health Review

The limited research on humans does seem to show that results vary between men and women. Some women have experienced missed periods, metabolic disturbances and even early onset menopause. However, other women swear by it. So many variables could be at play here, including age, whether you’ve had children, been through menopause etc.

There are also questions about when is the best time to fast. Some research indicates eating earlier in the day is better than later. However, given the common social practice of going out for dinner, this could be problematic for many.

In short, a lot more research is needed.

All of this noted, anyone who has diabetes; eating disorders that involve unhealthy self-restriction (anorexia or bulimia nervosa); use of medications that require food intake; adolescents; and pregnant or breast feeding women should not consider IF. Further, anyone with a chronic condition needs to check with their medical provider before trying a significant diet change and should be monitored for its effectiveness or possible side effects.

Further Reading

• Intermittent Fasting: Surprising Update (Harvard Health)

• Fasting Diets are Going Mainstream-Ahead of the Science (Vox)

• Are There Any Proven Benefits to Fasting: Johns Hopkins