The scary polio-like illness

Leaky gut gets blamed for everything from everyday stomach issues to pain to anxiety, yet it is one of the most mysterious ailments to diagnose and treat.

Part of the reason for this medical mystery is because the gut is such a vast and complex system. “Science continues to find new ways that the gut can influence everything from heart health to keeping our brains young,” says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment with Harvard-affiliated Massachusetts General Hospital. “There is much we know about leaky gut in terms of how it affects people’s health, but there is still so much that is unknown.”
What is leaky gut?

You have to begin at the cellular level. The lining of your intestine is made of millions and millions of cells. These cells join together to create a tight barrier that acts like a security system and decides what gets absorbed into the bloodstream and what stays out.

However, in an unhealthy gut, the lining can weaken, so “holes” develop in the barrier. The result is that toxins and bacteria can leak into the body. This can trigger inflammation in the gut and throughout the body and cause a chain reaction of problems, such as bloating, gas, cramps, food sensitivities, fatigue, headaches, and joint pain, to name a few.

How do these “holes” form? The biggest culprits are genes and diet, according to Dr. Fasano. “Some people may have a weaker barrier because they were born with it, or they follow an unbalanced diet low in fiber and high in sugar and saturated fats, which may be the trigger that weakens the gut lining.” Age also plays a role because as you age, cells get damaged more easily and heal slowly, if at all, so the gut becomes more vulnerable.
The role of leaky gut in overall health remains unclear

“Leaky gut could be the cause of some health problems, or a sign of something larger,” says Dr. Fasano. “The science is still up in the air.” For example, digestive conditions like inflammatory bowel disease, celiac disease, and Crohn’s disease share many of the same symptoms as leaky gut, and all are linked with chronic inflammation, but it’s not known how, or if, they are connected.

“The challenge is that it’s difficult to measure the strength of a person’s gut barrier, so you can’t know for certain when leaky gut is really present, or what influence it may have elsewhere in the body,” says Dr. Fasano.
Can you treat leaky gut?

You can, but the approach is similar to diagnosing a broken car, says Dr. Fasano. “You don’t know the exact problem until the mechanic lifts the hood, looks around, and tries different things — there is not a simple, direct approach to fixing the problem,” he says. “It’s the same with leaky gut. We have to try different strategies to see what helps.”

Your first step is to share your symptoms with your doctor. If leaky gut is a possibility, he or she can try several strategies to help relieve symptoms and reduce inflammation. The most common is to review your diet and eliminate known dietary causes of inflammation, such as excessive consumption of alcohol and processed foods, and to explore whether you have any food sensitivities — for instance, to gluten or dairy. “In theory, reducing inflammation from your diet like this also may rebuild the gut lining and stop further leakage,” says Dr. Fasano.

The best way to protect yourself from leaky gut is to invest more in your overall digestive health, he adds. This means being more attentive about following a gut-healthy diet that limits processed foods and high-fat and high-sugar foods, and includes enough fiber. Sticking to a regular exercise program also can strengthen your digestive system. For example, studies have suggested that taking a 15-to 20-minute walk after a meal can aid in digestion. “Your gastrointestinal system is complex, but caring for it doesn’t have to be,” says Dr. Fasano. It’s understandable, given how precious and elusive a full night’s sleep can be for new parents. The quest for a full night of sleep becomes so important that many a book has been written on how to achieve it, and it’s a common topic of conversation among new parents. Those whose babies sleep through the night feel like they have accomplished something important — and those whose babies don’t sleep through the night are often wondering if there is something wrong with their baby or their parenting. This is especially true because among Western cultures, there is a perception that by around 6 months of age, if not sooner, babies should be sleeping through the night.

This perception, it turns out, is not exactly correct. And that’s where the good news/bad news thing comes in. According to a study published in the journal Pediatrics, if your baby doesn’t sleep through the night at 6 months, or even at 12 months, it’s perfectly normal.

It’s always good news to hear that your baby is normal — but for some parents, it may understandably feel like bad news that a full night of sleep is further out on the horizon than they had hoped.

Researchers from Canada studied 388 infants at 6 months, and 369 infants at 12 months. They defined sleeping through the night as six or eight hours of sleep without any waking. They found that at 6 months, 38% of the babies couldn’t make it six hours without waking — and a full 57% didn’t sleep eight hours at once. At 12 months, those numbers were better but still not great: 28% didn’t sleep six hours straight, and 43% didn’t sleep eight hours.
It’s not a baby problem and it’s not a parenting problem — it’s not actually a problem at all

As cranky as being woken up at night can make a parent feel, the researchers did not find a correlation between waking at night and the “postnatal mood” of the mothers. They also found that babies that woke up at night didn’t lag behind the sound sleepers when it came to their cognitive, language, or motor development. The babies did fine either way.

They also found that babies who woke up at night were more likely to be breastfeeding. This makes sense, given that breast milk is more easily and quickly digested than formula, causing breastfed babies to get hungrier sooner. Given that breastfeeding has known health benefits, a little extra waking could end up working out for baby (and for the mother, given that breastfeeding has benefits for mothers too).

Now, for some parents waking up at night is a problem, and that’s where sleep training comes in. There are certainly various techniques and methods that can help teach babies to sleep longer and more independently. Many of them, though, involve letting the baby cry for a while — and while studies have shown that this doesn’t harm babies, it can be hard and stressful for many parents.

What this study shows is that if your baby is waking during the night and you’re doing okay with it, you don’t need to do anything. With time, it will get better. While those first few months of life can feel like an eternity, they aren’t. Before you know it you will be up at night for an entirely different reason: waiting for them to get home from a night out with friends. And when that does happen, those days of waking up with them as babies won’t seem so bad at all. Frequent use of hand sanitizer, instead of soap and water, may lead to fewer respiratory infections, fewer sick days, and less antibiotic use — at least if you’re a toddler. A Spanish study enrolled 911 children who attended day care, from newborns up to three-year-olds, and randomly assigned them to one of three groups.

In the control group, parents and caregivers continued usual hand care for the toddlers. In the two intervention groups, children were assigned to either labor-intensive hand sanitizer use or soap and water handwashing. Parents and caregivers were instructed to either apply hand sanitizer or wash the toddlers’ hands when they arrived at the classroom in the morning; before and after lunch; after playing outside; after coughing, sneezing, or blowing their noses; after diapering; and before they left for home. In both groups, handwashing with soap and water was mandatory after using the toilet or when hands were grossly soiled.

Outcomes in the hand sanitizer group were significantly better than either the soap and water group or the control group. The hand sanitizer group had lower rates of respiratory infections and missed fewer days of school, compared to the other two groups. Kids in the hand sanitizer group were also less likely to be prescribed antibiotics for respiratory infections.

The families or day care providers in the hand sanitizer group went through 1,660 liters of hand sanitizer during the eight-month study. Based on this, the researchers estimated that each toddler used hand sanitizer six to eight times daily, on average.

There are reasons to take the results of this study with a grain of salt. A great deal of time and effort went into reinforcing the importance of hand hygiene. Researchers visited the day care centers every two weeks to tell stories and sing songs about germs and cleanliness. This probably led to levels of hand sanitizer use that would be difficult to duplicate in a real-world situation. As well, some, but not all previous studies of hand sanitizer use in preschoolers have shown lower rates of cold and flu infections.

The researchers did not assess how often the kids in the handwashing group actually washed their hands. It is possible that the better outcomes in the hand sanitizer group were related to the greater ease of use of hand sanitizer, compared to handwashing, which usually requires a little more time and effort.
Take-home points

    Hand sanitizer use in toddlers may be associated with lower rates of respiratory infections than handwashing with soap and water alone.
    Hand sanitizer use probably has to be fairly compulsive for users to see significant benefits.
    Hand sanitizer should contain 70% ethyl alcohol to reliably kill bacteria and viruses; some bacteria have shown tolerance to lower amounts of ethyl alcohol.
    Although there is little high-quality evidence on the benefits of hand sanitizer use in the community at large, the use of hand sanitizer, along with handwashing and flu vaccination, is a reasonable measure to reduce the risk of respiratory infections in adults at risk.

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Healthy eating through the holidays

Right now the world is experiencing an epidemic that is projected to get much, much worse. It’s an epidemic of dementia, affecting 40 million people — and millions more of their caregivers — staggering numbers that will likely triple by 2050.

Dementia is a progressive deterioration of brain functioning associated with aging. While there are different causes, the most common — Alzheimer’s and vascular dementias — are now thought to be closely related.
How is heart health related to cognitive health?

We have long known that the diseases and conditions that clog the arteries of the heart also clog the arteries of the rest of the body, including the brain. It all boils down to damage of the arteries, the blood vessels that are critical for blood flow and oxygen delivery to the organs. Arterial damage leads to arterial blockages, which leads to heart disease and heart attacks, strokes, peripheral vascular disease, and vascular dementia.

Meanwhile, Alzheimer’s disease used to be thought of as a different process, because the brains of people with Alzheimer’s seemed to be full of tangled tube-shaped proteins (neurofibrillary tangles). However, more and more research is linking Alzheimer’s dementia to the same risk factors that cause heart disease, strokes, peripheral vascular disease, and vascular dementias: these risk factors are obesity, high blood pressure, high cholesterol, and diabetes.

The evidence is substantial: studies show that people with these conditions are significantly more likely to develop Alzheimer’s disease. Meanwhile, studies also show that people with Alzheimer’s disease have significantly reduced brain blood flow, and autopsy studies show that brains affected by Alzheimer’s can also have significant vascular damage.

Researchers are now focusing on why this is — what is the connection? It appears that good brain blood flow is key for clearing those tubular proteins that can accumulate and become tangled in the brains of Alzheimer’s patients, and so one solid hypothesis is that anything that reduces that blood flow can increase the risk for Alzheimer’s, and conversely, anything that increases blood flow can reduce the risk for Alzheimer’s.
Healthy heart behaviors can lower your risk of dementia

And it is true that exercise lowers the risk of dementia, even Alzheimer’s. Studies show that people who exercise more are less likely to develop dementia of any kind, and this stands even for adults with mild cognitive impairment. There is also substantial research evidence showing that eating a Mediterranean-style diet high in fruits, vegetables, whole grains, healthy fats, and seafood is associated with a significantly lower risk of cognitive decline and dementia.

The take-home message here is, even if someone has a family history of dementia, particularly Alzheimer’s dementia, and even if they already have mild cognitive impairment (forgetfulness, confusion), they can still reduce their risk of developing dementia by simply living a heart-healthy lifestyle. That means a Mediterranean-style diet with 4 or 5 servings of fruits and veggies daily, and 150 minutes per week of activity. Lifestyle factors that help to reduce stress can also help: enough hours of good sleep, positive relationships, and social engagement have been shown to protect cognition.
Holiday time is here again! So are the joys and challenges of holiday eating. The big challenge is to have fun at special occasions without jeopardizing some of the healthy practices you have worked on throughout the year.

Here are some tips to help you survive the holiday season.

Do not arrive hungry to the party! Skipping meals before a holiday party in an effort to save calories for the big party will only make you overeat. Eat a light meal or snack before arriving to the party. A snack or meal that is high in fiber and contains lean protein is ideal because it can help control your appetite and help you avoid overeating.

Choose the right plate. You are more likely to eat food that ends up on your plate. Thus, choosing a smaller plate will not only prevent you from filling your plate with more items then you really need, but it will also make the amount of food on your plate seem larger.

Be merry. Spread holiday cheer by spending time enjoying the company of others at the party. The more you talk, the less time you will spend eating.

Balance your plate. Aim to fill half your plate with vegetables, a quarter with lean protein, and a quarter with starch.

Bring something to the party. Offer to bring an appetizer, side, or dessert to the party. Not only will the host or hostess appreciate the help, but you’ll also have control over what goes into the dish.

Fill up on vegetables and fruits. Not only do these foods have plenty of vitamins and minerals, but they also contain fiber, which helps keep you full longer and may leave less room for other high-calorie foods.

Watch the liquid calories. For some, a holiday party is not complete without traditional drinks and cocktails. Beware that these drinks often contain a large number of calories. One cup of eggnog can set you back around 360 calories, while hot chocolate can contain around 200 calories. Alcoholic mixed drinks and punches can easily contain over 200 calories. Opt instead for a glass of sparkling water with a splash of your favorite juice or wine.

Be choosy. If you are at a buffet, scan the table before you enter the line. Choose small servings of the foods you want, but try not to return for seconds.

Food gifts. With the holidays come tins full of cookies and sweets. If you know that these will be trouble once you bring them home, open them up at work and pass them around for all to enjoy. If you are in the position of giving a gift to someone that is trying to eat healthy or lose weight, why not give them a non-food gift like a plant, balloons, or a healthy cookbook.

Be active. A short trip over the holidays doesn’t have to mean taking a vacation from your workout. Pack your sneakers or walking shoes and make a plan to fit in some activity each day.
When you think of menopause, you might think of hot flashes and night sweats. But many women also experience symptoms of depression. The risk of depression doubles or even quadruples during the menopausal transition, which has researchers looking for ways to address — or even prevent — the problem.

One study published in JAMA Psychiatry found that hormone therapy may help ward off symptoms of peri- and postmenopausal depression in some women. Researchers found that perimenopausal and early postmenopausal women who were treated with hormones were less likely to experience symptoms of depression than women in the study who were given a placebo.

But unfortunately, the findings present a far-from-perfect solution. Hormone therapy brings its own set of risks, and for this reason it likely shouldn’t be widely used for preventing depression in women at this stage of life, says Dr. Hadine Joffe, the Paula A. Johnson Associate Professor of Psychiatry in Women’s Health at Harvard Medical School, who wrote an editorial accompanying the study. “It’s not a ‘never,’ but it shouldn’t be a standard approach; in general, all of medicine has moved away from using hormones for prevention,” she says.
About the study

The study included 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who were experiencing low-level symptoms of depression. Roughly half used a skin patch containing the hormone estradiol for 12 months, as well as intermittent oral progesterone pills. The rest received a fake skin patch and placebo pills.

The women were evaluated at the beginning of the trial and throughout for symptoms of depression, using the Center for Epidemiologic Studies Depression Scale. Researchers found that only 17% of women in the hormone group developed clinically significant depression, compared with 32% of those in the placebo group.

Untreated depression can cause physical symptoms, such as headaches and fatigue, in addition to emotional symptoms, including persistent sadness and even suicidal thoughts. It can interfere with daily function and reduce quality of life. However, hormone use brings its own health risks, such as a greater chance of blood clots and stroke. “It would be irresponsible to recommend this as a blanket prevention treatment for women,” says Dr. Joffe, who is also executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.
Lessons learned

Despite the caveat about hormone therapy, the findings should not be ignored. Rather, the key message for women is that depression during perimenopause and early postmenopause should be taken seriously, and women at this stage of life should be more closely monitored for depressive symptoms. In addition, study authors identified at least one risk factor for depression that stood out among women in this group — recent life stress. “A lot of people have stress, so I think it’s an important message that stress contributes to depression,” says Dr. Joffe.

Depression symptoms are not a sign of someone’s failure to cope. “This really is a brain phenomenon,” says Dr. Joffe. So here are some action points based on the findings.

    Be aware of depression risk. Knowing that depression is more common during perimenopause and early postmenopause can help you identify worrisome symptoms and act quickly. If you are perimenopausal or in early postmenopause, your doctor should ideally be screening you for mood symptoms at your regular visits. If not, bring up the topic yourself. If symptoms do develop, ask your doctor for a referral to a mental health specialist.
    Weigh hormone therapy’s pros and cons. Hormone therapy may be the right choice for some women. Talk to your doctor about the potential benefits and risks. Consider how long to use hormone therapy and whether there are other medical reasons to consider taking it. Keep in mind that more research is needed to fully understand the potential benefits and drawbacks of using this therapy to prevent depression, says Dr. Joffe. Talk with your doctor about whether behavioral strategies or antidepressant drugs might be a good alternative choice for you.
    Consider lifestyle changes and treatment. Regardless of whether you opt for hormone therapy or not, nondrug strategies can also be used to reduce the likelihood of depressive symptoms, including managing stress and boosting physical activity.
For generations, midwives and doctors have looked for ways to imitate human physiology and nudge women’s bodies into giving birth. Synthetic hormones can be used to start and speed up labor. Soft balloons and seaweed sticks placed alongside the cervix can shape a pathway through the birth canal. Self-stimulation can spontaneously spark natural labor transmitters.

But the start of labor remains a complex and mysterious process. And part of this mystery is figuring out which women to induce, when to induce labor, and how. Now, a landmark study known as ARRIVE has brought a bit of clarity.
What does the study tell us about inducing labor?

This multicenter, randomized, controlled trial involving thousands of women compared outcomes of induced labor versus “expectant management” — just waiting for labor to begin. All participants in the study were expecting their first baby, and all were within one week of their due date. For most of the women, their cervix wasn’t really open yet. No special methods were used to induce labor, just what was standard at each institution.

The results were interesting. For the baby, similar numbers of complications and need for intensive care occurred in both groups. However, when compared with waiting for labor, induction decreased the likelihood that the baby would need help with breathing. Breastfeeding success was no different between the two groups.

The big news? Inducing labor was associated with a lower rate of cesarean delivery (approximately 19% versus 22%).
What else is important to know?

It’s worth pointing out that the overall rate of cesarean birth among women in the study is quite a bit lower than the national average. The study participants were also younger, more likely to be black or Hispanic, and more likely to have public insurance than the general population of women having their first baby. So these results would not apply to all women equally. Also, of all the patients who were initially eligible and asked to join the study, only about one-third chose to participate. It could be that women opting to participate in a study of induction of labor had a particular leaning that could skew the results. It also tells us that many women may not want to have labor induced. And, while the chance of cesarean was lower in the induced patients, labor took longer than it did for those women who waited for labor to kick in on its own.

Doctors sometimes recommend inducing labor and birth for the benefit of the baby, mother, or both. Hypertensive diseases, including chronic high blood pressure and preeclampsia, are dangerous conditions that may require accelerated delivery. Over time, the health of the placenta that nourishes the fetus can deteriorate, leading to lack of growth and low amniotic fluid levels. When problems like these occur, inducing birth is appropriate. Other conditions — such as diabetes requiring insulin and, at times, the age of the mother — may be good reasons to induce. But even without a medical reason, the ARRIVE trial tells us it may actually be safer to induce labor in some women than to wait for labor to happen.
Should a woman choose to have labor induced?

So, should a woman choose to be induced? The answer may be yes if she is having her first baby, is not opposed to the idea of inducing labor, and is within one week of her due date. However, the benefits become less clear if her characteristics differ from those of the study participants in the ARRIVE trial. It’s best for a woman to discuss the options with her health care team.

We also don’t yet know how the longer labor and length of hospital stay associated with induction affect the cost of care. And most labor and delivery units are not built or staffed appropriately to accommodate the increase in occupancy that would result if many more first-time mothers were induced at full term. So, while the ARRIVE trial has answered some critical questions about inducing labor, some of the mystery remains.

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The new cholesterol guidelines: What you need to know

If you’re a smoker looking for another reason to quit, consider this: in addition to raising your risk of heart and lung disease, as well as cancers of the bladder and kidney, smoking could boost the odds that you will develop aggressive prostate cancer that metastasizes, or spreads through your body. That’s according to research published by an Austrian team in 2018.

The evidence connecting tobacco use with prostate cancer (which tends to grow relatively slowly) isn’t as strong as it is for other smoking-related diseases. Researchers first detected the link only after pooling data from 51 studies that enrolled over four million men. Published in 2014, this earlier research showed that smokers have a 24% higher risk of death from prostate cancer than nonsmokers, but it left an open question: did the men who died from these other causes also have high-grade prostate cancers that had not yet been detected? Experts suspected that since smoking kills in different ways, some of those who pick up the habit simply may not live long enough to die from prostate cancer.

To investigate, the Austrian researchers limited their analysis to just over 22,000 men who had recently been treated surgically for prostate cancer, but were otherwise healthy. This was a smart move. By focusing on prostate cancer patients instead of just smokers and nonsmokers, they excluded the men who were at higher risk of death from competing causes.

After roughly six years of follow-up, the data told a clear story: prostate cancer patients who smoked were nearly twice as likely to die of their disease (89% higher risk) than nonsmokers. In addition, the risk that their cancers would spread was 151% higher, and there was a 40% higher risk that their prostate-specific antigen levels would rise again after surgery, signaling the cancer’s return.

The biological link between smoking and prostate cancer is not clear. The cancerous pollutants that smokers inhale are excreted to some extent in urine, which flows through the prostate. Smoking might boost levels of toxic inflammation. Or perhaps it’s not even the smoking itself, but the poor lifestyle choices that often accompany it, such as inadequate exercise, or excessive alcohol use..

“I continue to try to understand why some smoking patients are so concerned about simple modifications in diet and querying about supplements (most of which have never been proven to be of any benefit for prostate cancer patients) yet continue with their habit,” says Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org/ “The message is clear – if you have prostate cancer and are concerned about how you can modify risk for cancer progression, and you are a smoker — simply STOP.”
The new cholesterol guidelines from the American College of Cardiology and American Heart Association are out! These guidelines — last updated in 2013 — have been highly anticipated by the cardiology and broader medical community. They have been approved by a variety of additional professional societies, including the American Diabetes Association. Thus, the majority of physicians are very likely to follow them. So, what exactly is new and what do you need to know?
It starts with a healthy lifestyle, with statins for those who need them

A healthy diet and regular physical activity are recommended for all age groups as the foundation to prevent cardiovascular disease (CVD) and CVD risk factors such as high cholesterol.

However, once there is atherosclerotic cardiovascular disease (plaque in the arteries), the new guidelines recommend that high-intensity statin therapy or maximally tolerated statin therapy should be used, in addition to lifestyle modification, to reduce low-density lipoprotein cholesterol (LDL-C). For example, this recommendation applies to patients with a history of prior cardiovascular events such as heart attacks, or of procedures such as stenting. The goal is to lower LDL-C levels by 50% or more.
Cholesterol targets are back!

Much to the delight of physicians, concrete LDL-C targets have been reintroduced into this version of the guidelines. For individuals with atherosclerotic cardiovascular disease who are at very high risk of cardiac complications, drug therapy beyond statins is recommended to achieve a target LDL-C of 70 mg/dl.

The first addition beyond high-intensity statins would be the now generic ezetimibe, a cholesterol-lowering drug that works by preventing the absorption of cholesterol in the intestine. If that does not do the trick, the injectable PCSK9 inhibitors are considered a reasonable next step, with the caveat that the drugs are expensive and their long-term safety beyond three years is not well established. However, since the guidelines were finalized, one of the two companies that makes PCSK9 inhibitors has lowered the list price. This may ultimately help make these potent cholesterol reducing drugs more cost-effective.

The same algorithm as above is recommended for otherwise healthy people whose LDL-C is greater than or equal to 190 mg/dL. In this case, however, the target is 100 mg/dL instead of 70 mg/dL, presumably because there is no evidence (yet) of actual atherosclerosis.

In people 40 to 75 years of age with diabetes who have an LDL-C greater than or equal to 70 mg/dL, a moderate-intensity statin is recommended. If there are additional risk factors or the person is 50 years or older, then a high-intensity statin is considered reasonable.

The above recommendations are not controversial among expert physicians in the field. In fact, some may say that these guidelines are not aggressive enough in terms of wanting lower cholesterol targets in very high risk patients. But none who understand the data would disagree with the above guidelines as general starting points. If you have atherosclerotic cardiovascular disease, a very high cholesterol level, or diabetes, then, in addition to a healthy lifestyle, you really ought to be on a statin, assuming you can tolerate it, and maybe additional medications, depending on your cholesterol level.
What about healthy people with moderately elevated cholesterol levels?

What about healthy people who don’t fit into the above categories? The guidelines provide clear guidance, but things do get a bit more nuanced. Here, there really needs to be a discussion between the patient and their doctor.

Whether to start a statin or not depends on whether there are other cardiovascular risk factors, such as smoking, high blood pressure, or diabetes, and the actual LDL-C level. A family history of premature atherosclerotic cardiovascular disease would be another factor to consider, as might South Asian ethnicity or premature menopause (before age 40). Other blood test abnormalities, such as elevated triglycerides or elevated high-sensitivity C-reactive protein levels (a marker of inflammation), might also push towards starting someone on a statin. Another recommendation in the new guidelines is for potential use of coronary artery calcium (CAC) scans to decide whether or not to initiate statin therapy in select cases where the decision based on clinical risk factors is unclear. Patient preferences and cost (though most statins are now generic) are other potential issues to weigh. Online risk calculators may help.

Bottom line: If you are one of the large number of people who fall into this category, talk to your doctor about whether you should be on medications to lower your cholesterol, or whether lifestyle changes are enough.

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Creating recovery-friendly workplaces

If you can’t stop picking your skin, you may have a very common condition called skin picking disorder (SPD). We all pick at a scab or a bump from time to time, but for those with SPD, it can be nearly impossible to control those urges. Apart from the cosmetic impact of recurrent skin lesions and scarring, SPD can lead to serious infections, shame, depression, and anxiety.

You may be feeling alone or embarrassed, but you should know that this condition affects at least five million Americans. A diagnosis of SPD, also known as excoriation disorder, is made when there are repeated attempts to stop picking, and the skin picking is either distressing or interfering with social or work functioning. SPD is one of a group of disorders that is related to obsessive-compulsive disorder (OCD).

You already know that it is not a matter of will — trying to stop is the equivalent of telling one not to have high blood pressure. The good news is that therapy, medication, and dermatologic treatments can help. For most, though, no one treatment will be curative, and you will experience remission and recurrence.

Having realistic expectations and arming yourself with a variety of skills for skin picking flares will make this condition much more manageable. Here are four tips that can help you tackle your picking.
1. Know your triggers

You may be tempted to pick for a variety of reasons, from boredom, itch, or negative emotions, to blemishes or simply looking at or feeling your skin. You may even find the experience of picking itself pleasurable. Understanding your triggers can be a first step in deciding which treatments to pursue. For example, if your picking is triggered by a skin condition such as acne or itch, you might be best served by first seeing a dermatologist. If, however, your picking is triggered by depression, anxiety, or more of an urge, you should consult with a mental health professional with expertise in skin picking.
2. Make it harder to pick

One simple strategy to reduce picking, called stimulus control, involves changing your environment to make it harder to pick. Examples of this technique include keeping your nails short, wearing gloves at times when you are most likely to pick, and making the skin more difficult to access by wearing tight-fitting clothing or long-sleeve shirts. You can also try distracting your hands with any number of items including silly putty, stress balls, fidgets, and tangle toys. Once you have found an item that works for you, make sure to have one everywhere you spend time such as work, home, and your bag, so you are fully covered.
3. Get therapy

Cognitive behavioral therapy (CBT) is a structured type of psychotherapy that aims to produce healthier behaviors and beliefs by identifying unhelpful thoughts and behaviors. A specialized type of CBT has been developed for SPD. This type of CBT includes more of the stimulus control techniques described above, as well as habit reversal training, in which individuals are taught to engage in a harmless motor behavior (like clenching one’s fists) for one minute when triggered to pick. Clinical trials have demonstrated that skin-picking for CBT can be extremely effective. But because it is different than other types of CBT, it will be important to work with a therapist who is trained in treating SPD. You can find skin-picking experts at the TLC Foundation for Body-Focused Repetitive Behaviors.
4. Consider medication with your providers

While no medication has been formally approved by the FDA to treat SPD, there is evidence to suggest that selective serotonin reuptake inhibitor (SSRI) antidepressants and N-acetylcysteine (NAC), an antioxidant supplement, can be helpful. Owing to the limited and evolving research on medication treatments for SPD, you may find that your provider is not up to date on current skin picking treatments. If you or your provider would like more information about these medication treatments and others, you can look here.

Please be aware that even over-the-counter, well-tolerated supplements like NAC should always be taken under the supervision of a medical professional for guidance on dosing, duration of treatment, drug interactions, and side effects.
Our country’s ongoing opioid crisis has many faces, from teenagers on Cape Cod to middle-aged parents in West Virginia. A recent report from the Massachusetts Department of Public Health provides another demographic affected by opioids: people who work in the trade industries, namely construction. The report broke down overdose deaths by industry, and construction workers were involved in almost a quarter of overdose deaths recorded in the state over five years. Farming, forestry, and hunting, along with fishing, are the next most dangerous industries. And there are relatively high overdose death rates for women working within health care support and food services.

This research supports what we have seen in our own work treating patients for substance use disorders who work in manual labor jobs. On-the-job hazards and related injuries are common, and pain medications of all kinds tend to be readily available as workers informally share and sell them on worksites.
The need for recovery-friendly workplaces

A recent National Safety Council report found that 70% of surveyed employers have been impacted by prescription drug misuse, but fewer than 20% feel extremely prepared to deal with it. The financial cost to employers in lost productivity is significant: in Massachusetts alone, opioid addiction cost businesses $2.5 billion annually from employees who aren’t functioning at full capacity, and $5.9 billion in lost productivity from people who can’t join the workforce due to addiction. Opioid use disorder has kept nearly 33,000 people in Massachusetts from participating in the labor force each year, on average, over the past five years.

But what could a recovery-friendly workplace look like? Drawing inspiration from models like Supported Employment, an evidence-based intervention for individuals with serious mental illness, and recovery high schools, we describe five key features of a recovery-friendly workplace:

Available counseling for scheduled and on-demand recovery support. Manual labor workers with varying schedules often have trouble making appointments in traditional healthcare settings, which tend to be offered only during normal business hours. Missed work equals lost income, which is harmful to workers and employers alike. An onsite counselor for large worksites or availability of remote telehealth counseling on-demand during work breaks could encourage participation in these programs.

Peer support groups built into the daily schedule. Like individual appointments, therapy groups often occur during the business day. Open and safe discussions with crewmates who are also in recovery can help build a culture of mutual support. Onsite peer support by recovery coaches in the industry might be particularly impactful.

A supervisor who understands the challenges and needs of people in recovery. Slip-ups are part of the recovery process, and a positive drug test should signal the need for more counseling support and closer monitoring, not automatic termination of employment.

Support for medication-assisted treatment. We’ve heard anecdotally about certain union health insurance plans that deny coverage of buprenorphine (Suboxone), a medication for opioid use disorder that calms cravings and halves the risk of overdose death. This kind of discrimination is a federal crime, and for good reason — imagine employer-based health insurance refusing to pay for insulin for workers who have diabetes. Unfortunately, stigma and fear of retribution may keep union workers from speaking out to claim their rights.

Onsite drug testing (where appropriate) and telepsychiatry. Regular drug testing could help make construction sites safer and indicate when people need more support. Crews often share transportation to and from worksites, making it hard for an individual to leave in the middle of the day for a medication appointment or to provide required toxicology testing for their program. Telepsychiatry visits in a secure room on a worksite could allow people to get assessed more regularly and prevent missed doses of recovery medications like buprenorphine.
Recovery-friendly workplaces may lower healthcare costs

Employers in all kinds of industries should consider how establishing recovery-friendly workplaces may help them access an underutilized workforce while addressing a vital social need. People in recovery from opioid use disorder commonly describe their core recovery goals as needing to keep busy, to achieve financial self-sufficiency, and to recapture the dignity of being a working member of society. Our clinical work can go only so far in supporting our patients’ recovery, but with the right kinds of partnership across sectors, we can make great strides together.

Given the high prevalence of substance use disorders in certain sectors, investing in supported employment with recovery support and medication-assisted treatment might reduce costs associated with missed work as well as employee hiring and retraining, improving overall work quality while also lowering overall healthcare costs. Finally, substance use is rampant on construction and manual labor worksites, so investing in recovery support and treatment might improve the relationship of workers with management and unions and reduce risk for accidental injuries in the future.

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Eat more plants, fewer animals

Antibiotics can be lifesaving, but they can have serious downsides — including increasing the risk of obesity when they are given early in life, according to a recent study.

Antibiotics kill bacteria. That can be a very good thing when the bacteria are causing a serious infection. But antibiotics don’t limit themselves to killing infection-causing bacteria; they kill other bacteria in the body, too. And that can be a very bad thing.

Our bodies are full of bacteria. These bacteria, part of our microbiome, are important. Along with other micro-organisms in our body, they play a role in how we digest foods, in normal growth, and in our immune system. When we take antibiotics, we inadvertently kill some of those bacteria. At first glance, it seems like this wouldn’t be such a big problem; after all, the world is full of bacteria, can’t we replace them? But as we learn more about our microbiome, it appears that the way it gets started — meaning the bacteria that we gather and grow early in life — is very important and can have lifelong effects.

Studies have shown that babies who are born by caesarean section are more likely to be obese as they grow, and part of the reason is thought to be that because they aren’t born through the birth canal, they don’t get that natural birth dose of bacteria to get them started in the right direction.

In the study, researchers looked at more than 300,000 infants born into the military health system. They looked at whether they were given antibiotics during the first two years of life. They also looked at whether they were given either of two medications used to decrease stomach acid, commonly prescribed to treat stomach reflux in babies. Giving antacids can alter bacteria, both by allowing the bacteria from the mouth and nose that usually get killed by stomach acid to move into the intestine, crowding out other species — and by killing bacteria themselves.

In the study, children who got antibiotics had a 26% higher chance of obesity. Taking one or both of the two kinds of antacid also increased the risk of obesity, although to a lesser extent. Taking antibiotics along with one or both kinds of antacid increased the risk, as did being on the antacids for longer periods of time.

Interestingly, farmers have been using this to their advantage for some time. Giving livestock antibiotics early in life makes the animals heavier, which means there is more meat on them. This use of antibiotics in livestock may mean more profits for farmers, but it has been a significant contributor to the problem of antibiotic resistance.

It’s not just obesity; giving antibiotics and antacids early in life increases the risk of food allergies and other allergic disease like asthma. Bottom line: we need to be very careful before we do anything that messes with the bacteria in our bodies.

As I said before, antibiotics can be lifesaving, and messing with the bacteria in our bodies is a risk absolutely worth taking — sometimes. But too often we use antibiotics when they aren’t really needed: many prescriptions, for example, are written for the common cold, something caused by viruses. Some infections, like ear infections, can get better without antibiotics — and even when we do need to use antibiotics, we often use them for longer than is necessary, or use stronger antibiotics than are necessary.

Since doctors write the prescriptions, it’s mostly doctors that need to make the change. But parents can play an important role, by asking if a prescription for antibiotics (or antacids) is truly necessary. If the answer is yes, parents should give it — but they should also ask about giving the shortest course possible.

We are in the midst of an obesity epidemic, one with so very many health implications for us and our children. As with any epidemic, we have to fight it in every way possible.
Science has shown us over and over again that the more meat we eat, the higher our risk of diabetes, heart disease, and strokes. Conversely, the more fruits and vegetables we eat, the lower our risk for these diseases, and the lower our body mass index.

Why is eating meat bad? High-quality research shows that red meats (like beef, lamb, pork) and processed meats (bacon, sausage, deli meats) are metabolized to toxins that cause damage to our blood vessels and other organs. This toxic process has been linked to heart disease and diabetes. (Want to know more? Read about how these animal proteins harm the body here and here).
Should we all become vegetarian or vegan?

Not necessarily. One can be 100% perfectly vegetarian or vegan and still have an unhealthy diet. Many foods that aren’t made with animals are still unhealthy. Think candy, soda, and pasta, and baked goods made with refined flour. Sugar-sweetened beverages and refined grains are also toxic to the body and associated with significant health risks.

A better approach is a plant-based diet. This means consuming mostly fruits and vegetables, including beans and legumes, nuts and seeds, and whole grains. A plant-based diet is well associated with a lower risk of diabetes, high blood pressure, heart disease, stroke, and death from any cause.

An estimated 90% of the population of the United States is omnivorous, and the vast majority of people aren’t going to give up meat. The good news is, they don’t need to. A 2017 study published in JAMA showed that consuming just 3% less animal protein and replacing it with plant protein was associated with up to a 19% lower risk of death from any cause.

Not only that, but a plant-based diet can protect us when we do occasionally eat meat. Fruits and vegetables contain special plant nutrients that neutralize toxins. These are antioxidants, and they are really good for us. But they cannot be isolated and packed into a capsule or pill — supplements don’t work. A balanced diet that includes a wide variety of colorful fruits and vegetables is what works. Just eat more plants that anything else, and minimize the meats, and you’ll be doing your body a huge favor.
Where will I get my protein?

Protein does not have to mean meat. As a matter of fact, many plant foods are excellent sources of protein. And no, it doesn’t have to be tofu. Think beans, lentils, peas, and edamame! Nuts and nut butters, seeds and seed butter! Whole grains contain a fair amount of protein as well.

Having trouble envisioning meals without meat? You can enjoy the same classic meals, just substitute in plant protein. For example:

If you love tacos, replace the meat filling with spiced lentils. (Try my Easy Spiced Lentil Taco Filling recipe below.)

If you love shepherd’s pie, use finely diced mushrooms instead of ground meat.

If you love fajitas, switch out the steak or chicken for portabella mushrooms.

Classics like minestrone soup, chili, spaghetti, and lasagna are easily converted into healthier, animal-free meals. Use whole grain pasta where pasta is called for, and add extra veggies. Even if you prepare any of these dishes using animal protein, add extra veggies and you will be benefiting.

Going to a plant-based diet doesn’t have to mean eating plants exclusively. Just aiming to eat more healthful plant foods, focusing on overall nutrition, decreases health risks significantly. Even a little improvement can have big results.

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Giving babies and toddlers antibiotics can increase the risk of obesity

In my experience, most people dealing with infertility would say that their longing for a child brings sadness year-round. Still, there are times and seasons when the pain intensifies.

This may be in spring or early summer when the world is in bloom, winter coats are off and pregnant bellies are out, when greeting card companies and florists ambush airwaves to promote Mother’s Day and Father’s Day.

Similarly, the winter holidays present an ever-lengthening stretch during which many women and men who are struggling with infertility feel pummeled. Bookended by Thanksgiving and New Year’s, this has become a season of holiday cards spotlighting happy children, and loud messages of merriment in stores and public places. Short days, dark nights, cold, snow, and clouds further conspire to tell those who are struggling with infertility that ‘tis hardly the season to be jolly.
Approaches to coping with infertility

So, how best to get through the holidays when you are enduring infertility? You might wish to set sail for an island paradise and remain there until the January blizzards take everyone’s focus off babies and young children. An escape could be sweet, but for many, the desire to share holidays with loved ones coexists with the pain of being infertile.

Rather than isolating yourself or disconnecting from those you love, you may simply want to hurt less. One way to do so is to find ways to claim some modicum of control during the winter holidays. Here are some ideas that have worked for people I’ve counseled over the years.

    Develop a strategy for opening holiday cards. For anyone going through infertility, the contents of each envelope may bring pain. While you have endured a year — or yet another year — of longing and disappointment, other people’s children have grown. Some cards hurt more: announcements of a new baby entering the world. One coping strategy is collecting the cards and opening a batch with a partner or a close friend who “gets it.” It can help a lot to feel that you are doing this as a team, letting fly with dark humor or sarcasm to fortify you in the process. Celebrate when the last envelope has been opened. For some, a bottle of wine or a nice dinner to enjoy afterwards eases sadness.
    Host a holiday gathering? Or just make a cameo? No one going through infertility wants to feel trapped in a holiday gathering with no way to escape. But how to avoid this? Surprisingly, one way is to host the party. Yes, it’s a lot of work, but you set the timing and format, and can shape content for the occasion to focus guests on something other than family chatter. A Yankee swap? A wine, cheese, or olive oil tasting?

    Alternatively, leave the heavy lifting to others and participate in their events on your terms. Agree on an escape clause — a reason to depart from a gathering early. That way, you know you can leave if someone announces a new pregnancy or is gushing about his children — or worse, grumbling about them and seemingly oblivious to her good fortune in having children. If you like, you can share your strategy with your host. The key, as with opening holiday cards, is to find pathways to control.

    Decide what to share. One way to claim some control at family holiday gatherings — and in general during infertility — is to manage information and communication. What do you want people to know? What is too much information? For example, you may feel it’s important that people you care about know you want to have a baby and are seeking medical help. Yet they need not know exact treatments, timing and outcomes of treatments, or the doctors you are seeing. Providing basic information protects you from being misunderstood, or the subject of queries. Offering detailed information invites commentary and advice.
    Consider how it might feel to acknowledge pain without showing it. Acknowledging pain might sound like this: “This has been a hard year. We’ve had some disappointing fertility treatments and gone through tough times, but we’re so happy to be here welcoming a new year with all of you.” Showing pain might sound like this: “It’s too hard for me to be here with all the children. I need to leave now.”

Giving back

Infertility draws us inward, prompting us to focus on our bodies, our sadness, our longings, and our helplessness. It blurs time and strains relationships, even when we do our best to stay connected. The holiday season, for all its commercial fanfare, is also a time when we remember those in need and those whose suffering eclipses ours.

Think perhaps of the holiday lights: Hanukah, the festival of lights, Kwanzaa, with seven glowing candles in the kinara, and Christmas, with its illuminated trees and homes, remind us that light in darkness is far more beautiful than light in light. At the risk of sounding preachy — which is not my intent — I think that doing good in dark times alleviates some of the seasonal pain of infertility. It reminds us that we do have some control, that the holidays are not simply a time to escape from, and that in helping others, we help ourselves.
Are you counting down the days until you find yourself face-to-face with certain family members or friends who know exactly where your buttons lie and push them, repeatedly? While we all long for an abundance of good cheer, an overflow of ready affection, and easy conversations, handling challenging relationships during the holidays can trip up even the best-intentioned. So, how to navigate the gatherings ahead?
Simple tips to help you navigate

Here are some simple tips to keep in mind:

Prepare. Sometimes we can avoid what we fear by anticipating and accepting what is. Why would Aunt Bertha be any different this year than last? Why set yourself up for disappointment or frustration? Identifying one or two traits that you appreciate about her (okay, one) can help you adopt an attitude of tolerance in your interactions.

Let awareness and acceptance lead to useful action. What kind of time are you willing to spend with those you find most challenging? Do you get along best with one sibling while doing the dishes together at the end of the meal? Is an after-dinner walk the best way to engage with another? Group versus one-on-one time? Think ahead about when and how you want to engage with others, then look for those opportunities.

Be curious. We can’t always control the conversations that arise, especially around the dinner table. Uh-oh, who just brought up politics? If there’s genuine curiosity about others’ points of view, the conversation may be terrific. But being curious takes a willingness to not be right and to listen simply to understand. Listening takes the discipline and desire to stay in the moment without formulating your rebuttal while another person is talking. It also takes a kind of humility to recognize that you might learn something new. And if you don’t think that’s possible — for you or for others — sometimes a simple “no politics” (or “no whatever-is-too-controversial”) rule is helpful with challenging relationships.

Redirect. And what about the 27th retelling of a hackneyed family story, maybe even one where you — or someone else — come out looking a little worse for wear? Intentional, light-hearted interruption and redirection may be just what’s needed. Keep the focus on the speaker to minimize the potential that they will feel slighted. “That was a horrid day at the beach. Did I hear you’re planning a trip to Spain in February?”
Time for a difficult conversation?

Carpe diem. When we live far from others, we sometimes need to seize the rare in-person moment to talk about challenging matters. A few words of guidance:

    Give your intended recipient advance notice. “When we get together, I’d really like to talk about the argument we had at Thanksgiving so that we can do better in the future.”
    Find the right time and place for your conversation. Try to ensure you’ll have enough time to talk things through.
    Take responsibility for your contributions to a problem. An apology, when sincere, can go a long way.
    Frame your concerns in neutral, non-blaming language. Try leading with “I” instead of what often sounds like an accusatory “you.” “I felt really betrayed when I found out you told Joe I lost my job,” versus “You are so untrustworthy, telling Joe I lost my job when you promised to keep it confidential.”
    You’ve got two ears and one mouth. Reflect that ratio in how you use them. Listen twice as hard for feelings and concerns, and speak to acknowledge what the other person shared.
    Stay focused on your goals. If you’re clear that your goals are mutual understanding, resolution, and harmony, your intentions will help guide your actions and keep you on track.

Be the light

As much as you might wish to choreograph a perfect holiday gathering — who doesn’t? — you probably know deep down that the only person you can control is yourself. With awareness, preparation, and discipline, you can, in fact, be the light no matter what else is swirling around you. And when all else fails, there’s always refuge behind the locked bathroom door on the second floor.

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Gut feelings: How food affects your mood

We spend our days interacting with the world around us through our senses of sight, sound, and touch. But anyone who has developed complete nasal obstruction from an infection or severe allergies has experienced what it’s like to be without one of our most basic senses: our sense of smell.
The many functions of smell

In other animals, the sense of smell is absolutely crucial for survival, reproduction, and rearing of young. Although humans can survive without smell, research has shown that losing the sense of smell negatively impacts quality of life, even driving some people toward clinical depression. Just as other animals depend on the sense of smell as an alarm system for danger, we also depend on smell to warn us of the hazards of smoke from a fire, natural gas leaks in the home, and spoiled food.

On a daily basis, smell rounds out our experiences and is often an integral part of our memory of events from years gone by. Memories of a perfume worn by your spouse or the bread being baked at your grandmother’s house when you were a child last for decades, and are often intricately tied in with strong emotions.

The flavor of a meal depends heavily on the ability to smell, and without it, eating is just a bland means to dispel hunger. With so much of our social activity involving congregating at restaurants, bars, and cafes, it is understandable how someone losing the sense of smell can develop a sense of alienation.
Impact of smell disorders

Smell disorders affect 19% of the population over the age of 20 and 25% of the population over 53. If smell loss from aging alone is considered, one out of eight people between 53 and 91 will be affected over a five-year period. The detrimental effect of smell loss on flavor of food could significantly impact the elderly population, where diet and nutrition are already often a concern.

The sense of smell (olfaction) is dependent on millions of specialized nerve cells that are located in a deep protected recess high in the nasal cavity. Remarkably, these nerve cells normally die and are replaced throughout our lifetime. Therefore, the system has the capacity to repair itself after injury, but this isn’t always possible or complete.

The most common causes of prolonged smell loss occur as a result of upper respiratory infection, head injury, chronic sinus disease, and aging. However, other conditions such as Alzheimer’s disease, Parkinson’s disease, and tumors can be associated with smell loss.

In some cases, the loss of smell is complete (anosmia), while in other cases there is only a partial loss (hyposmia). In many instances where smell loss occurs, remaining smells are distorted. The distortions are either experienced as odors smelling dramatically different from what was remembered (parosmia) or smelling an odor that isn’t present (phantosmia).

Perhaps if they were pleasant, these distortions of smell might not be as distressful. However, in almost all instances, the experienced smells are unpleasant, with “smoke,” “swamp-like,” “musty,” “garbage,” or “chemical-like” among some very common descriptions. The odor is usually hard for people to describe, since it is not like anything they have experienced before.
Treating smell disorders

In cases where smell loss results from sinus disease, we have had some success in treating the condition. Oral and topical steroids often provide relief. Sometimes surgery is required to reduce the obstruction of odors to the sensory nerve cells. Sinus disease usually requires long-term management, and fluctuations in the ability to smell are common.

In contrast to chronic sinus inflammation, success in treating people with loss of smell resulting from head injury, upper respiratory infection, or aging is poor. The natural ability of the olfactory system to repair itself allows for some patients to regain the sense of smell after a respiratory infection-related loss or head injury. This recovery can take over a year, and can be so gradual that people have difficulty recognizing the change. Predicting whether recovery will occur in an individual is usually not possible, but overall any improvement that occurs within a one-year period increases the chances of recovery.

If you experience any persistent change in your sense of smell, visit your doctor for an evaluation. Some rare forms of smell disorders may result from tumors in the brain, neurodegenerative disease, or infection. These conditions should be diagnosed expediently for proper management and treatment. In addition, your doctor should talk to you about risks, such as depression and nutritional concerns that may stem from loss of smell.

Although therapies are currently lacking, there is hope for future breakthroughs. Ongoing scientific work is investigating how stem cells in the nose replace dying olfactory nerve cells. In the future, we will be able to add medication in the nose to trigger these cells to make more neurons, or replace missing stem cells to regenerate the neurons. Or we may be able to electrically stimulate a sensation of smell using an artificial implant. Continued research advances in this field will someday allow us to restore this important sensory system to those unfortunate enough to experience smell disorders, and provide them with the ability to once again fully experience the world around them.
It’s the holiday season, time for buying toys for the children in our lives. As we do, the American Academy of Pediatrics (AAP) encourages us to think about buying toys that can actually help children as they grow and develop.

Play is the work of children. That doesn’t mean it can’t be fun; of course play should be fun. But play is at its best when it encourages learning and development, and when it encourages interaction with other people. So many gifts these days are full of bells and whistles and cool electronic gadgets, but don’t really help children (and are often quickly discarded). The AAP thinks that when buying gifts for children we should think more about getting back to basics, and suggests we think about toys from traditional toy categories:

    Symbolic/pretend play. These toys are the building blocks for imaginative play. They are things like dolls, animals, dollhouses, kitchen sets, tool sets, dress-up costumes, or puppets. Children can use them to create their own stories, doing it differently each time. Simple is best: toys don’t need to walk or talk or do anything, really. It’s better to leave that up to children.
    Fine motor/adaptive/manipulative. These are things like actual building blocks and other building sets, train sets, or puzzles. These are toys that not only encourage children to build and create, but also encourage fine motor skill development and early math (and even engineering) skills. There are apps that allow kids to build things digitally, but using their hands is best; nothing outdoes the three-dimensional approach.
    Art. Nothing encourages creativity and fine motor skills better than drawing, painting, and building with clay. So buy paper, crayons, markers, paint and paintbrushes — and modeling clay. They are inexpensive gifts that can keep children happy for hours. There is something very powerful for development when children have to start a project from scratch, like a drawing from a blank piece of paper.
    Language and interaction. This is where books come in — there is nothing better for learning new words, and appreciating words, than books. And when they are read aloud, in someone’s lap, they encourage interaction, which helps children flourish. Games encourage interaction too; traditional board games can be fun for everyone, and bring people together.
    Gross motor. In general, we are a sedentary nation — and most children do not get the recommended hour of physical activity every day. So make it easier for them. Buy them a bike or a trike, or a basketball and a net, or a soccer ball or a jump rope. Anything you do to get them moving not only builds strength and skills, it builds habits that can keep children healthy for the rest of their lives.
The human microbiome, or gut environment, is a community of different bacteria that has co-evolved with humans to be beneficial to both a person and the bacteria. Researchers agree that a person’s unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life.
Ultra-processed foods and gut health

What we eat, especially foods that contain chemical additives and ultra-processed foods, affects our gut environment and increases our risk of diseases. Ultra-processed foods contain substances extracted from food (such as sugar and starch), added from food constituents (hydrogenated fats), or made in a laboratory (flavor enhancers, food colorings). It’s important to know that ultra-processed foods such as fast foods are manufactured to be extra tasty by the use of such ingredients or additives, and are cost effective to the consumer. These foods are very common in the typical Western diet. Some examples of processed foods are canned foods, sugar-coated dried fruits, and salted meat products. Some examples of ultra-processed foods are soda, sugary or savory packaged snack foods, packaged breads, buns and pastries, fish or chicken nuggets, and instant noodle soups.

Researchers recommend “fixing the food first” (in other words, what we eat) before trying gut modifying-therapies (probiotics, prebiotics) to improve how we feel. They suggest eating whole foods and avoiding processed and ultra-processed foods that we know cause inflammation and disease.
But what does my gut have to do with my mood?

When we consider the connection between the brain and the gut, it’s important to know that 90% of serotonin receptors are located in the gut. In the relatively new field of nutritional psychiatry we help patients understand how gut health and diet can positively or negatively affect their mood. When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.

When the balance between the good and bad bacteria is disrupted, diseases may occur. Examples of such diseases include: irritable bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems. For example, IBD is caused by dysfunction in the interactions between microbes (bacteria), the gut lining, and the immune system.
Diet and depression

A recent study suggests that eating a healthy, balanced diet such as the Mediterranean diet and avoiding inflammation-producing foods may be protective against depression. Another study outlines an Antidepressant Food Scale, which lists 12 antidepressant nutrients related to the prevention and treatment of depression. Some of the foods containing these nutrients are oysters, mussels, salmon, watercress, spinach, romaine lettuce, cauliflower, and strawberries.

A better diet can help, but it’s only one part of treatment. It’s important to note that just like you cannot exercise out of a bad diet, you also cannot eat your way out of feeling depressed or anxious.

We should be careful about using food as the only treatment for mood, and when we talk about mood problems we are referring to mild and moderate forms of depression and anxiety. In other words, food is not going to impact serious forms of depression and thoughts of suicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself.

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