This episode is about a clever way one entrepreneur connects people directly with their local food economies to save money, get more nutritious food, and support small family farmers. I’m here with Matthew, who’s the co-founder of LAEF, which is short for Local Agriculture Expansion Foundation. In a nutshell, LAEF is a free payment and …
Continue reading 396: A Better Way to Connect With Small, Sustainable Farms, and Agriculture With LAEF...
Cyber Monday is a day when many online companies offer their best sales of the year. I’ve found some great deals this year and stocked up on pantry essentials, supplements, and some other gifts for everyone on my list! In fact, my Christmas shopping is done… now I just have to pull the Advent wreath …
Continue reading Best 2020 Cyber Monday Discounts on Natural Products...
I’ve learned over and over that health and wellness is increasingly personalized! I largely credit my transformation to addressing trauma… and figuring out the personalized diet/lifestyle approach that worked for me after years of experimenting. The latest in my quest for personalized health is wearing a continuous glucose monitor. As a population, we consume over …
Continue reading What I Learned From Wearing a Continuous Glucose Monitor (CGM) for a Month...
It’s been such a tough year for many people, and Thanksgiving is bound to feel different for many of us. In tough and uncertain times, it’s easy to focus on the negative… but what’s the benefit in that? In this Thanksgiving podcast, I share the lessons I’ve learned through all of this, including reinventing many …
Continue reading 395: Gratitude and Silver Linings of This Year – Thanksgiving Podcast...
Once a year we set aside a day as a nation to reflect on all of the reasons we have to be grateful (yes, it’s not just about turkey and stuffing!). Many of us are well aware of the spiritual and mental benefits of cultivating gratitude in our lives, but it turns out that these …
Continue reading Health Benefits of Gratitude (& Why We Have to Work at It)...
Although it’s been several years since salted caramel became all the rage, it continues to be a popular choice for coffee drinks and desserts today. I’ve shared my recipe for my favorite way to drink coffee, but I realized that it could be easily adapted to be a salted caramel latte and still be healthy! If …
Continue reading Homemade Salted Caramel Latte Recipe...
Today I have the pleasure of welcoming a much-requested guest, Dr. Paul Saladino of “The Carnivore Code” fame. He’s a double board certified doctor with a controversial claim: vegetables aren’t as good for you as you think! Dr. Saladino goes deep on how he used a meat-only diet to reverse autoimmune issues, chronic inflammation, mental health …
Continue reading 394: The Carnivore Code, Plant Toxins, and Optimal Protein With Dr. Paul Saladino...
I’ve never understood it… the idea of running out early on holiday celebrations with family to go shopping for gifts for those same people! No judgment from me if that is your thing, but this year, why not have the turkey and eat it too? (Literally and figuratively). I’m doing my early shopping from the …
Continue reading The Best 2020 Black Friday Sales & Deals on Natural Products...
We’re back for a second episode with Nora Gedgaudas, who is a board-certified nutritional consultant and a clinical neurofeedback specialist. She has over 20 years of clinical experience and she’s also an extremely detailed researcher. I always love to hear her thoughts on controversial health topics since she goes deep and leaves no stone unturned. …
Continue reading 393: Fish Oil, Nature’s Real Superfoods, and Strengthening Immunity With Nora Gedgaudas...
What’s an ancient remedy for hemlock poisoning, used by Cleopatra, and burned in some churches? If you guessed frankincense, you got it right! Resin from this tree has been used in skincare, medicine, and religious ceremonies for thousands of years. This tree’s soothing and clarifying properties make it the ideal ingredient in frankincense face cream. …
Continue reading Soothing Frankincense Face Cream for All Skin Types (DIY Beauty Recipe)...
Holidays are a time to honor traditions, break out our best recipes, and celebrate in high style. Still, it can’t be denied that the usual Thanksgiving menu is rough on those with dietary restrictions, and generally leaves most of us feeling as overstuffed as the turkey! Years ago I decided to take our Thanksgiving menu …
Continue reading How to Plan a Healthy Thanksgiving Menu (Recipes + Printable)...
I am thrilled to say today I’m sitting down for round two with Dr. Ben Lynch, one of my favorite experts on genetics and epigenetics. He’s going to give us some very practical, useful tips on supporting your health by paying attention to your genes, and how to teach your kids to do this too. …
Continue reading 392: Understanding Genetics vs Epigenetics: How Genes Work Like Dominos and What Yours Are Telling You With Dr. Lynch of StrateGene...
Thyroid problems seem to be everywhere these days! Women especially are more prone to them. Hypothyroidism can happen for many different reasons, but our current modern, chaotic lifestyle can contribute to it. I’ve struggled with thyroid problems for more than a decade now. While I also have Hashimoto’s, an autoimmune thyroid condition, part of that …
Continue reading Hypothyroidism 101: How to Boost an Underactive Thyroid Naturally...
Liver may be a nutrition-packed powerhouse, but for many this offal is, well… awful tasting. While I do love some liver and onions with bacon (because, hello, bacon!), these liver capsules are a virtually tasteless way to get your liver on. Should We Eat Liver? So why would we want to eat liver? Isn’t it the …
Continue reading How (& Why!) to Make Your Own Liver Capsules...
Three effective forms of birth control contain the hormone estrogen: the birth control patch, combined hormonal birth control pills, and a vaginal ring. Doctors have typically recommended that women avoid birth control with estrogen if they have high blood pressure, which current US guidelines define as 130 mm Hg systolic pressure and 80 mm Hg diastolic pressure, or higher. A recent clinical update in JAMA clarifies whether it’s safe for some women with high blood pressure to use these forms of birth control.
Birth control containing estrogen can increase blood pressure. When women who have high blood pressure use these birth control methods, they have an increased risk of stroke and heart attack compared with women who do not have high blood pressure. However, their actual chances of having a stroke or a heart attack are still quite low.
When considering birth control options, it’s important to also weigh the possible risks of an unintended pregnancy. A woman who has a history of high blood pressure before she becomes pregnant is more likely to experience
She’s also at higher risk for problems with fetal growth and preterm birth.
When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. That happened because the new guidelines tightened standards, as follows:
With these updated definitions, nearly half of American adults have high blood pressure. Black women are at particularly high risk: more than half of Black women over the age of 19 are diagnosed with high blood pressure.
If a woman has high blood pressure, the JAMA update recommends weighing three factors before starting an estrogen-containing birth control: a woman’s age, control of blood pressure, and any other risks for heart disease.
The JAMA update reviewed evidence based on an older definition of high blood pressure in the context of birth control use. Further research is needed to better understand how different ranges of blood pressure might affect women using birth control that contains estrogen. However, it’s unlikely that these recommendations would change further based on the newer definition of high blood pressure.
So, what can women who are unable to use birth control containing estrogen use to prevent pregnancy? The good news is that there are a variety of other birth control methods available, both hormonal and nonhormonal.
If you do have high blood pressure, exercise and dietary changes remain an important component of maintaining your heart health. Discuss with your doctor which birth control options might be best for you, so that you and your doctor can engage in shared decision-making about your preferences.
See the Harvard Health Birth Control Center for more information on options.
The post Birth control and high blood pressure: Which methods are safe for you? appeared first on Harvard Health Blog.
The “battle of the bulge” gained a new foe this year: quarantine snacking. Sales of snack foods like cookies and crackers shot up in the early days of lockdowns, and recent consumer surveys are finding that people have changed their eating habits and are snacking more.
We don’t yet have solid evidence that more snacking and consumption of ultra-processed food this year has led to weight gain. While memes of the “quarantine 15” trended on social media earlier this year, only a few small studies have suggested a link between COVID-19-related isolation and weight gain. But you don’t need scientific evidence to know if your waistband is tighter.
Regular junk food snacking brings many risks. Processed foods are typically filled with loads of unhealthy saturated fats and high amounts of salt, calories, added sugar, and refined (unhealthy) grains.
Eating too much of these foods can lead to increased blood sugar (which raises the risk for diabetes), constipation, or an increased LDL cholesterol level (which boosts the risk for heart disease).
If your snacking habits are off the rails, here are some tips to get back on track.
The post Quarantine snacking fixer-upper appeared first on Harvard Health Blog.
It’s been more than 17 years since the FDA last approved an Alzheimer’s drug. Will Biogen’s drug, called aducanumab, end this drought? The FDA will decide by March 2021, based on its own analysis of clinical trial data and an advisory panel’s review of the evidence.
Aducanumab is a monoclonal antibody engineered in a laboratory to stick to the amyloid molecule that forms plaques in the brains of people with Alzheimer’s. Most researchers believe that the plaques form first and damage brain cells, causing tau tangles to form inside them, killing the cells. Once aducanumab has stuck to the plaque, your body’s immune system will come in and remove the plaque, thinking it’s a foreign invader. The hope and expectation is that, once the plaques are removed, the brain cells will stop dying, and thinking, memory, function, and behavior will stop deteriorating.
If aducanumab works, it would be the first drug that actually slows down the progression of Alzheimer’s. That means we could possibly turn Alzheimer’s from a fatal disease into one that people could live with for many years, in the same way that people are living with cancer, diabetes, and HIV/AIDS.
For researchers, it means that more than 20 years of scientific work, which suggests that removing amyloid from the brain can cure Alzheimer’s, may be correct. But many of us have begun to doubt this theory, because trial after trial has shown that amyloid could be cleared from the brain but clinical disease progression was not altered.
I attended the day-long FDA hearing on November 6, 2020, and also independently reviewed all the publicly available data for aducanumab. There was one small (phase 2) clinical trial to assess efficacy and side effects, and two large (phase 3) clinical trials to assess effectiveness, side effects, safety, and how the drug might be used in clinical practice. The small phase 2 study and one of the large phase 3 studies were positive, meaning that the drug worked to slow down the decline of thinking, memory, and function that is usually impossible to stop in Alzheimer’s. The other large study was negative. Hmm… Is two out of three positive studies good enough? Biogen’s scientific team had many plausible explanations for why that one study was negative.
The advisory panel, however, was not convinced. They pointed out that phase 2 studies are always positive, because otherwise you wouldn’t move on to phase 3, so that study doesn’t count. They also pointed out that, although you can think of the positive phase 3 study as the “true” one, and try to understand why the negative one failed (which is what Biogen did), you could equally think of the negative study as the true one, and try to understand why the other one showed positive results.
The advisory council was concerned that there was “functional unblinding” in both studies, because large numbers of participants in the treatment group needed additional MRI scans and physical exams to deal with side effects, which did not occur in the placebo group. Hence, if you were asked to come in for an extra MRI scan, you knew that you were on the real drug. This knowledge may have influenced the responses subjects and their family members gave regarding how they were doing, which were the primary outcomes of the study.
To determine if a drug should be approved, many factors need to be considered. First is whether it works and, as discussed above, there are questions regarding its efficacy. You also have to consider side effects and other burdens on patients, families, and society.
You first need an amyloid PET scan to be sure you have the amyloid plaques of Alzheimer’s. Then to take the drug, you need an intravenous infusion every four weeks — forever. Thirty percent of those who took the drug had a reversible swelling of the brain, and more than 10% had tiny brain bleeds. These side effects need to be watched closely by an expert neurology/radiology team who understand how to monitor for these events, and know when to pause or stop the drug.
Another factor to consider is the size of the benefit. Here, it was fairly small. Looking at the two objective measures, in the positive trial, the high dose made a 0.6-point change on the 30-point Mini-Mental State Examination (MMSE). On the 85-point Alzheimer’s Disease Assessment Scale–Cognitive Subscale-13 (ADAS-Cog-13), the high dose made a 1.4-point change. In the negative trial, the analogous results were -0.1 (worsening) for the MMSE and 0.6 for the ADAS-Cog-13.
Cost also needs to be considered; for aducanumab, this is estimated at $50,000 per year per patient. There are more than two million people with Alzheimer’s in the mild cognitive impairment and mild dementia stages. If one-quarter of those decide to take the drug, that’s $25 billion each year — not including the cost of the PET scans and the neurology/radiology teams to monitor side effects. Since most people with Alzheimer’s disease have Medicare, we will all share this cost.
Moreover, Dr. Joel Perlmutter, a neurologist at Washington University in St. Louis and member of the FDA’s advisory committee, argued that if the FDA approves aducanumab, fewer people would want to participate in a trial of a novel medication — and that would likely delay the approval of better medicines.
There are many other treatments for Alzheimer’s that are also being developed. Drugs that remove tau — the tangles of Alzheimer’s — are being tested. Treatments using flashing lights to induce specific brain rhythms may protect the brain. Other treatments change the microbiome of the gut or other parts of the body. Drugs are being developed which alter nitric oxide — a gas that has critical functions in brain health. Lastly, in my laboratory, we are developing strategies to help individuals with mild Alzheimer’s and mild cognitive impairment to remember things better, because, at the end of the day, that’s what matters most.
The post A new Alzheimer’s drug: From advisory panel to FDA — what’s at stake here? appeared first on Harvard Health Blog.
Over the last few years, I have shared more about my own health journey and how I truly had to figure out my own individualized approach to health. I saw benefits from other systems — paleo, AIP, keto — but it wasn’t until I found a personalized approach that everything started to change. It can …
Continue reading 391: Using Detailed Health Journaling and Mindset Shifts to Heal With Sarah Kay Hoffman...
With a sharp increase in working from home during the COVID-19 pandemic, more people are noticing age-related skin changes up close on their videoconference calls.
The good news? You don’t need to rush to the dermatologist for your anti-aging needs. The best skincare regimens to combat the cardinal signs of aging, which include uneven skin tone, fine lines, roughness, and dryness, can start from the comfort of your own home. You don’t need a prescription, time to get to a dermatologist, or deep pockets to score quality products.
Here are a few science-backed, dermatologist-favorite ingredients that can help to slow, or even reverse, signs of aging. All of the ingredients listed below can be found over the counter (OTC) and are available in preparations that cost under $30.
Niacinamide, or vitamin B3, helps to block extra pigment formation by inhibiting the transfer of melanin (the major pigment in the skin) between skin cells. Applying topical niacinamide (5% concentration) twice a day was shown in a randomized and controlled, split-face trial to reduce freckles and sun spots in as soon as four weeks. The results were maintained throughout the eight-week treatment period. Another clinical study showed improvement of skin redness and sallowness (yellowing of the skin that occurs with age) in people who used topical niacinamide, resulting in a more even complexion. Niacinamide may also improve acne and fine lines.
Topical niacinamide appears to be well tolerated, with no serious side effects.
Aging can contribute to gradual loss of vitamin A, a retinol, which naturally occurs in the skin. This can be replenished by vitamin A derivatives, known as topical retinoids. Topical retinoids, such as retinol and adapalene, are available over the counter. They have been shown to significantly improve fine wrinkles, likely due to increased skin collagen thickness with prolonged use. Other benefits of retinoids include improvement of dark spots and reduction of atypical skin cells that could lead to skin cancer.
If you have acne or clogged pores, you may want to opt for adapalene, which appears to have more uptake in the follicles where acne starts, and also has anti-inflammatory effects. Both of these factors are important in acne formation. Adapalene may also be less irritating than some other retinoids.
The most common side effects of topical retinoids are dryness, redness, and irritation. This can be mitigated by gradually increasing use (from every third night, to every other night, to nightly), or by avoiding use with other potentially irritating or abrasive products.
Avoid topical retinoids if you are trying to get pregnant, or are currently pregnant or breastfeeding. Also make sure to use an SPF 30+ sunscreen on your face daily, due to increased sun sensitivity with this product.
The very top layers of skin, known as the stratum corneum, may increase in thickness with age, possibly because older cells are less able to renew and turn over. This can lead to skin roughness and can interfere with skin “glow” or luminosity. Alpha-hydroxy acids, such as glycolic acid or lactic acid, are naturally occurring substances that help to break down the bonds between cells in this top layer of skin, which results in smoother skin in as little as 24 hours. Over time, regular use may also improve fine lines, skin yellowing, blotchiness, and dark spots.
Glycolic acid at concentrations of 30% or more is used in the dermatologist’s office as a peel. But there is evidence that OTC preparations at concentrations of around 10% can give you real results and are safe to use at home.
Alpha-hydroxy acids such as lactic acid can also be found in OTC body lotions. They help to smooth the skin from the neck down.
The most common side effect is excess redness, and this can be made worse by using several new, irritating products at once.
An important (but often overlooked) sign of aging skin is dryness. As we age, our skin naturally loses its ability to retain moisture. This is due to decreasing stores of hyaluronic acid, an important component of healthy skin that has the ability to suck in water. Replacing hyaluronic acid through topical serums or moisturizers may help to boost overall skin hydration. Hyaluronic acid can also improve the appearance of wrinkles and skin firmness.
Start slow. If you are new to skincare, you don’t want to start using all of these ingredients at once (this is especially true of using a retinoid and an alpha-hydroxy acid together). Begin in a stepwise fashion, and increase frequency or add additional products only as tolerated. Remember that improvements in skin appearance with any skincare regimen may be subtle and can take time.
Once your skin has become accustomed to these ingredients, consider combination products that combine two or more of the ingredients you’re looking for. Finally, no skincare regimen is complete without good sun protection, so limit sun exposure, wear broad-brimmed hats and sunglasses when outside, and apply daily sunscreen.)
For treatment of deep wrinkles or sagging skin, or for medical skin concerns, seek care from a board-certified dermatologist.
The post Drugstore skincare: Science-backed anti-aging ingredients that don’t break the bank appeared first on Harvard Health Blog.
If you suddenly experience a strange but fleeting symptom — your arm or face suddenly feels weak or numb — you might be tempted to brush it off, especially if it’s short-lived.
But if those odd, unexplained symptoms last more than a few seconds, they could signal a transient ischemic attack, or TIA. Commonly referred to as a ministroke, a TIA is caused by a temporary lack of blood in part of the brain. Most of the time a blood clot is to blame, and the symptoms resolve quickly because your body’s natural clot-dissolving action restores blood flow. But according to the American Stroke Association (ASA), these events should be called warning strokes rather than ministrokes.
“A TIA can be a harbinger of a much more serious stroke,” says Dr. Christopher Anderson, director of acute stroke services at Harvard-affiliated Massachusetts General Hospital. If a blood clot blocking a brain artery doesn’t dissolve and remains in place for more than a few minutes, it can destroy brain cells by depriving them of oxygen and nutrients. Known as an ischemic stroke, these account for 87% of all strokes. As many as 17% of people who have a TIA will suffer a full-blown ischemic stroke within the next 90 days, with the greatest risk in the first week.
A recent study found that women with short-lived sensory or visual symptoms were less likely to be diagnosed with TIA compared with men. One reason could be that migraines are more common in women. As a result, both women and doctors may be less likely to suspect a TIA in women with sensory or vision changes, which may occur with or without a migraine headache. “But it’s important to consider a TIA in all people with those symptoms, regardless of their gender,” says Dr. Anderson.
Other short-lived TIA symptoms may be easy to dismiss, says Dr. Anderson. “Sometimes, people will say, ‘That’s funny, I can’t feel one side of my face,’ and garble their words for a short time,” he says. People may repeatedly drop objects (a cooking utensil, for example) but then be able to function normally after a few minutes. Another classic TIA symptom is seeing what’s often described as a dark curtain dropping over one eye from top to bottom. This symptom is called amaurosis fugax (from the Greek amaurosis, meaning dark, and the Latin fugax, meaning fleeting).
The ASA coined the mnemonic FAST to help people recognize stroke symptoms. The first three letters, which stand for Face drooping, Arm weakness, and Speech difficulties) account for about 75% of the symptoms people experience during a stroke. (The T stands for Time to call 911.)
But some neurologists suggest adding two additional letters: B for balance and E for eyes. Balance is a tricky one, because balance problems can occur due to a range of problems other than a stroke, especially in older people, says Dr. Anderson. With a stroke, balance problems rarely appear in isolation; they usually occur in tandem with other symptoms such as leg weakness or vision problems, he explains. Vision problems during a TIA or stroke can include reduced, blurry, or double vision.
The simpler FAST makes sense for a public health campaign. But if you’re at risk, knowing BE-FAST may be the most helpful, as it may help you recognize even more potential TIAs and strokes. High blood pressure is the leading cause of stroke. Other risk factors to be aware of include smoking, diabetes, physical activity, and obesity. People with heart disease (such as coronary artery disease, atrial fibrillation, and heart failure) face a higher-than-normal risk of stroke. Talk to your doctor about your risks for stroke or TIA, and healthy steps you can take to lessen your chance of having either one.
The post How to recognize a ministroke or stroke — and what to do appeared first on Harvard Health Blog.
I’ve been thinking for a while that it’s high time for a new dessert recipe! I know ice cream is a popular summer dessert choice, but does cold weather really make it any less delicious? Obviously not, since snow cream is a thing! Add coffee and you have the perfect treat for any time of year. If …
Continue reading Decadent (Dairy Optional) Coffee Ice Cream...
I’m here with Julie Lythcott-Haims, who is the author of The New York Times best-selling book How to Raise an Adult. It’s one of my favorite books and I think her message is incredibly, incredibly important. I’m so excited to have her on today to share her perspective because Julie is a mom (and also …
Continue reading 390: How to Raise an Adult: Break Free of the Overparenting Trap and Prepare Your Kids for Success With Julie Lythcott-Haims...
Soon after the coronavirus pandemic began, we learned that older adults and people with certain chronic conditions, such as high blood pressure or diabetes, are at increased risk for severe COVID-19. One condition on that list is an immunocompromised state (a weakened immune system). This can be due to a number of conditions, including having had an organ transplant, having HIV, or taking medications that suppress the immune system.
If you have an autoimmune condition such as rheumatoid arthritis or lupus (also called systemic lupus erythematosus), you may wonder how this affects your risk. It’s thought that these conditions occur because the immune system misfires and attacks organs in the body. And many people with these disorders are treated with medications that suppress the immune system.
Two newly published studies examine this. While the results are not definitive, they do provide some reassurance. Most people recovered from COVID-19, and most of their prior treatments did not seem to worsen their infections.
In the first study, researchers enrolled 226 people with lupus. After comparing those who had COVID-19 with those who did not, they found that
The second study included 103 people with inflammatory arthritis (which includes rheumatoid arthritis and related conditions) who were also diagnosed with COVID-19. Some were hospitalized with severe disease, while others were treated as outpatients. Here’s what the study found.
These studies only included patients with COVID-19 and either SLE or inflammatory arthritis. It wasn’t possible to rigorously compare the study participants to people without lupus or arthritis. Also, these studies did not include large numbers of people with lupus or arthritis who tested positive for the virus, yet did not have symptoms of COVID-19 (asymptomatic infection). Nor did they confirm the diagnosis of COVID-19 in every suspected case. So, while this research offers some new information, the true impact of lupus or arthritis on people who develop COVID-19 hasn’t yet been determined.
Finally, the lupus study was small: only 41 subjects had confirmed COVID-19. Although the findings on steroid treatment weren’t statistically significant, that might not have been true if the differences observed persisted in a larger study.
Public health experts often include people with autoimmune disease on the list of those who are more likely to have a bad outcome if they develop COVID-19. The relatively high rate of hospital admission for lupus patients with COVID-19 confirms an increased risk for severe disease. Other standard risk factors (such as high blood pressure or lung disease) apply, but steroid therapy may increase risk even further. Other studies have come to similar conclusions (see here and here).
There was some good news to emphasize in these trials: the survival rate among patients with lupus or inflammatory arthritis who develop COVID-19 was relatively high. Also, biologic therapy did not appear to worsen prognosis for the arthritis patients. And other immune suppressants did not worsen prognosis for those with lupus. And, the hospitalization rate for COVID-19 among patients with inflammatory arthritis was similar to what has been reported for people without arthritis.
These findings add to what we are learning about COVID-19. Clearly, we need to learn more. For example, is there a dose of steroids to treat chronic illness that is so low that it does not increase the risk of a worse prognosis with COVID-19? Do certain medications (such as biologics) actually reduce the risk of severe COVID-19? Until we do know more, it remains particularly important for people with lupus and inflammatory arthritis — especially those taking steroids — to be especially vigilant about measures to avoid COVID-19.
Follow me on Twitter @RobShmerling
The post Does lupus or arthritis affect your prognosis if you get COVID-19? appeared first on Harvard Health Blog.
I don’t know about you, but this year I’m thinking about the holidays a little earlier than usual — in part for something nice to look forward to, and on a practical level just to make sure everything gets here on time! Many companies are offering holiday deals earlier than ever to allow for extended …
Continue reading 2020 Ultimate Holiday Gift-Giving Guide for the Whole Family (Natural + Eco-Friendly)...
Being an early bird has long been associated with a go-getter attitude. Early birds, or those who tend to wake early and go to bed early, are people who naturally feel sleepy earlier in the evening and naturally wake early in the morning. For an early bird type, a 9 pm bedtime may be the norm, and rising at 5 am without an alarm clock feels relatively effortless.
Being an early bird, or the opposite night owl, is usually not something that is thought of as being highly under our control. Some people seem to be hardwired to sleep early, while others get a second wind and tend to sleep late. This internal clock is called our circadian rhythm, each person’s unique internal timekeeper and the body’s own master controller of many functions. Most obvious is our sleep patterns; however, our internal clock also plays a role in our hunger and eating patterns, hormone levels, and maybe even our mood.
A growing body of research shows that we may want to pay more attention to circadian rhythm, also called our chronotype. Identifying if we’re more of an early bird or night owl may help predict our risk of potential health problems.
A recent study from the Scandinavian Journal of Medicine and Science in Sports looked at whether the body clock is related to levels of physical activity. Using a wrist-based device that measures movement, over 5,000 participants’ activity levels were collected for two weeks. Researchers also identified whether each person was more of an early bird or night owl, based on a well-studied questionnaire. After considering some factors that may explain differences, such as education or background health conditions, they found that being a night owl was linked to lower physical activity. Night owls, as compared to morning types, had up to 60 to 90 fewer minutes per day of activity.
In short, more research in this area is needed to know for sure. Most studies on this topic look at patterns; there seem to be trends emerging that certain body clock patterns and health conditions run together. What we don’t know, though, is whether being a night owl or early bird is the cause. But when trying to understand why, there are a number of potential factors that come into play.
For those with a more of a night owl or an “eveningness” type, it may be more of a challenge to incorporate activity into their day. For many night owls, jobs or other demands on time may mean that a morning alarm is sounding well before their natural wake time. As a result, a night owl type may be starting the day relatively “jet lagged” — feeling out of sync with their body due to being awake when the body would prefer to be asleep. They also may be sleep deprived if they had to get up significantly earlier than desired. These may contribute to less activity on a regular basis.
On days off, catching up on sleep may become a priority given too little sleep during the week. Sleep patterns, such as how much or when people are sleeping, are potentially the key here, but this information wasn’t captured in this study. Other health conditions or behaviors that interfere with sleep, such as mood disorders, may be found more often among night owls.
We should emphasize that this study does not tell us that being a night owl is the cause for lower physical activity. (This is true for much research around our body clock, as previously mentioned.) It simply shows an association between being an early bird or night owl and certain conditions. In addition, the factors at play — sleep patterns and activity — are factors we have some control over. Though we may be hardwired to lean toward being a night owl or morning bird, most people fall somewhere in the middle. Sleep patterns and activity are modifiable, and even small changes can have a big impact over days, weeks, months, and years.
Reflecting on your sleep patterns is one way to take advantage of the best times of the day for more activity. Are you someone who feels ready and alert first thing in the morning? That may be the best time to get those steps in. More energy in the evening? Then scheduling that walk for after dinner may be best. Using your body clock to your advantage may help optimize the best time to be active.
The post Early birds may be more active, but night owls can catch up appeared first on Harvard Health Blog.
If you are living with type 2 diabetes, you certainly are not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal.
In part, this may be because doctors can be slow to make changes to a patient’s treatment plan, even when a patient’s treatment goals are not being met. One reason for this may be the overwhelming number of medications currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications.
Type 2 diabetes is a chronic disease where the body’s ability to use glucose or sugar as fuel is impaired. Our bodies produce a hormone called insulin which enables sugar from carbohydrates in food we eat to reach the cells and be used as energy. In type 2 diabetes, insulin’s ability to do its job is compromised, and over time the body actually produces less of it. This means less sugar in the cells for fuel, and more sugar in the blood where it can’t be used. Having high levels of blood sugar over time can cause damage to vital organs like the heart, kidneys, nerves, and eyes.
Some risk factors that predispose people to developing type 2 diabetes, such as genetics and age, are not modifiable. Other risk factors, such as being overweight or having obesity, can be altered. This is why losing 5% to 10% of one’s baseline weight by healthful eating and physical activity remains the backbone of type 2 diabetes management.
The blood sugar goal for most adults with diabetes is an A1C of below 7%. (A1C is a measure of a person’s average blood sugar over a period of about three months.) In many people, diet and exercise are not enough to reach this goal, and one or more medications may be needed. Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy. It is affordable, safe, effective, and well tolerated by most people.
When metformin does not adequately control blood sugar, another medication must be added. It is at this point that doctors and patients must choose among the many drugs and drugs classes available to treat type 2 diabetes. In general, for people who are at low risk of heart disease or have no history of diabetic kidney disease, most diabetes medications that are added to metformin effectively reduce blood sugars and can lower A1C to under 7%.
So, how to choose a medication? Each person with diabetes has their own goals, needs, and preferences. Before choosing a medicine, it is important to ask some relevant questions: Is my blood sugar at goal? Is this medicine affordable? Do I have heart or kidney disease? What are the side effects? Is it a pill or injection, and how often is it taken?
Regardless of which treatment is selected, the American Diabetes Association Standards of Care recommends reassessment of diabetes control every three to six months, followed by modifications to treatment if needed.
Lately, newer treatment options for type 2 diabetes — glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors — have been heavily advertised. These newer drug classes lower blood sugar and also have cardiovascular and kidney benefits.
GLP-1 receptor agonists are drugs that lower blood sugar after eating by helping your body’s insulin work more efficiently. All drugs in this group except one are self-injected under the skin, either daily or weekly. Several of them, such as liraglutide (Victoza), semaglutide (Ozempic), and dulaglutide (Trulicity), have been shown to lower the risk of cardiovascular disease in people who are at high risk for it, or who have pre-existing heart disease. They also promote weight loss. Some people who take GLP-1 receptor agonists may have side effects such as nausea and vomiting, and in very rare cases pancreatitis.
SGLT2 inhibitors like empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro) are also a newer class of medications that work by blocking your kidneys from reabsorbing sugar back into your body. They also have cardiovascular benefits, especially in those who have heart failure, and have been shown to slow the progression of diabetic kidney disease. Other benefits include lowering blood pressure and promoting weight loss. Use of these medications may increase the risk of genital yeast infections, especially in women. A rare but serious consequence of SGLT2 inhibitors is diabetic ketoacidosis, which is a medical emergency that can be avoided by stopping these medications in consultation with your doctor before major surgeries, or if you are ill or fasting.
While these diabetes medications certainly have more to offer than just improvements in blood sugar, they remain costly and inaccessible to many individuals. This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.
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