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Alopecia: What causes the hair loss condition? – Home – WSFX

Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development.(iStock)

Hair loss is typically considered the domain of aging men, but this equal-opportunity condition which has many causes can affect virtually anyone.

Alopecia is the medical term for hair loss, and it doesnt only happen on the scalp. Some illnesses and medications can trigger balding over the entire body, though genetics account for most cases on the head, according to theCleveland Clinic.

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Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development. Americans spend more than $3.5 billion each year trying to treat it, according to theAmerican Hair Loss Association.

Most peoples hair grows about a half-inch per month, and about 90 percentof your hair is actively growing at any given time, with the other 10 percentin dormant phase. After two or three months, this dormant hair falls out and its follicles begin growing new hair as other follicles begin a dormant phase.

Shedding hair is different from hair loss, when a hair falls out and doesnt grow back. People often shed hair during stressful events, such aschildbirth, a breakup or divorce or during times of grief.

It still doesnt feel good, and it takes the hair [awhile] to reach a certain length where you perceive its presence, said Doris Day, a board-certified dermatologist New York City and an attending physician at Lenox Hill Hospital, also in New York. So it feels like a hair loss, but its not a hair loss.

Aside from heredity, noticeable hair loss can be caused by wide variety of factors, including:

Harsh hairstyles or treatments: Hairstyles that consistently use rubber bands, rollers or barrettes, or pull hair into tight styles such as cornrows, can inflame and scar hair follicles. So can incorrectly used chemical products such as dyes, bleaches, straighteners or permanent wave solutions. Depending on the degree of damage, resulting hair loss can be permanent.

Hormone imbalances: In women, hormonal shifts from birth control pills,pregnancy, childbirth, menopause or hysterectomy can induce more hair follicles than normal to enter the dormant phase.

Illness or surgery: The stress from sickness or surgery may prompt the body to temporarily cease nonessential tasks such as hair production. Specific conditions can also trigger it, including thyroid disorders,syphilis, iron deficiency,lupusor severe infection. An autoimmune condition called alopecia areata, which has no cure, causes rapid body-wide hair loss.

Medications and vitamins: Cancer chemotherapy, which attacks hair follicles in its attempt to kill all fast-growing cells around the body, is a well-known reason for hair loss. Other medications side effects include hair shedding as well, such as some that treat high blood pressure andgout(a painful joint condition caused by a buildup of uric acid). Excessive levels of vitamin A also contribute.

Nutritional deficits: Heavy dieting or eating disorders such asbulimiaandanorexiacan temporarily stun hair follicles to cease growth. This can also occur from insufficient protein, vitamin or mineral intake.

Aging: A natural effect of growing older is slowed hair growth.

Women usually dont go completely bald, but lose hair on the top of the head or the temples. Men tend to lose hair on their temples, and are more likely than women to go completely bald, Day said.

Dermatologists will examine the persons scalp and take a history of medical or stressful events to see whats been going on in their life and their world, Day said.

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The dermatologist may take a biopsy a small patch of skin that includes the hair follicle and send it to a pathologist to determine if an autoimmune disease, such as lupus, is the cause of the hair loss.

Examining the hair and follicle can also determine whether someone has a bacterial or fungal infection, Day said.

Hair loss remedies range from the mild to the extreme and the inexpensive to the costly. Much depends on how much hair is gone and how high a priority it is to mask its absence or replace it.

According to the Cleveland Clinic, treatments include:

Hair weaves or wigs: Typically expensive, wigs and hair weaves either completely cover the head or add to existing hair, restoring the appearance of a full head of hair. They are especially practical for cancer patients and those whose hair loss is temporary.

Topical creams and lotions: Over-the-counter minoxidil (also known as the brand name Rogaine) can restore some hair growth, especially in those with hereditary hair loss. It is applied directly to the scalp. Prescription-strength finasteride (Propecia) comes in pill form and is only for men. According to theAmerican Academy of Family Physicians(AFP), it may take up to six months to tell if these medications are working.

Anti-inflammatory medications: Prescription steroid-based creams or injections can calm follicles damaged or inflamed by harsh chemicals or excessive pulling.

Surgery: Men tend to be better candidates for surgical hair-replacement techniques because their hair loss is often limited to one or two areas of the scalp. Procedures include grafting, which transplants from one to 15 hairs per disc-shaped graft to other locations. Scalp reduction removes bald skin from the scalp so hair-covered scalp can be stretched to fill in the bald areas. Side effects include swelling, bruising and headaches.

Hair-growth laser treatment can also help stimulate hair follicles and improve growth, Day said. People often see results when they combine laser treatment with another intervention, she said. Treatments range in price from $30 and up for Rogaine to about $3,000 for laser treatment, she added.

According to theNational Institute of Arthritis and Musculoskeletal and Skin Diseases(NIAMSD), alternative therapies may not help hair regrow and many are not supported by medical research. However, other treatments that reportedly improve alopecia areata include Chinese herbs, acupuncture, zinc and vitamin supplements, evening primrose oil and aroma therapy.

Viviscal, a natural supplement, has also shownmore hair growthin men compared to those who took fish extract in clinical trials, Day said.

The NIAMSD recommends discussing any alternative treatments with physicians before use.

The drug Tofacitinib is approved to treat adults witharthritis, but a growing number of cases suggest that it can also treat alopecia universalis, a condition in which people lose all of the hair on their body because theirimmune systemattacks hair follicles,Live Science previously reported.

The finding occurred after doctors prescribed a 25-year-old man with alopecia universalis the drug because they had heard it had treated a similar condition in mice,according to a statement from Yale University. After three months of treatment, the man had completely regrown the hair on his scalp, and he had visible eyebrows, eyelashes, facial hair, as well as hair elsewhere on his body.

Its exciting, said Day, who did not treat this particular patient. There seems to be a real effect here.

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Its unclear how Tofacitinib (brand name Xeljanz) works, but researchers hope to determine its mechanism soon. This data may help them learn which biological pathways lead to hair loss.

There are now clinical trials taking place around the country to test the safety and efficacy of the drug for hair loss conditions. One such study lasting 3 months gave Tofacitinib to 66 people with alopecia areata (an immune system condition that causes hair to fall out in patches). Half of the people regrew some hair, and one-third had more than 50 percentof the hair on their scalp grow back, according to the 2016 study, published in the journalJCI Insight.

However, researchers are still working to determine the best dose needed, whether the results are lasting, and whether they can develop a topical form of the drug, Day said. She added that patients should be aware that Tofacitinib has side effects. Its already associated with an increased risk of serious infections, as well as stomach and intestinal tears, according to Pfizer, the manufacturer.

Besides investigating Tofacitinib, researchers are also looking at ways to clone hair or use stem cell therapy to treat alopecia, Day said.

This article first appeared on LiveScience.

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What Kind of Tired Are You? – The Cut

Photo: Kohei Hara/Getty Images

Like everyone else, I wonder all the time: Why am I always tired? But sometime last fall, I started getting extra droopy every afternoon. Even when Id done all the right things slept eight hours, eaten a healthy lunch, exercised Id be fighting to keep my eyes open by 4 p.m. On one of those days, as I waged war against my thousand-pound eyelids, a friend started complaining to me about her new glasses, which shed been forced to buy because contact lenses irritated her eyeballs in the dry winter air. As a fellow contact-lens wearer, I realized that perhaps my 4 p.m. sleepiness problem wasnt that I was tired maybe my eyes were. When I tested my theory and used Visine drops in the afternoons, my midday nap attacks went away.

Of course, most fatigue problems arent so easily solvable. Even the simplest fix to sleep more can be hard to come by, especially when theres an underlying problem in the mix. Unfortunately, most tiredness feels about the same; Lyme disease doesnt really give you a different flavor of exhaustion than, say, an iron deficiency or garden-variety night of tossing and turning. But if you look at other symptoms accompanying your fatigue, you might find clues to where its coming from.

If your tiredness is chronic and inexplicable or just feels off you should consult a doctor, as it could be a red flag for something more serious. And either way, its a problem you should be able to solve. To understand more about the different types of fatigue, I spoke to Dr. Jaclyn Tolentino, a primary care physician at Parsley Health, as well as Dr. Richard Firshein, a general practitioner and insomnia specialist who runs the Firshein Center in Manhattan. Here are the most common culprits of exhaustion, and how to treat them.

Hormone fluctuations can turn anyone into a nap machine, as anyone whos ever had PMS knows. But chronic hormonal imbalances can make you sleepy and grumpy all month long. The good news is that doctors can test for the presence of most hormones, so they should be able to diagnose an imbalance if you have one; most are also largely treatable with medication and/or nutritional changes. One common issue is underproduction of estrogen or progesterone, which can cause tiredness, irritability, unpredictable periods, and night sweats. (If you wake up feeling like youve just run a marathon in your pajamas, this could be your issue.)

Other hormones that can disrupt your sleep if they get out of whack are melatonin and cortisol, which are produced by your pituitary glands. You can get supplements of the former from almost any drugstore, but Dr. Tolentino recommends taking no more than 3 milligrams. The amount of melatonin your body produces is tiny compared to the melatonin supplements you can buy, so most people are actually taking much more than the body needs or should have, making the imbalance worse, she says. In other words, taking melatonin supplements to help you sleep at night could actually be contributing to your overall tiredness during the day the irony, I know!

If your tiredness coincides with weight gain, dry skin, and constantly feeling cold, you could be having issues with your thyroid, which produces hormones that regulate your metabolism, among other things. Hypothyroidism is one of the most common conditions associated with fatigue, says Dr. Tolentino. Other symptoms of hypothyroidism include constipation, hair loss, and irregular menstrual cycles. If youre experiencing any of these symptoms, its best to consult a doctor as soon as possible.

Take it from someone whos frequently anemic no matter how much steak I eat: The tricky part of getting enough vitamins and minerals is that certain nutrients are essential for the absorption of others so if you arent getting enough of one, then youre probably missing out on a bunch. Common deficiencies that cause fatigue include iron, magnesium (which contributes to the bodys absorption of iron as well as other nutrients), B vitamins, and vitamin D (which your body produces when its exposed to sunlight which doesnt happen much in the winter). Your doctor can test for all of the above, but for what its worth, Ive been taking magnesium powder every night before bed for the past six months, and it has made a huge difference in how I feel every morning. Dr. Tolentino says she recommends it to many of her patients, because it binds to melatonin and supports its production in your body.

You cant sleep because youre staring at the ceiling, ticking through all the things you messed up that day and didnt get done, and now youre extra stressed because youre stressed, and if you dont get to sleep soon then youll be even more stressed tomorrow, and blah blah stress is bad and we all need to manage it better. But in addition to making you miserable and annoying, chronic stress actually causes the overproduction of cortisol (see No. 1), a hormone that disrupts sleep. Ignore the problem and it spirals, causing weight gain, more sleeplessness, and a whole host of other issues.

You know what youre supposed to do for stress: Take breaks. Exercise. Cultivate supportive relationships. Meditate. And get enough sleep. But those things take time and energy, which seem in short supply when youre dealing with a firestorm at work (or just normal life). Dr. Firshein recommends what he calls mini-meditations, which he practices himself. Its a huge luxury to be able to set aside 30 minutes or an hour to meditate, but if you take just a few moments throughout the day, it can have a similar effect, he says. In between every patient, I take ten or 20 seconds to breathe deeply, do some visual imagery, and relax my muscles before I move on. By the end of the day, it adds up to 15 or 20 minutes of meditation. He urges patients to do the same every time they check their phone, for example, or get a text from a certain person, or get up from their desk at work. If you reset your mind consistently throughout the day, then it can keep anxiety from sneaking up on you.

Its true: Certain genes have been linked to chronic fatigue issues, including a specific one known as the CLOCK gene (yep), which is linked to faulty circadian rhythms. People with wonky CLOCK genes have issues with their metabolism, body temperature, blood pressure, and liver functions, among others. Luckily, its very rare.

A more common genetic mutation that could disrupt your sleep is one that affects your bodys ability to process alcohol, says Dr. Firstein. Alcohol causes a lot of sleep problems in itself, but some people are predisposed to be even more sensitive to it.

A doctor can test for these genes, although it can be expensive to do so and insurance may not cover the lab costs. Before you go down that rabbit hole, look at your family history do any of your relatives have similar bad reactions to alcohol, or other symptoms of the CLOCK gene? While you cant change your own genetic makeup, identifying a genetic issue can help you and your doctor come up with a plan to treat the problems that stem from it.

Speaking of alcohol and sugar, caffeine, your phone, your laptop, your TV screen, your neighbors music, your roommates music, LED lighting, your newborn kid, or the fries you just ate, you are surrounded by things that cause you to sleep poorly and be tired the next day. Both Dr. Firshein and Dr. Tolentino said that lifestyle is usually the No. 1 cause of tiredness, but the good news is that you can do something about it.

Weve become a little bit lazy around sleep, says Dr. Firshein. Good sleep hygiene begins hours before you actually go to bed. It takes discipline to power down at the end of the day, turn off the TV and the computer, and cut back on external light, noise and stimulus. If youre not able to do all that (because, come on), he recommends at least wearing blue-light-blocking glasses, dimming the lights, and not eating or exercising within two to three hours of bedtime.

And finally, pony up the $20 to buy an actual alarm clock and put your phone in another room before you go to bed. Ive personally found this helpful not only for falling and staying asleep, but also for getting out of bed in the morning. Instead of snoozing my phone a million times and then lazing around scrolling through garbage, I actually get up and brush my teeth and start my day after my alarm goes off, for the most part. One other tip: I sleep with a white noise machine and earplugs. (I live next to a fire station, so.)

Does your bedmate frequently shove you in the middle of the night to get you to pipe down? Do you have allergies or get a lot of sinus infections? You might have sleep apnea, a deviated septum, or another issue that inhibits your breathing and stops you from getting the kind of deep sleep that makes you feel truly rested. There are various solutions for these problems, ranging from special breathing machines to surgery; youll want to consult a doctor if you suspect you fall into this camp.

Hopefully not! But fatigue is often the most obvious symptom of autoimmune conditions like lupus, fibromyalgia, and Hashimotos thyroiditis, says Dr. Tolentino. The same goes for chronic infections like Lyme disease. Often these conditions are accompanied by other symptoms. But just like with sleep apnea, dont waste time trying to self-diagnose and get to a doctor.

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Kentucky bill would require athletes to compete based on sex at birth – Courier Journal

High school and college athletes in Kentucky would only be allowed to compete in sports that align with their biological sexand not their preferred gender identityunder a bill that a state lawmaker filed Friday.

Sen. Robby Mills, R-Henderson, introduced Senate Bill 114 and titled it the "Save Womens Sports Act."

The bill calls for students to only participate in sports and use athletic facilities that correspond with the sex listed on their birth certificates.

If astudent's birth certificate has been edited or if the student's biological sex is officially challenged, then the student would have to undergo a medical examination performed and signed by a physician, physician's assistant or advanced practice registered nurse.

The examination would establish the student's sex based solely on "internal and external reproductive anatomy," testosterone levels and an "analysis of the student's genetic makeup," according to the bill.

Mills could not immediately be reached for comment.

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SB 114 would allow students who have been "deprived of an athletic opportunity" or who have suffered "any direct or indirect harm" or privacy violations due to violations of the bill's regulations to school districts and universities within two years "after the harm occurred."

Chris Hartman, executive director of the Louisville-based Fairness Campaign, an LGBTQ advocacy organization, said the bill is "once again a solution in search of a problem" and "a plea for votes in an election year."

"This is clearly part of a politically motivated (and)expanding slate of hate that's being introduced in the state targeting all LGBTQ people but with particular emphasis on transgender students," Hartman said. "...Imagine how hard it is for trans kids already on a daily basis. This bill tells them they shouldn't be participating in athletics."

"Transgender kids want to join sports teams for all the same reasons any other student does," Hartmanadded.

The Kentucky High School Athletic Association currently has a policy that recognizes the ability of transgender student-athletes to compete in sports "free from unlawful discrimination based on sexual orientation."

But some still view the KHSAA policy as restrictive, as it requires transgender athletes to undergo sex reassignment surgeryeither before or after puberty inorder to compete in sports based on their gender identity.

If reassignment surgery occurs after puberty, then transgender student-athletes in Kentucky must demonstrate that they've taken or are taking hormone therapy "for a sufficient length of time to minimize gender-related advantages in sports competition," according to the KHSAA policy.

As The Courier Journal reported last year, Kentucky was one of nine states with such policies for transgender high school athletes.

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Hartman said "few, if any" transgender students can currently meet the KHSAA guidelines, making Mills'bill unnecessary.

"I guarantee that Sen. Mills doesn't have a single instance in Kentucky athletics that this bill would address, not a single one," Hartman said. "If he can bring a witness to the table whom this applies to...I'd be shocked."

The topic of transgender athletesin Kentucky came up during the 2019 gubernatorial race between DemocratAndy Beshear and then-Republican Gov. Matt Bevin when aconservative political action committee released an ad claiming Kentucky boys are changing their gender to participate in high school sports.

The ad from the Virginia-based Campaign for American Principlesfeatured a narrator saying that Beshear the state's attorney general at the timewho is now governor after beating Bevin in November's election "supports legislation that would destroy girls' sports."

It showed a male competitor portraying a transgender girl and passinga group of female runners tofinishfirst.

The new proposal from Mills related to high school and college athletes is not the only bill in the 2020 legislative session that deals with transgender students.

House Bill 132 would bartransgender students from usingrestrooms that alignwith their gender identities.

State Rep. David Hale, R-Wellington, is the lead sponsor of the bill, which is titled the "Kentucky Student Privacy Act"and says non-transgender students could suffer"potential embarrassment, shame and psychologicalinjury" by using the same restroom or changing room as their transgender peers.

LGBTQ advocates have called Hale's bill "dangerous" and warned it would contribute to depression and suicide rates among transgender youth.

A similar bill has been introduced inpast General Assembly sessions, including one proposal in 2015 that would have allowedstudents to sue aschool for $2,500 ifthey encountered a person of the opposite biological sex in a bathroom or locker room and staff hadallowed it or failed to prohibit it.

State Sen. C.B. Embry Jr., R-Morgantown, proposed the2015 version of the "Kentucky Student Privacy Act" in response to a 2014 controversy at Louisville's Atherton High School in which the principal allowed a transgender student who was born male but identifies as a female to use the girls' bathrooms and locker rooms.

A bipartisan group of Kentucky lawmakers are also behind a push to ban conversion therapy in the Bluegrass State.

On Politics:Can conversion therapy ban pass if top Kentucky lawmakers don't understand it?

This story may be updated.

Reach Billy Kobin at bkobin@courierjournal.com or 502-582-7030. Support strong local journalism by subscribing today: courier-journal.com/subscribe.

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What Is Perimenopause And How Young Can It Start? : Shots – Health News – NPR

Katherine Streeter for NPR

Katherine Streeter for NPR

Sarah Edrie says she was about 33 when she started to occasionally get a sudden, hot, prickly feeling that radiated into her neck and face, leaving her flushed and breathless. "Sometimes I would sweat. And my heart would race," she says. The sensations subsided in a few moments and seemed to meet the criteria for a panic attack. But Edrie, who has no personal or family history of anxiety, was baffled.

She told her doctor and her gynecologist about the episodes, along with a few other health concerns she was starting to notice: Her menstrual cycle was becoming irregular, she had trouble falling asleep and staying asleep, and she was getting night sweats. Their response: a shrug.

It wasn't until Edrie went to a fertility clinic at age 39 because she and her partner were having trouble conceiving that she got answers. "They were like, 'Oh, those are hot flashes. It's because you're in perimenopause,' " she says.

If you haven't heard the term "perimenopause," you're not alone. Often when women talk about going through menopause, what they're really talking about is perimenopause, a transitional stage during which the body is preparing to stop ovulating, says Dr. Jennifer Payne, who directs the Women's Mood Disorders Center at Johns Hopkins University.

"Technically, menopause is only one day in a woman's life, which is exactly when she has not had a period for 12 months," she says. "It's the period of time leading up to menopause that causes all the trouble."

And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.

When Edrie went back to her OB/GYN with the fertility clinic's conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn't satisfied with that answer. "Yeah, it's a normal part of life, but it would be great if we could talk about it and figure out strategies."

With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.

How early can perimenopause start?

It's quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.

How do you know if you're starting perimenopause?

The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women's Health and Gender Biology at the Brigham and Women's Hospital in Boston.

"It's the menstrual cycle pattern that really defines this lead-up to menopause," she says. During perimenopause, periods "might be shorter, then a long one, or then a skipped one, or then the flow might be different," says Joffe.

There's no blood or hormone test that can "diagnose" perimenopause. Joffe says a hormone test isn't helpful because hormonal cycles become erratic and unpredictable during this stage.

"There's not really one point in time when a hormone test is done that can be definitive," she says. Even if you took several tests over time, "you might get a very different readout."

Surprisingly, sometimes doctors aren't prepared to help women recognize the start of this life phase. Edrie was upset at her doctors' responses or lack thereof. "I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?"

What symptoms to expect

Be prepared for your PMS symptoms to possibly shift, becoming either more or less extreme, says Dr. Cynthia Stuenkel, a founding member of the North American Menopause Society and a professor and endocrinologist at the University of California, San Diego, School of Medicine. "Women might not get the same kind of breast tenderness or mood shifts that they may have noted in the past," she says.

Mood problems like depression can spike during perimenopause, especially among women who have previously experienced them. Many of our listeners wrote in to say that during perimenopause, they felt incredibly irritable and quick to anger in a way that they had never experienced before.

And of course, many but not all women experience hot flashes, though they may not recognize them. "It's hard, because no one sits us down and teaches us, 'Here's what a hot flash feels like,' " Stuenkel says. "I've seen women who think they're having panic attacks, or heart palpitations. That can be frightening."

Other common symptoms include more frequent urinary tract infections, difficulty sleeping through the night, vaginal dryness that can make sex painful, night sweats and a decrease in libido.

What treatments are there for symptoms?

Some symptoms, like heavy or irregular periods, can be managed with an oral contraceptive, which can "shut down the body's own erratic hormonal fluctuations," says Stuenkel.

"This can kind of be a lifesaver," she says. Such medication may help with hot flashes, too.

In some cases, doctors may prescribe menopausal hormone therapy, or very low doses of hormones to supplement estrogen levels. Stuenkel says it's not a fit for everyone, but it doesn't deserve the bad reputation it has in some circles. She says there was an "exodus" from the use of hormone replacement therapy after the Women's Health Initiative trial halted a study over safety concerns in 2002. But many clinicians now feel much more comfortable using hormone therapy again and usually recommend low doses, selectively, for shorter periods of time.

For people who cannot take estrogen therapy, or choose not to, Stuenkel says some drugs in the antidepressant family, such as SSRIs and SNRIs, can help with hot flashes. Stuenkel says, "While they're not perfect, they can take the edge off and help enough so that women can get a better night's sleep."

There are an abundance of nonhormonal, nondrug treatment options for managing symptoms, some of which have significantly more evidence backing them than others. In 2015, a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes. The same panel also found that popular herbal remedies (like black cohosh, dong quai and evening primrose) are "unlikely to help," although some NPR listeners who wrote in said they got relief from some of those treatments.

For depressive and anxiety symptoms, women may want to seek out professional counseling or a psychiatrist.

When do I need to see a doctor?

You might not need to at all. Some people sail right through menopause with little trouble. But if you are experiencing symptoms that are interfering with your life, it's worth making an appointment. Some of these symptoms could indicate other problems that need treatment, such as fibroids or even cancer.

Ways to cope with symptoms

For people approaching this stage of life or who are already going through it, here are four steps for making this transition more manageable.

1. Get educated

"Information is key," says Joffe. She suggests that people approaching perimenopause age empower themselves with knowledge.

The Massachusetts General Hospital Blum Center has a curated list of suggested books. The National Women's Health Information Center has a section on menopause and perimenopause. The American College of Obstetricians and Gynecologists also has a perimenopause FAQ.

2. Monitor your health

Joffe encourages people to track symptoms: "menstrual patterns, hot flash patterns, mood issues, major life triggers." Using a paper calendar or an app to monitor symptoms can make it easier to give your doctor details that can be otherwise hard to remember.

"Knowing that information, somebody can say, 'Well, over the last six months, I only had two periods or I had hot flashes almost every day,' " Joffe says, "or, 'My mood was as bad as it gets for only two days or for a third of the time.' "

And if you bring a thorough health history to your physician and they still give you a shrug, consider a specialist. "There are OB/GYNs that specialize in perimenopause and menopause," Joffe says.

3. Practice smart self-care

Joffe encourages women to protect themselves from things that might worsen their mood or well-being. This includes reducing stress when they can and making sure they get enough sleep.

"Sleep is critical," she says. "Getting a good night's sleep, and making sure it's not broken in the middle of the night."

There are lots of online tools and apps to help with sleep, she adds.

And familiar health advice like getting enough exercise, eating well and moderating alcohol consumption apply to perimenopause too, says Dr. Steven Goldstein who is the co-author of Could It Be ... Perimenopause? and a professor of obstetrics and gynecology at the New York University School of Medicine.

At her doctor's suggestion, Edrie developed a mindfulness practice. She says, "I thought it sounded a little 'woo-woo' at first, but being able to pay attention to what my body is doing and why helps me separate those symptoms from what I need to get through my day. So I'm not overwhelmed by what my body is putting me through."

4. Cultivate community

Most of the women who wrote to NPR about their experiences going through perimenopause said that they felt alone and isolated during this transition.

Having a community to talk to can make it easier to cope with the changes, says Payne, who's going through perimenopause herself. She says she has found support from a few close friends from college.

"To be able to reach out to a group of women who are our same age and say, 'Did you go through this? And, you know, it does provide support. I think that's another version of a coping skill," she says.

Edrie says she joined a few Facebook groups dedicated to perimenopause and found one in particular where she got tips on coping with one of her most troublesome symptoms: brain fog. The conversations made her feel understood and validated.

"I can post about it in this group, and, you know, 10 women will be like, 'Oh, last week, that totally happened to me,' or like, 'I forgot my kid's computer on the top of my car and drove away,' " she says.

She says that being able to commiserate helps her get through symptoms "that maybe don't have a magic pill." Some of her online friendships have even taken shape offline. Edrie has met up with some of the Facebook group members while touring the country with her band.

Now she's a big proponent of finding community and speaking out. "As we get older, we get more and more quiet about what's going on with our bodies and ourselves and our lives. We kind of just, buck up and deal with it."

"And I feel like if we talked more about the things that are happening to our bodies even if we can't actually do anything about some of these things it would just be better for society in general if we were more vocal about it."

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‘I Am Jazz’: Jazz Shows Off Her ‘Battle Scars’ in Bathing Suit Photos – Showbiz Cheat Sheet

Jazz Jennings of TLCs I Am Jazz has had a long road to self-confidence. The trans rights advocate began hormone blockers under a physicians supervision when she was just a child, and the trans teen has been open with followers and viewers ever since about her journey to gender confirmation surgery.

Along the way, the 19-year-old activist has struggled with her mental and physical health, as well as three complicated surgeries. But recently, the I Am Jazz star showed off her scars from bottom surgery in a poignant Instagram post about her transition and body positivity.

On Jan. 3, Jennings posted two photos of herself in a bathing suit on the beach with visible scars on her legs. She added the snapshots to both Instagram and Twitter.

These are my scars on full display in #2019, the I Am Jazz star and LGBT rights activist wrote in her caption. Im proud of my scars and love my body just the way it is. I call them my battle wounds because they signify the strength and perseverance it took to finally complete my transition.

Her family, who has always strongly supported her throughout her journey to personal and public acceptance, immediately jumped in to offer their support. Your strength is changing the world and makes me so proud to be your brother, wrote Jennings older brother, Sander Jennings, on Twitter. Thank you for inspiring me everyday.

No one has been more supportive and protective of Jennings than her mom, Jeanette Jennings, who commented under the post on Instagram: My sweet girl, you are the strongest and bravest of all the souls Ive even known and Im blessed to be your mom. Your scars are just as beautiful as the rest of you. I love you with all that I am. You make me proud everyday.

Of course, Jennings family members and loved ones werent the only ones to praise the advocate for bravely sharing her story. Instagram commenters flooded her post with gratitude and support.

Proud of you, Jazz! Scars are a sign of courage and strength, wrote one Instagram user. Youve earned them twice over.

Another supporter added, Youre really really strong Jazz, stronger than I ever will be.

One parent thanked Jennings for being so open about her struggles and triumphs alike. I know we are all strong in our own ways, but I hope my little girl is strong and brave as you when she grows up, she wrote. Wear those scars with pride, we all have some scars to deal with.

Although it looks like Jennings gender confirmation surgery might now be behind her, the upcoming season of I Am Jazz will feature her third harrowing surgery after complications from the two previous ones required her to get yet another intense procedure.

I Am Jazz Season 6 premieres on TLC on Jan. 23. In addition to deciding on a future college, planning a drag show fundraiser to support her friends gender confirmation surgery, and wrestling with the aftermath of her breakup from ex-boyfriend Ahmir, viewers will watch Jennings return to the hospital herself. It looks like the long road of Jennings transition may finally be coming to an endbut not with difficulties and challenges along the way.

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'I Am Jazz': Jazz Shows Off Her 'Battle Scars' in Bathing Suit Photos - Showbiz Cheat Sheet

Religious initiatives have no place in the UC health care system – The Aggie

UC partnerships with faith-based health systems such as Dignity Health, Catholic Health Initiatives undermines the quality of patient care in our hospitals.

It is not news to anyone that our current healthcare system struggles to meet the needs of millions of patients in California and across the country. This care gap is especially wide for brown, black, poor and queer communities that have been consistently excluded from accessing the same resources that others are given freely.

It is because of these inequities that I find it especially alarming that the UC currently has existing contracts with Dignity Health, despite the massive outpouring of opposition to affiliations with Dignity by students, physicians and Californians across the state earlier this year. UC contracts with faith-based health systems represent a blatant disregard for the UCs own stated mission of public service and undermines patient autonomy in healthcare decision making.

UC affiliation with faith-based health systems such as Dignity and CHI will severely restrict the scope and quality of health care that providers can offer, even when a patients life is threatened. According to the Ethical and Religious Directives for Catholic Health Care Services (ERDs), physicians in Catholic hospitals are barred from providing basic reproductive health care services such as contraception, abortion and in vitro fertilization. It also prohibits the provision of gender-affirming services such as hormone therapy, hysterectomies and mastectomies. These types of sweeping and biased care restrictions are immoral in any scenario and unacceptable in the setting of a publicly-funded institution.

In particular, limiting access to reproductive and gender-affirming health care can be life-threatening. Research consistently indicates that nearly every restriction on abortion access yields a corresponding rise in injury and death as a result of people attempting to self-abort. When folks are not allowed to access gender-affirming care, it undermines their right to self-determination, exacerbates mental health conditions and increases their risk of experiencing violence.

As a life-long resident of California and a future physician, I am ashamed that the UC system, an institution intended to represent the strength and future of our state, is taking a step back from its progressive vision by allowing religious institutions to restrict the quality of medical care that patients receive in our hospitals. As a student, I am outraged that the UC would detract from the quality of my medical training by agreeing to offer fewer services when it has the resources to provide more.

Patients deserve nothing less than wholly inclusive, evidence-based care that addresses every aspect of their health.I urge UC leadership to reject the influence of religious institutions on our healthcare system and instead consider the many opportunities available to increase patient access to high-quality, comprehensive health care services.

Written by: Caitlin Esparza

Caitlin Esparza is a second-year medical student and co-president of Medical Students for Choice at UC Davis.

To submit a guest opinion, please email opinion@theaggie.org

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Religious initiatives have no place in the UC health care system - The Aggie

7 Signs You Might Have a Thyroid Problem – YouBeauty

The thyroid plays a huge role in the body. Its a part of the endocrine system whose core function is to help your bodys metabolic hormone stay in line at all times. Problems associated with the thyroid are very common, especially in women. According to a survey by the U.S Department of Health and Human Services, one in every eight women is likely to develop a thyroid problem in her lifetime.

Since there are so many factors that may contribute to a thyroid problem, here are nine signs that may indicate that someone has a thyroid problem.

Constant fatigueA core function of your thyroid is to help metabolism. When theres an issue with metabolism control, the body is bound to feel sluggish. A constant state of tiredness and diminishing energy can be one of the most apparent indicators of a problem with the thyroid.

Weight loss or weight gainRapid weight loss when you are not actively trying to lose weight or rapid weight gain without any change in activity or diet may be a tell. The absence of a functioning thyroid slows down the bodys metabolism, and consequently, a reduction in the rate the body expends energy.

Night sweatsIf youre waking up at night with chills and soaked sheets, its time to see the doctor.

A rapid change in appetiteSince there is a problem with the thyroid, you may feel less enthusiastic about eating as each day passes. This often comes with rapid weight loss or, in some cases, weight gain.

Your cycle changesIf you start experiencing irregular periods in conjunction with other symptoms, it might be a function of your thyroid malfunctioning.

Changes in bowel movementsConstant constipation or, in some cases, severe diarrhea can result from thyroid issues.

Constant Mood ShiftsA general hormone imbalance could occasionally change moods. The same can be said where there is a thyroid problem.

While this list is not exhaustive, some of these symptoms may be common indicators for other health problems along with thyroid issues. You must consult your physician if you have any of these symptoms in conjunction with each other for a prolonged period of time.

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7 Signs You Might Have a Thyroid Problem - YouBeauty

How fertile are you? ‘Ovarian reserve’ DTC tests that count your eggs offer mixture of control and misinformation – Genetic Literacy Project

The direct to consumer testing market comes in many flavors these days, with companies like 23andMe dominating headlines with their genetic/ancestry tests targeting folks eager to learn more about themselves. Also joining the fray are tests designed to help women in theory, at least assess fertility by counting the number of eggs left in their ovaries.

Sounds like a great idea. Just one problem: egg counts may not be such a great indicator of fertility, according to the American College of Obstetricians and Gynecologists.

Still, that doesnt mean these tests have no value. A new study suggests they can empower women. And thats especially true for those who do not fit into the binary gender categories that health insurers may require for covering clinical versions of the test that cost ten times as much.

At-home tests for reproductive health for women have been around since the first home pregnancy kits hit the market in 1978. In 1989 came the first DIY ovulation predictor kits.

Tests to measure ovarian reserve how many eggs are left dont have the track record of these older tests. And they may not even be accurate for women who havent had difficulty conceiving or are taking birth control pills.

But do they still have value?

Moira A. Kyweluk, a fellow in the department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania, decided to find out. She interviewed 21 women, of diverse backgrounds and circumstances, to tap their thoughts about direct-to-consumer (DTC) testing of ovarian reserve.

The women were recruited from social media, community center notice boards, and listservs, in Chicago during the first half of 2018. The findings appear in Social Science & Medicine.

Egg counters sold to consumers are part of the FemTech market. I view DTC testing as an entry point into what I term the new (in)fertility pipeline for women today. Because it is low cost and widely available, its reaching a larger demographic, people of diverse identities and backgrounds, and raising awareness of more advanced procedures and technologies like egg freezing, Dr. Kyweluk said in a news release.

But she questions the accuracy of these tests. Consumers continue to desire these tests, and theyre attractive, but they dont deliver on their promise.

The number of immature eggs in the two ovaries dwindles as a female ages.

Seven to eight million tiny undeveloped eggs are already present in a 20-week female fetus. That means, curiously, that a pregnant woman houses the cells that, when fertilized, will become her grandchild.

By birth, about a million oocytes remain, and that number is halved by puberty. Then by the start of menopause, around age 51, only 1,000 or so eggs remain. Over her lifetime, a woman ovulates 300 to 400 eggs.

Each egg occupies a chamber called a follicle. Each month between puberty and menopause, the largest egg pops out in response to a crescendo of luteinizing hormone thats ovulation. Meanwhile, anti-Mllerian hormone (AMH) suppresses release of the other, smaller eggs.

Its seemingly simple: The more AMH, the more eggs are left.

Measuring AMH is the basis of clinical tests used to predict ovulation in women undergoing in vitro fertilization (IVF) or egg freezing, presumably because theyve been unable to conceive. But the accuracy of AMH level to predict ovarian reserve among women who are fertile isnt known.

And so in 2019, the American College of Obstetricians and Gynecologists (ACOG) issued a statementthat consumer kits to measure AMH arent ready for prime time. The products are too variable and not standardized.

Serum anti-Mllerian hormone level assessment generally should not be ordered or used to counsel women who are not infertile about their reproductive status and future fertility potential, according to the statement. It includes a hypothetical case that illustrates misinformation about AMH testing:

A 26-year-old woman comes in for a wellness exam and the provider mentions the effects of aging on fertility. Im not ready to become pregnant now, but I would in the future. My friend recently took a blood test to check her egg count, so she knows how much longer she can wait to have a baby. Can I have that test?

If she meets criteria for infertility, her insurance might fork over a large part of the $1,500 cost for such a test. Thats why a DTC test kit that requires a pinprick of blood and costs $79 to $199, without requiring evidence of anything or an uncomfortable meeting with a health care provider, is an attractive alternative if it provides useful information.

The website for an ovarian reserve test kit from Modern Fertilitydoes comport with the ACOG statement.

Want kids one day? the opening page announces, like asking if you want to order a pizza. Women are invited to join a weekly egginar for information before they dive into the science that helps you do you.

Clicking ahead shows clear warnings that the test wont reveal infertility, but will indicate if a womans egg count is more or less than is average for her age. It sounds like peering into an egg carton to count whether it has all 12 expected eggs.

The test measures AMH, FSH (follicle stimulating hormone), and E2 (estradiol). Thats important to know, because a search for ovarian reserve testing on Amazon yielded first theEverlyWell ovarian reserve test egg quantity indicator, which measures only FSH not the important and telltale AMH.

The Modern Fertility test is also quite clear about what it can and cant do. A woman can discuss the results with her physician and ask about further testing and possibly pursuing IVF or egg freezing. Or, if she only has half a dozen in the egg carton analogy, she might expect to experience menopause sooner than shed thought.

Countering the ACOG statement is the LetsGetChecked product. The Ovarian Reserve Test is for anyone who is curious about their fertility status, according to the website. It costs $139.

The website for LetsGetChecked has a helpful list of conditions that can accelerate the whittling down of egg number, which a consumer can bring to a physician to explore further. These include polycystic ovary syndrome, chromosomal abnormalities such as Turners (XO) syndrome and fragile X, endometriosis, ovarian tumors, autoimmune disorders, and pelvic injuries. The woman would already know if shed had chemotherapy or radiation, which can damage eggs.

Dr. Kyweluk designed a study that would take a real-world view of the issues that might prompt a woman to take a DTC ovarian reserve test. Her paper is a series of vignettes.

The research differs from standard medical studies in that it is ethnographic, taking into account race and ethnicity, relationship status, insurance, sexual orientation, and socioeconomic group, because the reasons for seeking ovarian reserve testing go beyond biology. Dr. Kyweluk interviewed the women as they were deciding whether or not to take a test. She had a grant that paid for those who wanted to go ahead, using one company that provided access to a nurse practitioner to interpret findings.

Of the 21 participants, aged 21 to 45, 14 were white, 14 heterosexual, and 7 bisexual or queer. Three different scenarios of women seeking the DTC test indicate the variability of need.

Yvette was a 37-year-old African-American who had been trying with her husband to conceive for a decade. Their health insurance was quick to cover birth control, but assessing fertility, not so much.

When Yvettes ovarian reserve results were normal, the nurse suggested an ovulation predictor to better time intercourse and have her husband have a semen analysis.

Naomi was typical of a high-income, highly-educated white woman, who was stressing over whether she really wanted to have a baby. Would an ovarian reserve test indicate that it wasnt in the cards? Then she could stop thinking about it, or freeze eggs, which she could afford to do. Many women cant.

Josephine was 35 and African-American. A devout Catholic, she had just ended a long-term relationship. Her faith prompted her to ask, was I meant to be a parent? and she felt that the ovarian reserve test, if she had too few eggs, might reveal no.

Several women reported that taking the ovarian reserve test empowered them. Caroline, for example, was a 30-year-old queer white woman with a female partner. Medicaid had denied them coverage of any elective tests, and they didnt meet the diagnostic criteria for infertility because they were not a heterosexual couple.

The DTC test made me feel Im in control, like I can want some information, pay for it, and then get it. I didnt have to rely on a doctor to decide it was necessary for me to know this information. This is information that Ive wanted forever, Caroline told the researcher.

In one confusing case, the cisgender female partner (Breanne) of a transgender man (Tal) discovered, using a DTC test, that her ovarian reserve was quite low, something shed suspected from her age and irregular menstrual periods. The couple had planned to use a sperm donor and Breanne would carry the pregnancy. But if Breanne didnt have enough eggs, what would they do?

They had an idea. Did Tal still make eggs?

Hed been receiving testosterone injections for a decade as part of gender-affirming treatment and sported a full beard. But the DTC ovarian reserve test revealed he was still making the normal number of eggs for a cisgender woman his age. Hed carry the pregnancy!

But when Tal went to a clinical lab to repeat the ovarian reserve testing, the medical staff continually misunderstood their situation. Ultimately, Tal felt that inexpensive ovarian reserve testing was simply a foot in the door to other, more costly procedures, Dr. Kyweluk writes.

The bottom line: A DTC ovarian reserve test can give a woman a sense of control, but at the expense of an incomplete, confusing, or even meaningless clinical picture.

From a broader perspective, is egg counting an example of the medicalization of the range that is normal reproductive biology? Will it create the patients-in-waiting scenario that describes newborn screening that identifies genetic diseases well before they cause symptoms?

Steve Jobs is famous for inventing things that we didnt know we needed the iPod and then the iPhone. To paraphrase and take him a bit out of context, A lot of times, people dont know what they want until you show it to them.

Just as it took years for so many of us to realize that we couldnt live without smartphones, it will take time for data to accrue that improve the accuracy of DTC ovarian reserve tests in predicting infertility. Until then, it might be just one more thing to worry about.

Ricki Lewis is the GLPs senior contributing writer focusing on gene therapy and gene editing. She has a PhD in genetics and is a genetic counselor, science writer and author of The Forever Fix: Gene Therapy and the Boy Who Saved It, the only popular book about gene therapy. BIO. Follow her at her website or Twitter @rickilewis

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How fertile are you? 'Ovarian reserve' DTC tests that count your eggs offer mixture of control and misinformation - Genetic Literacy Project

Intermittent Fasting? Here’s The Right Way To Break Your Fast – mindbodygreen.com

By far, the most popular forms of intermittent fasting are the 18:6, 16:8, and 14:10 time-restricted eatingplans, in which you abstain from food for 18, 16, and 14 hours per day, respectively. While breaking these types of fasts doesn't require quite as much planning as breaking an extended fast, there are still some general recommendations.

First and foremost, stick to whole foods and opt for a mix of macronutrients when you break a fastyou don't want a straight shot of carbohydrates (especially refined carbs) on an empty stomach.

"Definitely avoid carb-loaded meals and sugary drinks as they will cause a blood sugar roller coaster, raising your insulin levels and making you feel even more hungry," says Amy Shah, M.D., who uses intermittent fasting in her practice. "Additionally, having lots of sugar will make fasting for the next day even harder because your hunger hormones [like ghrelin] will be raised."

So what should you eat?"For a standard 16:8 plan, one could break a fast with a low-glycemic meal of choice," says Ali Miller R.D., L.D., CDE, registered dietitian and functional medicine practitioner. "If you're going to have carbs, ensure that they're balanced with protein and fat. A salad with protein, eggs with avocado and vegetables, a homemade protein shake, or a leftover protein and roasted veggies could all work as meal number one."

Portion size matters a bitparticularly when you get into the more intense time-restricted eating plans like 18:6 or 20:4. Even though you may be quite hungry when breaking your fast, particularly if you're new to IF, avoid eating a huge meal or you might overload your digestive system and experience symptoms like bloating. Typically, "hefty snack or small meal is best," says Miller.

Some specific foods you can mix and match to incorporate into your first post-fast meal include:

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Intermittent Fasting? Here's The Right Way To Break Your Fast - mindbodygreen.com

10 Nutrition Myths That Need to Die (With Jordan Syatt) – BarBend

About half of all Americans are trying to lose weight, and with the weight loss service industry being worth billions of dollars some estimates put it at over seventybillion dollars there are a lot of hucksters and well-intentioned-yet-misinformed people trying to cash in.

There are a lot, a lot, a lot of myths out there about the best way to lose weight and about nutrition in general: which macronutrients are worse (is it fat this year, or carbs?) and whether you can supercharge your liver with a detox tea. Trainer and big-time-Instagram-guy Jordan Syattsat down with us to run over the worst myths in nutrition that need to die. Lets get started.

Editors note: The content on BarBend is meant to be informative in nature, but it shouldnt take the place of advice and/or supervision from a medical professional. The opinions and articles on this site are not intended for use as diagnosis, prevention, and/or treatment of health problems. Speak with your physician if you have any concerns.

You dont need to count your calories if you want to lose weight, says Syatt. But regardless of whether or not youre counting calories, your calories always count.

No matter what, your body obeys the laws of thermodynamics and it runs on energy. Energy comes into the body by way of food and is often stored in the form of fat or carbohydrates (glycogen).

There are a lot of ways to control your calorie intake: maybe increase your fiber, increase your protein, lower your fat intake, all of these can work without an individual counting their calories. But they work because they (can) lead you to consumer fewer calories, which is what controls your waistline.

It doesnt matter if you dont look at your bank account, says Syatt. If youre spending all the money, its gonna drain.If youre putting a bunch of money in, youre going to save it up, regardless of whether or not youre tracking it. This is whats really important to remember about calories.

The composition of calories changes, of course. If youre comparing a 500-calorie salad with a 500-calorie cheeseburger, the salad probably has more fiber, vitamins, and minerals, its probably more filling, and all of this can contribute to better health and weight management. Just remember that even healthy foods contain calories.

[Related: Check out our podcast with Jordan Syatt]

Yes, your body weight is a matter of energy balance. If you are in a calorie deficit you will lose weight, in a calorie surplus youll gain weight.

But quality and quantity matter here.As mentioned above, different foods have different effects on your appetite, but its also important to note that your balance of protein, carbs, and fat will affect what kind of weight you lose or gain.

If youre doing a smart workout program, youll lose more fat and retain more muscle in a deficit and gain more muscle and less fat in a surplus if youre making sure that enough of your calories come from protein usually 0.6 to 1 gram of protein per pound of bodyweight is recommended.(1)

Furthermore even if you hit the precise macro balanceyoure aiming for to but youre eating most of your calories from junk food and youre not eating fruits and vegetables, youll run low on important nutrients like magnesium, zinc, B-vitamins, and plenty of others. If youre low on these nutrients (or others) then performance in the gym can suffer, sleep can suffer, inflammation can increase, recovery can be impeded, focus takes a dive, immunity is compromised the list goes on. (And on.) All of these can negatively impact your physique.

Quality and quantity matter when it comes to nutrition, dont let anyone tell you otherwise. You can find room for junk food in your calories and still lose fat or gain muscle, but be mindful of your nutrients, macro and micro.

[Related: The Right Macros for Fat Loss vs Muscle Gain]

When people do keto they tend to lose weight faster, especially initially, because nearly eliminating carbohydrates causes the body to lose a lot of water weight, says Syatt. So they see very radical weight loss at the beginning, but then thats why they have a plateau almost equally as quickly a few weeks later. Because theyre not just losing water weight, they have to lose fat now.

The reality is that if youre not in a calorie deficit, you wont lose fat. Many keto proponents claim that keto causes the body to burn more fat for fuel, and while this may be true, this doesnt seem to promote more weight loss when calories are controlled, according to ameta-analysis of thirty-two trials that compared carbohydrate intake.(2)

The reality is you can do keto and see great progress, or you can not do keto and see great progress, says Syatt. As long as your calories are in check, youre going to lose fat over time.

For those who arent controlling calories, there is some evidence that keto can potentially be useful for managing hunger, which would result in weight loss. But again, thats because there are fewer calories being consumed, not because keto is anything magical in that regard. And importantly, whether or not keto works or feels good or results in fewer calories being consumed really depends on the individual.

This is a little related to keto, but irrespective of fat intake, many try to limit carbohydrates in general (bunless burgers, riceless burritos, etc.) because of a fear that carbs lead to fat gain.

Now, if youre cutting carbs and not replacing them with anything else, then youll be consuming fewer calories and thatll lead to weight loss, all else being equal. But for many people, dropping carbs means dropping fiber (perhaps the best natural appetite suppressant there is) and they can wind up eating more calories as a result.

Plus, carbs are often great sources of nutrients! Fiber, again, is great, with links not only to weight loss but also to lower risks of bowel cancer, Alzheimers disease, and more.(3)(4) But legumes, whole grains, and fruit are also jam packed with vitamins, minerals, phytonutrients, and antioxidants that may lower the risk of practically every disease there is. So there are plenty of reasons to limit refinedcarbs like sugar and white flour theyre not filling and very low in fiber and nutrients butits really important not to throw the baby out with the bathwater when it comes to carbohydrates.

This idea that fat makes you fat is bullshit, says Syatt. And we know it because there are many people eating very high fat diets, like the ketogenic diet, and losing fat. If fat made you fat then anyone doing keto would immediately be obese. Im not against keto, Im just forwhatever works for you.

Keto isnt inherently bad for you. Carbs arent inherently bad for you. Fat doesnt make you fat. Eating too many calories makes you fat, end of story.

There is a little caveat here: fat has more than twice the calories of protein or carbs, with nine calories per gram versus four calories per gram. So ten grams of fat will make you fatter than ten grams of chicken breast, if youre already eating over your daily calorie burn.

But that doesnt mean you should eliminate fat: it serves really essential functions like maintaining hormonal health and improving your absorption of important nutrients, like Vitamin D. If you have a diet without any fat at all, you wont last long, and if you have a diet thats deliberately, extremely low in fat, then important hormones like testosterone will take a hit.

[Related: The Best Natural Ways to Increase Testosterone]

Youre looking for a shortcut? You got it! Just grab a fat burner and your six pack will be waiting for you at the end of the bottle.

Were kidding. Thats not how they work.

Its not that fat burners are ineffective, exactly. There are some studies that have found that cayenne pepper, for instance, which is in just about every fat loss product out there, does increase the amount of calories you burn. But a lot of studies put it in the area of 5 to 10 calories, and some research shows no effect at all.(5)(6)(7)(8)

Some studies put it higher, at 50 calories, but thats still just half a tablespoon of peanut butter not actually that much in the grand scheme of things.(9)

Now for some people, that still matters a lot. Lets say youre a bodybuilder, you need to have 1,900 calories, but you just cannot have less than 2,000 calories without feeling extremely deprived. Popping a fat burner might be useful in that instance, as there are plenty of fat burners that probably burn around one to two hundred calories.

But you have to remember:

The reality is if your training isnt in check and your nutrition isnt in check and your sleep isnt in check, you have no reason to buy fat burners, says Syatt.

Do detoxes cleanse your system and wash out all the dirty toxins you have?

The reality is this: detoxes and cleanses dont do anything for you, says Syatt. Theres zero research to support it whatsoever.A very simple question to ask people trying to sell you detoxes and cleanses is which toxins are these cleaning out, specifically? Theyre always at a loss for words.

When people claim detoxes are scientifically backed, its usually because

Some studies have found that people who are hospitalized with liver issues might experience a slight improvement in some symptoms in conjunction with other treatment methods when theyre supplementing with a little milk thistle.(10) Marketers will see studies like that, conclude that milk thistle helps your liver work, your liver helps you filter waste, therefore milk thistle detoxes you. Theres no evidence for this for people with a healthy liver.

If your liver isnt functioning properly, you should see a fucking doctor! says Syatt. Not a fake a detox tea from someone selling diarrhea nonsense on Instagram. Dont trust the influencer, go to a doctor if your liver isnt working properly.

Theres no good evidence for this. Some older studies from the 1980s found that eating more protein resulted in more waste filtration from the kidneys, so they thought the kidneys were undergoing unnecessary stress.(11) But later studies found that wasnt the case for healthy kidneys, and some research has even looked specifically atathletes consuming well over a gram of protein per pound of bodyweight, and didnt find signs of kidney issues.(12)(13)(14)(15)

Sometimes, people with kidney problems are often advised to go on low protein diets, yes.(16) But people with broken legs are also advised not to run marathons. If youre healthy then evidence suggests high protein diets are fine.

[Related: Our full article on protein intake and kidney function]

Fortunately, this isnt true.

I love eating before bed, I eat a lot of food at night, and one of the easiest ways to dispel this myth is to look at all the research surrounding intermittent fasting, says Syatt. People basically save the vast majority of their calories before they go to bed, and what weve consistently found and it sounds boring and obnoxious, but its true as long as youre in a calorie deficit, youll lose fat.

Thats the reality.A calorie is a calorie at 8am and 8pm, it doesnt matter what time youre eating, it matters how much youre eating. Thats it.

If you read muscle mags in the 90s, theres a good chance you heard that eating six small meals a day boosts your metabolism and makes you burn more fat. Or conversely, that not eating frequently say, skipping breakfast causes you to gain fat.

Not true. Skipping a meal or two isnt going to slow down your metabolism or cause you to burn less fat.

A lot of people will tell you that because fasting increases the amount of growth hormone in the body, fasting helps you to build muscle. Its true that fasting has been seen to up your growth hormone, but this hormone really is more about preserving muscle it means that if you skip a meal or two, your body wont start eating all its muscle in some kind of starvation mode.(17)(18)(19) You can eat when you want. If youprefersix meals a day, thats fine. If youd rather save your calories for the end of the day, it doesnt look like itll make much of a difference.

OK, maybe if youre trying to win the Mr. Olympia competition, youd rather have ten meals to keep muscle protein synthesis as consistent as possible. But for the average person, even the one with a six pack, meal timing has no real, practical benefit. A 2016 study had a great example:when comparing people trying to lose weight over a period of eight weeks, people eating every day lost as much weight as people eating everyotherday when the calories were the same.(20)

If fasting helps you control your calories better, or ifnotfasting helps you control your calories better, then do what works for you! Neither is really that superior; it comes down to individual preference.

I think its a really important thing for people to take home, says Syatt. Were not saying that fasting is better for you or worse for you, were saying that whatever you choose to do fasting, keto, Paleo, Weight Watchers, whatever it is do what you enjoy and what you can do consistently.And if someones trying to sell you something and shove one method down your throat and say everything else doesnt work, dont listen to them.Because what were trying to say is that everything works, as long as you can do it consistently and your calories are in check.

1.Rodriguez NR, et al. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J Am Diet Assoc. 2009 Mar;109(3):509-27.2.Hall KD, et al. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology. 2017 May;152(7):1718-1727.e3.3.Aune D, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2011 Nov 10;343:d6617.4.Cremonini AL, et al. Nutrients in the Prevention of Alzheimers Disease. Oxid Med Cell Longev. 2019 Sep 4;2019:9874159.5.Chaiyata P, et al. Effect of chili pepper (Capsicum frutescens) ingestion on plasma glucose response and metabolic rate in Thai women. J Med Assoc Thai. 2003 Sep;86(9):854-60.6.Snitker S, et al. Effects of novel capsinoid treatment on fatness and energy metabolism in humans: possible pharmacogenetic implications. Am J Clin Nutr. 2009 Jan;89(1):45-50.7.Smeets AJ, et al. The acute effects of a lunch containing capsaicin on energy and substrate utilisation, hormones, and satiety. Eur J Nutr. 2009 Jun;48(4):229-34.8.Galgani JE, et al. Effect of capsinoids on energy metabolism in human subjects. Br J Nutr. 2010 Jan;103(1):38-42.9.Galgani JE, et al. Effect of dihydrocapsiate on resting metabolic rate in humans. Am J Clin Nutr. 2010 Nov;92(5):1089-93.10.Saller R, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplementmed. 2008 Feb;15(1):9-20.11. von Herrath D, et al. Glomerular filtration rate in response to an acute protein load. Blood Purif. 1988;6(4):264-8.12. Knight EL, et al. The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med. 2003 Mar 18;138(6):460-7.13. Beasley JM, et al. Higher biomarker-calibrated protein intake is not associated with impaired renal function in postmenopausal women. J Nutr. 2011 Aug;141(8):1502-7.14. Antonio J, et al. A High Protein Diet Has No Harmful Effects: A One-Year Crossover Study in Resistance-Trained Males. J Nutr Metab. 2016;2016:9104792.15. Poortmans JR, et al. Do regular high protein diets have potential health risks on kidney function in athletes? Int J Sport Nutr Exerc Metab. 2000 Mar;10(1):28-38.16. Levey AS, et al. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis. 1996 May;27(5):652-63.17.Moller L, et al. Impact of fasting on growth hormone signaling and action in muscle and fat. J Clin Endocrinol Metab. 2009 Mar;94(3):965-72.18.Vendelbo MH, et al. Exercise and fasting activate growth hormone-dependent myocellular signal transducer and activator of transcription-5b phosphorylation and insulin-like growth factor-I messenger ribonucleic acid expression in humans. J Clin Endocrinol Metab. 2010 Sep;95(9):E64-8.19.Lanzi R, et al. Elevated insulin levels contribute to the reduced growth hormone (GH) response to GH-releasing hormone in obese subjects. Metabolism. 1999 Sep;48(9):1152-6.20.Catenacci VA, et al. A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity. Obesity (Silver Spring). 2016 Sep;24(9):1874-83.

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10 Nutrition Myths That Need to Die (With Jordan Syatt) - BarBend

Don’t underestimate the winter blues – Chicago Daily Herald

If you're feeling down and uninspired right now, you're not alone. The winter blues -- including its most severe form, Seasonal Affective Disorder, or SAD -- really is a thing.

According to Rush University Medical Center, about 14% of Americans get the winter blues, while 6% wrestle with full-blown SAD. The good news is, these are treatable conditions, once you know the basics.

Many of us experience mood shifts during the long, dark days of winter, but if you're experiencing the following symptoms over an extended period, it may be something more:

You feel sluggish and can't get going.

You've lost interest in activities you usually enjoy.

You prefer to hibernate instead of socialize.

You're overeating (carbs cravings, anyone?), or conversely, have lost interest in food.

You're not sleeping well.

You feel hopeless or worthless.

Where's the line between simply the winter blues and an all-out case of SAD? Often, it's a matter of degree. With the winter blues, you can still function and go about your day. However, you may have SAD if:

You're unremittingly depressed or anxious.

You're having problems getting through your day.

You're abusing alcohol or other substances.

You're having suicidal thoughts.

In either case -- but especially if symptoms are serious -- seek professional help, starting with your primary care physician.

These are truly seasonal disorders. Science reveals that a lack of exposure to sunlight -- in short supply during fall and winter -- can wreak havoc on our biological clocks.

How it works: Sunlight triggers our brains to release serotonin, a powerful hormone that regulates mood. Less sunlight results in less serotonin and melatonin, which is key to a good night's sleep.

The further you live from the equator, the greater the risk. For those of us in the Chicago area, where days are short but winter is long, the risk is real.

Luckily, there are several successful treatment options, including:

Light therapy -- During light therapy, you sit in front of a special light box that mimics natural daylight. You can buy a light box without a prescription, but talk to your doctor first to learn what features to look for and how to use it.

Exercise -- Research shows exercise increases serotonin and endorphin production. Many doctors recommend exercising at least 30 minutes on most days.

Cognitive Behavior Therapy -- This effective form of psychotherapy helps people replace negative thoughts and behaviors with healthier habits.

Medication -- Some doctors prescribe antidepressants to regulate chemical imbalances caused by SAD. Never self-medicate; always consult your doctor.

If you don't have the winter blues, give thanks -- and practice good prevention by soaking up as much daylight as you can. When your schedule permits it, start the day with a crisp morning walk -- or at least get outside and moving at lunchtime. Grab a friend, or your dog, or your friend's dog.

And if you think you need help, ask for it. Don't wait for this to go away -- it's a way off until spring.

Teri Dreher is board-certified patient advocate. A critical care nurse for more than 30 years, she recently founded Seniors Alone Guardianship & Advocacy Services (SeniorsAlone.org), a nonprofit organization that serves the area's senior orphans. She also is the founder of NShore Patient Advocates, http://www.northshorern.com.

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13 sleep aids and bedroom products for better rest – NBC News

While popping a pill may sound promising to us sleep-deprived, walking zombies, there is little evidence to show that sleeping pills actually add very much shut eye to your daily count, not to mention the dangerous side effects that can occur from misuse.

That being said, there are some sleep trackers, sleep apps and natural sleep aids that can make dozing off and staying asleep a little bit easier. Here are some of our top picks:

"In order to create a conducive sleep environment we want it as dark as possible and the blackout curtains will block out warming light for people who are sleeping when the sun is shining, or in the summer when it starts to get light earlier. Street lights and city lights can also interfere with sleep," says Dianne Augelli, MD, a sleep physician at Weill Cornell Medicine in New York. "We generally want our rooms to be dark, quiet and cool. The idea is to use the blackout curtains so that your sleep isnt disturbed prior to your wake time. So if youre someone who is getting up at 7:30 a.m., but its already light at six, that extra light may cause awakening that can fragment your sleep."

If you live in an urban location, or have some loud neighbors, that's even more incentive to consider a new set of curtains. The Eclipse curtains arent only a decorative accent in the bedroom, they block over 99 percent of intrusive light and reduce unwanted noise making your sleep more restful.

Its not just the light coming from our devices, but other lights in the room, that can keep you awake.

I advise turning down the lights in your home towards the end of the day," says Dr. Apostolos Lekkos, found of Bios Functional Medicine. "Lower light levels can help promote your natural melatonin production your sleep hormone.

C-Sleep is a blue tooth enabled light bulb that supports your body's natural sleep cycle by emitting a calm light at night and vibrant light in the morning. You can instantly dim or brighten the bulb, without even having to get out of bed, thanks to a handy app. Plus, you can create schedules and groups to control multiple bulbs at the same time.

We've all been there: We're awakened from our sleep by the heat, and rustle around kicking off our socks and tossing the comforter to the floor. You curse your partner who insists on keeping the air off because they're always cold. What if we told you there is a sheet for that?

The Temperature Regulating Sheet Set is the ultimate solution for thermally incompatible couples. It uses the Outlast fabric technology, which was developed for NASA to deal with temperature fluctuations in space. The "phase change" fabric absorbs and stores excess heat from your body. When you cool off, it releases the heat back to your body to maintain a consistent temperature all night long.

"We definitely want you to be cool when you're sleeping. If you're too hot and you feel that the particular sheets that you have are making you too hot, then you can consider a different type of sheet," says Dr. Augelli. "Some people will swear by [temperature regulating sheets], others will notice no change. But people need a more breathable sheet. The National Sleep Foundation recommends 200-400 thread count sheets, which allow some air movement."

This set from Sharper Image clocks in at 300 thread count so if you find yourself waking up sweating at night, they are worth a try.

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Philips SmartSleep, which connects to your home Wi-Fi, helps improve your sleep quality and helps you learn how the environment of your bedroom affects your rest. You'll be interacting with its proprietary app SleepMapper to document and receive feedback on some of your behaviors.

The best cure for being unable to fall asleep is utilizing a sleep tracker which is available through many apps," says Lindsey Huttner, LCSW, psychotherapist, located in Queens, NY. "In the app you will document when you get into bed, approximate the time you fall asleep, how long you sleep, and how many times you woke and for how long. The app will then 'prescribe' how much sleep you should aim to get."

In addition to tracking your sleep patterns, SmartSleep works with its companion app to track and monitor your bedroom's temperature, noise, light and humidity levels. The light it emits is designed to ease you out of sleep in a healthy and productive way.

While Augelli is hesitant to recommend trackers that record sleep time (and unrest) due to a lack of evidence and accuracy, she does say that tracking your sleep patterns can be helpful for some.

"They will give you some idea of your sleep, but they arent really able to tell the difference between [REM sleep and deep sleep] with the technology thats available on them," she says. "It can be helpful if youre tracking your number of hours of sleep and making sure you get adequate sleep and that youre going to sleep around the same time. That can be a problem with a lot of people, just not sleeping enough hours. If youre not getting your seven hours of sleep then this can help track for that."

The Versa 2 is optimized with a sleep mode to mute troublesome notifications. It also provides you with a Sleep Score, a simple way to see how you slept the night prior based on the metrics it's detecting, from sleep time to wakefulness and duration of sleep. Essentially, you'll gamify your sleeping habits to improve them.

Your sky-high stress levels may be to blame for all the tossing and turning, but that lumpy pillow sure isn't helping the cause. Before you run to Bed Bath and Beyond and grab a new one, consider investing in a pillow that works double duty. The Eden Pillow is designed to provide you with better quality sleep. And the gel-infused memory foam and microfiber fill are blended to offer cooling properties.

If you just can't seem to part with your nightly Netflix ritual, you should wear blue light blocking sunglasses while watching television, advises Dr. Lekkos.

"There are some small studies that show that the time it takes to fall asleep has been reduced for people who wore the light blocking glasses for several hours before bedtime," adds Augelli. "What you want to do ideally, is put away all your work and phone an hour before bed, in the process of your wind down routine. But if you have to work, you want to employ whatever you can to reduce the amount of impact it will have. Blue light blocking glasses reduce exposure to blue light that suppresses melatonin, which is our natural hormone that helps with sleep; the decrease in melatonin can prevent you from falling asleep."

The glasses filter out the high energy visible (HEV) blue-violet light from backlit screens, helping to ease the disruption is has on your sleep cycle. Keep a pair next to your bed, ready to grab and slip on when you get sucked into that late-night "Friends" marathon.

"For some people sound is soothing and relaxing and helps deactivate them for sleep," says Augelli. "Some of them will act to cover up other environmental noise, so in those cases it can be helpful, you just want to make sure there is no big change in frequency of that sound. (For example, on the TV when theres a commercial thats much louder.) We generally recommend white noise machines because they are pretty stable, but it is helpful for some people to deactivate if they hear something very soothing and thats part of their wind down routine and they feel comfortable with that."

The Marpac Dohm's natural white noise is emitted by its built-in fan, rather than relying on digital recordings. You can choose between two speed options and adjust its tone and volume to reach the perfect level of white noise for you.

According to Michael Gelb, DDS, MS, co-author of the new book "GASP!: Airway Health - The Hidden Path to Wellness," more than half of us struggle with breathing through our noses. This struggle often results in snoring. And even if you're part of the lucky half who has no problem breathing at night, there's a good chance your partner's issues are affecting your quality of sleep. Time to trade in the shaking and kicking for tossing a Mute Snoring device their way.

By holding open the nasal airways like a stent, Mute helps noisy snorers and poor nasal breathers by increasing airflow in the nose. You can individually adjust the device for each nostril, so it's comfortable while you sleep. And user trials are promising: 75 percent of people reported less or much less snoring while using Mute.

If youre prone to checking email, or watching Netflix, on your laptop in bed at night, you may want to have your computer screen follow suit with reducing blue light. You can run apps like f.lux on your laptop or computer that will automatically change the screen color as the day goes on, says Lekkos.

Like Night Shift, f.lux uses your location to synchronize your computer with the rising and setting of the sun. At night, f.lux slowly adjusts the colors on your computer screen to a warmer hue that's supposed to be less abrasive on the eyes (especially if you're in an otherwise dark room) and helps reduce your exposure to that blue light that keeps you awake.

"Any platform that will reduce the amount of blue light that is emitted from your electronic devices will be helpful," says Augelli. "I definitely recommend employing them."

Smartphone apps aren't adequate substitutes for assistance from a professional but they can be helpful adjuncts to treatment for those who wish to track sleep time and quality or for promoting greater physical relaxation before bed, says Joel Minden, Ph.D,, clinical psychologist at the Chico Center for Cognitive Behavior Therapy. "CBT-i Coach is nice because it includes a sleep diary. One of the most effective treatments for insomnia is sleep restriction therapy, and tracking sleep data is an important part of the process.

The app was designed for those who have experienced symptoms of insomnia and are looking to improve their sleep habits. It guides users through the process of learning about sleep, developing a better sleep routine and improving sleep environments. Plus, it has a structured program that teaches strategies proven to help alleviate symptoms of insomnia.

In fact, one study found that 60 percent of doctors who used the app in conjunction with treatment for insomnia found it favorable in encouraging people to adhere to instructed techniques.

While you're staring at the ceiling at 1 a.m., ever think back to those wonderful days when your mom would read you a story and you'd be out cold two pages in? Well, maybe a little bedtime story is in order. Enter: Calm, a top-rated meditation app that recently launched a new feature to the platform called "Sleep Stories," which are essentially bedtime tales for adults.

You may recognize some of your storytellers: Matthew McConaughey narrates one about the mysteries of the universe, childhood favorite LeVar Burton take us on a journey across the solar system, and Steven Fry (the narrator of all 7 "Harry Potter" books) takes us through the lavender fields of France.

Way too many people are on their smartphone, tablet, reading device or watch TV just before going to bed. What people do not realize is that there is a blue light that is emitted from these devices that (when it hits the back of the eye) will stimulate brain waves that promote our 'awake' state of mind, thus making it very difficult to fall and stay asleep, says Lekkos. Many smartphones now have the 'Night Shift' feature that you can turn on to block this blue light.

To enable the feature on your iPhone, go to Settings, Display & Brightness, and then schedule Night Shift for the hours you will be winding down for bed (and sleeping). By doing this, you're telling your phone to move the color spectrum from cooler (blue) towards warmer (yellow) to limit your exposure to sleep-disrupting blue light at night. It will then readjust the tones in the morning when the sun rises.

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Analysis on Japan’s Biosimilars Landscape, 2020 – In the Next 7 Years, Biosimilars Will Pose a ~$550B Opportunity in Japan, Due to the Patent Expiry…

Dublin, Jan. 14, 2020 (GLOBE NEWSWIRE) -- The "Japanese Biosimilars Landscape Study, 2009-2020" report has been added to ResearchAndMarkets.com's offering.

In this report, we attempt to analyze trend/requirement of regulatory approval of biosimilars based on Ex-Japan clinical trialdata, factors responsible for each key launched biosimilar penetration (Made in Japan vs. Tested by Japan), and the future competitive landscape in the biosimilars space in Japan.

We also attempt to analyze detail BS market of EPO, Filgrastim/Pegfilgrastim/Insulin/Lantus apart from other key complex Mab Biosimilar opportunities and list out niche opportunities in biosimilar space in Japan. Details of all major consolidation activities done by JP/Foreign companies in biosimilar space in the last five years and crisp summary on strategies of each key player (~21 JP local companies, multinational companies), their interest & focus for future collaboration in biosimilar space.

Since 2009, 25 biosimilars of 12 originator products are approved in Japan and have yielded mixed performances and attained annual sales of ~32.4b ($300m).

Unique biosimilars landscape with the entry of NESP biosame by originator Kyowa Hakko Kirin through its subsidiary, co-promotion/marketing collaboration with local companies for the front-end skill sets (Ayumi, Kyowa Hakko Kirin, Teijin) and few skipped listing to better manage constant supply (Pfizer), a key requirement by MHLW, makes Japan a distinct market vs. US and EU.

Less stringent regulatory environment vs. US for approval, increasing healthcare burden and strong foothold of the marketers have played key roles in this early uptake which is at par to one of the best generic small molecule penetration in Japan in a short time (Filgrastim BS-volume share~45% in two years, Lantus BS- ~9% in 2 months vs. Lipitor generics ~50% volume share).

While analyzing the launched biosimilar penetration since 2009 in Japan, bolstering uptake of Enbrel, Rituxan, and Lantus biosimilar vs. very slow uptake of Remicade BS mainly been attributed with the use of biosimilars in DPC hospitals,product reimbursement under high cost medical care benefit system and front end presence of the local partner.

Despite the string of recent biosimilars approvals, healthcare professionals still harbor concerns over the quality of biosimilars.

MHLW's announcement to update a decade back biosimilars guideline by FY2020 to reduce cost of development as well as to increase confidence of physician on quality, is indicative of biosimilar as important weapon for Chuikyo(Central social Insurance Medical Council) to curb healthcare cost. Further, Biosame pricing game will play a major role in the future for biosimilar penetration. We see that Abenomics measures and government involvement in biosimilars use would lead to the Biosimilars promotions in the coming times in Japan.

Mixed strategies by originator for Bio-same launch (Kyowa Hakko Kirin to launch Biosame vs. Chugai said not to launch Biosame), therapy area wise biosimilars cherry picking by mid-size Japanese companies, and different strategies by local generic companies (NichiIko heading for global market vs. Sawai testing through co-promotion and Towa yet not decided to enter), demonstrates each company's different need and approach to cater biosimilar opportunities in Japan.

Since the last five years, most of the companies have some alliance in place for biosimilars, with most of the Japanese companies undertaking pacts with South Korean companies to ride on their back of biosimilar mAb expertise.

There is a trend of doing product specific alliance by most of the JP companies active in BS space and to go step by step on this high risk/high return opportunities. Against this backdrop, multinational companies like Pfizer are setting their sights on this market without local partnership taking advantage of pro-biosimilar environment to capture decent biosimilar market share. Overall, in the Japan market, each opportunity has a different competitive landscape for itself, and some companies are looking for niche opportunities in biosimilar space as per their specialty therapy area- like ophthalmology BS (Lucentis), Enzyme therapy BS (JCR).

While launched biosimilars now generates ~32b ($300m) sales and its penetration is accelerating, MHLW's approval of Biosame of NESP based on same clinical data as the originator NESP, and current ongoing dialogs to price Biosame higher than biosimilars, indicative of Biosame to be the key hurdle in the future for mid-size biosimilar companies in Japan. In the year 2020, MHLW's stand on Biosame, will be important to decide future of theses mid-size /generic biosimilar developers. Around ~550b opportunity is opening for biosimilar in the next 7 years in Japan due to patent expiry of Wave 2-3 biologics.

Key Topics Covered

CHAPTER 1: EXECUTIVE SUMMARY

CHAPTER 2: JAPANESE GOVERNMENT AND CHUIKYO INITIATIVES TO INCREASE BIOSIMILAR PENETRATION IN JAPAN

CHAPTER 3: LESSONS FROM LAUNCHED BIOGENERIC PROGRESS IN JAPAN SINCE 2009

CHAPTER 4: GROWTH HORMONE MARKET (SOMATROPIN) IN JAPAN

CHAPTER 5: ANEMIA MARKET IN JAPAN

CHAPTER 6: FILGRASTIM (GRAN) BS

CHAPTER 7: REMICADE (INFLIXIMAB) BS

CHAPTER 8: LANTUS (INSULIN GLARGINE) BIOSIMILAR

CHAPTER 9: ENBREL (ETANERCEPT) BIOSIMILAR

CHAPTER 10: ONCOLOGY BIOSMILARS ERA STARTS WITH RITUXAN (RITUXIMAB) BIOSIMILAR

CHAPTER 11: HERCEPTIN (TRASTUZUMAB) BIOSIMILAR

CHAPTER 12: AVASTIN (BEVACIZUMAB) BIOSIMILAR

CHAPTER 13: FABRAZYME (AGALSIDASE BETA) BIOSIMILAR

CHAPTER 14: FORTEO (TERIPARATIDE) BIOSIMILAR

CHAPTER 15: NEXT WAVEOF BIOSIMILAR OPPORTUNITIES IN JAPAN

CHAPTER 16: BIOSIMILAR/BIOPHARMA CMO OPPORTUNITY

CHAPTER 17: REGULATORY APPROVAL REQUIREMENT FOR COMPLEX MAB BIOSIMILAR IN JAPAN

CHAPTER 18: LICENSING/CONSOLIDATION ACTIVITIES IN BIOSIMILAR SPACE IN JAPAN

CHAPTER 19: JAPANESE COMPANIES ACTIVE INTO BIOGENERICS SPACE

For more information about this report visit https://www.researchandmarkets.com/r/edigvv

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Analysis on Japan's Biosimilars Landscape, 2020 - In the Next 7 Years, Biosimilars Will Pose a ~$550B Opportunity in Japan, Due to the Patent Expiry...

CHP’s Dr. Stoepker helping to change the landscape of accessible health care for LGBTQ infividuals | – theberkshireedge.com

Lee When Ray Garnett moved to the Berkshires five years ago, finding a primary care physician was at the top of his to-do list. I was looking for a specific model of care, he explained in a recent phone interview. Garnett, who identifies as a transgender individual, was looking for hormone replacement therapy via informed consent, which, in many places in the country, trans people can access at Planned Parenthood. There is no Planned Parenthood in Great Barrington, where Garnett lives and works, and the closest equivalent Tapestry Health did not provide this service. So he went to Springfield to have his medical needs met.

Ray Garnett, founder of Berkshire County Trans Group. Photo: Ashley Shade

Good LGBTQ care is really just good care, is how Dr. Jeremy Stoepker sees it. In creating an open, nonjudgmental, collaborative environment where the standards of care are met no matter who you are, what your background is, or what your disease process or screening requirements may be. Its just good care, he said in a recent phone interview. Stoepkers arrival to the Berkshires, just six months ago as a provider, is changing the landscape of accessible health care for individuals who identify as LGBTQ, despite the fact that ones sexual orientation and gender identity should be moot points when it comes to accessing health care.

From the very beginning, I had role models and inspiration for how it can be done well seeping into my little brain, said Stoepker, who was 7 years old when his father was diagnosed with HIV.I dont remember the journey so much as I remember the players, he added, and they were amazing. Stopeker remembers his fathers doctors as loving and caring, supportive and nonjudgmental. And really up-to-date, he added in a nod to his fathers participation in the first clinical trial for the first HIV medication and survival for 20 years following his diagnosis. This remains Stoepkers inspiration in his day-to-day work: caring for his patients while honoring his fathers legacy.

Stoepker is realistic about the examples of bad care that abound in any discipline of medicine, particularly primary care. As to how this manifests in the LGBTQ community? People just arent up to speed with the type of screening that is recommended, he said.Take the triple swab (or triple-site) testing for gonorrhea and chlamydia in men who have sex with men. A lot of providers do not even know what that is or what that means, said Stoepker, who explained that, potentially, one should be tested in the rectum, urethra and the back of the throat. Not getting the standard of care to which a patient is entitled is how this looks in its most benign form; in more upsetting instances, it is doctors saying they do not feel comfortable treating patients or openly shaming patients and being accusatory. Which, unfortunately, happens to lots of patients, including those in the LGBTQ community, Stoepker.

Alex Reczkowski of Pittsfield. Photo: Hannah Van Sickle

Alex Reczkowski of Pittsfield experienced this with his former primary care physician. It started with a routine conversation at his annual physical, one sparked by a startling statistic Reczkowski had heard: that 50 percent of men of color who have sex with men are estimated to be diagnosed with HIV before they die. This number made him pause. As a single, gay man, he decided to look into PrEP pre-exposure prophylaxis, a one-a-day pill to prevent HIV infection. Reczkowski was looking for peace of mind, even if the medication was not necessary, and wanted to explore his options. His doctor assured him this was not necessary. After a second appointment, for the express purpose of getting a PrEP prescription, Reczkowski was denied.The conversation turned to shaming and the need to include a specialist on infectious disease, which didnt feel great. Needless to say, the appointment deteriorated. If you cant meet my needs, I think we are done here, is how Reczkowski left it.

Reczkowski ultimately made his way to Community Health Programs, where he connected with Dr. Stoepker, who relocated from New York City in June to join the primary care team at CHPs Lee Family Practice. In addition to a prescription for PrEP, Reckowski got the most up-to-date information about the HPV vaccine, previously available only for those under 27 years of age. Stoepker knew that the FDA had just approved the vaccine for anyone under the age of 45, and he listened to me, he didnt lecture me and wasnt interested in giving advice for someone else he was really interested in me, which, Reczkowski feels, really speaks to the vision of CHP: It values an inclusive culture that champions patient-centered care. I feel like that is exactly what I experienced, he said. Exceptional, compassionate health care.

The Williams Institute at the UCLA School of Law says about 4.5 percent of U.S. adults 11 million people identify as LGBT; about 1.4 million people identify as transgender. Massachusetts law explicitly prohibits discrimination based on gender identity, sexual orientation and HIV status. But as Garnett puts it, there is friendly, and there is competent. If [a doctor] is not putting out that they are [trans] friendly, Im not even going to call or show up, he explained. And Stoepker understands this. Not getting up-to-date care is [a persistent problem] in all arenas: If it only affects 10 percent of the population, there are going to be some doctors who are up to speed and some doctors who arent, he said. He calls this one of the big problems with medicine. Once you have that end of residency, the training requirements are incredibly flexible; what you do to educate yourself as a physician is highly variable, he said. While LGBTQ-specific training and separate clinics specifically dedicated to providing quality care to those who identify as LGBTQ are being incorporated into medical schools and residencies, there is an underlying truth: Its going to be a generation of physicians before its truly a frame shift, Stoepker said.

From Reczkowskis perspective, it boils down to education. Cultural competency training [is necessary] so we can understand how other people perceive the world and how we can best interact [and] live together; this is what the medical institutions need to be doing as well, he said. In fact it is imperative at the doctors office. In a separate incident with a different provider, Reczkowski ran into trouble with regard to a prostate exam, one of which could be done in the office, rendering it immediate and not very expensive, while the other had expensive lab costs associated with it. Reczkowskis doctor was so uncomfortable, he would not do the prostate exam. It is [the doctors] job to make me feel comfortable about something that can be awkward; now you are making me feel more awkward because you feel uncomfortable and dont have the cultural competency to understand [my position]?

This is part of the ongoing conversation Garnett is facilitating as founder of the Berkshire County Trans Group. I think any time a person makes an effort to say, I am friendly, I am willing to learn, that is great. Health care is a hot topic at monthly meetings across the county,where informal lists of recommendations abound. Dr. Stoepker currently tops this list as one of the only openly LGBTQ-supportive providers in the area. Its the first thing you do when you move to a new area: Who is your doctor? Who is your dentist? Garnett said. Its difficult to see a new provider when you dont really know [what you are walking into], Garnett added, even when the issue for which you might need support is not trans- or LGBT-related. Garnett addressed the topic of labels, often seen as divisive. The value of labels comes when they are self-chosen, he explained. We choose them so we are not alone; having labels helps us find each other; it helps us to hear about someone elses experience, and it helps us to put our own experiences in context with other people.

This is not a local problem. Stoepker recalls his practice in New York City (he moved to the Berkshires 18 months ago but spent a year communing to the city). Every day I was seeing a new patient who said, This is New York City and it boggles my mind, but I was not getting affirming, supportive care at my PCPs office. So I Googled around and found you, which is why he has worked to create a safe zone in his office by providing informed, compassionate medical care to LGBTQ patients not individuals living with HIV or AIDS, who are under the care of specialists, rather individuals seeking good primary care. Its what keeps him motivated in his work: The privilege of doing what I do is amazing, and Im excited about it every day; the ability to honor my dads memory, and the tradition of amazing doctors he had that I was inspired by. But mostly its just because, when you do something the right way and people appreciate it, it feels really good.

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CHP's Dr. Stoepker helping to change the landscape of accessible health care for LGBTQ infividuals | - theberkshireedge.com

The Common Health Condition That Could Be Killing Your Sex Life – SheKnows

In the years since I was diagnosed with hypothyroidism, each day seems to bring about a new and unexpected symptom. But putting the pieces together and discovering that my hypothyroidism was negatively affecting my sex life felt like a gut-punch, even more so than finding out about the gastrointestinal problems or night sweats. This aspect of my life that had come to feel so wholly and totally mine was just another thing to add to the list of things stolen by this illness.

The thyroid is a butterfly-shaped gland located at the base of the throat. It controls the speed at which every cell of the body operates a process known as metabolism. When the thyroid is off, it isnt able to properly produce T3, T4, and TSH (Thyroid Stimulating Hormone) which are the hormones that communicate to the body how each bodily process should go. This can affect literally everything from digestion to brain function to fertility.

Before having a thyroidectomy, I didnt even know what the thyroid was. I was completely unprepared for how it would affect my life, but even more how it would affect my sexual health as doctors arent always so keen on talking about these things with patients. When I was being prepared for life post-thyroid, not once did any of my doctors mention how it would affect my menstrual or sexual health. And, as it turns out, thyroid disease has totally changed my sex life.

Hormonal disordersincluding an under-active thyroidare responsible for about one third of all sexual problems people experience, says Dr. Vedrana Hgqvist Tabor, PHD, CEO of Boost Thyroid. Low T4 (one of two thyroid produced hormones) or high TSH (thyroid stimulating hormone) are to blame.

The imbalance of these hormones can cause hyperprolactinemia, or elevated levels of prolactin in the blood. Prolactin is made by the pituitary gland and affects the level of estrogen and testosterone in people. When T4 and TSH are out of whack, it can also cause the sex hormone binding globulin (SHBG) levels to change, which can throw off the estrogen, testosterone and progesterone balance. Low thyroid hormone levels can cause changes in blood vessels and nerve sensitivity, resulting in reduced sex drive, breast pain, painful vaginal penetration, and vaginal dryness.

Sexual disorders are typically experienced more by people who have fatigue, muscle pain, and/or feel depressed, says Dr. Hgqvist Tabor. These are all common side-effects of a thyroid condition, so tracking can help patients understand when these symptoms worsen and improve.

Thyroid disease can cause a variety of symptoms that affect a persons sex life from low sex drive, difficulty getting aroused, erectile dysfunction, vaginal dryness, inability or difficult reaching orgasm, delayed ejaculation and pain during or after vaginal intercourse.

Awareness depends on three factors: the patient, the physician, and the country, says Dr. Hgqvist Tabor. It depends whether the patient will share any sexual problems with their physician, whether the physician is aware of the thyroid and sex connection and their countrys guidelines for physicians.

Sexual health is a major part of a persons health, and why these sexual side-effects have been continuously ignored or glossed over by my doctors when hypothyroidism affects approximately 10 million Americans (and as many as 10 percent of women experience some thyroid hormone deficiency) still sort of baffles me. If I had known what to look for, I may have been clued-in earlier when I first had a dip in my hormone levels or when my birth control was interacting weirdly with my thyroid meds. Being sexually well is part of being totally well and ignoring that doesnt do anything but hurt patients.

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The Common Health Condition That Could Be Killing Your Sex Life - SheKnows

January Is Thyroid Awareness Month: Mount Sinai Doctors Offer Unique Procedures for Thyroid Nodules and Stress Importance of Early Detection – PR Web

NEW YORK (PRWEB) January 10, 2020

January is Thyroid Awareness Month, and physicians from the Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease and the Department of Otolaryngology Head and Neck Surgery at the Mount Sinai Health System are emphasizing the importance of being aware of symptoms that may be related to thyroid disease.

The thyroid gland is located in the front of the neck and under the voice box. It produces hormones that help the body control the rate of metabolism, and regulate the production and consumption of energy. When thyroid function is accelerated, the condition is called hyperthyroidism; when slowed, it is called hypothyroidism. Imbalances in thyroid function may be a result of environmental, autoimmune, or genetic factors. Additionally, thyroid issues may lead to cancer.

Thyroid disease affects roughly 200 million people worldwide, and thyroid cancer is on the rise, with roughly 52,000 new cases diagnosed in 2019, according to the American Cancer Society. Three out of four thyroid cancer diagnoses are made in women. Data from the American Thyroid Association shows that more than 12 percent of the U.S. population will develop a thyroid condition in their lifetime, and the cause of these problems is largely unknown. An estimated 20 million Americans have some form of thyroid disease and up to 60 percent of them dont know they have it, so they go undiagnosed and untreated. Women are five to eight times more likely than men to have thyroid issues, and one in eight women will develop a thyroid disorder. People with a family history of thyroid disease and/or thyroid cancer, and exposure to high doses of radiation, are also at increased risk, said Terry Davies, MD, Co-Director of the Mount Sinai Thyroid Center at Union Square and Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai.

How to Perform a Thyroid Neck Self-Exam:

Symptoms and Facts about Thyroid Disease

Thyroid Disease and Pregnancy Pregnant women should be aware of changes to their thyroid gland, which can be affected by different levels of pregnancy hormones. The thyroid hormone greatly contributes to the development of a healthy baby, and it is important that expectant mothers be properly diagnosed with and treated for thyroid disease. Otherwise, they could be at higher risk of miscarriage or preterm delivery, and their children may have developmental delays. For that reason, thyroid function is routinely checked in pregnant women.

When it comes to thyroid cancer, a large number of women develop this during their reproductive age. Since thyroid cancer tends to be mediated by hormones in the body, it tends to grow faster when patients are pregnant. There is no special cancer screening recommendation for pregnant women.

Mount Sinai Is a Leader in Noninvasive Thyroid Treatment

Radiofrequency Ablation for Thyroid Nodules Mount Sinai West is one of only two hospitals in New York State offering a minimally invasive procedure to treat non-cancerous thyroid nodules that are symptomatic and would have otherwise required invasive surgery for removal. The procedure is called radio-frequency ablation (RFA). It offers eligible patients a much quicker recovery, less pain and risk of infection, and no scarring. With RFA, surgeons use guided ultrasound to deliver radio-frequency current to heat up and shrink the thyroid nodule. RFA can be done on patients with large non-cancerous nodules that cause swallowing, voice, breathing, and neck discomfort.

Patients who undergo RFA can return to normal activity the day after the procedure and can exercise within several days. Additionally, they are extremely unlikely to require permanent thyroid hormone medication. Patients who have standard thyroid nodule surgery typically cant resume normal activity for at least a month and 20 to 30 percent of these patients require thyroid medication.

Radiofrequency ablation for thyroid nodules has been performed in Korea for over a decade and throughout Europe and their outcomes are excellent. The published data shows impressive nodule shrinkage rates of more than 80 percent with RFA that is maintained over years of follow-up, explained Catherine Sinclair, MD, Associate Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai and Director of Head and Neck Surgery at Mount Sinai West. Thyroid nodules are very common and, although many people will never require any intervention for their nodules, there is a significant minority who will seek treatment due to symptoms. I expect RFA to be a terrific new option for these patients.

Ethanol Ablation for Thyroid NodulesAnother noninvasive procedure, performed at Mount Sinai-Union Square, ethanol ablation is when an alcohol solution is injected into thyroid nodules, killing cells and causing the masses to slowly shrink. The procedure leaves only a small scar and is performed in office with local anesthesia.

The candidates for RFA and ethanol ablation are very similar, says Maria Brito, MD, Co-Director of the Mount Sinai Thyroid Center at Union Square. Dr. Brito and Michael Via, MD, both Associate Professors of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai, are two of only a handful of physicians in the New York metropolitan region to perform ethanol ablation.

The procedures will not necessarily eliminate the nodule completely, and patients will still need to have ultrasound follow-ups to monitor the nodule, Dr. Brito says. But in appropriate cases, they are a terrific option. They make it very easy for the patient.

About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

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January Is Thyroid Awareness Month: Mount Sinai Doctors Offer Unique Procedures for Thyroid Nodules and Stress Importance of Early Detection - PR Web

How to Keep a Sunny Outlook During the Dreary Days of January – Healthline

Theres a feeling that sweeps over many people this time of year, and it might be summed up best with a twist on a famed quote from the cult movie classic Office Space.

Looks like somebodys got a case of the Januarys.

January is the time of year when the combination of less daylight, colder weather, less activity, and a letdown from the holiday vibe can lead to feelings of isolation, sadness, and in extreme situations, depression.

Why does it happen?

Experts point to a combination of things.

Its almost a perfect storm of seasonal happenings, according to Marna W. Brickman, LGSW, a psychotherapist with Spectrum Behavioral Health in Annapolis, Maryland.

There are the shorter days, the colder weather that means people are isolating themselves more, the less physical activity that can come with this time of year, and seasonal affective disorder, she told Healthline.

A combination of some or all of these factors, Brickman said, can lead to that January blues vibe and even depression.

Leigh Leader of Michigan knows the January feeling.

The mother of two in her early 30s battles a case of the Januarys each year.

You know what it feels like when you look out your window sometimes and just see that dull, snow, cold, gray world? Thats what it feels like, she told Healthline. Some days I wake up and just want to stay under the covers and not move. But I have two small daughters, so I have to.

Phyllis Perkins, a mother of teens also from Michigan, fights the feeling as well.

Before I realized I could take action, all I wanted to do this time of year was get the kids from school, cook dinner, and then go to bed, she told Healthline.

For a while, Perkins thought she was physically ill. But after a panel of tests by her physician showed no physical issue, she said they began to put the pieces together and find a way to help her improve her January mood.

So whats a person like Leader or Perkins to do?

There are steps you can take now, and proactively in years to come, to better your frame of mind and mood in the winter months.

Brickman points to elevated fatigue, oversleeping, isolating yourself, and a sense of helplessness as symptoms people should be aware of.

She says they should take note if they experience any or all of them.

What could be causing those symptoms and what pushes it over to depression?

There is an underlying neurological basis for major depressive disorder with a seasonal pattern, in which people have difficulty regulating the neurotransmitter, serotonin, which is responsible for balancing mood, Dr. Ash Nadkarni, associate psychiatrist and director of wellness at Brigham and Womens Hospital in Boston, told Healthline.

Nadkarni explained that people may also have difficulty with overproduction of melatonin, a hormone produced by the pineal gland that responds to darkness by causing sleepiness.

In the winter, melatonin production increases, causing sleepiness and lethargy, she said. Both decreased serotonin and increased melatonin impact circadian rhythms, or the bodys internal 24-hour clock, which responds to light-dark changes that occur daily and throughout each of the seasons, she said.

In people with depressive disorders, she said, the circadian signal that indicates a seasonal change in day length has been found to be timed differently, challenging the bodys ability to adjust.

In other words, our bodies crave warmth, sun, and light.

There are steps you can take now if youre feeling blue, said Brickman.

Find natural daylight. Find the sun if you can, she said.

Brickman also suggests investing in a light box, in particular one that treats mood disorders and not skin disorders.

One added suggestion: change your diet.

Even healthy eaters can shift to a looser dietary pattern in the holidays and in cold, dark January eating that way can magnify sad feelings.

High-fat, sugary diets are tough on the mind, Brickman said. People dont think enough about food and how it impacts all of this.

She also suggests looking at using eating and food in a positive way by making plans and meeting up with friends for meals.

Eat socially, she said. Everything is better with company.

Perkins uses light therapy. Her physician suggested replacing her kitchen lights with bright 75 watt bulbs and shes found that helped.

She also has another suggestion: pick up or reclaim a hobby. For her, crafting does wonderings.

Its sounds so silly but something simple like this really can help, Perkins said. For me, crafting keeps my mind occupied and makes me feel useful, inspired and busy.

Its also important to report your symptoms to your physician or therapist and take any medical action they may deem necessary.

Seeking treatment is important, said Nadkarni. Antidepressants, light therapy, vitamin D to replete any deficiency, and psychotherapy have all been found to be evidenced-based options for treatment.

Brickman agrees.

Talk therapy is a great treatment for this, she said. Antidepressants, if needed, can also be a fix for 90 days or until the days extend and weather changes.

Leaders physician does something Brickman suggests ups her dosage of vitamin D for this time of year.

Its funny, she said. I never really believed something like that would make a difference until I tried it. It really helps.

Signs that you may sink into a case of January seasonal affective disorder or actual depression may begin to show months before, Nadkarni said.

When major depressive disorder has a seasonal pattern, it most often tends to be associated with an increase in symptoms in October or November, when light patterns first begin to shift, she said.

What to do?

Nadkarni says pay attention to the signs and be aware of them possibly showing up in your life.

When you see one or more, proactively battle those feelings with these suggestions.

How is one to be motivated to do that?

Both Perkins and Leader say people should simply try to avoid the painful sadness theyve fought in the past.

Leader has one more tip: just do it.

I have two small children, so I really have no choice but to try to stay ahead of this and focus on not having it drag me down, she said. Having two little kids to get out of bed and take care of every day is motivation to be mentally healthy for that.

For people without children, she urges them to find a place and a way you are needed.

That makes it all so much more important, and that makes it get your focus, she said.

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How to Keep a Sunny Outlook During the Dreary Days of January - Healthline

Is It Normal to Want Sex All the Time? How to Tell If You’re an Addict – AskMen

Does Wanting A Lot of Sex Mean Youre Addicted? Experts Explain

You might be familiar with the statistic that claims men think about sex every seven seconds.

That statement has garnered plenty of skepticism from gentlemen thatve heard it, and not just because theres no research to back it up. After all, its difficult to see how someone could get anything accomplished if they thought about getting it on 500 times an hour (thats 8,000 times a day).

RELATED: Dealing With Porn Addiction

So lets ask the question on everyones mind: Is it normal to think about sex all the time?

According to a 1995 survey conducted by the Kinsey Institute, 54 percent of men said they think about sex several times a day, and 43 percent said its on their mind a few times per week or just a few times per month. Only 4 percent reported thinking about it less than once a month. Its worth noting that the Kinsey Institute survey included men of all ages, meaning their sex drives varied.

But when it comes to thinking about sex, at what point do all of those racy thoughts become problematic, going as far to interrupt your regular day-to-day routine?

The line between a typical horny guy and sex addict can get pretty blurry. To figure this out, AskMen spoke with three experts to clarify the difference.

Dr. Joshua Klapow, clinical psychologist and host of The Kurre and Klapow Show, asserts that sex drive can vary greatly among men, with age being one of the key factors that impact it. Still, even within the same age range, its very difficult to define whats normal.

Younger men (17-30), with more testosterone production on average will have stronger sex drive than older men, he explains. However, environmental and biological factors can impact that significantly. We see men in their 20s with moderate drive and men in their 50s with a strong drive. Sexual experience, social norms, learning history and expectations (i.e. how much sex theyve had in the past) all affect the degree of sexual drive.

Klapow also notes that life circumstances can have an effect on sex drive. For example, stress, grief, anxiety, and sleep deprivation can all come into play in terms of your sexual interest and activity.

Dr. Dawn Michael, clinical sexologist founder of TheHappySpouse.com, states that every man has his own unique sex drive.

Sex drive can be dependent on a mans pattern of masturbation and sexual release (orgasm), she says. If a man orgasms every day, his body gets used to that pattern.

Given that the Kinsey Institute study included participants within such a wide age range, its difficult to discern any norms for particular groups from the findings. However, Dr. Leslie Beth Wish, licensed clinical psychotherapist, relationship expert and author of Training Your Love Intuition, points at a 2016 study from Ohio State University as a more reliable source due to its focus on men between the ages of 18 to 25.

Researchers gave participants a counting machine, which they used to track their thoughts about sex. On average, participants had explicit thoughts about 19 times per day (or once every 1.26 hours). This may come as no surprise, but the men thought about food almost just as often (18 times per day).

In other words, even if youre thinking about sex about once every hour or two, youre right in line with the average for young men. How do you know if its becoming a problem? According to Klapow, if youre preoccupied with thoughts of sex to the point that they interfere with your ability to work, study, maintain relationships or have a social life, thats a red flag.

Experts agree that the definition of sex addiction is nuanced and delicate in fact, theres no official medical diagnosis for it.

We have to be careful to label someone as having a sex addiction, says Michael. The label sex addiction is very complicated and misused often. Some men are labeled sex addicts by their partners who may simply not have the same sex drive.

That said, there are some tell-tale signs that can suggest youre experiencing compulsive sexual behavior. Below, youll see some of the most common indicators of addiction via Klapow and Wish:

Wish states that sex addiction is often marked by a constant need to expand your sexual activities. Its not unlike a drug addiction, where you need to continually increase your dosage of the substance to experience the same pleasurable effects. For example, you might feel compelled to incorporate more elements of danger into your sex life for more of a thrill, or need to seek out increasingly hard-core pornography in order to reach an orgasm.

Our brain and body like variety, she adds. Imagine if you had to eat your favorite meal three times a day, every day. This loss of pleasure creates a compulsion for something new. Regardless of the next choice, that choice, too, most likely will stop being as satisfying, and, as a result, men get trapped in an endless cycle.

Even if some of the aforementioned signs sound familiar, all experts agree that sex addiction isnt something that should be self-diagnosed.

Wish points out that you could be overlooking a medical issue, such as a mental health disorder or hormone imbalance, at the root of your addiction. Additionally, Michael notes that past traumatic experiences may be contributing to this behavior, and those are best worked through with a professional such as a licensed counselor or therapist.

Ideally, consult a mental health professional who specializes in sexual addictions, advises Klapow. The key is to recognize that if you see yourself as having a sexual addiction, you are not likely to be able to modify your behavior on your own. Its important to contact a mental health professional as sexual addiction is not by itself a diagnosis and often is a problem that presents with other psychiatric problems (i.e. bipolar disorder, OCD, mania, etc.)

If you cant find a licensed professional who specializes in sexual addictions in your area, contact a licensed mental health professional, or talk to your primary care physician.

The bottom line? If your sexual thoughts and activities are negatively impacting your life in any way, then it may be time to figure out what you can do to address those compulsions. If they arent, take a deep breath and know that those frequent naughty thoughts are totally normal in fact, its just points at a healthy, active sex drive.

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Is It Normal to Want Sex All the Time? How to Tell If You're an Addict - AskMen

All About Epinephrine: What It Does in a Reaction, How Long It Lasts, When It Gets Hot or Cold – Allergic Living

One of the nerve-racking parts of living with severe allergies is having to make the call about if and when an allergic reaction is anaphylaxis. A shot of epinephrine can save a life, but having to inject ourselves or our child with a needle is something we did not sign up for.

However, mistakes in the critical areas of recognizing and responding to anaphylaxis can mean the difference between life and death. Plus, studies are showing that prompt administration of epinephrine can simply reduce the chance that a food allergy reaction moves from relatively mild to severe anaphylaxis.

Over the years, Allergic Living readers have raised many questions related to epinephrine: from when to give it, to when a person needs a second dose, to issues such as how much heat or cold an epinephrine auto-injector can take, whether antihistamines mask anaphylaxis symptoms and more.

We asked Gina Clowes, the nationally known food allergy educator and parenting coach and consultant at AllergyMoms.com, to help us create a go-to epinephrine resource with answers to these vital questions.

Ginareached out to Dr. Julie Brown, anemergency medicine physician at Seattle Childrens Hospital, for her expertiseon the topic. Dr. Brown works closely with the food allergy community and has acontinuing research interest in epinephrine, auto-injectors and anaphylaxis. AsGina says, Were so grateful to Dr. Brown for agreeing to answer commonepinephrine questions. I find her insights and answers fascinating, and knowtheyll be helpful to a lot of people.

Following you will find written answers about epinephrine in a handy Q&A format. Plus, we include a podcast featuring Gina and Dr. Brown that offers further elaboration on some of the key answers.

Allergic Livings Epinephrine Q&A

Dr. Brown explained that epinephrine is adrenaline, the same hormone that is formed in the body in the fight or flight response. But it also has a very important role, probably by design, in turning off allergic reactions.

In the allergy context, she says epinephrine acts on a number of different receptors on cells in the body, and seems to reverse fairly pointedly all of the things that are happening in allergic reactions.

The reason is, the earlier you give epinephrine, the better outcomes are, says Dr. Brown. The longer one waits, the more likely the reaction is to progress and require multiple doses of epinephrine.

If we wait, were more likely to get sicker and have much more significant symptoms, she says. We are more likely to need multiple doses of epinephrine or need to stay in the hospital.

She reminds us that patients can start off having very mild symptoms, and then turn very quickly to getting very sick. What we want to do is to treat before things get serious. Sadly, most patients who have died from anaphylaxis had delayed treatment with epinephrine.

Dr. Brown generally recommends between 5 and 15 minutes as a reasonable timeframe between doses to determine if the epinephrine has taken effect. She says that if you have someone who looks like they are not breathing, they are turning blue, they are passed out, you would shorten the time window.

In such a case she says it may be reasonable to give a second dose, just to make sure that youve got a good amount of epinephrine circulating while awaiting an ambulance.

All About Epinephrine Podcast with Dr. Julie Brown and Gina Clowes

After the death of a U.K. teenager, whosecase involved getting two injections of epinephrine in the same thigh, therewas some suggestion that a second dose should have been given in the oppositethigh.

Thesuggestion was that this might increase the circulation of epinephrine in thebody. However, Dr. Brown does not seea concern with injecting a second dose in the same thigh. As this is such a largemuscle, she says you are highly unlikely to inject in the exact same location.

However, she agrees that there is no problem with injecting a second dose in the opposite thigh (to the first dose) if there is no barrier to doing so.

Ina severe anaphylactic reaction, Dr. Brown says there is a lot of fluid leakage fromthe blood vessels internally, which makes it hard for your body to pump enoughblood through your heart. Its often helpful for a person to lie down with feetelevated when suffering from a serious reaction.

Youare helping them to circulate their blood the best if theyre lying down,she says. And after youve given epinephrine, youre helping to circulatethat epinephrine the best if theyre lying down.

Shediscussed U.K. research into cases of patients who had died from anaphylaticshock. Some patients worsened after they stood up quickly or were propped up duringtheir extreme reactions. The lack of blood flow to the heart may have led to aheart attack, which contributed to the fatal outcome.

Dr.Brown recommends that patients experiencing active anaphylactic symptoms shouldlie down, if possible. However, I certainly see lots of kids who aresitting comfortably for hours in our emergency department, and they dont allneed to be lying down. She says this recommendation is probably mostimportant when a patient feels faint or light-headed or early in a reactionthat is progressing rapidly.

Importantly, she says, not everybody is going to be best off lying down. Dr. Brown gives the example of someone whos having respiratory distress as a symptom. If its upper airway difficulty, with what we call stridor the kind of noise where youre having trouble breathing in that person often needs to be sitting up and leaning forward. This is a position that allows your airways to be the most open.

In addition, she says that individuals who are vomiting should be lying on their side to reduce the chances of choking.

This is an issue of concern particularly in schools. The teacher should never send a kid in school on their own to the nurses office, says Dr. Brown. You dont know how the disease is going to progress between the classroom and the nurses office.

She recommends sending someone with the student, at a minimum, so they can monitor and advocate for the child or teen if needed. If the child is feeling faint, then help should be brought to the child, rather than sending the child to get help.

According to Dr. Brown, studies have shown there is epinephrine in your system for at least 6 hours. Its at a higher level for about an hour, and it peaks around 5 minutes. Theres a pretty decent amount [circulating] for 40 minutes.

Shesays people often think epinephrine only lasts 15 minutes because thats whenyoure suggested to take a second dose if needed. But it doesnt mean that thereisnt medication still on-board from the first dose.

Evidenceshows most people only need one dose of epinephrine, says Dr. Brown. One reasonis that it lasts for the duration of most reactions. A second reason is thatepinephrine stabilitizes mast cells, making them less twitchy, aneffect that may last even after the epinephrine is gone.

She says a third factor is that, even for patients who dont get epinephrine, a lot of these reactions will burn out on their own. Thank goodness for that, because everybody [with food allergies] has a first reaction where they arent carrying epinephrine! she says. Of course, you never want to count on it burning out on its own, so you should always treat anaphylaxis early with epinephrine.

Thegood news is: There are a number of studies that have looked at what happenedto epinephrine when you freeze it. Theyve shown that both refrigerating andfreezing epinephrine does not degrade epinephrine. So it maintains high levelsof epinephrine.

Dr. Brown and colleagues have further investigated what happens to auto-injector devices when frozen. Dr. Brown was senior author of a study [by Alex Cooper et al] in which 104 EpiPens were frozen for 24 hours, then thawed while their mates [from EpiPen 2-Pak cartons] were left at room temperature. The frozen-then-thawed devices fired a similar amount of epinephrine to their never-frozen paired device. When another 104 frozen-thawed devices were opened unfired, there was no damage to the syringes or other device parts.

This research didnt find any evidence of adverse effects to the device of having been frozen for 24 hours. It looks like freezing has pretty minimal effects on EpiPens, said Dr. Brown. She cautions that this research looked only at EpiPens, not other auto-injectors, and the impact on other devices could be different.

Dr. Brown explains that heat is much more problematic than cold. Previous research has shown that you can definitely see the degradation of epinephrine itself with high heat. She says temperatures in a car on a hot, sunny day can exceed 194 degrees F, and a device exposed to this sort of heat could have degradation of the epinephrine.

The device itself can also be negatively impacted by heat. Her teams ongoing research [lead investigator Samuel Agosti] is examining the impact of high heat, and exposing EpiPens and EpiPen Jrs to 183 degrees F for 8 hours. In this study, Dr. Brown reports, were seeing differences in the amount of epinephrine fired from heated-then-cooled devices compared with their unheated pairs [from EpiPen 2-Paks]. We are also having trouble getting some devices out of the cases.

Sherecommends replacing a device that has had significant heat exposure. Shecautions if it feels hot to the touch, I would say thats pretty suspect that thedevice is not reliable anymore. Theres a risk there.

Dr. Brown doesnt think so. She says that in the United States, we have safe devices that have really maximized needle lengths for serving a wide range of population and different-sized people. Longer needles might be more suitable for some extremely large patients, but those longer needles might be long enough to reach bone in many normal-weight patients.

She notes that the goal is to get the medicine into the thigh muscle, and the device mechanism that pushes the drug out also plays a role. So needle length isnt the only factor. Although there will always be challenges to meet every patients needs, Dr. Brown believes the options available the devices in the U.S. are probably doing a reasonable job, all things considered. She notes there is even a third dose option now, the Auvi-Q device for infants.

Dr. Brown had no concerns about airport scanners. Shes not aware of any specific research in this area, but doubts an airport scanner would have any ability to impact your dose of epinephrine or the functioning of the device.

Her team [led by investigator Andrew McCray] has researched this easy mistake to make and the news is not good for an EpiPen that has gone through the laundry. While prescribing information does not address what to do if the device is submerged in water, the EpiPen website says the carrier tube is not waterproof and that a submerged device should be replaced. However, Dr. Brown said: I still thought that they would do pretty well because it looks like a robust device that was based on a design developed for the military. But our results are not encouraging.

She reports that water gets lodged in the outer layer of the device, and more importantly the amount of drug that fires appears to be impacted. She recommends following the advice to replace an auto-injector that has gone through the washing machine.

Epinephrinedevices do continue to maintain a high level of the labeled dose of epinephrineas they age. While Dr. Brown recommends keeping current, unexpired deviceswhenever possible, she has little concern about the four-month expiration dateextension that the FDA issued on certain lot numbers during periods of shortage.

However, as Dr. Brown explains, the amount of epinephrine is only part of the story. There are epinephrine metabolites that occur as the medication ages. The safety or toxicity of these metabolites in the body in expired medication is unknown. While the theoretical risk of these metabolites shouldnt prevent use of a potentially life-saving medication in an emergency, it is a good reason to keep a current device on hand.

Shes aware that many allergy families keep older auto-injectors in case of emergency, but cautions that the level of epinephrine is getting pretty low after two years, and the level of metabolites is probably getting fairly high. Two years is probably a reasonable limit for keeping back-up devices. After that, its really time to just toss them in your med recycling bin.

With heat, light exposure or over time after expiration, epinephrine is degraded and metabolites begin to increase. Epinephrine metabolites can exceed FDA recommended levels well before the medication shows any discoloration, says Dr. Brown. However, some pharmacists still perpetuate the notion that as long as the medication is clear, its OK to use.

If the epinephrine has been exposed to heat, it can have a fairly significant increase in epinephrine metabolites and not be discolored. You cant rely on color tell you whether or not your device is safe to use, she cautions.

If it is discolored, it is unsafe. But if it was exposed to heat and is clear, it could still have significant degradation.

Although Dr. Brown acknowledges the concern of Benadryl masking anaphylaxis, she says that is giving antihistamines way more power than they have in allergic reaction. Her view is that if a reaction is going to be an anaphylactic one, an antihistamine wont stop it. There is no argument that epinephrine is the drug of choice to treat anaphylaxis, a life-threatening allergic reaction. But for a mild symptom, such as a mild runny nose or slight rash, she says its fine to give an antihistamine. Youre not going to mask anything. As long as youre still keeping a watchful eye for symptom progression.

She shares two caveats, though. Dr. Brown is among a growing number of experts who prefer a non-sedating antihistamine, such as Zyrtec, rather than Benadryl, as the latter is more sedating. She recommends this to avoid confusion between drowsiness from the medication and drowsiness related to anaphylaxis.

The second caveat is that if an antihistamine has been given for a single symptom, such as hives, you would still count that symptom as one system affected, even if the symptom resolves. She explains that if youve treated hives with an antihistamine and theyve improved, but half an hour later you go on to start vomiting, now youve hit two systems. According to most care plans, you would meet criteria for using epinephrine.

Interestingly, research shows conflicting benefits of corticosteroid medication in anaphylaxis. First, Brown explains there is a misconception that steroids take a long time to work, but theres some evidence that steroids actually can work within 30 minutes.

However, research from Canada suggests that steroids given prior to admission into the hospital increased intensive care admissions. She notes that its unclear if that truly was an effect of the steroids, or if perhaps steroids were being used instead of epinephrine.

There is also a notion that steroids decrease the risk of a biphasic or secondary reaction. But a review of cohort studies suggests that steroids are not having an impact on biphasic reactions. Brown concludes that theres really not a lot of great evidence to support that steroids are doing anything in anaphylaxis.

There are many other drugs and supports that can help a patient recover from an anaphylactic reaction such as fluids, oxygen, antihistamines, albuterol and other asthma medications. The additional drugs and monitoring available are why it is so important to seek medical care during an anaphylactic reaction.

Thefirst thing to remember is that [patient emergency anaphylaxis] care plans havea very low threshold for giving epinephrine. Often you are giving epinephrinebecause you meet this two-system criteria for giving epinephrine, Dr. Brownexplained.

Thatthreshold for using epinephrine by a lay person, who is not in a medicalsetting, is lower than it would be in a hospital. In the emergency departmentBrown notes:

The physician has the advantage of having you on monitors, of knowing your vital signs, what your exam is like, what kind of a timeframe were talking about. Time is very important in anaphylaxis, and thats not something that is incorporated into emergency care plans. The doctors will incorporate all that information into the decision-making about whether or not its appropriate to give more epinephrine at that time, whether or not they want to do something else, or whether they just want to watch further.

All of those may be safe and appropriate options in the emergency department setting, while you might make very different decisions if youre in the community and following your care plan.

Dr. Brown cautions that its important to understand that there is no rhyme or reason to food allergy reactions and that any reaction can become the bad reaction. You can have had very mild reactions all of your life, and then your next one can be really severe.

At the same time, it is wise to be aware that if youve had very life-threatening reactions in the past, then that may increase your chance of having one again, she says.

While our individual histories are things we cant necessarily change or impact, co-factors are things that we can be aware of. Dr. Brown explains that co-factors are things like exercise, heat, alcohol consumption, illness and menstruation. All of those can exacerbate your allergic reaction.

So if youre having a mild allergic reaction and you go out for a jog, that may really flare up that reaction. Or if youre having a bit of a reaction and you go take a hot shower, that may really activate all your masts cells and you may come out of the shower just covered in hives. Some people are exacerbated by cold, so they might go out on a very cold day and find that that sets them off. Illness certainly decreases peoples threshold for reaction. So they may find that they can tolerate a food pretty well most of the time, and then when they are ill have a decreased threshold for reacting to that food. Some women find around their menstruation theyre much more likely to react to certain foods, she says.

Dont be afraid of epinephrine. It is unfortunately so hard for so many people to get past the mental idea of giving themselves [or a child] a shot, but it invariably makes you feel so much better when youre having an allergic reaction, says Dr. Brown. It only does good things, it only keeps you safe. It really is a wonder drug in anaphylaxis.

She puts it succinctly: Dont be afraid to use it yourself. Dont be afraid to use it for your child. Youre only going to make things better.

Allergic Living and Gina Clowes extend our appreciation to Dr. Julie Brown for her generous time in helping to create this go-to resource for the food allergy community. Dr. Brown is an emergency medicine physician and co-director of emergency medical research at Seattle Childrens Hospital, with study interests in epinephrine, auto-injectors and anaphylaxis. Gina is the founder of AllergyMoms.com.

Feeding Babies and Toddlers to Protect Against Food AllergiesAuvi-Q Injectors Now On-Board with American, Other AirlinesEpinephrine Underused in Study, But Teens Proved Surprising Exception

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All About Epinephrine: What It Does in a Reaction, How Long It Lasts, When It Gets Hot or Cold - Allergic Living

Patients and Doctors on Different Pages for Acromegaly Symptoms – Medscape

Clinicians who treat patients with acromegaly commonly show a lack of awareness of the severity and pattern of patient symptoms that can occur even when treatment suggests the condition is under control, according to new research.

"Compared with patients, medical providers tended to report fewer acromegaly symptoms and injection site reactions, and rated general health higher [than patient reports]," write the authors of the study, recently published in the journal Pituitary.

Acromegaly, an endocrine disorder characterized by changes in facial appearance and enlargement of the hands and feet, is typically treated with somatostatin receptor ligands (SRLs).

However, even when the over-production of growth hormone and insulin-like growth factor (IGF-1) that cause the disorder are brought to normal levels with the medication, patients may continue to experience symptoms.

In the first study of its kind to evaluate concordance regarding symptoms, treatment satisfaction, and general health between clinicians and patients with acromegaly, Eliza B. Geer, MD, Memorial Sloan Kettering Cancer Center, New York City, and colleagues, conducted an online survey with 47 pairs of patients with acromegaly who were on a stable dose of SRLs and their medical providers. Patient self-reports were compared with those of their physician.

The patients and clinicians in the cross-sectional study were recruited by the US-based Acromegaly Community, a patient support group, through social media and at clinical practices in the United States. The study was funded by Chiasma, which is developing an oral formulation of maintenance therapy for adults with acromegaly.

Nicholas Tritos, MD, DSc, who was not involved in the study, told Medscape Medical News the new research points to the need for a heightened focus on communication in the treatment of acromegaly.

"The findings of the present study are intriguing and suggest that there may be lack of sufficient communication between patients with acromegaly and their healthcare professionals at least in some cases," said Tritos, an associate professor in the Neuroendocrine and Pituitary Clinical Center and Neuroendocrine Unit at Massachusetts General Hospital, Harvard Medical School, in Boston.

"Larger studies are needed to confirm these findings, however," he said. "The use of validated symptom scores may help improve communication between patients with acromegaly and their healthcare professionals."

In acromegaly, a rare but severe disease that is often diagnosed late, morbidity and mortality rates are high, particularly as a result of associated cardiovascular, cerebrovascular, and respiratory disorders and malignancies.

Of the adult patients surveyed, 83% were women and the mean age was 49 years. Patients had a mean duration of acromegaly of 10 years, and 47% were being treated with octreotide and 53% with lanreotide, with most receiving low to middle doses.

Their mean medical provider-reported IGF-1 level was 0.85 upper limit of normal (ULN), with 79% of patients having an IGF-1 level of 1 ULN or lower.

For the online survey, patients were asked about disease characteristics and management, and they also completed the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ). The latter is an acromegaly-specific patient-reported outcomes assessment of symptoms and gastrointestinal interference, treatment satisfaction, injection site interference, emotional reaction, and treatment convenience.

The medical providers were interviewed about their practices and perceptions of the patients' symptoms, level of control, and general health, and they also completed relevant sections of the Acro-TSQ.

The most common symptoms reported by patients were "acro-fog,"described as a general forgetfulness or short-term memory loss, and joint pain (81% for both), soft tissue swelling (79%), fatigue/weakness/tiredness (77%), and headache (72%).

However, the most common patient symptoms reported by medical providers differed, led by fatigue/weakness/tired (92%) followed by joint pain (75%)and headache (62%).

Symptoms most often viewed by patients as severe were joint pain (described as severe by 34%), headache (29%), fatigue/weakness/tired (28%), and acro-fog (26%).

With the exception of carpal tunnel syndrome, clinicians were less likely than patients to rate any of the other symptoms as severe.

In addition, although patients specified a worsening of multiple symptoms toward the end of the treatment cycle, clinicians commonly reporting being "not sure" of when patients experienced symptoms.

Patients and clinicians both reported various injection site reactions; however, the medical providers reported fewer injection site reactions than patients and were often unaware of the severity of the reactions.

The largest discrepancies involved nodules (43% reported by medical providers vs 68% by patients) and pain during injection (66% vs 90%).

When asked about their general perception of symptom control, 38% of patients indicated their symptoms were "well controlled,"43% reported they were "partially controlled,"and 17% reported they were "not controlled."

Comparatively, 28% of medical providers indicated their patient's symptoms were well-controlled, 64% said they were "partially controlled,"and 6% said they were "not controlled."

Although the patient and clinician differences were not evaluated for statistical significance, the authors note that "the low kappa statistics reflect the generally poor agreement between medical providers' and patients' responses of symptom frequency, severity, and pattern."

Current treatment guidelines recommend that when patients receiving SRLs achieve IGF-1 levels of 1 ULN or less, adjustments to treatment are not necessary, and data are lacking on whether SRL dose titration can reduce symptom burden when IGF-1 levels are 1 ULN or less.

However, thenew results suggest "these patients are still symptomatic and that the frequency and severity of symptoms is often unrecognized by their treating physician," the authors write.

"This suggests an unmet need," they state.

Tritos told Medscape Medical Newsthe current study has some limitations. In addition to the relatively small sample size, he cited the use of social media in patient selection.

"These observations may limit the external validity (generalizability) of the findings reported in the present study," he noted. "Larger studies in unselected populations of patients with acromegaly would be helpful to confirm and extend these findings."

In the meantime, efforts to prevent symptoms early on could be beneficial, he said.

"Earlier detection and treatment of acromegaly before complications ensue may be helpful in mitigating the development of such symptomatology," he said.

"Clinicians should spend sufficient time eliciting the extent and severity of patient symptomatology," Tritos added.

"Use of validated symptom scores in patient care and clinical research (including clinical trials) may improve both routine care and the evaluation of investigational therapies," he concluded.

Pituitary. Published December 5, 2019. Full text

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Patients and Doctors on Different Pages for Acromegaly Symptoms - Medscape

What you need to know about hCG, the ‘pregnancy hormone’ – INSIDER

Known as the "pregnancy hormone," human chorionic gonadotropin (hCG) is a type of hormone that is produced in large amounts during pregnancy, with levels peaking during the first 8 to 11 weeks of pregnancy, and can be detected in the urine of pregnant women with at-home pregnancy tests.

However, pregnant women aren't the only ones who produce it. Certain cancers and other medical conditions can lead non-pregnant women and men to produce moderate to high levels of hCG.

Here's what you need to know about hCG, whether you're pregnant or not.

"HCG in its regular form is produced almost exclusively by a pregnant woman by special cells which become a part of the placenta, called the syncytiotrophoblast which is why we see it in such high levels in pregnancy," says Dr. Kristina Mixer, MD with Spectrum Health.

She explains that during pregnancy, hCG's primary role is to support the production of the hormone progesterone by the ovaries until the placenta is sufficiently formed and can produce adequate amounts of progesterone on its own, typically by 10 weeks gestation.

That's important because progesterone is absolutely vital for healthy reproduction. It's responsible for facilitating the successful attachment of the embryo within the uterine cavity, modulating the immune system to prevent miscarriages, and for suppressing uterine contractions. In certain situations of recurrent pregnancy loss, healthcare providers will sometimes prescribe progesterone or hCG as a way to support the pregnancy early on.

Once you've conceived, the body begins to produce hCG as soon as a fertilized egg implants into the uterine wall, and it typically takes another 8 to 14 days before the hCG levels rise enough to be detected by an at-home pregnancy test. Most urine pregnancy tests will detect a pregnancy at the time of your first missed period.

A woman can exhibit elevated hCG levels after a molar pregnancy, as well. Molar pregnancy happens after an egg is fertilized, but the tissue that usually grows into the placenta forms an abnormal growth, instead. So the egg never develops into an embryo.

Women often have the molar tissue removed, but sometimes it can return and develop into a uterine tumor. This can lead to certain types of cancer like choriocarcinoma and malignant gestational trophoblastic disease. Since these tumors involve the same cells that produce hCG, women with these conditions often have elevated hCG levels, as well, even though they're not pregnant.

"In non-pregnant women or men, levels are usually very low and do not play an important role in daily hormone function," Mixer says. However, there are some situations that could lead to moderate to high hCG levels in a non-pregnant woman or man, such as:

"All of these conditions should be discussed with and managed by a physician or healthcare provider," says Mixer.

In addition to medical conditions that could lead to elevated hCG levels, some cases of high hCG are the result of hCG injections. "We often see this in male athletes in an effort to boost testosterone production," Mixer says. This occurs because hCG is very similar to the pituitary hormone LH, which stimulates the production of testosterone in the testes.

HCG can also be used as an identifying marker during pregnancy to detect Down's Syndrome. "A certain subtype of hCG can be measured to predict the likelihood of Down Syndrome affecting the fetus," Mixer says.

Certain types of cancerscan produce higher-than-normal levels of hCG in both men and women. The types of cancers that can lead to elevated hCG levels include:

Measuring hCG levels in the above types of cancers can help identify tumors in the body, diagnose cancer, or evaluate how well a cancer treatment is working.

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What you need to know about hCG, the 'pregnancy hormone' - INSIDER

Sleepless nights: Some naturopathic solutions that may help relieve insomnia – TheHealthSite

You will feel better in the morning if you had a good night sleep. But it wont be a good morning if you dont get inadequate amount of sleep. Dear busy people! Take your sleep quality seriously. Because sleep disorders may lead to health problems, including obesity, heart disease, diabetes, high blood pressure, and depression.

Many people suffer from insomnia, which may be due to psychiatric and medical conditions, unhealthy sleep habits, specific substances, and/or certain biological factors. Lifestyle changes may help lessen the severity of insomnia. But several naturopathic solutions have also been found effective in lessening the severity of insomnia. If youre also having sleepless nights, these below naturopathic approaches may help you get the sleep you need.

It is an age-old healing practice of traditional Chinese medicine and inserting very thin needles through the skin at specific points in the body. Its primarily used to relieve pain but also used for a wide range of other complaints. In a study, acupuncture treatment helped participants recover their normal sleep patterns.

Many studies have suggested that taking valerian extract help fall asleep easier and get better quality sleep. A study also found a combination of valerian and lemon balm as effective as the prescription sleeping pill Halcion.

In a study, older adults who drank eight ounces of tart cherry juice twice a day were able to sleep 90 more minutes per night. Researchers explained that compounds that give the cherries their colour increased the availability and inhibited the degradation of L-tryptophan. Tryptophan is an amino acid that interacts with brain chemicals that are important to sleep and the timing of our biological clocks sleep-wake cycle.

Inhaling the aroma of lavender oil before bedtime may help you sleep better. Onset of menopause may cause sleep disturbances. If you are near your menopause, lavender aromatherapy may help improve your sleep. The positive effects of lavender oil have been shown in studies.

Taking melatonin supplement under the supervision of an experienced naturopathic physician may also help sleep well at night. Melatonin is a hormone that plays a role in your natural sleep-wake cycle. Researchers suggest that melatonin supplements might help provide some relief from insomnia.

Published : January 8, 2020 3:14 pm | Updated:January 8, 2020 3:16 pm

Original post:
Sleepless nights: Some naturopathic solutions that may help relieve insomnia - TheHealthSite

What we need to know about gallstones – INQUIRER.net

Professor Ed Tadem and Dr. Victor Philip Delos Reyes after the laparoscopic surgery at the Capitol Medical Center in Quezon City, Philippines. CONTRIBUTED

I stared at the computer monitor looking at my organs my gall bladder, kidney, spleen, pancreas and uterus. I never thought of myself as a walking set of organs. I had always detached myself from the things I loved to eat papaitan (cow innards), bopis (cows lungs) and those sweet meats my Ilocano grandfather cooked for us. The surgeon interrupted my reverie.

This is your gall bladder and that is a gallstone, he pointed at the sac-like image.

How big is the stone? I asked him.

It is 2.37 centimeters, he said as a matter of fact.

My 2020 seemed bleak.

Routine check-ups

Ive been in and out of the hospital since October due to various ailments. On December 10, I had bronchitis. I was in medication for 10 days. After two days, I had difficulty urinating. I was back to the hospital for a series of tests. I got kidney stones, but very minute, just 0.31 millimeter. I was given antibiotics to flush this out. My attending physician recommended an Intravenous pyelogram (IVP) for further evaluation. IVP is an x-ray exam that uses an injection of contrast material to evaluate kidneys, ureters and bladder and helps diagnose blood in the urine or pain in the side or lower back. I fasted for 48 hours, and given an enema before the procedure. After waiting for more than 6 hours, the result showed a mass located in my bladder.

An ultrasound was scheduled on the 27th of December. The mass is actually a large gallstone.

Gallstone and its symptoms

My doctor, a Thai specialist and a surgeon at PorPhat 2 Hospital in Nakhon Ratchasima, explained that the presence of a gallstone does not always manifest in patients. Usually it is discovered during routine check-ups.

Out of 100 people with gallstones, only 16 people showed symptoms, and those are the ones needing operations, he explained.

At the same time that I was in the hospital, Ed Tadem, a retired University of the Philippines professor of Asian Studies was also at the Capitol Medical Center in Quezon City. Unlike me, Professor Tadem showed symptoms.

I had intense abdominal pain and a bloated tummy. There were about twenty-five tiny stones found in my gall bladder, Prof. Tadem says.

According to the Bangkok Hospital website, Gallstones are one of the most common digestive diseases which small stones are formed in the gallbladder. If a gallstone lodges in a bile duct and causes a blockage, it eventually results in severe life-threatening complications such as bile duct inflammation and infection, pancreatitis or cholecystitis (an inflammation of gallbladder).

I am quite lucky because I only have one. Some people can have several tiny pieces. Gallstones can also be as large as a golf ball!

Bangkok Hospital categorizes three types of gallstones. The cholesterol type is very common. It is chalk-white or greenish-yellow due to undissolved cholesterol as the main component. Pigment gallstones are dark brown or black containing bilirubin, which is caused by liver diseases. Mixed gallstones are a mixture of both cholesterol and pigment gallstones with a sticky mud-like appearance. This is due to secondary infection of the biliary tract, liver and pancreas.

Gender, diet and gallstone

As part of the routine questions, the doctor asked about my diet. Like most Filipinos, my diet is high in fat. Fortunately, I do not feel discomfort when I eat even fatty foods and dairy products.

Professor Tadem admits having had a high-fat and oily diet when he was younger. Though in the past ten years he has been diet-conscious; but the damage has been done.

Gender plays a role in the formation of gallstones. More females age 40 and above are prone to develop gallstones. It is attributed to medications that contain estrogen, or to hormone replacement therapy. Drastic weight loss and obesity are also factors. Family history is also considered. My grandmother had her gallbladder removed in her 40s.

Since the diagnosis came during the holidays, I promised my doctor to have a healthy diet after New Year. I was not given any medication. After four months, I will have an ultrasound again.

Alternative cure?

Upon posting my ultrasound result, well-meaning friends sent messages to me not to go under the knife. A friend shared how she flushed out three large gallstones by drinking radish juice before going to bed. Eating apples and drinking a particular apple juice brand are also recommended. Sambong (Blumea balsamifera) is also a known herbal medicine endorsed by some doctors. But its efficacy is only tested for kidney stones.

My Thai doctor did not recommend any drugs or alternative medicine since it is dangerous if the gallstone moves out of the bladder due to its size.

The authors lower abdominal ultrasound. CONTRIBUTED

Professor Tadem did not try herbal medicine either.

I was advised by my doctor that these are not effective, he says.

Gallstone removal procedure and costs

At this stage, my doctor does not advise me to undergo laparoscopic gallbladder surgery because the stone does not bother me yet. He further mentioned that usually, surgery is performed when the stone is 2.5 cm or larger.

According to Healthline, laparoscopic gallbladder surgery or(cholecystectomy) removes the gallbladder and gallstones through several small incisions in the abdomen. The surgeon inflates the abdomen with air or carbon dioxide in order to see clearly. This type of surgery takes lesser time to recover. After 12 hours, the patient can be discharged. Usually, the patient can go back to normal activities after a week or two. No special diet is required. But I guess, when a part of you is taken out, you have to think twice before eating particular foods again.

In the Philippines, after Philhealth insurance and Senior Citizens discount, Professor Tadem spent 190,000 pesos ($3,700) for laparoscopic cholecystectomy at the Capitol Medical Center.

Dr. Victor Philip de los Reyes, my surgeon was trained at the World Laparoscopy Hospital in New Delhi. He performed a complicated surgery, which took one hour instead of the normal 30 minutes, Professor Tadem says.

Professor Tadem shares that complications arose because of other factors such as the blood thinning medication he was taking, adhesion of previous operation, and the gall bladder was thicker than normal that it stuck to his intestine.

In Thailand, surgery costs around $3,000, with insurance, tests, medications included. Under the Social Security (SS) or PhraGansangkhom, members can avail of medical benefits such as hospitalization (in accredited hospitals), maternity benefits, cremation, and repatriation. I have been paying SS for the past seven years.

Ive always considered myself healthy. My cholesterol level is within the normal range. I exercise every day. But my diet may not be really healthy. I look at the mirror, seeing my abs, shoulders, and arms developing into muscles. I look better than 10 years ago. At this stage, I am not really healthy. But I will not allow myself to get sick.

Meanwhile, Im contemplating whether to eat the sisig (pork cheeks) I ordered last week. It is still sitting in the freezer.

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What we need to know about gallstones - INQUIRER.net

Eat This, Not That: To Combat Stress and Anxiety – AskMen

How good does it feel to reach for chocolate or fast food after a particularly stressful day? We cant deny the instant satisfaction of biting into a greasy burger but that instant gratification may be doing more harm than good.

According to Dr. Anna Cabeca, physician and Amazon #1 best selling author of "The Hormone Fix," when we are first under some sort of stress in our fight, flight or freeze mode, our body releases cortisol (our stress hormone). Over time with the chronic persistent state of "fight, flight or freeze" our body produces very high amounts of cortisol. This results in a feeling of disconnection and burnout and inflammation, which only worsens with sugar and fat.

RELATED: How Famous Men Fight Stress

So how do we reverse and prevent burnout and the disconnect that comes with it while satisfying our urge to grab a snack after a long day? We spoke to health and nutrition experts to get their thoughts on the best foods to fight stress and dont worry, (some!) chocolate is actually OK.

While coffee may be your first inclination during a particularly stressful afternoon at the office, you may want to swap out the hard stuff for something a little more green. Green tea is one of the best foods/drinks for fighting stress and anxiety while increasing focus due it's L-Theanine content, explains Forrest Przybysz, MBA and owner of Nootropics Resource. L-Theanine is a natural amino acid found primarily in green and black teas that has been linked to several health benefits including reduced anxiety, lower stress levels, increased focus and better sleep quality.

According to Jared Heathman, MD, meals high in carbohydrates and sugar spike glucose, which initially gives us a rush of endorphins, which is why those greasy burgers are so satisfying after a long day. This can feel good initially, but the resulting crash can leave us feeling fatigued and irritable, explains Heathman, when our mind feels fatigued and irritable, it can't adequately cope with stress levels. This can lead to a worsening in our mood and anxiety. Eating high fiber foods like vegetables with each meal can assist in maintaining glucose uptake in a slow, steady fashion.

Organ meat from pasture-raised animals aresome of the most nutrient-dense foods you will find Beef Liver and heart especially, says Erik Levi, functional nutritional therapy practitioner, They are loaded with brain-healthy nutrients like B-Vitamins, choline, and omega 3, and high-quality protein.

Yes, plain old water may just be the key to feeling less stressed throughout your day. Dehydration leads to both mental and physical stress. Your body literally needs water to survive and when it doesn't get enough, metabolic processes begin to shut down and this can affect your well-being. Levi recommends getting at least 1/2 your body weight in ounces per day.

RELATED: Foods That Affect Your Bedroom Performance

See? You can still get your chocolate fix without sacrificing your mental wellbeing.Studies have tied the polyphenols and micronutrients in cacao to both stress relief and lower instances of cardiac disease keep your heart rate low, keep stress low. Look for at least 70 percentcacao, with low to no sugar chocolate for this effect.

This is one of the highest sources of good fats you're going to find. Although fat has been demonized for years, modern research has found that fat-rich foods like butter deliver lots of vitamin A-retinol, which is involved in hundreds of metabolic processes in the body, says Levi. Its also a good source of butyrate, which is a small-chain fatty acid made in the colon that helps your body's immune system and overall digestive health, which both help physically keep your stress level low.

This is another food that has been demonized through the years, but according to Levi, eggs from pasture-raised chickens who eat a real chicken diet and not grains are one of the best sources of choline you can find. Choline helps make dopamine in the brain, which you need more of to mentally deal with stress. You also get lots of omega-3 and B12. explains Levi.

Omega-3 fatty acids, which fish like salmon are excellent sources of, actively work to suppress the development of stress hormones, as well as feelings of depression. According to Jamie Bacharach, licensed medical acupuncturist and health expert, this is thanks to the anti-inflammatory effects of omega-3 fatty acids, which in supplement form have been proven to provide a 20 percentreduction in anxiety versus placebo groups. As salmon possesses high amounts of omega-3 fatty acids, it only needs to be enjoyed once a week or so in order to take advantage of its anti-stress benefits.

Complex carbohydrates like oatmeal can help to promote serotonin production, directly boosting feelings of happiness and diminishing feelings of stress, explains Bacharach. Unlike regular carbohydrates, a complex carb like oatmeal won't cause a spike in blood glucose, which can lead to a rise in feelings of stress or tension.

It's not a coincidence that turkey has a reputation for making people feel fatigued or relaxed. Turkey contains tryptophan, an amino acid which helps to regulate the production of serotonin a bodily chemical that promotes feelings of happiness and calm, says Bacharach. Tryptophan supplements in and of themselves have demonstrated in scientific studies that they can make people more agreeable, or less argumentative, helping to diminish feelings of anger or stress.

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Eat This, Not That: To Combat Stress and Anxiety - AskMen

7 Reasons to Commit to a Booze-Free January – EDGEOnTheNet

Saturday Jan 4, 2020

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By January, many people are saturated with the parties, get-togethers, and drinking that comes with the holidays. Odds are at some point in the 2019 holiday season you had a bit of a hangover from too much champagne, egg nog, or cocktails.

In comes the dry-January trend to help bring in the new year by putting a brake on alcohol for the whole month. EDGE turned to NYC neuropsychologist, Dr. Sanam Hafeez, for insight into the benefits of taking a month-long booze-free challenge for a fresh start to the new year.

1. You Save Money On Alcohol.

According to Fortune magazine in 2018, overall price averages for alcoholic beverages increased thanks to craft cocktail trends. The same can be expected for 2019. A survey by OnePoll last year estimated that Americans' social spending around the holiday season more than doubles and alcohol is part of that spending. So if your wallet has felt the alcohol as much as you have this season, the math could be reason enough to pause the drinks and close your tab for a month.

"Think of the stress you could take off your back by cutting back on the money you spend on alcohol during January," says Dr. Hafeez. "An average person could hit the bar twice a week, spending about $30-$75 dollars depending on what drinks you are purchasing. Add tip, and your expenses for a night of drinking could reach or surpass $100 easily. Throughout a single month, this could cost you a good chunk of change." Add more money saved if you're also a weekend social drinker. Add way more money if you are inclined to purchase bottles in the VIP section for hundreds of dollars.

2. In The Absence of Alcohol, Your Skin Rejuvenates.

While alcohol consumption doesn't directly cause acne, it destabilizes hormone levels and immune functions, which lead to dull skin, breakouts, flushed complexion, and puffiness. If you like to "ros all day" or consume mixed drinks with more sugars, syrups, and other additives, you can start seeing the toll of these habits on the texture and tone of your skin. "A part of being successful when reducing alcohol intake is the compliments you receive, the energy you feel, and the changes you see in the mirror. These can all be fuel to help you live a healthier life in the new year," says Dr. Hafeez.

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3. Get A Headstart on Your Weight Loss Resolution.

Research in the Journal of Obesity says people who don't drink, eat less, simply because alcohol heightens the senses and numbs reasoning. It makes the sauce and cheese on a pizza or those late-night tacos tastier. When you remove alcohol intake, it diminishes the calories you consume.

Think about three beers or glasses of wine at about 150 calories each. Those calories add up. Dr. Hafeez explains that "any person seeking help with weight management has heard the advice 'don't drink your calories,' alcoholic beverages are some of the drinks that most easily overwhelm your caloric consumption. Drinking less, or not at all for a month, will leave you with improved blood sugar and cholesterol levels and help optimize your organ function, which will help you be more active and in a better mental state."

4. More Energy, More Creativity, More Endurance

The last thing you want is to be tired into the new year. "One great benefit of going alcohol-free is renewed energy. You will not be giving up your day to recover from last night's drinking. Waking up earlier will help you establish better morning habits that prime your brain for productivity and creativity," says Dr. Hafeez. "You will also see improved concentration and endurance as the day goes on because your energy level will not be in a deficit before the day even begins," she says.

5. Less Alcohol Can Lead to Improvement in Depression.

Depression is a mood disorder that can cause feelings of sadness, rage, grief, and emptiness. More than 16 million Americans suffer from Major Depression Disorder while anxiety disorders affect about 40 million adults according to the Anxiety and Depression Association of American.

"The problem comes when depression and anxiety, even at the mild levels, begin to be alleviated momentarily with alcohol. This can become dangerous because it will work in a negative cycle. Alcohol intake will get worse which will heighten the depression which will cause the person to drink more," explains Dr. Hafeez. The NYC psychologist explains that alcohol is actually a depressant and it affects the neurotransmitters in the brain.

"Seratonin is a neurotransmitter that helps us feel joyful and stabilizes our mood. Drinking alcohol can temporarily boost serotonin levels, therefore making you feel upbeat, but the long-term excessive consumption of alcohol can actually lower serotonin levels, and therefore either cause or worsen depression," she says.

6. Better Sleep

Alcohol affects your sleep pattern by inhibiting your REM sleep and affects your circadian rhythm. "REM sleep is incredibly important to the quality of your rest. When blocked by alcohol, you could lose out on the most restorative part of your sleep, which can affect the way you think, concentrate, and process information the next day," explains Dr. Hafeez. Another issue with alcohol is that it makes you wake up during the night to go to the bathroom.

"Alcohol is a diuretic, meaning an agent that prompts the passing of urine. This means that at nighttime, instead of sleeping throughout the night, you may need to get up repeatedly to relieve yourself. This will make it even harder to get the rest you need. In the absence of alcohol, your sleep is more comfortable and energizing," says Dr. Hafeez.

7. More Time for Yourself and New Friends

"It is important to note that when our friendships and relationships rely on social drinking, a booze-free month can affect how those interactions happen. While we have more time and energy, we might need to invest it in ourselves or new friends. This is not to say that you have to break up with your friends when you pause the alcohol, but it means you can try new activities and endeavors with new people and plant new friendships as well," explains Dr. Hafeez.

The NYC psychologist also talks about the opportunity to focus on you, explaining that "self-care is important yet often neglected over a good night out for drinks. Suddenly, happy hour is not an option, but a fitness class after work is, or a workshop on a topic that interests you. The time will add up, and you can use it to promote your self-confidence and personal development.

A Cautionary Note From The Expert.

"One thing to consider is that people who label themselves "social drinkers" may feel these improvements within days. Meanwhile, people who battle with alcoholism can often cause harm to themselves if they decide to stop drinking cold turkey. If you are a frequent/binge drinker, speak with your physician before abruptly ceasing alcohol consumption.

Committing to going without alcohol may reveal there actually is a bigger issue going on. "If someone can't last the week without alcohol and feels physical repercussions like nausea, headaches, night sweats, and tremors, or insomnia, consulting a doctor would be an important next step," cautions Dr. Hafeez.

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7 Reasons to Commit to a Booze-Free January - EDGEOnTheNet

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