Harnessing the upside of stress

Changing your mindset doesn't mean taking a different view of the world. The key isn't to deny stress, but to recognize and acknowledge it — and then to find the upside, because a full-throttle fight-or-flight response is not the only possible reaction to stress (at least when the stress does not involve a potentially life-threatening situation).

In people with a more stress-hardy mindset, the stress response is often tempered by the challenge response, which accounts for the so-called excite-and-delight experience that some people have in stressful situations, such as skydiving. Like the typical stress response, the challenge response also affects the cardiovascular system, but instead of constricting blood vessels and ramping up inflammation in anticipation of wounds, it allows for maximum blood flow, much like exercise. The balance of hormones is different, too.

Another modification to the stress response is called tend-and-befriend. It explains why, after the September 11 terrorist attacks in 2001, the 2013 Boston Marathon bombing, or the 2016 massacre at the Pulse nightclub in Orlando, people felt the need to reach out to friends and relatives in the community — to assure themselves that loved ones were all right, to comfort the distressed or bereaved, and to shore up social networks. Connecting in this way actually helps reduce stress as opposed to, say, watching an endless loop of TV coverage. That's because tend-and-befriend also involves different balances of hormones — in particular, increased levels of oxytocin, which enhances bonding between a mother and child or between sexual partners, for example. It makes the brain's reward centers more responsive to social contact, and it is an important part of resilience.

Dialing back from full-on fight-or-flight can be simply a matter of changing your mindset. Studies have shown that when participants are told "You're the kind of person whose performance improves under pressure," it does — by as much as one-third. How can you shift your mindset? A 2015 book called The Upside of Stress by Kelly McGonigal gives multiple ideas. Here are just a few suggestions:

·       When you notice a racing heart — for example, before you give a presentation or initiate a tough conversation — realize that your body is trying to give you more energy and see if you can capitalize on that.

·      If you are feeling nervous, pause to consider why, and ask yourself if it's because you're doing something that matters to you and therefore reinforces your values and gives meaning to your life.

·        . Don't deny the stress, but redirect your energy away from it and toward the task at hand.

·      If you are feeling overwhelmed with work or cares, try doing some small act of kindness for someone and note the mental reward you reap.

·        Nurture your social networks. Caring creates resilience.

·        Try to focus on the larger purpose of whatever you're doing. When you're stuck in a traffic jam taking your daughter to school, remember that it's because you love her and want her to get a good education.

·       Whatever you're doing, don't pretend that stress doesn't exist. People who deny it tend to isolate themselves and reinforce their fears. Instead, ask yourself why you're experiencing this stress and look for any positive aspects to it. Are you learning something from it? Are you gaining strength? Are you connecting with people on a more fundamental level? Do you feel more intensely alive?

Article courtesy of Harvard Health Publications

Are you getting enough B12?

Vitamin B12 may not be high on your nutritional radar, yet it is essential to some of the body's most important functions, like forming red blood cells and maintaining nerve function. Doctors don't routinely test for vitamin B12 levels, so vitamin B12 deficiency can go unnoticed. But over time, such deficiency may cause anemia, nerve damage, and even problems with memory and reasoning. However, it's easy to avoid vitamin B12 deficiency, according to Stacey Nelson, manager of clinical outpatient nutrition at Harvard-affiliated Massachusetts General Hospital. "What's important is to recognize if you're at risk and take measures to avoid developing a deficiency," Nelson says.

How vitamin B12 works

Vitamin B12 is a water-soluble vitamin that is naturally found in animal products. Some fortified foods, dietary supplements, and medications contain a synthetic version of vitamin B12. When you eat meat, fish, eggs, or dairy products, vitamin B12 is released from protein by hydrochloric acid and enzymes in the stomach; synthetic vitamin B12 is already in this released (free) form. Free vitamin B12 then combines with intrinsic factor — a substance secreted by the stomach cells—which enables it to be absorbed from the small intestine.

Who needs more B12?

Most women get the recommended daily amount — 2.4 micrograms (mcg) for most adults, 2.6 mcg for pregnant women, and 2.8 mcg for women who are breastfeeding — in their diets. However, you are at increased risk of vitamin B12 deficiency if any of the following applies:

You're age 50 or older. With age, your stomach cells become less efficient and secrete less hydrochloric acid, which means you absorb less B12.

You have altered gastrointestinal function. People who have gastrointestinal disorders like celiac disease or Crohn's disease or who have undergone weight-loss surgery may secrete too little hydrochloric acid or -intrinsic factor.

You're a strict vegan. If you've given up all animal products, you should consider using fortified cereals or nutritional yeasts or taking a vitamin B12 supplement. It's especially important that pregnant vegan women who are planning to breastfeed exclusively talk to their medical team about getting adequate vitamin B12 for both themselves and their infants. Babies who don't get any vitamin B12 can develop a deficiency and may sustain permanent neurological damage.

You take certain medications. Two types of medications for ulcers and gastric reflux — proton-pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid), and H2 blockers like cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac) — inhibit the release of stomach acid necessary to free dietary vitamin B12. There is some evidence that the diabetes drug metformin (Glucophage) may reduce vitamin B12 absorption when used for several years.

You have pernicious anemia. This autoimmune condition affects the stomach's ability to produce intrinsic factor, so you can't absorb vitamin B12 through your digestive system.

Symptoms of B12 deficiency

A vitamin B12 deficiency may go undiagnosed because many of the symptoms — fatigue, weakness, constipation, loss of appetite, and weight loss — mirror those of minor illnesses or chronic conditions, Nelson explains. Other symptoms of B12 deficiency, such as numbness and tingling in the hands and feet, are also common in people with diabetes and spinal stenosis. If you have some of those symptoms — especially if you have a low red blood cell count — you should talk to your doctor about further blood tests for vitamin B12.

Preventing B12 deficiency

If you're at risk for vitamin B12 deficiency, the following can provide some protection:

Supplements. Even the lowest doses in B12 supplements are many times the recommended dietary allowance. Doses up to 1,000 mcg, though unnecessary, probably aren't harmful.

Fortified foods. Many breakfast cereals, soy products, and yeasts are fortified with B12.

Fortified toothpaste. Sante toothpaste delivers vitamin B12 to the bloodstream through the mucous membranes lining the mouth.

Injections. If you have had weight-reduction surgery or have pernicious anemia, celiac disease, or Crohn's disease, B12 injections may be recommended.

Article courtesy of Harvard Health Publications; Published: April, 2017

Are painkillers also killing your hearing?

When you think of risk factors for hearing loss, over-the-counter pain relievers probably aren't among them. But a Harvard study published in the American Journal of Epidemiology suggests that frequent use of ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) may be an important contributor. In the study, women who took the pain relievers at least twice a week were more likely to experience hearing loss, and more frequent usage increased the risk by up to 24%. The findings are similar to a study of men and hearing loss, although aspirin was also found to contribute to risk in that study.

Researchers speculate that the pain relievers may be damaging the cochlea, the snail-shaped hearing mechanism in your inner ear. "Ibuprofen can reduce blood flow to the cochlea, which could result in cellular damage and cell death. Acetaminophen may deplete the antioxidant glutathione, which protects the cochlea from damage," says study author Dr. Sharon Curhan, instructor in medicine at Harvard Medical School.

Does this mean you should think twice before popping a pill for headache or back pain? These medicines do provide good pain relief for many people. "However, frequent use of these medications and use over long periods of time may increase the risk of hearing loss and may cause other adverse health effects. Therefore, it is important to take these medications mindfully and to limit their use as much as possible," says Dr. Curhan. As always, talk to your doctor before making any changes in your medication use.

Article courtesy of Harvard Health Publications

Men: Stand up and protect yourself from the risk of osteoporosis

 Older men at increased risk of fractures from this bone-thinning disease

Older men have a greater risk of osteoporosis-related fractures than of getting prostate cancer. In fact, about one in four men older than 50 will break a bone due to osteoporosis during their lifetime, according to the National Osteoporosis Foundation. How can men protect themselves and lower their risk of osteoporosis? Here are some strategies:

Get plenty of calcium and vitamin D.

Studies have shown that low calcium intake is associated with low bone mass and higher fracture rates. Vitamin D is needed to help absorb calcium in the body, so you need adequate amounts of each. The Institute of Medicine's recommendations for adults include 1,000 milligrams (mg) per day of calcium until age 50 and 1,200 mg per day afterward, and 600 international unites (IU) daily of vitamin D until age 70 and then 800 IU afterwards.

Some of the best sources of calcium include tofu, spinach, greens (collard, turnip, mustard, and kale), and dairy products like yogurt, cheese, and milk. High amounts of vitamin D are found in salmon, sardines, tuna, milk, and mushrooms. If you have a deficiency, or have trouble consuming these foods, you may need daily supplements. Speak with your doctor about whether you need to add them to your diet.

Increase exercise.

Regular weight-bearing exercise, such as dancing, aerobic classes, running, stair climbing, and power walking, helps to stimulate bone formation.

Manage medications.

Certain drugs can raise the risk of osteoporosis in men, too. These include steroids to treat rheumatoid arthritis and some cancers; androgen deprivation therapy used to treat prostate cancer; anticonvulsants for epilepsy; thyroid hormone replacement for an under-active thyroid; and some chemotherapy drugs. Speak with your doctor about your dosage and how they may influence your risk of osteoporosis.

Testosterone replacement therapy.

Low testosterone levels are associated with osteoporosis in men. However, research is ongoing what impact, if any, replacement therapy has with improving bone building. Ask your doctor if this is an option.

Stop smoking and monitor alcohol intake.

Both smoking and heavy alcohol drinking raise the risk of osteoporosis in men. Visit the American Lung Association's website at ww.lung.org/stop-smoking for tips on how to quit smoking. Limit alcohol intake to one drink per day; for example, 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits like gin or whiskey.Keep in mind that other uncontrollable factors also may raise your risk of osteoporosis, such as family history and ethnic background (whites and Asian Americans have a higher risk) and chronic diseases that affect the kidneys, lungs, intestines, and stomach.

Article courtesy of Harvard Health Publications

Higher Death Rate Among Youth with First Episode Psychosis

NIH-funded study highlights need for increased early intervention programs

April 6, 2017 • Press Release

A new study shows that young people experiencing first episode psychosis have a much higher death rate than previously thought. Researchers’ analyzed data on approximately 5,000 individuals aged 16-30 with commercial health insurance who had received a new psychosis diagnosis, and followed them for the next 12 months. They found that the group had a mortality rate at least 24 times greater than the same age group in the general population, in the 12 months after the initial psychosis diagnosis. This study, funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, underscores that young people experiencing psychosis warrant intensive and proactive treatments, services and supports.

The research, led by Michael Schoenbaum, Ph.D., Senior Advisor for Mental Health Services, Epidemiology, and Economics at NIMH, was published online April 6, 2017 in the journal Schizophrenia Bulletin.

The research team used insurance claims data to identify young people aged 16-30 who had been diagnosed with a first episode of psychosis in 2008-2009. They used data from the Social Security Administration to identify deaths in this population within 12 months of the initial psychosis diagnosis. Data on cause or manner of death were not available for this research. The 12-month mortality rate for these young people—from any cause—was at least 24 times higher than their peers in the general population. In the general United States population, only individuals over age 70 come close to a similar 12-month mortality rate.

“These findings show the importance of tracking mortality in individuals with mental illness,” said Schoenbaum. “Health systems do this in other areas of medicine, such as cancer and cardiology, but not for mental illness. Of course, we also need to learn how these young people are losing their lives.” 

In addition to mortality, the study examined the health care individuals received in the 12 months after the initial psychosis diagnosis. Those data showed that young people with a new psychosis diagnosis had surprisingly low rates of medical oversight and only modest involvement with psychosocial treatment providers. Overall, 61 percent of them did not receive any antipsychotic medications, and 41 percent did not receive any psychotherapy. Those who died within 12 months of diagnosis received even less outpatient treatment and relied more heavily on hospital and emergency care.

“Other studies have shown that early coordinated treatment for psychosis produces the best results. However, we know that the typical duration of untreated psychosis in the United States is around 17 months,” said Robert Heinssen, Ph.D., director of the NIMH Division of Intervention Services and co-author on the paper. “This study reinforces federal and state support for funding evidence-based psychosis treatment programs across the country, and the need for communities to invest in more treatment programs.”

“Grants from the Substance Abuse and Mental Health Services Administration promote many of these programs in communities throughout the U.S.,” said Acting Deputy Assistant Secretary Kana Enomoto, head of the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The future of this research will show us what is happening with young people in this population, and help us tailor interventions to address their risks,” added Schoenbaum. “In the meantime, this study is a wake-up call telling us that young people experiencing psychosis need intensive, integrated clinical and psychosocial supports.”

Reference

Schoenbaum, M., Sutherland, J., Chappel, A., Azrin, S., Goldstein, A., Rupp, A., Heinssen, R. Twelve-Month Health Care Use and Mortality in Commercially Insured Young People with Incident Psychosis in the United States. Schizophrenia Bulletin, April 6, 2017.

How U.S. Olympians and Navy SEALs boost their mental strength

Life as a busy entrepreneur is a bumpy roller-coaster ride, to say the very least. So how do successful people get through those crazy days? It all starts with waking up mentally tough. Skills can only take you so far without the grit, determination, and mental willpower to tackle anything life throws at you. Thankfully, there are some pretty simple techniques that everyone from Navy SEALs to U.S. Olympians use to stay mentally strong. Start adopting these powerful habits in the morning to become just as mentally resilient: 

 1. They practice positive self-talk 

Studies estimate that we say 300 to 1,000 words to ourselves every single minute. That’s why none other than the U.S. Navy SEALs swear by positive self-talk as a way to take on a strenuous day. When their oxygen flow is suddenly cut off underwater, SEALs are able to tough it out by telling themselves that everything is fine and thinking positively. So you can probably also use this tip to get through a day at the office, to start, tell yourself how great your day is going to be. If you start encountering a rough morning, go outside for a few minutes and repeat some more positive affirmations to yourself.

 2. They visualize tackling tasks

Champion U.S. Olympians use visualization as an effective way to stay tough when they’re running a marathon or endlessly swimming. Rather than just picturing themselves at the finish line, they visualize themselves going through the motions of the race. It’s a scientifically proven way to boost your mental willpower — whether you’re jumping over a hurdle or filing paperwork. By visualizing how you’ll get through a task in the morning, you’ll not only give yourself the self-confidence to do it, you’ll also come up with unexpected solutions along the way.

 3. They work on their hardest tasks first

One thing mentally tough entrepreneurs understand is the discipline of working on their biggest or most undesirable task at the start of the workday. It’s been scientifically shown that motivation and willpower is a finite resource that dwindles throughout the day, so frying your biggest fish first ensures you’ll have the energy to complete the task at hand. Answer high-priority messages first, but save low-priority emails for later in the day after you’ve completed important projects.

 4. They don’t give up their power

How many times have you thought something along the lines of “my mother-in-law drives me crazy”? TED Talk star and motivation expert Amy Morin says thinking like this“gives away your power.” Rather than believing you have to get up early and head to a stressful job, start thinking about it as an opportunity to change your success and have an impact on the world. By believing you’re in control, you’ll start to be in control.

 5. They avoid comparisons (and Twitter)

If your morning routine involves checking Facebook or scrolling through Instagram, you’re starting off on the wrong foot. As Amy Morin wisely put it, “The only person you should compare yourself to is the person that you were yesterday.” Social media aside, only focusing on your own self-improvement is an excellent way to start the day off strong.

 6. They exercise and prioritize their health

It’s been scientifically proven that being physically strong is an integral part of being mentally strong. Doing aerobic exercises has been shown to reduce anxiety and stress and have other amazing benefits. It’s no wonder that ultra-successful people channel that energy into exercise before they go to work in the morning. As a busy entrepreneur/employee, life can get crazy, but putting a little extra time into having a good meal and taking care of your body is an investment that will pay off tenfold.

 7. They connect with loved ones before work

Being an effective executive doesn’t mean sacrificing everything for your job. Even the busiest people in the world know that a part of staying mentally strong means cultivating a meaningful life for yourself outside of work. Whether it’s a friend or family member, connecting with someone important to you at the start of your day helps maintain healthy relationships, and it can also give your day perspective, while keeping your spirits up while you work.

 This article was originally published at www.inc.com on July 8, 2016.

Study ties Mediterranean diet to larger brain volume

Can eating a Mediterranean diet help you hold on to more brain cells in older age? A study published online Jan. 4, 2017, by Neurology suggests there's an association. Scientists measured the brain volumes of about 400 dementia-free people, taken when participants were age 73 and again at age 76. Researchers then compared the changes in brain volume over the three years to questionnaire answers about how well participants stuck to a Mediterranean-style diet. The diet includes lots of fruits, vegetables, olive oil, legumes, and whole grains; moderate amounts of fish, dairy foods, and red wine; and limited amounts of red meat and poultry.

Sticking to the diet was associated with a lower amount of total brain shrinkage over the three-year study period. The finding is only observational and doesn't prove that eating a Mediterranean diet slows age-related brain shrinkage. But other studies have linked eating a Mediterranean diet to larger brain volumes. The diet is also associated with better thinking skills, a reduced risk of Parkinson's disease and Alzheimer's disease, and a reduced risk of dying from heart disease or cancer.

Article courtesy of Havard Health Publications.

Diet tips to improve insulin resistance; part two

Glycemic index

One of the simplest ways to tackle insulin resistance is to eat foods with a low glycemic index (GI). Low GI foods are digested slowly and don't produce as many blood sugar spikes. The difference between low GI and other foods is particularly noticeable when it comes to carbohydrates. Carbohydrates that have a high GI can cause blood sugar spikes and put more demand on the pancreas to make insulin. As such, eating low GI foods is a good way to maintain balanced blood sugar levels.

Foods to eat

Western diets typically lack certain nutrients, such as magnesium, calcium, fiber, and potassium.

These nutrients are especially important to maintain blood sugar levels. So, people with insulin resistance should seek out foods rich in these ingredients. It's possible to enjoy foods from every food group even with insulin resistance. Understanding which foods increase blood sugar and which support insulin sensitivity is key.  The following foods help to support insulin sensitivity:

§  non-starchy vegetables, such as broccoli and peppers

§  high-fiber foods, such as beans and whole grains

§  protein-rich foods, including lean meats, fish, and nuts

§  foods rich in omega-3 fatty acids, such as salmon

§  antioxidant foods, such as berries

§  sweet potatoes, which are lower GI than other potatoes

§  water, especially as a substitute for sweetened drinks

§  unsweetened teas

Foods to avoid

Certain foods are more likely to raise blood sugar. These foods should be limited or avoided to help maintain a steady blood sugar level:

§  sweetened beverages, including fruit juices, soda, and fountain drinks

§  alcohol, particularly beer and grain alcohol, especially in large quantities

§  grains, whether refined or whole, may worsen insulin sensitivity in some people

§  starchy vegetables, such as potatoes, pumpkin, corn, and yams

§  processed snacks and boxed foods

§  excessive sugary sweets, such as cupcakes, ice cream, or chocolate bars

§  white bread, rice, pasta, and flour, which is lower in fiber than whole grain

§  dairy from cows, especially milk

§  fried foods, even if the food is otherwise healthful

§  foods high in saturated fats, including chocolate, butter, and salt pork 

Finding a healthful balance

It's possible to sometimes eat foods on this list and still improve insulin sensitivity. The key is to limit these foods, and to replace them with more healthful options as often as possible. By sticking to a diet rich in fiber and plants while being low in added sugars, it's possible to steadily improve insulin sensitivity. Daily exercise is also an important factor. These lifestyle changes can reduce the risk of type 2 diabetes, cardiovascular disease, and other health conditions.

Causes of insulin resistance

Research shows ethnic and genetic factors may increase the risk of insulin resistance. However, lifestyle factors also make a big difference. Making positive changes to lifestyle can greatly decrease the risk of insulin resistance.

Diet

Diet affects insulin resistance in at least two ways. Firstly, consuming too many calories whether from too much fat, sugar, or alcohol can make people gain weight. This increases the risk of insulin resistance. Secondly, different food types affect insulin resistance. Some foods increase the risk and some foods reduce it. 

Weight

Physical activity lowers blood sugar levels by causing muscles to use the glucose consumed at mealtimes. Being overweight makes insulin resistance much more likely. People with lots of fat around their middle, in particular, are at an even greater risk. This is because fat secretes hormones and other substances that may interfere with insulin. Excess fat around the waist is also linked to chronic inflammation. This can trigger a wide range of health problems, including insulin resistance.

 Not enough exercise

Not getting enough exercise can affect the way insulin regulates glucose. Physical activity plays an important role in keeping blood sugar levels steady. It is a great idea to do light exercise after meals because exercise causes the muscles to use up glucose and they don't need insulin. This lowers blood sugar levels.

 Other lifestyle factors

A number of other lifestyle factors affect insulin resistance, including:

§  smoking 
§  sleep issues 
§  older age 
§  use of steroids

Article courtesy of Medical News