Category Archives: Health

What Is Diabetic Retinopathy

There are plenty of complications that can arise from diabetes, but one you may not have considered is diabetic retinopathy. Without regular screening, diabetic retinopathycan lead to blindness.

“Diabetic retinopathy is an eye disease that affects the tissues in the back of the eye – called the retina – which process light and vision for the brain,” says Dr. Nancy Kunjukunju, a retina specialist at Krieger Eye Institute at LifeBridge Health in Baltimore. “High blood sugar levels can cause the retinal blood vessels to leak, swell, grow abnormally or be blocked. If that happens, the lack of normal blood and oxygen flow can cause a loss of tissue function that seriously affects vision.”

Among people who have had Type 1 diabetes for five years, 25 percent will develop diabetic retinopathy, Kunjukunju says. That number shoots up to 60 percent after 10 years. The numbers vary a bit more when you have Type 2 diabetes, but 53 percent of people who have had Type 2 diabetes for more than 10 years develop the disease. Many people with diabetic retinopathy are not aware that they have it, says Dr. Gregory Dodell, an assistant clinical professor of medicine, endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mt. Sinai in New York.

The risk for diabetic retinopathy increases as you get older. You’re also at higher risk if you smoke. Of course, elevated blood sugar over an extended period leads to a higher risk for diabetic retinopathy as well.

“Other factors may also be high blood pressure, high cholesterol and kidney disease,” Kunjukunju says. “All of the different components of the body work together so when anything affects our blood vessels, including heart disease, our eyes can also be affected.”

A recently published study found a link between obstructive sleep apnea and diabetic retinopathy in patients who have Type 2 diabetes. However, when those patientsreceived continuous positive airway pressure treatment, or CPAP, they were less likely to develop retinopathy.

Having poor vision that makes you wear glasses or contacts has no connection to the development of diabetic retinopathy.

Many times, diabetic retinopathy has no symptoms until it’s too late – and that’s why regular eye exams are so important. “If diabetic retinopathy is not treated, symptoms can worsen, and eventually an individual may become blind,” Kunjukunju says.

Other times, symptoms like blurred vision, loss of color vision and floaters can occur. Other symptoms include spots, bleeding in the eye and an inability to see from the center of the eye. That’s the kind of vision you use when you are driving or reading, says Dr. Mark Goldfarb, an ophthalmologist with Advanced Eye Care in River Edge, New Jersey. If you haven’t already seen an eye doctor, make sure to do so when you have these kinds of symptoms.

The American Diabetes Association recommends that adults with Type 1 diabetes have an eye exam within five years of diabetes onset; people with Type 2 diabetes should have an exam at the time of diagnosis. Although someone with Type 2 diabetes may be newly diagnosed, that person could have been living with diabetes for as little as a month or as long as several years. That’s why an eye exam right after a diabetesdiagnosis is so important.

Even women who have diabetes and get pregnant or those who develop gestational diabetes while pregnant should be screened, Goldfarb recommends.

Although guidelines aren’t as clear on how often to return for an eye exam, Goldfarb generally advises returning once a year – although that will become more frequent if you’re diagnosed with diabetic retinopathy.

“I aim to ask patients during every office visit when their last ophthalmology evaluation was,” Dodell says. “Ideally, the ophthalmologist should be sending a note to the endocrinologist or primary care doctor regarding the office visit.”

During an exam for diabetic retinopathy, your eye doctor will dilate your eyes to see the back of the eye (the retina). He or she will look for abnormalities like swelling or the leaking or closing off of blood vessels. There are also newer imaging devices, like optical coherence tomography, that help eye doctors better view the back of your eye, Goldfarb says. These exams are also important to check for other eye problems that are more common when you have diabetes, such as glaucoma and cataracts.

When you see your eye doctor, be ready to share some of your recent blood sugar readings, Goldfarb says. This information can be helpful.

If you’re diagnosed with diabetic retinopathy, your eye doctor may tell you that you have nonproliferative diabetic retinopathy – which is an earlier stage of the disease – or proliferative diabetic retinopathy. With the latter, blood vessels become so damaged they close off, according to the American Diabetes Association. Then, newer but weaker blood vessels grow and leak blood, which can block your vision and potentially lead to the growth of scar tissue. Proliferative diabetic retinopathy can also lead to something called retinal detachment, and that can cause permanent vision loss, Goldfarb says.

Diabetic macular edema is a condition that can also develop when you have diabetic retinopathy. It involves swelling in the macula of the eye, according to the American Academy of Ophthalmology.

Treatment for diabetic retinopathy is most effective when it’s started early. Your eye doctor may perform laser treatments on the retinal blood vessels to help stop them from bleeding and leaking and to reduce swelling. There are also injections that can be made in the eye to slow or stop tissue damage.

Because many patients do not see an eye doctor regularly, there are efforts underway to increase the use of telemedicine to screen more patients for diabetic retinopathy. “This is fantastic, and I suspect will lead to better outcomes for patients,” Dodell says. However, telemedicine screenings can’t replace a full eye exam, Goldfarb believes.

The best way to reduce your risk for diabetic retinopathy is to keep your blood sugar under control and follow other healthy habits, like eating a balanced diet, exercising, not smoking and using your medications as prescribed. “If blood sugar levels are close to normal, an individual is less likely to be at risk,” Kunjukunju says.

Providing Social Support To Overcome Depression

Humans are social animals by nature. But modern life has disrupted many of the traditional social norms that people have relied on for millennia, to the detriment of our overall health. The American Psychological Association reports that loneliness has been linked to health problems including “high blood pressure, diminished immunity, cardiovascular disease and cognitive decline” and that “low levels of social support have even been linked to increased risk of death from cardiovascular disease, infectious diseases and cancer.” Social support plays a big role in depression, as well.

Individuals with poor social support have a higher probability of developing depression, according to a study in the Journal of Clinical Nursing. And many Americans today don’t feel like they have a social network they can count on. The APA reports that 55 percent of survey respondents said they could use “at least a little more emotional support” when talking about problems or making difficult decisions. Strong social support can help people cope with problems and improve self-esteem and a sense of autonomy, the APA says. But not everyone has the skills to be socially connected, while many others find that maintaining those connections are harder these days.

“At its worst, depression is a disease of isolation,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University and chair of the American Psychiatric Association’s Council on Communications. “People generally tend to be social creatures. We feel best when we are connected to others and to our community. That is a huge part of the human identity.” It also provides us with important psychological benefits. “It’s like the keel on the ship,” Ramsey says. “You can have an awful day, but if you can lean on social support, be that your regular Tuesday basketball game, your church choir or whatever you use, the bumps in life are digested much better.”

Breaking Out of the Cycle

While social support is one of the most powerful protections against depression, it’s also one of its most challenging treatments. “In the depths of depression, someone’s self-esteem is awful,” Ramsey says. “They know they are not their best selves, and so they don’t want other people to see them that way. They are alone in the darkness, which perpetuates the depression and is also dangerous. Our biggest fear is that they end up isolated and disconnected, which leads to the worst outcome, which is suicide.”

Carl Tishler, a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University, adds that trying to help depressed people back into the world when they don’t want to go can be difficult for those trying to help them. “The ‘alone’ feeling is something they don’t know what to do about. The friend or relative or significant other who is trying to help the person gets frustrated and throws her hands up and walks away,” he says. “That causes frustration for support-givers, who can feel overburdened, and then the depressed person feels increased guilt and becomes more withdrawn. It’s a viscous circle.”

How can depressed individuals escape this circle? Psychotherapy can help patients reframe their view of the world, making it less scary for them to re-enter. “Depression is a distortion in the mirror we evaluate ourselves in,” Ramsey says. “When we see or more importantly feel our role in others’ lives, that is very protective from the worst of depression.” Mental health professionals screen suicide risk by asking patients what keeps them alive. “We are reassured when people look you in the eye and say, ‘I know I need to be here for my children’ or ‘I need to show up to work because my employees depend on me,’” Ramsey says.

He also reminds patients that, even in the depths of depression, “their light can still shine and people can enjoy them. I spend a lot of time with people who are depressed, and I often find them making me laugh. I remind them that, in the midst of feeling horrible, they are still themselves.”

Start Small

Someone who is depressed isn’t likely to go to a big party. But he may be convinced to make baby steps back into society. That may be a small community function without much social interaction, or going to a movie instead of dinner with a friend to limit conversation, or simply taking a walk in a park, Ramsey says. “I want to chip away at their isolation,” he says. “One of the tips I learned from patients is that it is easier to socialize if there is something other than yourself to focus on.”

He also tries to add structure to their lives by creating commitments they need to meet. “It’s hard to go work out when you’re depressed, but it’s easier if you have a commitment of a class to go to.” He might also suggest less stressful ways to revisit activities patients usually enjoy. “If they used to like dinner parties, they might take a cooking class or go to a tasting menu, or simply go to a farmers’ market,” he says. “The goal is to get them out of the home and with other individuals. What makes you feel good is being with other people mutually enjoying an activity. Getting out of your head and into your life is one of the things I try to engage people in.”

Tishler adds that taking care of another living thing is also helpful. “[Caring] for plants or animals makes them feel they have some responsibility for another life, not just their own,” he says. “I have had a number of patients who, were it not for their dog, wouldn’t get out of the house. The dog forces them to meet the neighbors, say hello, go to the vet or to buy dog food. It forces interaction.”

Ramsey provides one more caution. “The word ‘social’ has changed because of social media,” he says. “Socializing online doesn’t count.” Indeed, data suggest that social media networks lead to more depression, he says. “Social media provides the potential for connecting us, but is real human connection really happening? When we spend hours online comparing ourselves to others, counting ‘likes,’ that is horrible for the human psyche. Make sure social media is actually social in that it is making you feel good and connecting you with friend outside the house. That is what feels best as humans, and I don’t need any research to support that.”

Sleep Better With Ways Diabetes

Sad but true: If you have diabetes, quality sleep may be hard to get.

However, you should work with your doctor to try and pinpoint just what’s causing your sleep problems.

“While a good night’s sleep and maintenance of a healthy weight are good for everyone, those good habits promise special health benefits for people with diabetes,” says Dr. Paris Roach, an endocrinologist with Indiana University Health in Indianapolis.

There are a few reasons why you may not get the restful sleep you need when you have diabetes.

First, major swings in your blood sugar at night can disrupt your sleep. “Very high blood glucose levels can lead to excessive urination, and sleep may be interrupted by frequent visits to the bathroom if blood sugar is poorly controlled,” Roach says. If your blood sugar gets too low at night, symptoms like restless sleep, excessive sweating and a pounding heart can occur.

A common condition called sleep apnea is more common when you have diabetes. “Apnea literally means ‘not breathing,’ and sleep apnea refers to brief periods of a minute or two when breathing is extremely shallow or absent during sleep,” Roach says. Usually, it’s a partner who spots this problem because you’re snoring or breathing shallowly at night. However, you also may feel fatigue or sleepiness during the day or have trouble concentrating.

Sleep apnea increases your chance of a heart attack and stroke, and the more severe the sleep apnea, the more severe the risk for diabetes, says Dr. Christopher Winter, medical director of Sentara Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Virginia, and author of “The Sleep Solution: Why Your Sleep Is Broken and How to Fix It.”

Another common problem in some people with diabetes is diabetic neuropathy. That can cause painful sensations in the feet like burning or stinging that can disrupt sleep. Another sleep disorder called restless legs syndrome can cause an urge to move your legs when you fall asleep. “Diabetic neuropathy and restless legs syndrome can be present in the same person, making the two sometimes difficult to separate diagnostically,” Roach says.

Because of these problems, insomnia is often more common in people with diabetes, says Dr. Rajkumar Dasgupta, an assistant professor of clinical medicine at Keck Medicine of USC in Los Angeles. Insomnia also can occur as a side effect of certain medications such as antidepressants – and depression can be more common in people with chronic diseases such as diabetes.

That lack of sleep can cause an increase in stress hormones, which then make it harder to control your weight. It can start a tricky cycle that connects to diabetes, obesity and sleep deprivation, Dasgupta explains.

To find out what’s causing your sleep issues, your doctor will likely recommend a sleepstudy. During a sleep study, your heart rate, body movements and brain activity are monitored to see how well you sleep and to determine what may cause your sleepproblems. Although these tests are often done in a lab, they can also now be done at home, Dasgupta says. This makes these tests more common and less of a hassle.

It’s important that you get treatment for any sleep disorders so you can have deeper rest at night and better function during the day. For example, if your doctor says you have sleep apnea, one common treatment is a CPAP mask, short for continuous positive airway pressure. You wear the mask over your mouth and/or nose, and it helps provide pressure to the upper airway so it stays open during sleep. “Most people can be fitted with a mask they can sleep with comfortably and are often surprised how much better they feel during waking hours when their sleep apnea is effectively treated,” Roach says.

Sleep apnea treatment may help with blood sugar control, insulin resistance and other signs associated with heart disease, Winters says. Also, losing weight can help improve and possibly eliminate sleep apnea.

For less-severe sleep apnea, doctors may recommend a dental device that moves your jawbone slightly forward while you sleep.

For blood sugar swings, some people will use a continuous glucose monitoring device, Roach says. Another solution is waking up once or twice at the night for a week to check your blood sugar and track trends. Usually, adjustments in medication or diet can help address this problem.

For RLS, your doctor may prescribe medications. You may also have to get your iron level checked, as that can contribute to the problem, especially in premenopausal females, Dasgupta says. If you smoke and you have RLS, there’s yet one more reason to quit: Smoking cessation can help alleviate the problem, Roach says.

There are some things you can do on your own to help improve your sleep:

Make sleep a priority. Sleep at consistent times and in adequate amounts, advises says Susan M. De Abate, a nurse and certified diabetes educator and team coordinator of the diabetes education program at Sentara Virginia Beach General Hospital. Many Americans are not getting the recommended seven to eight hours. Make a commitment to better sleep.

Sleep in a dark, quiet cool room, De Abate recommends. And put the technology away, as it can work against going to sleep.

Avoid sleep medications. They can make sleep apnea worse and have other side effects.

Use your bed for sleep only. If you have trouble going to sleep after 15 to 20 minutes, leave the bed and go read a book (preferably not on a tablet or electronic device, Dasgupta cautions). Do something that’s not stimulating for your brain.

Make exercise a habit. It will help you sleep better at night.

Talk about sleep problems with your doctor. Dasgupta sees a lot of focus on what’s happening in patients’ lives during the day and how that relates to health problems, but he’d like more talk about sleep issues. By diagnosing and treating sleep issues, you can improve your quality of life and your health, he says.

Food That You Should Not Eat

Imagine the following scenario. You’re engaged in conversation at a dinner party with friends that you feel comfortable enough to discuss “hot button” topics with. Politics, religion, and parenting techniques probably come up and most likely, the views vary by person. When I attend dinner parties, however, the issue of food is often the hot topic of the night, and even hotter, the opinions surrounding the right and wrong way to eat. It’s not enough these days that we are eating more kale (thank you trendy farmers markets and Hollywood celebrities!), we have to now dissect the right and wrong way to eat it as well. It was discussions like these that motivated me to write this blog. After all, my career surrounds helping people to simply eat better — to get, what I call, the most bang for their nutritional buck. There are many factors that impact the amount of nutrients that you will derive from a food. Things such as cooking and ripening method, food pairing and even your own gut flora may impact how much benefit you get from plant-based foods. Different varieties of foods affect this as well. Not all nuts, apples or as you’ll read in my first example, potatoes are created equal. If you’re interested in knowing how science views the best way to eat, then read on. Spoiler alert: Raw is not always the right way to go!

Potatoes 
Think you’re getting the benefits of the potato vegetable when you consume French fries, mashed or baked potatoes from white potatoes? Think again! One study found that it was purple potatoes that gave the best benefits, like lowering blood pressure and reducing the risk for cancer. Further, a 2014 study found that purple potatoes surpassed their white counterparts when it came to high amounts of polyphenols and decreased effect on overall blood sugar response.

Carrots 
As fall gears up, our love of soup increases as well. Next time you’re making a batch of chicken noodle soup, resist the urge to cut up your carrots. One study found that cutting carrots increased surface size and allowed more nutrients to leach out. That means after washing and peeling, your carrots should hit the water in their whole form. Keep cooking (vs. raw) though. One study found that cooking carrots increased the bioavailability of carotenoids.

Tea 
If you want high nutrient absorption with your high tea, then forget about doing as the Brits do it! Several studies have shown that adding milk to your tea may actually take away some of the cardiovascular benefits that tea provide. Going with green tea? Add a little juice instead to sweeten. The vitamin C in juice may help to increase the bioavailability of green tea’s nutrients.

Garlic 
Don’t rush your garlic, CRUSH your garlic! Research indicates that crushing your garlic and allowing to sit for at least ten minutes released an enzyme called allicin that has been shown to help reduce the risk of cardiovascular disease by making platelets less sticky or more likely to flow freely through the cardiovascular system.

Salad dressing 
Fat free dressing may seem like a good idea in theory, but when you look at what you give up; it’s no match for the full fat counterpart. Several studies have shown the benefits that fat has when dressing your greens, from keeping you fuller and more satisfied after consumption to getting more nutrient absolution from your salad (specifically from lutein, lycopene, beta-carotene and zeaxanthin).

Apples & Pears 
Let your fruit ripen up a bit! One study found that the ripening process allowed the breakdown of chlorophyll in ripening apples and pears which, in turn, produced more “highly active” antioxidants in the fruit.

Broccoli
Broccoli is, without doubt one of the best foods you can feed your body! Broccoli is part of the brassica family of foods, a family that has shown to be quite effective in terms of prevention of certain cancers from breast cancer to skin cancer , but how you prepare your broccoli makes all the difference in the world. A 2008 study found that steaming was the only cooking method that completely preserved, and even increased, the cancer fighting components of broccoli. Boiling and frying were found to be the worst cooking methods. Still don’t want to ditch the boiled broccoli? Pairing with a spicy food may help! A 2012 study found that adding spicy foods to broccoli increased its cancer fighting power and the spicier the better according to the study authors!

Mustard
Mustard in any form is a fabulous condiment to add to sauces, salads and sandwiches, but if you’re interested in decreasing overall inflammation as well as reducing your risk for certain cancers then you better keep your mustard choices simple. That’s right! It’s the cheap yellow mustard options that have the best benefits. Why? Because they contain a compound called curcumin (that’s the active ingredient in turmeric) that not only gives cheap yellow mustard its yellow color, but all of its potential health benefits as well!

While the factors discussed in this blog have an impact on the best ways to consume your foods, the truth is, simply adding these foods to your diet is a huge step in the right direction. Once you have mastered a liking for these healthier food options, the next logical step is to prepare in the best way for maximum nutrient density!

Healthy Foods for Your Eyes

Eggs

The yolk is a prime source of lutein and zeaxanthin—plus zinc, which also helps reduce your macular degeneration risk, according to Paul Dougherty, MD, medical director of Dougherty Laser Vision in Los Angeles.

Almonds

They’re filled with vitamin E, which slows macular degeneration, research shows. One handful (an
ounce) provides about half of your daily dose of E.

Beyond carrots

You’ve probably heard that carrots and other orange-colored fruits and vegetables promote eye health and protect vision, and it’s true: Beta-carotene, a type of vitamin A that gives these foods their orange hue, helps the retina and other parts of the eye to function smoothly.

But eating your way to good eyesight isn’t only about beta-carotene. Though their connection to vision isn’t as well-known, several other vitamins and minerals are essential for healthy eyes. Make these five foods a staple of your diet to keep your peepers in tip-top shape.

Leafy greens

They’re packed with lutein and zeaxanthin—antioxidants that, studies show, lower the risk of
developing macular degeneration and cataracts.

Citrus and berries

These fruits are powerhouses of vitamin C, which has been shown to reduce the risk of developing macular degeneration and cataracts.

Fatty fish

Tuna, salmon, mackerel, anchovies and trout are rich in DHA, a fatty acid found in your retina—low levels of which have been linked to dry eye syndrome, says Jimmy Lee, MD, director of refractive surgery at Montefiore Medical Center, in New York City.

How to Heal Pain

The bright sun, longer days and warm heat of summer seem to effortlessly pluck people outside for an activity-packed couple of months. It’s no surprise that this time of year offers the best weather for outdoor activities, pool parties, traveling and spending as much time out and about as we can. “Summer break” seems to not only apply to our school-aged children, but us as adults, as well. Though these summer months are most definitely an invitation to stay active, the extra physical demands can be tough on the back, especially if you’ve previously dealt with spine issues. In the spirit of staying back pain-free, while still enjoying this sunny time of year, here are some helpful ways to take care of your spine this summer.

For those people with back pain that’s worsened by cold weather, the warm summer months can signal relief, but for others, the change in temperature can be a factor that causes more pain. Increasing heat, humidity and barometric pressure over the summer months can be responsible for back pain “flare-ups,” even in the absence of activity. The easiest way to combat this weather-related pain is to stay indoors in an air-conditioned room to instantly cut out the heat and humidity. Though this option works, it may not be as convenient if you’re someone who likes being active outside. If this is the case and you can’t see yourself hiding from the summer rays, the next best bet is to use ice therapy. Applying ice packs will simultaneously help you cool down, reduce inflammation and soothe your achy muscles. Trade in the heating pad for 20 minutes of icing, remembering that the key is to achieve numbness in the irritated area, and repeat this several times each day (eight to 10 times during a 24-hour period).

Summer is the perfect opportunity for quick weekend trips or long relaxing vacations, but getting to your destination can pose a problem for your back. Long rides in cars, planes or trains with typically uncomfortable and unsupportive seats can do a number on your spine and posture. If you plan to be traveling for an extended period of time, bring a lumbar support pillow with you (or make your own out of a rolled-up blanket) and position it between the seat and your lower back to reduce the stress on your muscles. Traveling always equates to luggage, and handling those heavy suitcases with care can make all the difference. Always bend at the knees when lifting luggage (never at the back), avoid twisting while lifting anything heavy and hold your items as close to your body as possible. Ladies, purses can sometimes be the biggest culprits, so if you’re carrying a shoulder bag, switch sides frequently. And if something is just too heavy to lift, don’t hesitate to ask for help.

Our bodies are designed to move, which circulates the blood and keeps the muscles warm, and sitting in one position for too long starts to stiffen the muscles – making them more prone to pain or injury. If you can, pull over every hour during a road trip to get out of the car for a little walk and stretch out the back and leg muscles. On a plane, get up as often as you can (every 30 minutes to an hour is optimal) to walk back and forth down the aisle and get some stretching in, as well.

Along the same lines of getting up to stretch when you’ve been sitting too long is to sit down when you’ve been standing too long. This may sound like common sense, but you’d be surprised how many of us actually forget to take a break. With all the activity going on – whether that’s spending hours upon hours walking through an amusement park, losing track of time working in the yard or packing up and moving (a summertime chart-topper for many) – sometimes we have to remind ourselves to stop and rest, even for just a few minutes. Sit down, take a few deep breaths, drink some water and stretch. Taking multiple rest breaks combined with some deep stretching will keep the neck, back and leg muscles warmed up and flexible, as well as rejuvenated for the rest of the day.

Perhaps the most refreshing summertime spine health tip is to swim. You’re most likely to be near a pool this summer, so why not hop in and turn it into a workout? Swimming is an ideal exercise for low back pain because of its low-impact nature. It allows the back, leg and core muscles to be strengthened without applying much stress on the spine. Along with muscle strength, you’ll get cardiovascular benefits, as well, and all in a cool and rejuvenating atmosphere. While you’re out at the pool relaxing, supervising kids or getting your workout in, remember to always practice safety first. Never run through the pool deck, as the ground is slippery and one misstep can mean game over for your back. Likewise, avoid a traumatic spine injury by never diving into shallow water. If you’re unsure of the depth, definitely look before you leap.

The warmer months of the year can be chock-full of fun times and adventure, so don’t let spine troubles stand in the way. These tips will surely help you enjoy a happy, healthy and back-pain free summer.

Users of Cannabis Highly at risk for Psychosis

Psychotic illness occurs significantly earlier among marijuana users, results of a meta-analysis suggest.

Data on more than 22,000 patients with psychosis showed an onset of symptoms almost three years earlier among users of cannabis compared with patients who had no history of substance use.

The age of onset also was earlier in cannabis users compared with patients in the more broadly characterized category of substance use, investigators reported online in Archives of General Psychiatry.

“The results of this study provide strong evidence that reducing cannabis use could delay or even prevent some cases of psychosis,” Dr. Matthew Large, of the University of New South Wales in Sydney, Australia, and co-authors wrote in conclusion.

“Reducing the use of cannabis could be one of the few ways of altering the outcome of the illness because earlier onset of schizophrenia is associated with a worse prognosis and because other factors associated with age at onset, such as family history and sex, cannot be changed.”

Psychosis has a strong association with substance use. Patients of mental health facilities have a high prevalence of substance use, which also is more common in patients with schizophrenia compared with the general population, the authors wrote.

Several birth cohort and population studies have suggested a potentially causal association between cannabis use and psychosis, and cannabis use has been linked to earlier onset of schizophrenia. However, researchers in the field remain divided over the issue of a causal association, the authors continued.

Attempts to confirm an earlier onset of psychosis among cannabis users have been complicated by individual studies’ variation in methods used to examine the association. The authors sought to resolve some of the uncertainty by means of meta-analysis.

A systematic search of multiple electronic databases yielded 443 potentially relevant publications. The authors whittled the list down to 83 that met their inclusion criteria: All the studies reported age at onset of psychosis among substance users and nonusers.

The studies comprised 8,167 substance-using patients and 14,352 patients who had no history of substance use. Although the studies had a wide range of definitions of substance use, the use was considered “clinically significant” in all 83 studies. None of the studies included tobacco in the definition of substance use.

The studies included a total of 131 patient samples.

Substance use included alcohol in 22 samples, cannabis in 41, and was simply defined as “substance use” in 68 samples.

Alcohol use was not significantly associated with earlier age at onset of psychosis.

On average, substance users were about 2 years younger than nonusers were. The effect of substance use on age at onset was greater in women than in men, but not significantly so. Heavy use was associated with earlier age at onset compared with light use and former use, but also not significantly different, the authors reported.

Substance users were two years younger at the onset of psychosis compared with nonusers. Age at onset was 2.7 years earlier among cannabis users compared with nonusers.

Acknowledging limitations of the study, the authors cited the lack of information on tobacco use and its association with earlier age at onset of psychosis, and the lack of data on individual patients inherent in all meta-analyses.

Despite the limitations, the authors said the findings have potentially major clinical and policy implications.

“This finding is an important breakthrough in our understanding of the relationship between cannabis use and psychosis,” they wrote in conclusion. “It raises the question of whether those substance users would still have gone on to develop psychosis a few years later.”

“The results of this study confirm the need for a renewed public health warning about the potential for cannabis use to bring on psychotic illness,” they added.

Alcohol Is Not The Main Killer of Drink

Older people who drink heavily don’t necessarily have to fear dying of liver disease, a researcher said.

In a population-based Dutch study, only a handful of heavy drinkers in an older cohort died of liver-related causes, according to Jeoffrey Schouten, MD, of Erasmus Medical Center in Rotterdam, the Netherlands.

The major causes of death were cardiovascular disease and cancer, but not hepatocellular carcinoma, Schouten reported at the annual meeting of the American Association for the Study of Liver Diseases.

On the other hand, the study confirmed previous studies that suggest light and moderate drinking is protective, Schouten said.

He and colleagues followed 3,884 residents of Rotterdam — all 55 or older at the start of the study in 1990 — for a median of 15.2 years, until they died or until Dec. 31, 2008.

The participants were stratified by their drinking level, with the aim of understanding the causes of death for those who drank heavily, as well as the links between all-cause mortality and alcohol consumption.

Every four or five years, participants went through cycle of examinations, including clinical studies and questionnaires on various aspects of their lives, such as alcohol consumption. The clinical exams included blood work, anthropomorphic measurements, and imaging studies.

The study included the following:

  • 1,398 non-drinkers
  • 1,144 light drinkers (less than one gram of alcohol a day)
  • 963 moderate drinkers (between 10 and 30 grams daily)
  • 379 heavy drinkers (more than 30 grams a day)

Over the study period, Schouten reported, there were 1,825 deaths: 556 from cardiovascular disease, 496 from cancers, and 773 from a host of other causes, including three from alcohol-related liver disease.

Among the 188 heavy drinkers who died, 28% died of cardiovascular causes and 34% of cancer, he said. But only three cases of alcohol-related cancers and no cases of liver cancer were reported.

Only two of the heavy drinkers, or 1%, died of alcohol-related liver disease, he said.

A multivariate analysis showed that light and moderate drinkers fared better than both non-drinkers and heavy drinkers in terms of all-cause mortality.

Schouten said previous studies have showed similar patterns, but they were limited because older people were under-represented.

He added that doctors can use the findings to discuss the major risks among older patients who drink heavily, such as cardiovascular disease and cancer, rather than liver disease.

The findings, while not surprising, have some implications for how doctors counsel older patients about their drinking, according to Mack Mitchell, MD, of UT Southwestern Medical Center in Dallas, who was not part of the study, but who was one of the moderators of the session at which it was presented.

“Many people believe they should not drink alcoholic beverages above a certain age for health reasons,” he told MedPage Today, but the study showed that, “the mortality rate for those drinking in moderation was actually lower.”

So the message should not be to stop drinking but to stop drinking to excess, he said.

But for patients who remain heavy drinkers, he said, doctors can tell them that liver damage is the least of their worries — heart disease and cancer are the risks they should be concerned about.

Make Your Brain Younger

As our life expectancy continues to increase, one of the biggest fears for our senior citizens is that they may physically live longer than their brain functions.

This thought is being fueled by numerous press reports about the  increase in Alzheimer’s disease and other dementias.

Dementia is generally relates to loss of cognitive function.  Alzheimer’s is a type of dementia, but there are many others like senile (aging) dementia and dementias associated with other neurologic disea

The good news is that the evolving neuroscience shows that there are things we can do to preserve and even enhance our cognitive ability through the life span.

The concept of neuroplasticity shows that our brains can recover after injuries and strokes as well as, in some cases, improve brain function in the face of chronic neurologic disease.

In my book, “30 Days to a Better Brain,” I outline the mind, body and spirit approach to preserving and enhancing cognitive function as practiced at Canyon Ranch.

As we age, we have learned the value of healthy eating and remaining physically active through the life span. Each of these factors is an essential variable in overall health to include brain health and cognitive vitality.

We also know that if we don’t stay physically active, our muscles will atrophy and as we weaken, we lose our ability to actually participate in life activities and we become more vulnerable to falls and injury.

The brain also needs continuing challenges to stay vital as well and to prevent atrophy from minimal activity. So the brain needs a “brain gym”, that is, new information and challenges that give your brain a workout so that brain nerve cells are challenged and preserved and new brain neural networks are made to capture and store the new information.

No matter your age, even centenarians can benefit from learning new things, from a new language to playing a musical instrument or simply staying socially engaged with active stimulating conversation.

Dr. Richard Carmona is the 17th Surgeon General of the United States and president of Canyon Ranch Institute. He is the author of “30 days to a Better Brain.” 

Helping Kids Cope With Anxiety

From starting school to fearing rejection by friends, anxiety and worry are expected components of child development. We all worry from time to time, and kids are no different.

Teaching children coping skills to deal with their stressors and worries is like teaching other skills. How do we teach dental hygiene or how to read? We can start by creating a plan, modeling the steps by showing them and practicing the task together, and gradually children will practice the technique independently.

How do we teach children to cope? We do so with intention and on purpose. Here are some suggestions for helping kids cope with anxiety:

Do validate. While a parent’s instinct may be to jump in and solve the problem, first take a moment to validate that certain situations or experiences are indeed scary. Helping kids make sense of their emotions includes helping them feel them. Anxiety is normal – it’s even good for you. It may help to start out by saying things like: “I can see why that situation makes you nervous. Sometimes I get nervous when I have to… (e.g., meet a new person, speak in front of an audience, try something new).”

Don’t offer general advice statements. Although it’s important to validate and empathize when a child is feeling anxious, offering general advice statements such as “Don’t worry” or “You’ll be fine” may feel invalidating or even dismissive. Learning to cope with anxietyincludes helping kids learn how to get specific about their experiences. Try: “It sounds like you’re pretty worried about failing this upcoming math test, and I know how important it is to you. Let’s see if we can come up with a plan…”

Do work with kids to understand the problem. Fear and anxiety are emotional responses to threat and perceptions of danger. Our brains naturally react to environments we perceive as dangerous. When we sense “danger” or “threat,” our bodies get activated to fight, flee or freeze. When we feel anxious, it’s a signal that there is perceived threat; it is a signal to act. Before we can problem solve, we must understand the problem. Anxietyand stress include feelings, thoughts and behaviors; in turn, problem solving includes helping kids learn how to identify and understand that how they think is related to how they feel and determines their actions:. Try: “What’s the worst that can happen if you take that test? What will happen if you don’t take the test?”

Do practice problem-solving/coping. Teaching kids to cope with anxiety, stress or worry includes teaching them to problem solve. Helping kids learn how to identify and understand the problem is key. When dealing with stress or anxiety, kids can learn to identify a problem, come up with a plan and execute the plan. Think about how often we have to utilize this sequence in our daily lives. When kids feel anxious, they may have trouble seeing options. Teach kids to recognize their anxious thoughts and self-validate, and also practice labeling feelings, thoughts and behaviors, or avoidance:

  • “When you feel nervous, what does your body feel like?”
  • “Do you get shaky? Or jumpy? When you have worries, do you feel like you have butterflies in your stomach?”
  • “It sounds like you’re worried that it will be a disaster? What do you think will happen?”
  • “What are the chances that you will fail the math test? What is the worst that can happen if you do fail?”

For anxious bodily reactions:

  • If your body is feeling anxious, slow down and take some deep breaths.”

And then team up and brainstorm some things they can do:

  • What can you do to prepare for the oral report in front of your class? You can create a slide presentation or use flash cards. We can practice in advance at home. You can ask the teacher for help.”

Don’t encourage avoidance. While avoiding a situation that makes us nervous is an option for temporary relief, it does not work very well and serves to keep anxiety going in the long term. Avoidance deprives kids of potentially learning that outcomes are not always as bad as we predict and discourages them from practicing coping skills. Rather, it’s helpful to coach kids to approach scary situations gradually and encourage them to approach, rather than avoid.

Do model your own stress management skills. Often, parents try to hide their worries or share their worries without sharing their coping steps. Just as children may learn how to tie their shoes by observing adults in their lives, parents can model coping and problem solving. What do parents do when they’re stressed? Talk it out. “When I get nervous, I take some deep breaths and then make a to-do list. If I’m stressed about a problem at work, I write down my worries, talk to a friend and then come up with a plan.”

For many children and adolescents, anxiety may become so severe that it interferes with healthy development. Some potential red flags include:

  • Chronic stomach pains or physical symptoms when worried.
  • Frequent requests to leave and/or be picked up from school, or multiple trips to the school nurse.
  • Withdrawal from peers or social activities (e.g., clubs, parties, teams).
  • Excessive clinginess and/or reassurance-seeking questions that are asked repeatedly.
  • Sleep or eating disturbances.

For these children, parents may consider further evaluation. Fortunately, anxiety disorders are treatable and may be helped by a type of psychotherapy called cognitive behavioral therapy. For more information, visit:

  • Society of Clinical Child and Adolescent Psychology
  • Association of Behavioral and Cognitive Therapies
  • Anxiety and Depression Disorders Association of America