Tech time not to blame for teens’ mental health problems

A new study, published in the journal Clinical Psychological Science, suggests that the time adolescents are spending on their phones and online is not that bad.

The study tracked young adolescents on their smartphones to test whether more time spent using digital technology was linked to worse mental health outcomes. The researchers — Candice Odgers, professor of psychological science at the University of California, Irvine; Michaeline Jensen, assistant professor of psychology at the University of North Carolina at Greensboro; Madeleine George, postdoctoral researcher at Purdue University; and Michael Russell, assistant professor of behavioral health at Pennsylvania State University — found little evidence of longitudinal or daily linkages between digital technology use and adolescent mental health.

“It may be time for adults to stop arguing over whether smartphones and social media are good or bad for teens’ mental health and start figuring out ways to best support them in both their offline and online lives,” Odgers said.

“Contrary to the common belief that smartphones and social media are damaging adolescents’ mental health, we don’t see much support for the idea that time spent on phones and online is associated with increased risk for mental health problems,” Jensen said.

The study surveyed more than 2,000 youth and then intensively tracked a subsample of nearly 400 teens on their smartphones multiple times a day for two weeks. Adolescents in the study were between 10 and 15 years old and represented the economically and racially diverse population of youth attending North Carolina public schools.

The researchers collected reports of mental health symptoms from the adolescents three times a day and they also reported on their daily technology usage each night. They asked whether youth who engaged more with digital technologies were more likely to experience later mental health symptoms and whether days that adolescents spent more time using digital technology for a wide range of purposes were also days when mental health problems were more common. In both cases, increased digital technology use was not related to worse mental health.

When associations were observed, they were small and in the opposite direction that would be expected given all of the recent concerns about digital technology damaging adolescents’ mental health. For instance, teens who reported sending more text messages over the study period actually reported feeling better (less depressed) than teens who were less frequent texters.

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Actually Realistic Advice for How to Share Your Sexual Fantasies

If the idea of sharing your sexual fantasies makes you want to crawl out of your skin, welcome to the club. Talking about sex with a partner is a vulnerable act as it is, and voicing your sexual fantasies can leave you feeling extra exposed, especially if you think those fantasies are embarrassing or taboo. You might worry that your thoughts and desires won’t line up exactly with your partner’s or that they might judge what you’re into. You might even fear what your fantasy says about you or your relationship.

I’ve heard it all. As a professional sex coach and educator, I’m intimately familiar with how scary it can feel to admit your sexual fantasies to yourself, much less say them out loud to someone who could, in the worst-case scenario, reject you. But it’s really important to talk about your fantasies with your partner—and to give them space to feel they can talk about their fantasies with you, too. Of course, easier said than done, right? Here are some steps for approaching the topic of sexual fantasies with your partner in the easiest and most comfortable way possible.

Remember that you’re not weird for having fantasies.

Fantasies aren’t inherently gross or creepy. They’re a natural part of being a sexual person.

“The brain … is the most erogenous zone in the body,” Kimberly Atwood, licensed professional counselor and certified sex therapist, tells SELF. “Sex generally begins with the mind and our attitude toward sex, which often means fantasies.”

The fantasies you’re having don’t mean there’s something wrong with or bad about you—in fact, they don’t necessarily have to mean anything about you at all. From “I think about having threesomes with my wife’s best friend,” to “I can’t stop thinking about being tied up during sex,” there are no limits to the unspoken desires people have. (FYI: Some of the most common fantasies I see from clients and in my research happen to revolve around group sex and BDSM.)

“Think of [fantasies] as ways to express your [unconscious needs or desires] that you can’t control, just like dreams,” board-certified sex therapist Kristie Overstreet, Ph.D., tells SELF.

Figure out what your goal is in sharing your fantasy.

Thinking about certain sexual situations doesn’t mean you necessarily want them to happen. Perhaps you daydream about having a threesome, but you know that if you watched your partner being intimate with another person, you would freak out. Or you might get off on watching intense bondage porn‚ but the idea of being tied up in real life gets a big nope from you.

This is why it can be helpful to think about your goal in sharing your fantasy with your partner before bringing it up. Do you want your partner to know you on a more intimate level? Are you more interested in figuring out if they’d be down to watch porn about your fantasy as foreplay, or center their dirty talk around it? Or do you actually want to play out the fantasy with them?

You don’t have to have this all hammered out before you bring it up. In fact, telling your partner that you don’t know exactly what you want to do with a fantasy is helpful, too. Talking these questions through together can be enlightening and foster intimacy. But thinking about these questions beforehand can help you know yourself and your desires better, at the very least.

Obviously, if you decide to enact any of your fantasies together, you and your partner will need to have additional conversations about how to go about that in a way you’re both into.

Explain that there’s no pressure to act on your fantasy ASAP (or ever).

OK, so you’re ready to tell your partner you’ve been thinking about something that turns you on and you want to share it with them. Go for it!

When you do, emphasize that even if you’re interested in trying out this fantasy, there is no pressure to act it out right now or ever, if it’s not their thing. Otherwise, your partner may feel as though they’re being asked to role-play on the spot.

Then ask how they feel about what you shared, but also let them know they can sit with it for a little while. It’s fine if they aren’t ready to react or if they have a different reaction down the line than the one they had when you told them. Ultimately, you may find out that your fantasy is one your partner has as well, in which case, jackpot. It can also be a great time to ask if there is a fantasy they’d like to share with you. Being vulnerable might encourage your partner to do the same.

Be prepared for a positive or negative reaction, or maybe even a mix of both.

Speaking of vulnerability, it’s a huge part of speaking honestly about your fantasies. Your partner can have any number of reactions to the ideas knocking around inside of your head. They might be neutral about your fantasy, down to try it, completely uninterested, or even disgusted by it. (Which doesn’t automatically mean they think you’re disgusting.)

You have a right to think about whatever you want during sex or masturbation, but your partner does not have any obligation to fulfill or be open to a fantasy they’re not comfortable with. To that end, try to prepare yourself for any reaction that might come your way. And some advice if they react really negatively to your fantasy since that can be toughest to deal with: Try asking something like, “Why do you feel that way?”

To be real here, there are some times when the fantasy you’re sharing is a NBD thing you would be psyched to try one day and other times when it might be a VBD thing that you feel you need to be satisfied. If you shared a fantasy that falls into the latter category and your partner’s absolutely not interested, that might call for a larger conversation about sexual compatibility and what you’re both looking for in your sex lives.

But…what if your sexual fantasy is “dark” or taboo in some way?

Quick disclaimer: This section and the following section discuss topics related to sexual coercion and consent. If you might find that upsetting, I recommend skipping to the final section and reading from there.

The definition of a “dark” fantasy, or one that feels taboo or wrong, can differ from person to person. For some people, the thought of double penetration or face slapping counts as dark. For others, it’s the thought of harming someone or being harmed (either with or without consent).

No matter your specific fantasy, if it feels dark or strange to you, you might feel conflicted or upset about where your mind is taking you—and whether or not you want to share this with your partner. After all, most of the sexual and erotic stuff we’re exposed to in mainstream pop culture tends to be pretty vanilla, which means that being turned on by anything outside of that can make you wonder if you’re maybe abnormal.

To give you an example of how complex these more taboo fantasies can be, I want to discuss rape fantasies for a minute. For a lot of people, even seeing those words next to each other is jarring, which is understandable. But rape fantasies are more common than many people realize. In a 2009 study in the Journal of Sex Research, 62 percent of 355 women aged 18 and over reported having had at least one rape fantasy.

The first major thing to know about rape fantasies is that they usually aren’t about actually non-consensual sex. “Most people who have these fantasies are imagining a scenario in which someone is pretending to resist sex but truly wants to have it, which is why some refer to these fantasies as [depicting] ‘consensual non-consent,’” Justin Lehmiller, Ph.D., a research fellow at The Kinsey Institute and author of the book Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life, tells SELF.

There are all kinds of reasons someone might have this type of fantasy. It can come from a desire to give up or take control, not necessarily to harm someone without their consent or be harmed without consent. “One person may have rape fantasies because they have a need to relinquish all responsibility,” Mal Harrison, M.S., a sexologist and director of the Center for Erotic Intelligence, tells SELF. Harrison points out that a similar power exchange can be at play for the person who fantasizes about being sexually coercive. They could be the type of person who’s always putting others’ needs first, so fantasizing about having sex without tending to someone else’s pleasure may give them a moment of feeling carefree and irresponsible. But the human mind is complicated, so there’s no one personality profile that leads to or results in one kind of fantasy.

Of course, we should make it clear that you should never act on anything without getting explicit consent from everyone involved and in fact, you should make sure anyone you’re engaging in a sexual fantasy with is fully on board and understands your fantasy and the scope of how you want things to play out. But even if you know you’d never act on your fantasies—having a fantasy you don’t want to carry out IRL is really common—your thoughts might still scare you. It’s perfectly OK to seek help in understanding where they’re coming from. Which brings us to the next point…

If you’re feeling unsure about your fantasy, a sex therapist or mental health professional may be able to help.

Where do experts draw the line between a dark fantasy that’s “OK” to have and one that might warrant talking your thoughts through with a professional? Most experts believe that as long as you aren’t hurting anyone in real life (or intending to), it’s generally OK to have any type of fantasy. “There is a line between fantasizing and actually acting on the fantasy,” Overstreet says. But if you have a strong desire to act on a fantasy that might hurt someone else without their consent, that’s a sign to talk to someone about that desire.

Lehmiller agrees. “Most people will have a dark fantasy at one time or another, and that in and of itself is not necessarily a cause for concern,” he says. But if you’re nervous because you want to act out the fantasy and doing so might put you or someone else in danger, Lehmiller recommends talking to an expert.

Another sign you should talk to an expert about a dark fantasy: if you find your thoughts really distressing even if you know you’ll never try to make them a reality. “If your fantasy is negatively affecting any area of your life, speaking with a certified sex therapist can help you navigate through it,” Overstreet says. “Sometimes a person who has a dark fantasy may find it disturbing and not understand why they are experiencing it. This is why talking to a trained professional can help.”

Using rape fantasies as an example, they’re generally “OK” to have if you never actually intend on assaulting someone or engaging in any type of sexual activity without someone else’s consent. They’re also OK if they don’t bother you. But if you had these fantasies out of an urge to commit assault, or if you know you’d never act on them but they upset you, that would be a sign to seek help.

Rest assured that therapists are ethically bound to keep what you tell them confidential. Thanks to the code of ethics mental health professionals must uphold and the Health Insurance Portability and Accountability Act (HIPAA), which means whatever you tell them stays with them. The exception here comes when they think there’s an imminent threat of you hurting yourself or someone else.

Finally, have empathy for yourself and your partner.

Being a good sexual partner means trying to understand the needs, wants, and feelings of the people we’re intimate with. That calls for a lot of empathy flowing both ways.

Even if your partner truly is not picking up what you’re putting down, having a forthright, honest conversation can bring you closer and amplify your respect for each other. If your partner is a loving person (which we hope they are), they’ll be happy you felt comfortable enough to share your desires with them, no matter their willingness to make them come alive. No matter the outcome of your conversation, allowing yourself to be vulnerable by sharing shows a ton of strength, and that on its own should make you proud.

Gigi Engle is a certified sex coach, educator, and writer living in Chicago. Follow her on Twitter and Instagram @GigiEngle.


This SPF 30 Moisturizer Turned Me Into a Mineral Sunscreen Fan

Growing up in sunny Arizona, the idea that Sunscreen Is Important was drilled into my head from an early age. And I am now proud to be the friend that keeps a bottle of sunscreen in her purse and reminds everyone to reapply at the beach. But it took me until this year to find a mineral sunscreen that I actually liked—to the point that I now wear it literally every day.

I admit I had always been a little biased against mineral sunscreens because they tend to have a white cast and a texture that makes them harder to apply. But with my sensitive skin I’m often wary of trying out new chemical sunscreens that are more likely to irritate my skin (no emergencies yet, thankfully).

So, when I finally tried Paula’s Choice Essential Glow Moisturizer, $29, which has broad spectrum SPF 30 protection thanks to titanium dioxide and zinc oxide, I was surprised in the best way possible.

It’s a moisturizer first, meaning it has a really pleasant, creamy texture that absorbs into the skin quickly leaving just a natural-looking glow behind. It is still a mineral sunscreen, so it does have a faint white cast, but I find that it fades quickly as it absorbs and isn’t noticeable by the time I leave my apartment. Seriously, I let a friend borrow it on a recent trip and she told me she legit forgot she was wearing it! (Full disclosure: We both have pretty fair skin, so those with darker skin may not have as much luck.)

I also love that this moisturizer has niacinamide in it, an ingredient I’ve found to be really helpful for controlling oil without causing any irritation the way an exfoliant might. And what moisturizer would be complete without actually moisturizing ingredients? This one contains things like glycerin (a classic humectant) and argan oil that help my skin feel hydrated without any greasiness.

Not only do I have a daily SPF I actually enjoy wearing, but I’m now looking at mineral sunscreens with a much more open mind.

Buy it: Paula’s Choice DEFENSE Essential Glow Moisturizer SPF 30, $29,

All products featured on SELF are independently selected by our editors. If you buy something through our retail links, we may earn an affiliate commission.


Eating Before Bed: How It Affects Digestion, Sleep, and Weight

For many of us, a satisfying little bedtime snack is an essential part of our evening ritual. Having some cheese and crackers or a bowl of cereal before bed certainly beats trying to sleep with a rumbling belly. And of course there’s also something to be said for ending a weekend night out with that 1 a.m. slice, or ending a lousy day with a big ol’ bowl of rocky road.

At the same time, you may have heard advice warning against eating at night because it’s bad for your digestion, sleep, or weight. Well, before you even think about giving up your beloved bedtime routine (or spontaneous midnight picnic), let’s take a look at what effects eating before bed can actually have on your health.

Eating before bed and digestion

While our bodies are indeed perfectly capable of doing two things at once—sleeping and digesting, in this case—hitting the sack right after feasting is not ideal for many people because of the way the gastrointestinal (GI) tract is set up.

Between the stomach and the esophagus (the tube that carries food from your mouth to your stomach) is a muscular valve called the lower esophageal sphincter, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). Sometimes this valve remains open, allowing the contents of the stomach and digestive juices to flow back up into the esophagus and cause irritation, Scott Gabbard, M.D., a gastroenterologist at Cleveland Clinic, tells SELF. That unpleasant burning sensation (and sometimes taste) in your throat and/or chest is known as gastroesophageal reflux (i.e. acid reflux or heartburn).

Heartburn can be triggered by a few things, including eating and lying down, according to the Mayo Clinic. In other words, exactly the scenario when you eat before bed. When you lay horizontally with a full stomach, “[you] lose the effect of gravity that helps to keep the contents of the stomach down,” Dr. Gabbard explains, causing this backflow. Everyone can get heartburn once in a while, but if you have it more than twice a week you might have what’s called gastroesophageal reflux disease (GERD), according to the U.S. National Library of Medicine.

Another risk of nighttime eating is dyspepsia, more commonly known as indigestion or an upset stomach. This is a set of symptoms—like stomach pain, nausea, getting uncomfortably full or full very quickly, and upper abdomen bloating or burning—that can commonly be triggered by eating quickly, overeating, eating food that is fatty, greasy, or spicy, or drinking too many caffeinated, alcoholic, or carbonated beverages, according to the NIDDK.

Like with heartburn, mild or occasional indigestion is usually nothing to worry about. If it lasts longer than two weeks or is accompanied by other symptoms, it’s a good idea to see a doctor who can help you figure out if you have an underlying digestive issue, like gastritis, or functional dyspepsia, which is chronic and has no underlying cause, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK).

But whether you have occasional or chronic acid reflux or indigestion, “eating a large meal before going to bed could worsen the existing symptoms,” Dr. Gabbard says. That’s why the NIDDK advises avoiding late-night eating and waiting two or three hours to lie down after eating.

Also keep in mind the size and contents of your nighttime snack or meal if you experience either of these issues. Bigger meals take longer to digest than light snacks, Dr. Gabbard explains—and the fuller your stomach is, the longer it takes to break it all down, and the more likely it is you will experience GERD or dyspepsia. Some kinds of foods also take longer to digest than others, like anything high in fiber or fat. Spicy and acidic foods can also aggravate acid reflux and indigestion, per the NIDDK.

So in general, for your tummy’s sake, the ideal nighttime snack is going to be smaller, milder, lower in fat and fiber, and eaten a couple hours before bed. Of course, if making these changes isn’t helping, see your doctor, as there are other lifestyle modifications and medications available.

Eating before bed and sleep quality

If you regularly eat close to bedtime and have trouble getting a good night’s sleep, it’s definitely worth considering whether there’s a connection there.

The main concern actually goes right back to acid reflux and indigestion, which can make it hard to fall asleep, Dr. Gabbard points out, as can simply feeling too full. But GERD and indigestion can also make it harder to stay asleep, Rajkumar Dasgupta, M.D., a clinician and associate professor at Keck Medicine of USC’s division of pulmonary, critical care, and sleep medicine, tells SELF. Both issues can cause small arousals that you might not remember, but can prevent you from getting into deeper phases of sleep and leaving you under-rested and groggy in the morning, Dr. Dasgupta says.

At the same time, if you’re not having any issues with sleeping (or reflux or indigestion), there’s really no reason to change up your nighttime eating habits. In fact, a solid bedtime routine can help signal to your body and mind—which have been going all day—that it’s time to slow down and rest now, Dr. Dasgupta says. And like drinking tea, taking a bath, or reading a book, enjoying a snack may help you unwind and prepare for a good night’s sleep. Plus, laying there with a rumbling tummy can occupy your mind and make it hard for your body to relax, Dr. Dasgupta says. So if you need a bedtime snack to stave off late-night hunger, then go for it.

Also, keep in mind that there are approximately 7,000 things that can affect your ability to fall and stay asleep besides nighttime eating—caffeine intake, exercise, sleep habits, anxiety, sleep disorders. So instead of jumping to any conclusions, Dr. Dasgupta recommends keeping a sleep journal tracking all of these things for a couple weeks to see if there’s any correlation. If you notice that you consistently get less sleep or feel less well-rested in the morning after eating right before bed, then try shrinking or skipping your bedtime snack and see what happens.

Eating before bed and weight

Many of us associate nighttime eating with weight gain. In fact, you’ve probably seen weight loss tips about not eating past a certain hour. Plus, with the popularity intermittent fasting (where you only eat during a set window, like 10 a.m. to 6 p.m.), you might wonder if there’s something to that.

Long story short? There could be a connection there, but we don’t actually know enough about it yet to say much of anything. There is some research indicating an association between nighttime eating, weight, and metabolic function, Kelly C. Allison, Ph.D., an associate professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and director of the Center for Weight and Eating Disorders, tells SELF.

A literature review published in Physiology & Behavior in 2018, co-authored by Allison, concluded that while the body of research is flawed and incomplete, some findings from small studies suggest that the timing of eating impacts weight and metabolic function—specifically, with regular nighttime eating potentially contributing to metabolic dysfunction and daytime eating having no or beneficial effects.

One theory is that shifting calorie consumption to later in the day could alter the body’s circadian rhythm, which helps regulate metabolism. “Our bodies are set up to be awake and eating and moving during the day, and sleeping and fasting overnight,” says Alison. But this is still just a theory. The authors acknowledge the need for much more research, including larger and better-controlled studies conducted on diverse populations over longer periods of time, before we can make any generalizations about a link. (Alison recently wrapped up a pilot study on the topic.)

What we do know for sure? Even if there is a connection here, Alison says, it’s just one piece of the complex puzzle of your health, metabolism, and weight. “It’s still largely about the nutritional value and amount of food you’re eating, no matter the time of day,” Alison says.

Something else we can say with 100 percent confidence: Whether or not your weight ticks up or down based on your nighttime eating habits is not necessarily something to fret about. Weight is not the sole (or even most important) indicator of your health.

So at the end of the day—literally—you can probably snack before bed and sleep easy. If you are having a problem with heartburn, indigestion, or sleep quality, then it’s worth sticking to these general guidelines: Make it a smaller snack or meal, skip foods that are extremely fibery, fatty, spicy, or acidic, and time it at least a couple hours before you get into bed. And if your symptoms continue, make an appointment with your doc.


Do single people suffer more?

Researchers at the University of Health Sciences, Medical Informatics and Technology (UMIT, Hall, Austria) and the University of the Balearic Islands (Palma de Mallorca, Spain) have confirmed the analgesic effects of social support — even without verbal or physical contact.

The short communication, entitled “Dispositional empathy is associated with experimental pain reduction during provision of social support by romantic partners” by Stefan Duschek, Lena Nassauer, Casandra I. Montoro, Angela Bair and Pedro Montoya has recently been published in the Scandinavian Journal of Pain.

The authors assessed sensitivity to pressure pain in 48 heterosexual couples with each participant tested alone and in the passive presence of their partner. Dispositional empathy was quantified by a questionnaire.

In the presence, as compared to the absence, of their partners both men and women exhibited higher pain thresholds and tolerance as well as lower sensory and affective pain ratings on constant pressure stimuli. Partner empathy was positively associated with pain tolerance and inversely associated with sensory pain experience.

“Repeatedly, talking and touching have been shown to reduce pain, but our research shows that even the passive presence of a romantic partner can reduce it and that partner empathy may buffer affective distress during pain exposure,” said Professor Stefan Duschek of UMIT, speaking on behalf of the authors.

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Your heart’s best friend: Dog ownership associated with better cardiovascular health

Owning a pet may help maintain a healthy heart, especially if that pet is a dog, according to the first analysis of data from the Kardiozive Brno 2030 study. The study examines the association of pet ownership — specifically dog ownership — with cardiovascular disease risk factors and cardiovascular health. The results are published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

The study first established baseline health and socio-economic information on more than 2,000 subjects in the city of Brno, Czech Republic, from January 2013 through Dec. 2014. Follow-up evaluations are scheduled for five-year intervals until 2030.

In the 2019 evaluation, the study looked at 1,769 subjects with no history of heart disease and scored them based on Life’s Simple 7 ideal health behaviors and factors, as outlined by the American Heart Association: body mass index, diet, physical activity, smoking status, blood pressure, blood glucose and total cholesterol.

The study compared the cardiovascular health scores of pet owners overall to those who did not own pets. Then it compared dog owners to other pet owners and those who did not own pets.

“In general, people who owned any pet were more likely to report more physical activity, better diet and blood sugar at ideal level,” says Andrea Maugeri, Ph.D., a researcher with the International Clinical Research Center at St. Anne’s University Hospital in Brno and the University of Catania in Catania, Italy. “The greatest benefits from having a pet were for those who owned a dog, independent of their age, sex and education level.”

The study demonstrates an association between dog ownership and heart health, which is in line with the American Heart Association’s scientific statement on the benefits of owning a dog in terms of physical activity, engagement and reduction of cardiovascular disease risk.

Dr. Maugeri says that the study findings support the idea that people could adopt, rescue or purchase a pet as a potential strategy to improve their cardiovascular health as long as pet ownership led them to a more physically active lifestyle.

Francisco Lopez-Jimenez, M.D., chair of the Division of Preventive Cardiology at Mayo Clinic in Rochester, says that having a dog may prompt owners to go out, move around and play with their dog regularly. Owning a dog also has been linked to better mental health in other studies and less perception of social isolation — both risk factors for heart attacks. Dr. Lopez-Jimenez is a senior investigator of this study.

The study was performed in collaboration with Mayo Clinic, the International Clinic Research Center at St. Anne’s University Hospital, and the University of Catania. This research was supported by the National Program of Sustainability and the European Regional Development Fund.

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The fat of the land: Estimating the ecological costs of overeating

With every unfinished meal since Band Aid, you’ve heard it: “people are starving in Africa, y’know.” True, the UN estimates that rich countries throw away nearly as much food as the entire net production of sub-Saharan Africa — about 230 million tonnes per year. But is it any less a waste to eat the excess food?

Morally, it’s equivocal. Nutritionally, it depends. However: the land, water and carbon footprints are just the same.

In fact, researchers in Italy have proposed a way to measure the ecological impact of global food wastage due to excessive consumption. First, they estimated the net excess bodyweight of each country’s population — based on BMI and height data — and distributed its energy content among foods groups according to national availability.

Published in Frontiers in Nutrition, the results suggest that direct food waste — thrown away or lost from field to fork — is a mere hors-d’œuvre.

“Excess bodyweight corresponds to roughly 140 billion tonnes of food waste globally,” reports group lead Prof. Mauro Serafini, of the University of Teramo. This figure is a snapshot of the current world population’s accumulated dietary excesses, not a rate of overconsumption. It is, though, orders of magnitude higher than current annual direct food waste, estimated at 1.3 billion tonnes.

The disproportionate impact of Serafini’s so-called ‘metabolic food waste’ grows when its ecological costs are calculated, using per-kilo values from thousands of food lifecycle assessments. Fruits, vegetables, roots and tubers have the highest direct wastage rates, but excess energy consumption is dominated by more calorie-dense foods. These typically entail more land, water and greenhouse gases to produce.

So much so, that growing the world’s metabolic food waste would be expected to generate the equivalent of 240 billion tonnes of CO2. This is roughly the amount humankind released burning fossil fuels over the last seven years combined. Notably the EU, North America and Oceania together contribute as much to this estimate as the rest of the world combined, with meat, eggs and dairy accounting for 75%.

The total land and water figures are more difficult to interpret, as they do not take into account how long land is required to grow different foods — or the redistribution of water, which is not lost per se via agriculture. And though based on public data collected by the UN, WHO, WWF and BCFN — an EU-backed nutrition think tank — the whole approach is fraught with methodological and conceptual uncertainty.

The calculations are based on national availability of the main food commodities, not average food intake or typical sources of excess calories among the overweight and obese. They assumed that bodyweight beyond BMI 21.7 — midpoint of the ‘healthy’ range associated with lowest all-cause mortality — was all excessive, and all fat. How excess bodyweight is changing over time, or how much of it would vanish if physical activity were increased to healthier levels, are left unaddressed.

So, like Serafini we take metabolic food waste with a pinch of salt. But as back-of-a-napkin estimates of the ecological costs of dietary excess, these figures are close to as good as we’ll practically get. And they are monstrously high.

The glaring corollary: overeating is bad for our planet’s health, not just our own. And as highlighted by this month’s IPCC land-use report, overconsumption of farmed animal products by Westerners is probably the single biggest contributor.

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Junk food intake in children reduced by health education that addresses emotional issues

Teacher training followed by classroom education with information, activities, and emotional support improves lifestyles in teachers and students, according to research to be presented at ESC Congress 2019 together with the World Congress of Cardiology.(1) The study suggests that knowledge alone is insufficient to change behaviour.

“Numerous studies have addressed health issues in the school setting, but most have focused on physical activity and nutrition, with little attention to emotional issues such as self-esteem, depression and eating behaviours,” said study author Dr Carolinne Santin Dal Ri, a paediatrician at the Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil.

The Happy Life, Healthy Heart programme randomly allocated ten public schools in the city of Frederico Westphalen, Brazil, to the intervention group (five schools) or control group (five schools). The study included 473 students aged 6 to 12 and 32 teachers. Baseline assessments included weight, height, physical activity, food intake, and health knowledge in children; and physical activity and food consumption in teachers. Measurements were repeated after the intervention was completed.

The intervention had two stages: teacher training followed by students in the classroom. Teachers attended four meetings over a four-month period, were given a booklet, and had access to video lessons. The material was in seven chapters:

    1) risk factors for cardiovascular diseases in childhood;

    2) choice of healthy foods;

    3) food labelling;

    4) sodium, sugars and fats;

    5) emotional health and quality of life;

    6) physical activity; and

    7) healthy practices and changes in habits.

Each section contained theory plus suggestions for classroom activities based on the theme, age of the children, and intended goals.

In the classroom, teachers covered one theme per week, including at least one activity.(2) Teachers were free to choose or amend the activities and could incorporate them into projects based on the school’s syllabus. To encourage teacher participation, a group was created on a social network where they received messages and reminders from the researcher on the topic they were supposed to work on. Teachers also shared their own experiences. The researcher visited the intervention schools to stimulate teachers and offer guidance.

For the control group schools, teachers did not participate in the training course and students attended the school’s usual classes about health and healthy eating based on the curriculum.

Both students and teachers benefitted from the intervention. The proportion of students following Brazilian Food Guide advice to avoid pizza/hamburgers and soft drinks increased significantly by 15% and 20%, respectively. In addition, there was a 28% increase in the number of teachers who were physically active.

Dr Santin Dal Ri said: “Children in both the intervention and control groups increased their level of health knowledge during the study. But only those in the intervention group changed their eating behaviours. This suggests that information on its own does not lead to lifestyle improvements. In our study, a programme that combined information with playful activities and emotional support was beneficial for children and teachers.”

References and notes

(1) The abstract “Health education program at the “happy life, healthy heart” school: a randomized clinical trial” will be presented during Poster Session 7: Public health on Tuesday 3 September at 14:00 to 18:00 CEST in the Poster Area.

(2) The classroom intervention was scheduled for seven uninterrupted weeks. However, due to a state teachers’ strike, in four schools there was an average 45-day interruption at the end of week five, after which the intervention was completed. The fifth school was not affected by the strike and followed the initial schedule.

Story Source:

Materials provided by European Society of Cardiology. Note: Content may be edited for style and length.

So, Let’s Talk About That Whole Fertility and Age 35 Thing

You’ve probably heard the term “biological clock” used to describe the idea that, in people with ovaries, fertility potential is constantly ticking away as if it’s on a timer that will eventually reach zero. That ticking apparently gets louder and more urgent through your 20s and 30s, pushing you to get pregnant and have a baby. And then, so the story goes, something significant happens at the pivotal age of 35, when your chances of conceiving without assistance allegedly fall off a cliff, take a nosedive, or otherwise abide by whichever foreboding metaphor might come to mind. Except…that’s not really what happens.

As is usually the case with body-related things, the truth is so much more complicated than a pithy moniker like “biological clock” makes it seem. Unless something unusual and extreme happens, a person with ovaries won’t suddenly wake up on their 35th birthday unable to conceive. However, it is true that fertility declines over time and that fertility experts see 35 as something of a landmark age in this process. But why is that exactly? Here’s how fertility changes over time and what to keep in mind if you know you want to conceive at some point in the future.

Fertility is based on what’s known as ovarian reserve.

The term “ovarian reserve” generally describes how many eggs someone has available for ovulation, the quality of those eggs, and how well those eggs can interact with the hormones that control their development and ovulation, according to the American Society for Reproductive Medicine (ASRM). (Quick refresher: Ovulation is when an egg gets released from an ovary so it can potentially meet up with sperm and become fertilized. For a step-by-step explanation of that whole process, head right over here.)

It’s widely believed that people with ovaries are typically born with a whopping 1 to 2 million eggs, according to the American College of Obstetricians and Gynecologists (ACOG). That sounds like a hell of a lot. It is a hell of a lot. But most of those eggs don’t get a chance to burst forth from an ovary on a mission to potentially be fertilized.

By puberty (which is when ovulation starts), this egg number has already declined to 300,000 to 500,000, according to the ACOG. This is due to atresia, the ASRM explains, or the natural process through which follicles that house eggs in the ovaries degenerate and die.

Ultimately, of all those eggs you’re born with, “only approximately 400 will ovulate over the reproductive lifespan,” Pinar H. Kodaman, M.D., Ph.D., assistant professor in the division of reproductive endocrinology and infertility at Yale University School of Medicine, tells SELF. (This number will of course change if someone is on ovulation-suppressing birth control for long periods of time or if they have a health condition that impacts ovulation, like polycystic ovary syndrome).

Ovarian reserve is generally estimated to peak between a person’s late teens and late 20s, the ACOG explains. It then starts declining by age 30 (as does your fertility) partly because viable eggs are dying more quickly. But it’s not just the quantity of eggs you have that matters, it’s also the quality.

In addition to your number of viable eggs decreasing with age, as eggs get older, they’re more likely to have too many or too few chromosomes, the ASRM explains, which can make it harder to become pregnant and carry a pregnancy to term. “[With age], pregnancy rates decline [and]miscarriage rates increase,” Richard J. Paulson, M.D., division chief of reproductive endocrinology and infertility at the Keck School of Medicine of University of Southern California (USC), and director of USC Fertility clinic, tells SELF. Eventually, by the time you get to about age 45, the chances of conceiving without assistance are drastically lower than before, Dr. Paulson explains.

This is part of perimenopause, or the time when ovulation and menstruation happen less often, according to the Merck Manual. At this point, your menstrual cycle may get shorter, which means your periods might become irregular. It may still be possible to get pregnant naturally at that point, but it’ll be much more difficult. “With irregular cycles, the window of fertility is harder to predict,” Dr. Kodaman tells SELF.

Eventually, when you haven’t had a period for at least a year, you’re officially in menopause. The average age of menopause is 51, the ACOG says.

Since there’s a pretty wide gap between your mid-30s and when menopause sets in, what’s all the fertility-related commotion surrounding age 35?

There is some merit to treating 35 as a fertility landmark, but it’s not as scary as it sounds.

All of the experts SELF spoke to pointed out that this focus on fertility and age 35 isn’t baseless. This notion is founded in science.

“Declining fertility around the age of 35 is not just guesswork,” Joshua Johnson, Ph.D., assistant professor in the division of reproductive sciences at University of Colorado Denver, tells SELF.

As the ASRM notes in their committee opinion on optimizing natural fertility, it can be significantly harder for people with ovaries to get pregnant without assistance after age 35. However, this phenomenon has also been overstated to a potentially alarming point when there’s actually a ton of nuance involved.

In general, most people are still fertile and able to get pregnant naturally at age 35, but research shows that egg quantity and quality start to go down “more noticeably” around this age, Mary Ellen Pavone, M.D., associate professor in the division of reproductive endocrinology and infertility and director of in-vitro fertilization (IVF) at Northwestern University’s Feinberg School of Medicine, tells SELF. This can make it harder to get pregnant.

Note that she said “more noticeably.” As we mentioned above, declining fertility is a gradual process that starts around age 30, not one that’s non-existent until it kicks into overdrive at age 35. Plus, a ton of factors can influence fertility in different ways in different people of various ages, like health conditions, anatomical issues, and environmental influences we’ll discuss in some detail down below.

Figuring out the exact rate at which fertility declines by certain ages is actually pretty difficult, the experts explain. Landing on these figures would require a large number of couples having frequent, unprotected penis-in-vagina sex and reporting this activity honestly and accurately. That’s something researchers can’t easily coordinate. Instead, experts have concluded that fertility starts a steeper decline at 35 based on a variety of creative data, Dr. Johnson explains. Some of this thinking is based on studies of historical populations who didn’t use contraception for religious purposes or because it didn’t exist.

For instance, a 2014 review of six data sets in Human Reproduction examined women’s marriage and childbirth records from French parish registers between 1670 and 1830, combed through similar statistics from the Netherlands in the 1800s, and also looked at four other populations that haven’t had access to birth control. In total, they collected data for 58,051 women who’d gotten married at some point before 1900 and had children.

Across the data, the scientists looked at women’s ages the last time they gave birth to help estimate the end of their fertility. (Remember, the people in these studies weren’t using birth control. The age at which they stopped having kids was a pretty good indicator of their fertility, though not an absolute one, which we’ll discuss below.)

The researchers found that, on average, less than 3 percent of women had already had their last birth at age 20, meaning nearly 98 percent of people studied were able to have babies after that. Around 96 percent could still give birth after age 25, 93 percent after age 30, and 88 percent after age 35. The numbers changed a bit more sharply after that; by age 38, 20 percent of people had given their last birth, meaning around 80 percent (still a big number!) had at least one child after that. At age 41, the number of people who had no more children increased to almost 50 percent, and it was at nearly 100 percent by age 50.

Overall, those are pretty encouraging findings in the face of rumors that fertility free falls after 35. There are some questions that hang over this data, though. For example, the researchers couldn’t determine how often the people involved were having sex and whether this decreased over time, which could have made them less likely to get pregnant at an older age. But as the study authors note, the fact that this data came from a large sample size encompassing multiple countries in different time periods and with “remarkably similar” ages at last birth suggests a broad pattern in decreasing fertility with age. With that said, it’s worth noting that this is an observational study based on data from a pretty long time ago. Although the experts note that it’s unlikely for such a central process to humanity to change wildly in that span of time, they also explain that behavioral, societal, and historical shifts certainly have happened since then and could influence these results.

Large clinical studies using data from assisted reproductive technology (ART) clinics have also helped experts parse out how fertility declines with age, Dr. Johnson says. A different Human Reproduction study, this one published in 2011, looked at data from 3,889 cycles of IVF or ICSI (intracytoplasmic sperm injection) in people who were receiving donor eggs fertilized with the recipients’ partner’s sperm. Specifically, the researchers looked at the egg donors’ ages, recipients’ ages, and recipients’ partners’ age to see which most impacted the likelihood of pregnancy.

The results showed that the partners’ and recipients’ ages didn’t significantly affect the chances of conceiving, but the egg donors’ ages did. (Fertility in people who produce semen doesn’t generally decline significantly until around age 50.) People who used eggs from donors who were 35 to 39 were 14 percent less likely to get pregnant and 18 percent less likely to have a live delivery than people using egg donors who were 30 to 34. That’s definitely a decrease with age, but it’s not a stark drop-off right from 34 to 35—it’s a general reduction in odds across the age range of 30 to 39. As with the historical data study mentioned above, the decrease in fertility jumped much more after age 40. People using eggs from donors who were 40 and up were 42 percent less likely to get pregnant and 54 percent less likely to have a live delivery than people using egg donors who were 30 to 34.

So, no, fertility doesn’t do a straight vertical dive at age 35, but it does start to decline more rapidly.

Age isn’t the only factor that affects fertility.

Another issue with focusing the fertility conversation mostly on your 35th birthday is that it downplays the role that other factors can have on your fertility. In reality, there are other things that can cause problems conceiving sooner than many of us expect. Health conditions that affect the reproductive system are prime causes of this. For instance, polycystic ovary syndrome is the most common cause of infertility—defined as not getting pregnant within a year of trying—in people with ovaries, according to the Mayo Clinic. One of its hallmarks is irregular or absent ovulation, which can make it really difficult to get pregnant.

Conditions that damage or change important structures like the ovaries, fallopian tubes, or uterus can also make it harder than usual to conceive. Endometriosis, for example, can cause lesions on all of these structures, along with inflammation and scarring that can impede normal fertilization. Untreated pelvic inflammatory disease, which happens when bacteria (typically from a sexually transmitted infection like gonorrhea or chlamydia) spread to the reproductive organs, can similarly cause scarring and abscesses that make it really difficult or impossible to get pregnant.

These types of reproductive conditions can make it harder to get pregnant at any age, but according to the ACOG, the chances of developing a disorder that affects fertility increase as you get older. That’s yet another reason why it can be harder to get pregnant with age.

Then there are other factors that can harm fertility in a young person, like radiation treatment near the ovaries, chemotherapy, and smoking. These can bring about a condition known as premature ovarian failure, which is when your ovaries stop working for some reason before age 40, the Mayo Clinic explains. Heavy alcohol use can also damage fertility before it would normally drop with age.

If you know you want to conceive in the future, it’s a good idea to plan ahead.

If your 35th birthday is tomorrow, there’s no real reason to treat it as a funeral for your fertility. The data and the various factors affecting your fertility are much more complex than that. That said, if you know that you want to conceive with your own eggs and you have the resources available, it’s a good idea to be proactive. That means doing things like checking in with your gynecologist, quitting smoking, and cutting back on alcohol if you drink heavily. And, you know, factoring in the sperm, too. For some, that might mean having regular sex once you’re actually ready to get pregnant. (The Mayo Clinic notes that the highest pregnancy rates happen in couples who have sex every day or every other day, though it really matters most in the three days leading up to ovulation and the actual day you ovulate since that’s when you’re most fertile.) For others, that might mean talking to an assisted reproductive technology specialist about your options for sperm donation if that’s a route you’re looking to go down. It all depends on your situation.

If you’re under 35, experts generally recommend that couples with a penis and a vagina between them try to conceive the old-fashioned way for a year before checking in with a doctor about potential testing for infertility, the Mayo Clinic says. In this type of partnership, infertility happens due to issues with the partner with the ovaries one third of the time, the partner with the testicles another third, and both partners the remaining third. Testing may help you find out where you fall.

If you’re between 35 and 40, that recommendation to seek fertility testing drops to six months, and if you’re over 40, you may want to consider testing right off the bat.

However, Dr. Paulson says, if you’re in any age range and worried about your chances of getting pregnant, there’s no harm in talking to your doctor earlier on in the process for peace of mind or an action plan.

In addition, if you have a specific reason to think that you could have trouble conceiving, you might want to see a professional sooner than a year into trying, Lusine Aghajanova, M.D., Ph.D., clinical assistant professor of obstetrics and gynecology in the division of reproductive endocrinology and infertility at Stanford University, tells SELF.

If it turns out that you are having or would have trouble conceiving for a medical reason, you and your doctor can discuss potential options, like treating any related health conditions you may have, egg or embryo freezing, intrauterine insemination, and IVF.

The bottom line

Yes, you are statistically less likely to get pregnant after the age of 35 than you are in your 20s and early 30s, but it’s not as if every person’s chances of getting pregnant immediately plummet the same way and at the same exact age. In lieu of more perfect data, what we have is “just an increased risk [of trouble getting pregnant], it’s not an absolute,” Dr. Paulson says.

The earlier you start trying, the better your odds of not only conceiving but maintaining a pregnancy and having a healthy baby, but also, that doesn’t take your life into account. There are tons of reasons—financial, emotional, relationship-related, and more—why you might not be ready to have a baby in your 20s and early 30s. Now that you know it’s a myth that your biological clock is racing against age 35, hopefully you feel like you have a little more freedom to have babies in your own time.


Meet SCAD, a Major Cause of Heart Attacks in Women 50 and Under

If someone asked you to picture a heart attack patient, you might imagine an older man clutching his chest. In reality, every year an estimated 445,000 U.S. women 35 and older will experience a new heart attack, recurrent heart attack, or fatal outcome of coronary heart disease (which, in addition to heart attack, can cause issues like heart failure). A major cause of heart attacks in women is SCAD, or spontaneous coronary artery dissection. And the strangest thing about SCAD: It most commonly affects otherwise healthy women in their 40s and 50s.

In this article, we’ll be discussing how SCAD is known to be more prevalent in people who were assigned female at birth. We do not have data on whether or not hormonal or surgical transitioning has any effect on SCAD risk, but it is likely that this elevated risk also extends to trans men. While we refer to women throughout this article (particularly because gender bias is a known factor when it comes to diagnosing and treating heart attacks), it’s important to remember that you do not necessarily need to identify as a woman to be at a greater risk of SCAD.

How SCAD causes a heart attack

First, the basics: A heart attack occurs when one or more of the coronary arteries—blood vessels that have the all-important task of delivering oxygen to the heart—become blocked, according to the National Institute on Aging. This causes the part of the heart that doesn’t have enough oxygen to start to die.

In most cases, that blood vessel blockage happens because of a disease called atherosclerosis, or a buildup of plaque in your arteries that eventually hardens and constricts blood flow, the National Heart, Lung, and Blood Institute (NHLBI) explains. But other times, it occurs because of SCAD.

SCAD happens when a tear in an artery wall leads the inner layers of that wall to fill with blood and swell, according to the Mayo Clinic. This swelling compresses the lumen (the hollow part in the center of your artery through which blood travels) until adequate levels of blood can no longer stream through. That lack of blood flow can lead to a medical emergency like a heart attack.

Experts know SCAD is rare, but they aren’t sure exactly how often it happens. It has historically been underdiagnosed, mainly because heart attacks aren’t often suspected in younger, healthy women. Providers may also be less familiar with it as a cause of heart attack. In the general population, SCAD is estimated to cause just 1 to 4 percent of all incidents of acute coronary syndrome (a range of conditions that suddenly prevent blood flow to the heart), according to a 2018 scientific statement on SCAD from the American Heart Association (AHA). But its impact on women is shockingly disproportionate.

As a 2019 piece of research called The Canadian SCAD Study noted, women are estimated to comprise over 90 percent of SCAD patients. Many women with SCAD don’t have most of the risk factors you see in other cardiovascular diseases, like high blood pressure or diabetes, the Mayo Clinic explains. What’s more, SCAD affects many people who haven’t yet reached the average heart attack age, which is over 70 for women. These patients often haven’t even yet reached the age at which heart attack risk typically starts to rise, which is 55 in women.

“If you look at studies of SCAD, the mean age is anywhere between mid-40s to 50s,” cardiologist Marysia S. Tweet, M.D., assistant professor of medicine at the Mayo Clinic College of Medicine and Science and senior associate consultant in the department of cardiovascular medicine within the Division of Ischemic Heart Disease and Critical Care, tells SELF.

In fact, SCAD could be responsible for up to 35 percent of heart attacks in women 50 years or younger, the AHA concluded in their scientific statement. The others largely tend to be due to atherosclerosis. This distinction is really important—even though the number of female heart attack patients with SCAD is significant, they sometimes don’t receive proper diagnosis and treatment because they don’t have those typical heart disease risk factors.

Reading that is naturally a little scary, but remember that SCAD is a rare occurrence overall. It’s also not usually fatal; SCAD is thought to be at fault for around 0.5 percent of sudden cardiac deaths. Getting help as soon as you notice symptoms, no matter your age, is a critical part of surviving SCAD.

Symptoms of heart attacks caused by SCAD

Chest pain or chest pressure are the major symptoms of a heart attack for people of any sex, says Suzanne Steinbaum, D.O., a cardiologist at The Mount Sinai Hospital and volunteer medical expert for the AHA’s Go Red for Women. That includes heart attacks that happen due to SCAD.

Beyond chest discomfort, heart attack symptoms can be nuanced and surprising, especially for women. “In women, symptoms of heart attacks can be much more subtle,” Dr. Steinbaum tells SELF. These symptoms can include pain in the jaw, stomach, back, neck, and arms; nausea; lightheadedness; and shortness of breath severe enough to be “unignorable,” Dr. Steinbaum says. “If that’s what you’re feeling, that’s when you need to get help,” she adds.

At this point, you have a fair amount of background information about SCAD. But one of the biggest questions you may have—it’s certainly one of the most pressing questions troubling SCAD experts—is why this condition so disproportionately affects women.

How hormones and pregnancy play a role in SCAD

Experts believe that the hormones estrogen and progesterone could play a part in SCAD, the AHA’s 2018 scientific statement on SCAD explains. Estrogen and progesterone have been shown to weaken blood vessel walls, which could leave them more vulnerable to the kind of tear that results in SCAD.

With that said, researchers are still trying to narrow down the exact mechanism behind this potential cause and effect. Experts are also still investigating how much, if at all, external hormones like those in birth control or hormone therapy may contribute to weakened blood vessel walls. As of now, there’s no established evidence that these external hormone sources are clear SCAD risk factors. They only really become a concern in someone who already has a history of SCAD, at which point doctors want to really carefully weigh the benefits of hormone-containing contraception and hormone therapy against the theoretical (but unproven) risks.

Now that you know the hormone connection with SCAD, a few of the other risk factors will make a lot more sense. Pregnancy, for instance, increases a person’s odds of SCAD, especially having had four or more pregnancies (known as multiparity).

Before we explain why, it’s really important to remember that the vast majority of people will not have any kind of heart attack while pregnant or postpartum. A 2018 study in Mayo Clinic Proceedings analyzed 55,402,290 pregnancy-related hospitalizations that occurred from 2002 through 2014, finding that heart attacks happened in 8.1 per 100,000 of these hospital visits (some of which happened postpartum). Those are already really unlikely odds, even more so when you consider that this study looked at pregnant people who went to the hospital, not the total number of pregnant people in the country, many of whom wind up being completely fine.

However, of those heart attacks that happen during or right after pregnancy, a significant number involve SCAD. Some experts believe SCAD may even be the number one cause of heart attack in pregnancy and the postpartum period. A 2016 BMJ study the AHA referenced in their scientific statement on SCAD found 1.81 SCAD events per 100,000 pregnancies, up to and including six weeks after delivery. That’s still uncommon, but prevalent enough to get researchers’ attention.

Experts believe the significant hormonal changes that come with pregnancy and giving birth could be largely to blame here. Since most cases of pregnancy-associated SCAD actually occur in the postpartum period—which is when you see a significant drop in estrogen and progesterone—Dr. Tweet explains that fluctuating hormone levels (rather than the hormones themselves) could contribute to SCAD.

“There are receptors for hormones on the vasculature [i.e., blood vessels], including the coronary arteries, so we’re still trying to tie it together,” Dr. Tweet tells SELF.

Other physiological elements of pregnancy and birth can contribute to SCAD, such as increased blood volume shunting around the body. Pushing during vaginal labor can also be a factor, because it’s what’s known as a Valsalva maneuver, or essentially bearing down while holding your breath. This extreme physical exertion can be one of many things that coalesce to trigger SCAD. (We’ll explore that a bit more down below.)

Though it’s generally quite rare, researchers are keen to raise awareness about the risk of SCAD in pregnancy and the postpartum period because SCAD can be more serious at this time. “When it is a pregnancy-related or postpartum SCAD, those patients do tend to present more severely … which means usually they’re also sicker,” Dr. Tweet says.

How stress and mental health play a role in SCAD

SCAD patients commonly report having mental health conditions like chronic stress, depression, and anxiety, and notably at higher rates than other heart attack patients. On the flip side, having SCAD can bring about or exacerbate these conditions in the recovery period.

A more sudden type of stress could also trigger SCAD. Intense stress (like the type that comes with the sudden news of a death) can cause an adrenaline surge that increases blood pressure and heart rate, which can lead to an arterial tear, Malissa J. Wood, M.D., co-director of the Corrigan Women’s Heart Health Program, director of the SCAD program at the Massachusetts General Hospital Heart Center, and associate professor of medicine at Harvard Medical School, tells SELF.

It’s a well-known fact that women have higher rates of many mental health conditions than men do. According to numbers cited by the National Institute of Mental Health (NIMH), 23.4 percent of women reported having any type of anxiety disorder in the past year compared with 14.3 percent of men. When it comes to depression, 8.7 percent of women reported at least one major depressive episode in the past year as opposed to 5.3 percent of men, the NIMH says. These health conditions can contribute to stress and vice versa.

There’s a host of reasons why women can be more vulnerable to certain mental health conditions, the World Health Organization (WHO) explains. Women are more likely to experience things like gender-based violence, lower socioeconomic status, a lack of societal power, and pressure to care for others over themselves. But one major complicating factor in estimating gender-based differences in mental disorder prevalence is that women may be more likely to seek help for conditions like depression than men, the NIMH explains.

Other known risk factors for SCAD

Having certain conditions that affect the blood vessels can make someone more susceptible to SCAD. Fibromuscular dysplasia (FMD) is the arterial disease most strongly linked to SCAD, and it happens when irregular cell growth causes arteries to alternately swell and narrow, ultimately constricting blood flow. This can impact arteries all over the body, but when it happens to arteries leading to the heart, it can cause SCAD.

FMD symptoms can change depending on which arteries it affects, but overall, it doesn’t tend to cause any major signs. “Unfortunately, [FMD] tends to be silent with most cases,” Jacqueline Saw, M.D., clinical associate professor in the division of cardiology at the University of British Columbia in Canada and principal investigator of The Canadian SCAD Study, tells SELF. That is, until it becomes severe enough to lead to something like SCAD.

Some research suggests that as many as 60 to 70 percent of SCAD patients have underlying FMD, which tends to be vastly more prevalent in women. Estimates suggest that over 90 percent of people with FMD are women, according to the Cleveland Clinic. Again, hormones are a big contributing factor here, though experts aren’t sure how. Smoking (which damages arteries) and a family history of FMD are additional risk factors, according to the Mayo Clinic.

Since blood vessel problems are central to SCAD, other health conditions that affect this part of the circulatory system may also play a role. For instance, lupus (which more commonly affects women) causes bodily inflammation that can affect the blood vessels, the Mayo Clinic explains.
It’s also possible that SCAD can be triggered by excessive physical exertion, Dr. Wood says, like “doing something that is much more vigorous than one has done previously or routinely, such as going out and running very, very hard in a race, or lifting something extremely heavy.” In addition to FMD, physical exertion happens to be a major SCAD risk factor in men.

Finally, genetic connective tissue disorders like Marfan, Ehlers-Danlos, or Loeys-Dietz syndromes also seem to be associated with SCAD. However, since these conditions are already considered rare and not everyone who has them will experience SCAD, these represent a minority of cases, Dr. Wood tells SELF.

Taking SCAD symptoms seriously

If you experience any SCAD symptoms, call 911. “A lot of women—young women in particular—ignore their symptoms,” Dr. Saw says. But getting treatment ASAP “[increases] the likelihood that you will not damage your heart muscles further,” Dr. Tweet explains. “People [with SCAD] can go on to live very well, particularly since they usually don’t have a whole lot of other medical problems.”

Treatment for SCAD can be really varied depending on the specifics of the case, but the point is to repair the tear so blood can flow to the heart in normal amounts. SCAD can actually heal on its own in many people, the Mayo Clinic explains, in which case doctors might prescribe medications to relieve symptoms like chest pain while allowing your heart to mend and also monitoring whatever may have caused the SCAD.

If more conservative treatments like watchful waiting and medication haven’t been effective enough, surgery to repair the tear may be recommended. However, Dr. Wood says, this isn’t always necessary. Getting the right diagnosis is crucial when it comes to treating SCAD, so if you’re younger than expected for a heart attack, have any of the above risk factors, and your doctors diagnose you with atherosclerosis, ask them if they’ve considered SCAD as a cause.