Birth Control Helped Us Reach Historically Low Abortion Rates, But the Trump Administration Could Change That

A new report from the Centers for Disease Control and Prevention (CDC) shows that abortion rates are down across the board and suggests that people are able to more effectively plan their reproductive futures. Yet, the Trump administration has finalized a regressive set of health insurance policy changes that could roll back access to the very thing that has helped us get here: birth control.

For the report, the CDC looked at data from central health agencies in the District of Columbia, New York City, and 47 states (excluding California, Maryland, and New Hampshire) for every year from 2006 to 2015, and found a steep decline using every metric. In fact, all three metrics—the total number, rate, and ratio of abortions (the amount of abortions there are compared to live births)—reached historic lows for the study period (2006-2015).

The total number of reported abortions decreased 24 percent during this period, from 842,855 in 2006 to 638,169 in 2015. The rate of abortions among women aged 15 to 44 fell 26 percent, from 15.9 abortions per 1,000 women to 11.8. And the abortion ratio decreased as well, by 19 percent.

The report found that these numbers declined across all age groups, races, and ethnicities, yet “well-documented disparities persist.” For instance, abortion rates are 1.5 times higher among Hispanic women than among non-Hispanic white women, and 3.6 times higher among non-Hispanic black women than among non-Hispanic white women.

But the major factor behind these downward trends isn’t our shrinking access to abortions (although that undoubtedly played a role)—it’s our increased access to birth control. “Efforts to help women avoid pregnancies that they do not desire might reduce the number of abortions,” the report reads, continuing on to say that “providing contraception for women at no cost can increase use of these methods and reduce abortion rates.”

The CDC report follows previous research that showed that access to effective birth control could lead to lower abortion rates, likely by helping to prevent unintended pregnancies.

For instance, research from the Guttmacher Institute looking at data from 2008 to 2011 found that “the steep drop in unintended pregnancy—including births and abortions—was likely driven by improved contraceptive use.”

The researchers point specifically to increased use of highly effective long-acting reversible contraceptives (LARCs)—such as IUDs and implants—during this period. These forms of birth control “don’t have much room for user error, and so people are less likely to accidentally get pregnant,” Rachel Jones, Ph.D., principal research scientist at the Guttmacher Institute, tells SELF.

Later, the implementation of the Affordable Care Act (ACA) in 2012 bolstered this trend with its birth control mandate, which requires employers to offer insurance plans that cover at least one form of FDA-approved birth control from each method category at zero cost to the patient (meaning no co-pay or co-insurance). (The mandate included exemptions for churches and certain religious organizations, like Catholic hospitals.)

These provisions “appear to have spurred continued improvements in contraceptive use beyond 2012,” according to Guttmacher. The mandate made it more economically feasible for women to afford contraceptives, and previously cost-prohibitive LARCs in particular, Jones says. A study of 417,221 women in Contraception found that between 2012 and 2014, the rate of women paying out of pocket for an IUD fell from 58 percent to 13 percent. And research shows that when financial barriers are removed, women are much more likely to choose LARC methods, and therefore less likely to experience an unintended pregnancy and subsequent abortion.

The CDC report mirrors this trend: The drop in abortion was much more dramatic during the period from 2011 to 2015 (after the ACA was implemented) than the period from 2006 to 2010. For example, the abortion ratio decreased by 7.4 abortions per 1,000 live births per year from 2011 to 2015, but by only 0.37 abortions per 1,000 live births per year from 2006 to 2010.

Despite these trends, the Trump administration has made moves to limit access to birth control on the basis of companies’ religious or moral beliefs.

The final rules state that any privately or publicly held company, nonprofit, university, or individual may be exempted from the mandate if they hold religious or nonreligious beliefs against birth control.

If that sounds pretty vague to you, you’re right. The text does not lay out what constitutes a “non-religious moral conviction.” And the broad, ambiguous phrasing would seem to be potentially applicable to pretty much any person or entity who is against birth control on any grounds.

The rules will go into effect on January 7, 2019, barring lawsuits seeking to block them. As SELF previously reported, California and Pennsylvania have filed appeals after losing lawsuits against the federal government over early drafts of these rules, and more suits may be filed now that the rules are final.

The Department of Health and Human Services (DHHS) estimates that the exemptions will have minimal impact, affecting 200 or fewer employers and anywhere from 6,400 to 127,000 women. Jones says that her colleagues at Guttmacher also predict the effects will be “relatively small,” but it’s too soon to tell for sure. “To be honest, we don’t have any idea how many companies or organizations will take advantage,” she says.

Reproductive health experts see the move as a medically unsound threat to women’s reproductive health and the declines in abortion.

The decreases we’ve seen are “largely due to people’s increased access to effective and affordable birth control,” Leana Wen, M.D., president of the Planned Parenthood Federation of America (PPFA), said in a statement. “And yet, in the midst of this unprecedented progress, the Trump-Pence administration and politicians in states across the country want to take away our rights and access to reproductive health care, including placing restrictions on what we know works—birth control.”

On November 8, a broad consortium of medical organizations representing over 423,000 doctors and medical students—the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Psychiatric Association—issued a powerful joint statement rebuking the administration’s decision and urging them to withdraw the rules.

“By undercutting women’s access to contraception, a key preventive service, at no out-of-pocket cost in private insurance plans, the final rules conflict with our firmly held belief that no woman should lose the coverage she has today,” they write. “No-copay coverage of contraception has an undeniable positive effect on the health of women and families everywhere.” Correspondingly, “efforts to decrease access to contraceptive services will have damaging effects on public health.” (Plus, as SELF previously reported, hormonal contraception may come with a multitude of benefits that are unrelated to pregnancy, like making your period more manageable, managing pain from endometriosis, and lowering your risk for ovarian cancer.)

“The final rules follow an alarming pattern of medically unnecessary decisions in women’s health policy that, together, undermine women’s access to care,” Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists (ACOG), said in a statement. “This attack on birth control is only the latest in a series of attacks,” Dr. Wen said, such as changes to Title X funding and the proposed gag rule, and defunding Planned Parenthood.

The ultimate course of these policy changes is yet to be seen, but the medical community’s response to this most recent move has been loud and clear: We need more access to reproductive healthcare, not less. “If we want to continue to reduce the rate of unintended pregnancy in this country,” Dr. Wen said, “we must ensure that every person has access to the full range of birth control methods.”

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BRCA Testing: Do You Get It When You Have Breast or Ovarian Cancer?

It might feel like your world stops after receiving a diagnosis of breast or ovarian cancer. Even in that mental and emotional fog, there are several next steps to consider. Coming up with a treatment plan is a big one, along with finding out whether or not you need any kind of additional exams, like BRCA testing to look for certain genetic mutations that increase cancer risk. Here’s what you should know about BRCA testing and who might want it after a breast or ovarian cancer diagnosis.

In people without genetic mutations, BRCA1 and BRCA2 genes create proteins that help to suppress tumors by controlling cell growth.

These proteins repair damaged DNA that can otherwise lead to cancer, the National Cancer Institute (NCI) explains. So, if your BRCA1 or BRCA2 genes have mutated, they may not be able to adequately fix cell damage. As a result, your cells are more likely to develop more genetic alterations that can eventually lead to cancer. (FYI: There are some BRCA mutations that are “ambiguous” in that experts aren’t yet sure if they increase cancer risk. Unless otherwise stated, we’re only talking about BRCA mutations known to raise cancer risk.)

BRCA mutations are involved in 5 to 10 percent of breast cancer cases and about 15 percent of ovarian cancer cases, according to the Mayo Clinic. If either one of your parents carries a BRCA gene mutation, you have a 50 percent chance of inheriting it, the NCI says.

Although BRCA gene mutations can raise your risk of developing a variety of different cancers, like that of the pancreas, they’re most closely linked with increased odds of getting breast and ovarian cancer.

Around 12 percent of people with ovaries in the general population will get breast cancer at some point, according to the NCI. A 2017 study published in JAMA that analyzed 6,036 people with ovaries and BRCA1 mutations and 3,820 with ovaries and BRCA2 mutations sheds some light on how these mutations affect that risk. According to the study, about 72 percent of people with ovaries and a BRCA1 mutation will develop breast cancer before they turn 80. That number dips slightly to 69 percent for BRCA2 mutations.

The study also found that about 44 percent of people with ovaries with a BRCA1 mutation and 17 percent of people with ovaries with a BRCA2 mutation will develop ovarian cancer by age 80. That’s much higher than the general population’s risk of 1.3 percent.

If you already have a cancer diagnosis, your specific risk factors will help determine if you should get BRCA testing.

Unfortunately, developing one kind of cancer caused by a BRCA gene mutation doesn’t waive your risk of getting other BRCA-induced cancers in the future, Stephen Rubin, M.D., chief of the Division of Gynecologic Oncology at Fox Chase Cancer Center, tells SELF. “That’s why we often recommend genetic testing,” he says.

That doesn’t mean experts suggest that everyone with a breast or ovarian cancer diagnosis undergoes testing for BRCA mutations. Your other risk factors will play a huge role here. In general, your doctor is going to recommend testing if any of the following applies to you, according to the Mayo Clinic:

  • Being diagnosed with breast cancer before menopause or age 50
  • Being diagnosed with triple negative breast cancer diagnosed at age 60 or younger
  • Having cancer in both breasts
  • Having both breast and ovarian cancers
  • Having ovarian cancer at all, since it’s rarer and more closely linked with BRCA mutations
  • In addition to having breast cancer, having one or more relatives with breast cancer diagnosed at age 50 or younger, one relative with ovarian cancer, or two or more relatives with breast or pancreatic cancer
  • Having two or more close relatives, like parents or siblings, diagnosed with breast cancer at a young age
  • Having a male relative with breast cancer
  • Having a family member who has both breast and ovarian cancers
  • Having a family member with cancer in both breasts
  • Having a relative with ovarian cancer
  • Having a relative with a known BRCA1 or BRCA2 mutation
  • Being of Ashkenazi (Eastern European) Jewish ancestry with a close relative who has breast, ovarian, or pancreatic cancer at any age

But some of this will also depend on your doctor. Some doctors will strongly urge you to undergo testing if you’ve been diagnosed with breast or ovarian cancers, while others may not depending on the specific type of each cancer you have.

Either way, you should only get testing after receiving thorough information about the process and what the results might mean, Susan Vadaparampil, Ph.D., M.P.H., a senior researcher in the Health Outcomes and Behavior Department at Moffitt Cancer Center, tells SELF. For instance, getting a positive result doesn’t mean you’ll definitely get breast or ovarian cancer, just as a negative result doesn’t mean you absolutely won’t. A doctor or genetic counselor can walk you through whether or not BRCA testing makes sense for you.

If you do get BRCA testing, the physical process shouldn’t be complicated.

Ask your doctor how to prepare for the test, like by collecting as much information you can about your family’s medical history (and your own).

During the actual test, a medical professional will take either a blood or saliva sample, according to the Mayo Clinic. “Then off to a testing laboratory it goes,” David Cohn, M.D., a gynecologic oncologist and chief medical officer at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, tells SELF. The results should be available in about two to six weeks, Dr. Vadaparampil says.

Waiting for the results might be incredibly hard emotionally, as can receiving a positive or ambiguous result that may make it feel like you’re destined to get more cancer in the future. This is the time to really lean on your support system, like your oncologist, genetic counselor, loved ones you trust, and any cancer support groups you may belong to.

If your test shows a BRCA mutation, you can meet with your doctor or a genetic counselor to discuss the results and any next steps to consider in addition to your cancer treatment, like a risk-reducing surgery to remove both breasts, your ovaries, and/or your fallopian tubes (where many ovarian cancers actually originate). You can also discuss what this means for your family. You may want to share your results with any blood relatives and encourage them to consider genetic testing and counseling, Dr. Cohn says.

If your doctor has recommended BRCA testing and you’re on the fence, Dr. Rubin urges you to consider how important it is. “I tell patients knowledge is power,” he says. “Knowing that you do or don’t have these mutations can do a lot.”

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Bigger brains are smarter, but not by much

The English idiom “highbrow,” derived from a physical description of a skull barely able to contain the brain inside of it, comes from a long-held belief in the existence of a link between brain size and intelligence.

For more than 200 years, scientists have looked for such an association. Begun using rough measures, such as estimated skull volume or head circumference, the investigation became more sophisticated in the last few decades when MRIs offered a highly accurate accounting of brain volume.

Yet the connection has remained hazy and fraught, with many studies failing to account for confounding variables, such as height and socioeconomic status. The published studies are also subject to “publication bias,” the tendency to publish only more noteworthy findings.

A new study, the largest of its kind, led by Gideon Nave of the University of Pennsylvania’s Wharton School and Philipp Koellinger of Vrije Universiteit Amsterdam, has clarified the connection. Using MRI-derived information about brain size in connection with cognitive performance test results and educational-attainment measures obtained from more than 13,600 people, the researchers found that, as previous studies have suggested, a positive relationship does exist between brain volume and performance on cognitive tests. But that finding comes with important caveats.

“The effect is there,” says Nave, an assistant professor of marketing at Wharton. “On average, a person with a larger brain will tend to perform better on tests of cognition than one with a smaller brain. But size is only a small part of the picture, explaining about 2 percent of the variability in test performance. For educational attainment the effect was even smaller: an additional ‘cup’ (100 square centimeters) of brain would increase an average person’s years of schooling by less than five months.” Koellinger says “this implies that factors other than this one single factor that has received so much attention across the years account for 98 percent of the other variation in cognitive test performance.”

“Yet, the effect is strong enough that all future studies that will try to unravel the relationships between more fine-grained measures of brain anatomy and cognitive health should control for total brain volume. Thus, we see our study as a small, but important, contribution to better understanding differences in cognitive health.”

Nave and Koellinger’s collaborators on the work, which is published in the journal Psychological Science, included Joseph Kable, Baird Term Professor in Penn’s Department of Psychology; Wi Hoon Jung, a former postdoctoral researcher in Kable’s lab; and Richard Karlsson Linnér, a postdoc in Koellinger’s lab.

From the outset, the researchers sought to minimize the effects of bias and confounding factors in their research. They pre-registered the study, meaning they published their methods and committed to publishing ahead of time so they couldn’t simply bury the results if the findings appeared to be insignificant. Their analyses also systematically controlled for sex, age, height, socioeconomic status, and population structure, measured using the participant’s genetics. Height is correlated with higher better cognitive performance, for example, but also with bigger brain size, so their study attempted to zero in on the contribution of brain size by itself.

Earlier studies had consistently identified a correlation between brain size and cognitive performance, but the relationship seemed to grow weaker as studies included more participants, so Nave, Koellinger, and colleagues hoped to pursue the question with a sample size that dwarfed previous efforts.

The study relied on a recently amassed dataset, the UK Biobank, a repository of information from more than half-a-million people across the United Kingdom. The Biobank includes participants’ health and genetic information as well as brain scan images of a subset of roughly 20,000 people, a number that is growing by the month.

“This gives us something that never existed before,” Koellinger says. “This sample size is gigantic — 70 percent larger than all prior studies on this subject put together — and allows us to test the correlation between brain size and cognitive performance with greater reliability.”

Measuring cognitive performance is a difficult task, and the researchers note that even the evaluation used in this study has weaknesses. Participants took a short questionnaire that tests logic and reasoning ability but not acquired knowledge, yielding a relatively “noisy” measure of general cognitive performance.

Using a model that incorporated a variety of variables, the team looked to see which were predictive of better cognitive performance and educational attainment. Even controlling for other factors, like height, socioeconomic status, and genetic ancestry, total brain volume was positively correlated with both.

The findings are somewhat intuitive. “It’s a simplified analogy, but think of a computer,” Nave says. “If you have more transistors, you can compute faster and transmit more information. It may be the same in the brain. If you have more neurons, this may allow you to have a better memory, or complete more tasks in parallel.

“However, things could be much more complex in reality. For example, consider the possibility that a bigger brain, which is highly heritable, is associated with being a better parent. In this case, the association between a bigger brain and test performance may simply reflect the influence of parenting on cognition. We won’t be able to get to the bottom of this without more research.”

One of the notable findings of the analysis related to differences between male and females. “Just like with height, there is a pretty substantial difference between males and females in brain volume, but this doesn’t translate into a difference in cognitive performance,” Nave says.

A more nuanced look at the brain scans may explain this result. Other studies have reported that in females, the cerebral cortex, the outer layer of the front part of the brain, tends to be thicker than in males.

“This might account for the fact that, despite having relatively smaller brains on average, there is no effective difference in cognitive performance between males and females,” Nave says. “And of course, many other things could be going on.”

The authors underscore that the overarching correlation between brain volume and “braininess” was a weak one; no one should be measuring job candidates’ head sizes during the hiring process, Nave jokes. Indeed, what stands out from the analysis is how little brain volume seems to explain. Factors such as parenting style, education, nutrition, stress, and others are likely major contributors that were not specifically tested in the study.

“Previous estimates of the relationship between brain size and cognitive abilities were uncertain enough that true relationship could have been practically very important, or, alternatively, not much different from zero,” says Kable. “Our study allows the field to be much more confident about the size of this effect and its relative importance moving forward.”

In follow-up work, the researchers plan to zoom in to determine whether certain regions of the brain, or connectivity between them, play an outsize role in contributing to cognition.

They’re also hopeful that a deeper understanding of the biological underpinnings of cognitive performance can help shine a light on environmental factors that contribute, some of which can be influenced by individual actions or government policies.

“Suppose you have necessary biology to become a fantastic golf or tennis player, but you never have the opportunity to play, so you never realize your potential,” Nave says.

Adds Koellinger: “We’re hopeful that, if we can understand the biological factors that are linked to cognitive performance, it will allow us to identify the environmental circumstances under which people can best manifest their potential and remain cognitively health. We’ve just started to scratch the surface of the iceberg here.”

The research was supported by an ERC Consolidator Grant, the Wharton Neuroscience Initiative, and Wharton’s Dean Research Fund.

Why This Registered Dietitian Tells (Some of) Her Patients to Avoid Kale Salads

I’ve worked as a dietitian in a gastroenterology practice long enough to have seen many food trends come and go.

When I first started practicing, an austere, sugar-free regimen called the “candida diet” was popular among patients of mine who had gone the alternative health route before consulting with me, so I practically got whiplash when just a few years later, the juicing craze hit and suddenly everyone seemed to be consuming nothing but sugar. After all, juicing just means creating a cocktail of concentrated sugars from the fruits and vegetables they derive from. Soon after, my patients ushered me through the paleo craze (what I call the neo-Paleolithic era of 2013-2014), and I’ve watched as increasing numbers of them have gone gluten-free since then as paleo and paleo-esque diets like Whole30 mandate cutting out gluten-containing foods. Starting in 2015, I’ve been called upon by patients figuring out how to eat “normally” again after so-called clean diets scared them into thinking that dairy, sugar, grains, and legumes were basically poison. Soon after, I watched helplessly as the ketogenic diet claimed almost everything that was healthy and good from some of my patients’ diets in favor of bacon, beef, and cheese. Most recently, I’ve been helping patients make sense of the overwhelming dietary dictates emerging from personalized food sensitivity and gut microbiome tests.

The particulars of each new diet sensation vary, but the scenario I encounter with my patients on these programs has been remarkably consistent. People arrive at my office having recently adopted a new regimen for which they drastically change their usual eating habits—eliminating certain foods and wholeheartedly embracing others—all in a quest for better health, better energy, and better living. Sometimes, at least initially, weight seems to be coming off, much to their delight. They’re excited about this new-found way of eating that promises to help them achieve their goals for health and weight. But diets based in eliminating and/or restricting foods and food groups rarely lead to longterm, sustained change. As SELF has reported, the ketogenic diet, for example, doesn’t seem to be any more or less effective for short term weight loss than any other way of restricting calories (and long term weight loss by way of keto is thought to be unlikely). Not only are elimination-based diets not necessarily helpful for weight loss, cultivating a relationship with food that’s based on restriction and avoidance is just unhealthy.

But there’s another, slightly sneakier culprit lurking in these fad diets. They may bring exciting changes after a few days or weeks, sure. But digestive system bliss? Not so much. Sometimes, after pivoting hard to a brand new healthy eating habit, people make an unexpected discovery: the foods they think of as good can sometimes make you feel bad.

I’ve seen newly minted vegans struggle with incessant gas and bloating on their new plant-based diets. I’ve seen people embrace giant salads for lunch every day, only to be rewarded with the telltale lower intestinal churning that requires a graceful but urgent exit from afternoon meetings.

This is but a small sampling of all the healthy-eating deeds that haven’t gone unpunished in my years of counseling patients with digestive disorders.

There are countless reasons why objectively nutrient-dense, health-promoting foods might not agree digestively with a given individual.

One common issue I see pertains to foods high in insoluble fiber, or what we commonly think of as “roughage.” It’s the crunchy, tough stuff found in leafy greens, fruits and veggies with thick skins or lots of seeds, popcorn kernels and bran, tough-coated seeds and crunchy nuts, stringy celery, or woody asparagus stalks. These coarse, highly textured types of fiber can remain surprisingly intact even after chewing, which leaves quite a job for the digestive system organs to break down into passable particle sizes. For some susceptible people, this means that large portions of such foods will spend a prolonged time being churned around in the stomach, provoking acid indigestion and upper stomach bloating.

Insoluble fiber is also unable to absorb or retain water in the digestive tract, which can result in irregular bowel movements of varying types. People with speedy digestive systems or whose intestines are hypersensitive to stimuli—such as those with Irritable Bowel Syndrome (IBS)—can find that eating a load of bulky foods high in insoluble fiber triggers urgent, crampy and unformed stools, often within an hour of consumption. Conversely, some people with slower gut transit may find that diets very high in roughage leave them feeling totally backed up, able only to pass hard, dried out stools that come out in incomplete pebbles. As these people learn the hard way, adopting a low-carb diet that excludes grains, root veggies, and fruits—all foods that contain the moisture-holding, formed-stool-promoting soluble fiber—may change your bowel patterns in unanticipated and unwelcome ways.

Gas can be another side effect of healthy diets, owing to high intake of certain types of carbohydrates that our gut bacteria find particularly delicious. Beans and lentils, soy protein-based meatless foods, Brussels sprouts, broccoli, beets, and cashews are all highly nutritious staples of a plant-based diet—and all of them share a type of fiber called galacto-oligosachardies (GOS). As is the case for all fiber, we humans lack digestive enzymes to break GOS down and extract energy (calories) from it. (That’s what makes it fiber!) But the microorganisms inhabiting our intestines have no such problems. They can ferment this fiber particularly well, and ferment it they do. Fortunately for us, feeding bacteria with lots of fiber seems to promote good gut health. But unfortunately for us, a key byproduct of bacterial fermentation is gas, and the more such fibers we feed them, the more gas they produce. Different people make different amounts of gas based on what kind of bacteria they harbor. While having lots of intestinal gas can be a badge of pride bestowed on you by a healthy diet, some people find too much of it to be, well, too much, either for their physical or social comfort.

Similarly, we humans can’t digest a type of naturally occurring, highly fermentable sugar alcohol called mannitol which happens to be found in #cauliflower (1,000,000 Instagram posts and counting!). This may explain why some folks looking to reduce intake of carbs (in general) and highly processed grains (in particular) can find themselves battling a sharp uptick in gas and gas pain when embracing novel dishes like cauliflower “rice,” cauliflower crackers, cauliflower gnocchi and cauliflower pizza in lieu of their grain-based alternatives. To be clear, getting gassy from too much cauliflower doesn’t mean you have some underlying digestive disease that needs to be fixed; gas is only a problem if its, well…a problem.

Then there’s the diarrhea that some people experience as the result of too much fructose or sorbitol—two naturally occurring sugars found in many unrefined sugars and fruits. While you may have heard of lactose intolerance, there’s a lesser-known condition called fructose intolerance, in which an individual may not be able to absorb the natural sugar, fructose, particularly well. This predisposes them to diarrhea several hours after consuming fructose-rich foods. So if you find yourself clutching your belly as you race to the bathroom several hours after downing a green-apple-based cold-pressed juice, an agave-sweetened protein drink, or a mango and granola topped smoothie bowl, there’s a perfectly logical explanation.

The knee-jerk reaction most of my patients have when I explain why their healthy diet may not be agreeing with them is incredulous, “But I thought I was being so good!”

This is when I find myself explaining that healthfulness and tolerability are two separate issues.

Whether a food agrees with you digestively (or otherwise) says nothing about whether it is a “good” food, nor is it a referendum on your character. Contrary to the popular aphorism, you are not what you eat.

Consider the following: there are hundreds of objectively healthy foods out there for us to choose from: veggies rich in all manner of powerful antioxidants, fruits rich in potassium and vitamins, nuts and seeds rich in magnesium, fish and plant-based foods loaded with heart-healthy monounsaturated fats and omega-3’s, leafy greens and beans rich in folate, and herbs, spices and teas with known anti-inflammatory compounds.

Now, let’s say you have a friend who has an allergy to one of these healthy foods; we’ll choose nuts for the sake of this example. Does the fact of your friend’s nut allergy mean that nuts aren’t still an objectively healthy food for human beings in general? Should you encourage your friend to experience an allergic reaction because the nuts are a “superfood?” Are nuts a healthy food choice for your friend? Of course not. Can your friend obtain similar—if not the same—nutritional benefits from other foods that won’t endanger their life?

Most people considering the example of food allergy above would conclude that nuts can be both a nutritious food AND a food that happens to make this particular person feel “bad.” These two things can be true at once. We take it as a given that a person with a nut allergy should avoid nuts and replace them with something comparable but tolerable—like sunflower seed butter or roasted pumpkin seeds perhaps. It wouldn’t occur to us that the person should feel guilty for their allergy, as if the nut allergy were some sort of personal moral failing.

But I’m amazed by the guilt that seems to drive my patients to force down foods that make them feel digestively awful because they feel they “should.”

There’s something amiss in our wellness culture when people feel so guilty about the fact that eating a bagel may feel infinitely better than eating a giant kale salad that they wind up in a clinician’s office essentially seeking “permission” to stop eating the kale salad.

I attribute this largely to a public dialogue about food and health that has appropriated such virtuosic language that it’s easy to see how feeling bloated, gassy, and miserable after eating a kale salad could seem like a moral failing to someone on a quest for better health. If kale salads are part of a “clean” diet and wheat flour is deemed “toxic” or “inflammatory,” then it’s not hard to imagine the impulse to seek a dispensation from a doctor or dietitian to eat a so-called ‘bad’ food that feels—well, good.

Social media messaging within the healthy eating and wellness community—particularly on Instagram—seems to fuel feelings of guilt associated with “failing” to tolerate the staples of “clean living,” like kale salads, smoothie bowls, raw date cacao energy balls, avocado chocolate “mousse” and entire heads of roasted cauliflower. (Not to mention those of us who are able to tolerate them digestively but simply dislike them.) One small study published in the European journal Eating and Weight Disorders surveyed hundreds of social media users who followed healthy-food-focused accounts. The researchers found that higher use of Instagram was associated with a person exhibiting more symptoms of an eating disorder called orthorexia nervosa. Orthorexia describes a fixation with “pure” or “clean” eating to the point of becoming unhealthily restricted. It can express itself in terms of extreme psychological preoccupation with the provenance of the food one eats; guilt over perceived dietary indiscretions; social isolation due to rigid, inflexible eating habits; and/or malnutrition from excessive restriction.

The increasingly narrow portrayal of what’s “healthy” as defined by fad diet books or social media influencers is often at odds with the wide variety of dietary patterns that actual scientific research tells us are healthy. And it can really do a number on your emotional wellbeing.

“Let’s find the healthiest diet you can comfortably tolerate.”

The first step in liberating yourself from unhealthfully-limiting beliefs about what you should be eating is to broaden your mindset around what constitutes a healthy diet. In the U.S. we are fortunate enough to live in a country where a dizzying variety of foods is available all year round (although food deserts and food swamps mean that we don’t all have equal access to all foods). Because of this, no single food in our diets needs to carry the weight of delivering the entire supply of a single nutrient, nor is there any single, essential “superfood” we all must eat… or else. Since many different foods provide similar nutrients, I try to help my patients identify nutritious foods they love—and that love them back—to replace others they feel obliged to eat but don’t actually feel so good.

Green leafy roughage make you feel rough? I absolve you from the 11th commandment, “Thou Shall Eat Kale,” and suggest you get your folate from cooked beets, avocados or peanut butter, and your Vitamin A from cantaloupe, roasted butternut squash, or a carrot ginger soup.

Those large lunch salads not tasting as good on their way back up? Swap out raw veggies for cooked ones—whether steamed, sautéed, roasted or souped. (As I tell all my patients: soup is liquid salad.) Sometimes, taming the texture of a vegetable can make all the difference in how your digestive system handles it.

Looking to eat less animal protein, but beans produce too much gas for your comfort? Try cultured forms of legumes, like firm tofu or tempeh, instead. Or test your tolerance for small portions of less-gassy legumes like lentils and chickpeas with the aid of a bean-fiber-busting enzyme supplement called alpha galactosidase.

Cold pressed juices or smoothie bowls at breakfast giving you the afternoon runs? Skip apples, dried fruit and mangoes and opt instead for fruits lower in fructose or sorbitol, like blueberries, strawberries, raspberries, kiwi, banana, cantaloupe, pineapple and oranges.

You have permission to eat foods that feel good to eat.

You don’t need my permission—or anyone’s—to stop eating foods that ‘everyone’ says are healthy but that make you feel perfectly miserable. (But if you’d feel better having it, then consider it granted.) Achieving good health is a worthwhile goal, but know that there are many different dietary paths to that goal. The signposts to guide you on your journey toward the healthiest diet for you exist within yourself—and how your body feels in response to eating certain foods. They’re not to be found on Instagram, nor on dubious lab test results, nor from the diet your best friend or co-worker swears by, not from people trying to sell you on their one-size-fits-all proprietary diet program.

Just because a food is “good for you,” that doesn’t mean it’s good for you.

Kourtney Kardashian Is Freezing Her Eggs ‘for Safety’

The decision to freeze your eggs, like any decision about your fertility, is highly personal and, sometimes, stressful—emotionally and physically. In a preview for Sunday’s episode of Keeping Up With the Kardashians, Kourtney Kardashian, 39, is seen injecting herself with hormones in preparation for having her eggs retrieved and frozen, a process that seems to be taking its toll.

At one point, Kardashian lifts up her shirt to reveal bruises on her lower stomach where she’s been injecting herself. But it wasn’t the pain of the injections that bothered her: It was how the hormones affected her mood that she found most alarming.

“I’ve been so up and down emotional because I’ve been doing the shots for the egg freezing,” Kardashian says while talking to two of her friends. “I feel like I want to jump out of my skin…I can’t take it.” She adds with a smile, “I feel fine, I just cry myself to sleep every night.”

Although she hasn’t actually decided whether or not she wants to have more kids (she’s already a mom of three), “I just feel like it’s for safety,” she says in the clip. “I hope that going through all of this is worth it because I really don’t want to put my body through this again. The emotions of it all are just a lot.”

Freezing your eggs is definitely an option for preserving your fertility, but it’s not exactly a guarantee of a future pregnancy.

As SELF explained previously, egg freezing is an important option for people who may be undergoing chemotherapy or who have a health issue, like endometriosis, that could affect their ability to conceive in the future.

But freezing your eggs is also an expensive process—in terms of money, time, and the physical toll it can take on your body. And the success of the procedure (in ultimately leading to a healthy pregnancy down the line) depends on many factors, including your age at the time of freezing and any underlying health conditions you may be dealing with.

So, it’s important to keep your expectations reasonable before going through with any fertility treatment, including egg freezing. If you’re interested in your future fertility, talk about your options with your doctor or reproductive specialist to make sure you’re going in with all the information you need to make the right decision for you.

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Pet Allergy: 9 Ways to Deal If You’re Allergic to Your Pet

In the middle of a Venn diagram comparing fiercely loyal dog people and those who remain stubbornly convinced cats are superior, you’ll find people who adore animals but are also allergic. That doesn’t necessarily stop people in this predicament from sharing a roof with one (or many) furry soulmates.

If you’re one of those people who’s hella allergic to your pet, you already know this. Although your pet can breathe fresh, joyful energy into your life, they can also make it hard to…well, breathe. There has to be a way not to come under allergy-symptom siege every time you curl up next to your best friend. We spoke with three allergists to find out how.

1. Get tested for allergies so you know for sure what’s causing your symptoms.

You probably already know the basics of allergic reactions: They’re your immune system overreacting to an otherwise harmless substance, as the Mayo Clinic explains.

In the case of pets, the allergy has nothing to do with fur, as many people believe. Rather, it comes down to animal dander, an otherwise harmless protein found in a pet’s skin, saliva, and urine, according to the Mayo Clinic. Your pet can spread dander all over your place when they scratch behind their ears, chase their favorite toy around the room, and otherwise live their delightful animal lives. Lovely!

It’s easy to only think of dander when it comes to cats and dogs, but there is a whole wide world of pet possibilities out there, people. From parakeets to horses, pretty much every animal with feathers or fur has dander, Alice Hoyt, M.D., an allergist in the allergy and clinical immunology department at Cleveland Clinic, tells SELF.

That’s why all the hype about hypoallergenic pets contains more baloney than the average third grader’s lunch sandwich. A 2011 study published in the American Journal of Rhinology and Allergy looked at 190 one-dog homes and found no difference in the concentration of allergens in homes with “hypoallergenic” breeds compared to other dog breeds. This makes perfect sense because length of fur, shedding, and other similar variables don’t affect the amount of dander a pet has, according to the American Academy of Allergy Asthma & Immunology (AAAAI).

So, where does allergy testing come in? Well, you might be positive you’re allergic to pet dander but actually be reacting to a different houesehold allergen, like dust mites or mold spores. A lot of allergy tips—including many of the ones on this list—revolve around one specific allergen, so it’s best to get tested and make sure you know what your body is objecting to before moving forward. Here’s what you need to know about the allergy testing process.

2. Keep your pets out of the bedroom.

Sorry, but no using your dog as a body pillow. When you’re allergic, the bedroom should be completely off limits, Martha F. Hartz, M.D., pediatric allergist-immunologist at Mayo Clinic, tells SELF. You’ve got a better chance of rest and recuperation when your sleep chamber has a low allergy load, she says.

3. Clean your carpets and rugs at least once a week.

If you’re looking to reduce the amount of dander in your home, you need to focus on spots that tend to be magnets for it, like carpets and rugs, Taha Al-Shaikhly, M.D., an allergy and immunology fellow at UW Medicine, tells SELF. Make sure to vacuum carpets once a week with a device that has a high-efficiency particulate air (HEPA) filter. These suck up tiny bits of matter, like pet dander, that other vacuums might miss, according to the AAAAI. On a similar note, if you have rugs, launder those once a week.

Pet dander can also stick to hard surfaces like walls and floors, so be sure to clean those regularly based on the proper care instructions for the materials in question.

4. Use a HEPA air purifier.

HEPA vacuums can help when it comes to carpets, but if you have a pet, dander is probably all around you. HEPA air purifiers can reduce allergens floating in the air, Dr. Al-Shaikhly says, and keeping one in the area where your pet hangs out the most might help cut back on your allergy symptoms.

5. Try to keep your pet off lounging areas like the sofa.

Upholstered furniture can also attract dander, so keep your pets off the couch and similar pieces of furniture, Dr. Alice Hoyt says. We know, easier said than done. “If they do go on, [make] sure you vacuum every week,” Dr. Hoyt adds. The AAAAI also recommends covering furniture with towels or blankets that can be washed regularly.

6. Bathe your pet regularly (or take them to the groomer).

Dr. Hartz suggests bathing your pet every one to two weeks to help reduce the allergy load they’re carrying around. Er, we’re sorry about the cat scratches in advance? OK, to be fair, bathing your pet might not be feasible depending on their disposition, so this one’s really up to you.

7. Keep your allergy medications readily available.

For instance, keep antihistamines on hand. Histamine—the chemical your immune system releases when it bumps up against an allergen—is a big part of what makes allergies miserable, so getting on a non-drowsy 24-hour antihistamine may help manage the worst of your symptoms, Dr. Hoyt says.

Depending on where your symptoms strike, you should keep treatments like soothing eye drops and nasal sprays around to specifically target those areas. Thoroughly read the instructions before using them, though. For instance, if you use nasal sprays that actively constrict swollen blood vessels for more than three days in a row, you can wind up with an unpleasant condition sometimes referred to as rebound congestion, or rhinitis medicamentosa, according to the Mayo Clinic.

8. Consider allergy shots.

Allergy shots, also known as immunotherapy, are regular injections of small amounts of your allergy triggers over a period of three to five years, according to the Mayo Clinic. “Over time, we’re slowly convincing the immune system that those allergens are fine,” Dr. Hoyt says. You’ll need a shot as frequently as twice a week to as little as once every four weeks depending on factors like the phase of treatment you’re in, according to the AAAAI.

The AAAAI notes that immunotherapy’s effectiveness varies from symptom reduction to total relief from allergy symptoms after treatment. But if you have the time and your allergist thinks you’re a good candidate, they could help transform your life.

9. Know when it’s time to re-home your pet.

In a decidedly less cuddly reality where pets weren’t basically relatives, the first line of defense for a pet allergy would be clear: “The best way to avoid pet allergies to remove the pets from the environment,” Dr. Al-Shaikhly explains.

But pets can be like family. Allergists understand that, which is why they’re often willing to work with you to manage your symptoms in order to keep your beloved pet in your life.

There is a limit, though. If you have severe or poorly controlled asthma that your dander allergy triggers, it’s probably time to find a new home for your pet, Dr. Hartz says. “Asthma can be life-threatening,” she explains. Severe or poorly controlled asthma is critical enough that any and all measures to improve your environmental triggers need to be taken, she explains.

If you do find yourself in a situation where you need to rehome your pet, it may help you to know that pets are resilient, Joseph Turk, D.V.M, tells SELF. That doesn’t mean it won’t take a little work. “Pets give us so much, so we should do our best to find them a loving home if we aren’t able to keep them,” he says.

Friends, family, organizations like the Humane Society and, if applicable, breed-specific rescue groups are good options. No matter which avenue you choose, he recommends doing your due diligence to make sure wherever you place your pet has the knowledge and resources to take care of them.

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Swollen Vulva or Vagina: 8 Reasons This Can Happen

Having a vulva and vagina can be pretty superb. Depending on how your specific parts work, they may offer the potential to have plentiful orgasms, give birth to cute, chunky babies, and do so many other delightful things. But having a vulva and vagina can come with downsides, too, like a swollen vulva intense enough to earn you the nickname Michelin Mons or a swollen vagina that throws you for a loop. Here are eight reasons your vagina or vulva might get all swollen.

1. Vulvar dermatitis

Dermatitis is the medical term for skin inflammation, the Mayo Clinic explains, and it can affect your vulva, too. (As a reminder, your vulva is the external parts of your genitalia, like your mons pubis, labia minora and majora, and clitoris.)

Vulvar dermatitis typically happens because a substance irritates your skin or causes an allergic reaction, Mary Rosser, M.D., Ph.D., assistant professor of obstetrics and gynecology at Columbia University Medical Center, tells SELF. In addition to swelling, you might notice burning and itching, too.

The specific substance in question can vary based on your skin’s sensitivities. When it comes to the vulva, however, some of the main culprits include soaps, bubble bath products, detergents, and inexplicably scented items like toilet paper and tampons, Dr. Rosser explains.

It’s best to keep anything with fragrance away from your vulva, period. Yes, even soap, because it might bother the truly delicate skin of your genitals. You actually don’t need to clean your vulva with anything but water, but if you truly feel compelled, use the gentlest soap you can find and try to make sure none gets inside of you, where it can cause more irritation.

If you recently introduced a new product into your life that you think is affecting your vulva, whether that’s a shower gel or detergent you use on your underwear, ditch it and see if there’s any relief. “Identifying and removing the irritant will lead to resolution of aggravating symptoms,” Dr. Rosser says.

2. A yeast infection

This is one of the causes of vaginitis, or vaginal inflammation. As you may have experienced, yeast infections can cause vulvar swelling, itching, redness, and vaginal discharge that’s usually white-ish and curd-like, according to the Mayo Clinic.

Yeast infections happen due to an overgrowth of fungus, typically a kind known as Candida albicans, the Mayo Clinic says. This sounds pretty
grody, but it’s actually totally natural to have yeast in your vagina. It helps maintain the balance of microorganisms in there. But when something allows this yeast to proliferate uncontrollably (like taking antibiotics, which can hamper the activity of healthy bacteria that curb yeast production), you can wind up with an infection.

This can also happen due to something like staying in your sweaty leggings for too long after a workout, Prudence Hall, M.D., ob/gyn and founder and director of The Hall Center, tells SELF. Yeast is like a jungle plant that thrives in damp, warm environments.

Antifungal medications are the go-to for treating yeast infections, and they come in oral and topical forms, Dr. Rosser says. Here’s how to know if you’re good to treat your yeast infection on your own or if you should see a doctor.

3. Bacterial vaginosis

“This is caused by a shift in usual bacterial flora in the vagina,” Dr. Rosser says. Essentially, the “bad” bacteria in your vagina overwhelm the “good” bacteria, leading to vaginitis.

Sometimes bacterial vaginosis doesn’t cause any symptoms, the Mayo Clinic explains. But if it does, it can lead to vaginal swelling and itching, a “fishy” odor, and a thin gray, green, or white discharge.

Risk factors for this kind of vaginal inflammation include multiple or new sexual partners, having a sexually transmitted infection, and douching, since all of these can throw off your usual bacterial balance. If you do wind up with bacterial vaginosis, your doctor will prescribe antibiotics (there are oral and topical options) to restore harmony to your vaginal flora.

4. Trichomoniasis

Here we have yet another cause of vaginitis! This STI is caused by a parasite, and like many other sexually transmitted infections, sometimes it completely flies under the radar and doesn’t cause any signs of something amiss, according to the Mayo Clinic. If you do exhibit symptoms of trichomoniasis, however, they might include a swollen, reddened vulva, according to ACOG. You can also have white, gray, yellow, or green discharge that smells foul, burning and itching, and pain when you pee or have sex.

Treatment for trichomoniasis involves antibiotics, the Mayo Clinic explains. Typically, it’s just one dose taken by mouth.

5. A new cycling habit

“The vulva has a rich blood supply, and chafing and swelling may occur after cycling,” Dr. Rosser says, explaining that this phenomenon happens due to pressure on the vulva and is known as “saddle sores.” Also, if you hang out in your workout gear for extended periods post-cycling, that might increase your risk of yeast infections, she adds. Double whammy.

If you recently started cycling, your body might adjust to the pressure as it becomes more used to the bike. But there are still ways to treat your vulva kindly while kicking off your cycling habit.

To reduce friction, pressure, and swelling, consider buying a portable padded bike seat that you can slip on for maximum comfort and less chafing. If you’re in a cycling class, some of the pressure and pain might be due to incorrect positioning of your saddle or other bike-related settings, so have the instructor help you tweak the bike’s fit, Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, tells SELF.

The right type of clothing may be helpful in terms of yeast infection-prevention. “Try to use athletic clothing that wicks moisture,” Dr. Rosser says, and wear underwear made of breathable fabrics, like cotton. Then change as soon as you can once your workout is done. And if you’re dealing with an extreme amount of chafing, you can try applying something like a gentle diaper rash cream to the area, Dr. Rosser says. (Again, just make sure none gets inside of you.)

6. Pregnancy

It’s totally normal for your vulva to swell when you’re pregnant. “As the uterus grows, there is increased blood flow to pelvic region,” says Dr. Rosser. The further along you get in your pregnancy, the more you might feel full or swollen down there, she says. You can even get varicose veins on your vulva due to the heightened blood flow to the lower part of your body and reduced blood flow towards your heart, according to the Mayo Clinic.

Focusing on improved circulation in general might help this. “Lying down or elevating your feet frequently throughout the day will improve drainage of blood vessels,” Dr. Rosser says. Compression clothing like socks or stockings may also help, she says, and there are even some sets of compression underwear out there made specifically to help with vulvar swelling.

Also keep in mind that the hormonal shifts in estrogen involved with pregnancy can make you more prone to yeast infections, the Mayo Clinic explains. If you’re pregnant and dealing with any yeast infection symptoms like the ones covered above, see your doctor.

7. A Bartholin’s cyst or abscess

Your Bartholin’s glands, located on each side of the vaginal opening, pump out fluid to keep your vagina nice and lubricated, the Mayo Clinic explains. Unfortunately, these glands may become blocked, Dr. Rosser says, which can form a cyst (basically a fluid-filled bump) or an abscess (when that cyst becomes infected and inflamed). This can lead to swelling near the opening of the vagina, pain during sex, discomfort while walking or sitting, and even a fever, according to the Mayo Clinic.

If you’re only dealing with a cyst, you may not need any treatment because it might just go away within a few days. Even an abscess might rupture and drain on its own, Dr. Rosser says. To help it along, you can try a sitz bath, which essentially means soaking in a few inches of warm water, the Mayo Clinic explains. Doing this many times a day for three or four days might help a smaller abscess rupture and drain. Sometimes that’s not enough, though. If you’re in extreme discomfort, see your doctor to discuss if you need antibiotics or to have the abscess drained, Dr. Rosser says.

8. Sexual arousal and rough sex

If you’re turned on, your vulva and vagina aren’t just going to sit there—they’re going to prepare for action. Increased blood flow causes both your vulva and vagina to swell as part of the sexual response cycle, according to the Cleveland Clinic. But if the sense that you’re a little swollen down there persists well after you’re done, rough sex might be the cause.

“When rough sex occurs, the tissue gets a bit traumatized,” Dr. Hall says. “Just like with other tissue that has experienced trauma, the vagina [and vulva] can swell.”

You obviously don’t need to stop having rough sex if that’s what you’re into. But you can take steps to lessen any swelling afterwards, especially if the sex was painful (in a way you didn’t want). Sex should never hurt. One thing that helps is engaging in enough foreplay to get adequately warmed up. Be sure to use enough lube, too, Dr. Minkin says. If you still come away from sex feeling sore and swollen, you might want to try putting an ice cube wrapped in a washcloth or an ice pack over your underwear to give your vulva and vagina some much-needed relief.

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How you respond to drama depends on if you are a holistic or analytical thinker

Magnetic Resonance Imaging (MRI) scans of people watching the same clip from a dramatic film show that holistic thinkers all have similar brain responses to the scene, whereas analytical thinkers respond differently to each other.

Aalto University researchers showed volunteers the film My Sister’s Keeper on a screen while the research subjects were lying down in an MRI scanner. The study compared the volunteers’ brain activity, and concluded that holistic thinkers saw the film more similarly with each other than analytical thinkers. In addition, holistic thinkers processed the film’s moral issues and factual connections within the film more similarly with each other than the analytical thinkers.

Before conducting the MRI scan, the 26 persons participating in the research were divided into holistic and analytical thinkers on the basis of a previously established evaluation survey. According to previous studies, analytical thinkers pay attention to objects and persons while looking at photographs, whereas holistic thinkers consider also the background and context.

‘Holistic thinkers showed more similarities in extensive areas of the cerebral cortex than analytical thinkers. This suggests that holistic thinkers perceive a film more similarly with each other than analytical thinkers,’ says Professor Iiro Jääskeläinen.

Significantly more similarity was observed in holistic thinkers in the parts of the brain generally related to moral processing — in the occipital, prefrontal and anterior parts of the temporal cortices. This suggests the holistic thinkers processed the moral questions of My Sister’s Keeper in a similar way to one another. The anterior parts of the temporal lobes, however, process meanings of words.

Analytical thinkers showed similarities mainly in the sensory and auditory parts of the brain. They listen to the dialogue literally, whilst holistic thinkers perceive the meanings through the context and their own interpretation of the film’s narrative.

‘It was surprising to find so many large differences in so many cerebral areas between the groups.’ Professor Jääskeläinen said. ‘Analytical and holistic thinkers clearly see the world and events in very different ways. On the basis of the visual cortex, it can still be concluded that holistic thinkers follow the film scenes more similarly, whereas analytical thinkers are more individual and focus more on details.’

So far, research dealing with analytical and holistic views has focused on cultural differences between the east and west: more analytical thinking has been detected in western cultures, and more holistic thinking in eastern cultures. Now the study was carried out within one culture and, for the first time, as a film study.

‘The research can help people understand the way other people observe the world. A holistic thinker may find it frustrating that an analytical thinker interprets things literally, sticks to details and does not see the big picture or context. An analytical thinker may, on the other hand, see the holistic thinker as a superstitious person, who believes in long causal links, such as the butterfly effect.’

Iiro Jääskeläinen’s research group has also published an earlier brain study dealing with moral questions in October 2017. This article was the tenth most read article in 2017 in Nature science magazine’s Scientific Reports series, which published over 24000 articles last year.

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Materials provided by Aalto University. Note: Content may be edited for style and length.

Is being a night owl bad for your health?

Night owls may have a higher risk of suffering from heart disease and type 2 diabetes than early risers.

In the first ever international review of studies analysing whether being an early riser or a night owl can influence your health, researchers have uncovered a growing body of evidence indicating an increased risk of ill health in people with an evening preference as they have more erratic eating patterns and consume more unhealthy foods.

The findings have been reported in Advances in Nutrition today (Friday 30 November)

The human body runs on a 24-hour cycle which is regulated by our internal clock, which is known as a circadian rhythm, or chronotype. This internal clock regulates many physical functions, such as telling you when to eat, sleep and wake. An individual’s chronotype leads to people having a natural preference towards waking early or going to bed late.

The researchers found increasing evidence emerging from studies linking conditions such as heart disease and type 2 diabetes to people with the evening chronotype — a natural preference for evenings.

People who go to bed later tend to have unhealthier diets, consuming more alcohol, sugars, caffeinated drinks and fast food than early risers. They consistently report more erratic eating patterns as they miss breakfast and eat later in the day. Their diet contains less grains, rye and vegetables and they eat fewer, but larger, meals. They also report higher levels of consumption of caffeinated beverages, sugar and snacks, than those with a morning preference, who eat slightly more fruit and vegetables per day. This potentially explains why night owls have a higher risk of suffering from chronic disease.

Eating late in the day was also found to be linked to an increased risk of type 2 diabetes because the circadian rhythm influences the way glucose is metabolised in in the body.

Glucose levels should naturally decline throughout the day and reach their lowest point at night. However, as night owls often eat shortly before bed, their glucose levels are increased when they are about to sleep. This could negatively affect metabolism as their body isn’t following its normal biological process.

One study showed that people with an evening preference were 2.5 times more likely to have type 2 diabetes than those with a morning preference.

This also impacts on people who work shifts — particularly rotating shifts — as they are constantly adjusting their body clock to fit with their working hours. The researchers found that this reduces their sensitivity to insulin and affects their glucose tolerance, putting them at greater risk of developing type 2 diabetes.

The review also uncovered interesting trends:

  • People’s preferences to rising early and going to bed later change at varying points in the life cycle. The morning chronotype is more common in children and can appear when a baby is just three-weeks old. This changes during childhood. While over 90% of two-year-olds have a morning preference, this declines to 58% by the age of six, and shifts further towards an evening preference during puberty. This evening preference continues until an adult reaches their early 50’s and they then begin to revert back to a morning preference.
  • Ethnicity and society can also influence your chronotype. For example, studies have revealed that Germans are more likely to have an evening preference in comparison to Indians and Slovakians. There can also be differences between people living in urban and rural areas in the same country.
  • Another study noted that being exposed to daylight influenced sleep. Every additional hour spent outdoors was associated with 30 minutes of ‘advance sleep’ and that the noise, ambient lighting and crowding of urban environments can make people in some areas more likely to have a morning or evening preference.
  • The researchers also found evidence that night owls would accumulate ‘sleep debt’ during the working week and would sleep longer at weekends to compensate for this, whereas early birds had smaller differences in their sleeping patterns across the week.

The study was led by Dr Suzana Almoosawi from Northumbria University, Newcastle in the UK and Dr Leonidas Karagounis, Nestle Health Science in Switzerland with academics representing Nestle Research (Switzerland) the University of Surrey (UK), Orebro University (Sweden), the National University of Singapore, the London School of Hygiene and Tropical Medicine, Ecole Polytechnique Federale de Lausanne (Switzerland) and Plymouth Marjon University (UK).

Dr Almoosawi, a Research Fellow in Northumbria’s Brain, Performance and Nutrition Research Centre, explained: “We have found that your genes, ethnicity and gender determine the likelihood of you being a morning or evening type. In adulthood, being an evening chronotype is associated with greater risk of heart disease and type 2 diabetes, and this may be potentially due to the poorer eating behaviour and diet of people with evening chronotype. Our review also found that people who have a poorer control of their diabetes are more likely to be evening types.

“The review has highlighted a major gap in our understanding as to how our biological clock affects food intake in infants, children and the elderly. While most infants synchronise their body clock to that of their mothers, as they reach six-years of age, we observe that a large proportion begin to show signs of developing an evening chronotype. Whether physiological changes, school timings or social schedules determine this change, we do not know.

Dr Almoosawi added: “In teenagers, we also find that evening chronotype is related to more erratic eating behaviour and poorer diet. This could have important implications to health in adulthood as most dietary habits are established in adolescence.”

The review team have called for more studies in the general population that define people’s body clock and how this relates in the long-term to their dietary habits and health.

Dr Leonidas G Karagounis of Nestle Health Science, said: “Scientific evidence is providing increasing insight into the relationship between your chronotype, diet and cardiometabolic health. Overall, cross-sectional studies suggest that an evening chronotype is associated with lower intake of fruits and vegetables, and higher intake of energy drinks, alcoholic, sugary and caffeinated beverages, as well as higher energy intake from fat.

“Further research on the best methods to assess an individual’s chronotype and how this may affect their long-term cardiometabolic health can potentially guide the development of health promotion strategies aimed at preventing and treating chronic diseases based on an individual’s chronotype.”

Why patients lie to their doctors

When your doctor asks how often you exercise, do you give her an honest answer? How about when she asks what you’ve been eating lately? If you’ve ever stretched the truth, you’re not alone.

60 to 80 percent of people surveyed have not been forthcoming with their doctors about information that could be relevant to their health, according to a new study. Besides fibbing about diet and exercise, more than a third of respondents didn’t speak up when they disagreed with their doctor’s recommendation. Another common scenario was failing to admit they didn’t understand their clinician’s instructions.

When respondents explained why they weren’t transparent, most said that they wanted to avoid being judged, and didn’t want to be lectured about how bad certain behaviors were. More than half were simply too embarrassed to tell the truth.

“Most people want their doctor to think highly of them,” says the study’s senior author Angela Fagerlin, Ph.D., chair of population health sciences at U of U Health and a research scientist with the VA Salt Lake City Health System’s Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation.

“They’re worried about being pigeonholed as someone who doesn’t make good decisions,” she adds.

Scientists at University of Utah Health and Middlesex Community College led the research study in collaboration with colleagues at University of Michigan and University of Iowa. The results will be published online in JAMA Network Open on November 30, 2018.

Insights into the doctor-patient relationship came from a national online survey of two populations. One survey captured responses from 2,011 participants who averaged 36 years old. The second was administered to 2,499 participants who were 61 on average.

Survey-takers were presented with seven common scenarios where a patient might feel inclined to conceal health behaviors from their clinician, and asked to select all that they had ever happened to them. Participants were then asked to recall why they made that choice. The survey was developed with input from physicians, psychologists, researchers and patients, and refined through pilot testing with the general public.

In both surveys, people who identified themselves as female, were younger, and self-reported as being in poor health were more likely to report having failed to disclose medically relevant information to their clinician.

“I’m surprised that such a substantial number of people chose to withhold relatively benign information, and that they would admit to it,” says the study’s first author Andrea Gurmankin Levy, Ph.D., MBe, an associate professor in social sciences at Middlesex Community College in Middletown, Connecticut. “We also have to consider the interesting limitation that survey participants might have withheld information about what they withheld, which would mean that our study has underestimated how prevalent this phenomenon is.”

The trouble with a patient’s dishonesty is that doctors can’t offer accurate medical advice when they don’t have all the facts.

“If patients are withholding information about what they’re eating, or whether they are taking their medication, it can have significant implications for their health. Especially if they have a chronic illness,” says Levy.

Understanding the issue more in-depth could point toward ways to fix the problem. Levy and Fagerlin hope to repeat the study and talk with patients immediately after clinical appointments, while the experience is still fresh in their minds. Person-to-person interviews could help identify other factors that influence clinician-patient interactions. For instance, are patients more open with doctors they’ve known for years?

The possibility suggests that patients may not be the only ones to blame, says Fagerlin. “How providers are communicating in certain situations may cause patients to be hesitant to open up,” she says. “This raises the question, is there a way to train clinicians to help their patients feel more comfortable?” After all, a healthy conversation is a two-way street.