ADHD drugs do not improve cognition in healthy college students

Contrary to popular belief across college campuses, attention deficit hyperactivity disorder (ADHD) medications may fail to improve cognition in healthy students and actually can impair functioning, according to a study by researchers at the University of Rhode Island and Brown University.

Study co-investigators Lisa Weyandt, professor of psychology and a faculty member with URI’s George and Anne Ryan Institute for Neuroscience, and Tara White, assistant professor of research in behavioral and social sciences at Brown University, had anticipated different findings. “We hypothesized that Adderall would enhance cognition in the healthy students, but instead, the medication did not improve reading comprehension or fluency, and it impaired working memory,” she said. “Not only are they not benefiting from it academically, but it could be negatively affecting their performance.”

This first-ever multisite pilot study of the impact of so-called “study drugs” on college students who do not have ADHD comes at a time when use of prescription stimulants such as Adderall, Ritalin and Vyvanse is common among young adults who believe the drugs will improve their academic performance. Research by Weyandt and others has estimated that 5 to 35 percent of college students in the United States and European countries without ADHD illegally use these controlled substances, buying or receiving them from peers, friends, or family.

Results of the new study, published last month in the journal Pharmacy, show that the standard 30 mg dose of Adderall did improve attention and focus — a typical result from a stimulant — but that effect failed to translate to better performance on a battery of neurocognitive tasks that measured short-term memory, reading comprehension and fluency.

Weyandt has a theory about why working memory would be adversely affected by the medication. Brain scan research shows that a person with ADHD often has less neural activity in the regions of the brain that control executive function — working memory, attention, self-control. For people with ADHD, Adderall and similar medications increase activity in those regions and appear to normalize functioning. “If your brain is functioning normally in those regions, the medication is unlikely to have a positive effect on cognition and my actually impair cognition. In other words, you need to have a deficit to benefit from the medicine,” Weyandt said.

Participants in the study also reported their perceived effects of the drug and its impact on their emotions, with students reporting significant elevation of their mood when taking Adderall.

In contrast to the small, mixed effects on cognition, the drug had much larger effects on mood and bodily responses, increasing positive mood, emotional ratings of the drug effect, heart rate and blood pressure. “These are classic effects of psychostimulants,” said White. “The fact that we see these effects on positive emotion and cardiovascular activity, in the same individuals for whom cognitive effects were small or negative in direction, is important. It indicates that the cognitive and the emotional impact of these drugs are separate. How you feel under the drug does not necessarily mean that there is an improvement in cognition; there can be a decrease, as seen here in young adults without ADHD.”

The physical effects from the drugs, such as increased heart rate and blood pressure, were expected, and underscored the difference with cognition. “They are subjecting themselves to physiological effects but do not appear to be enhancing their neurocognition,” Weyandt said. She stressed, however, that the findings are based on a pilot study and need to be replicated with a substantially larger sample of college students.

The researchers recruited students from both universities, eliminating individuals who had taken ADHD medications or other drugs. After rigorous health screenings, 13 students participated in two five-hour sessions at White’s lab at Brown and at Memorial Hospital in Pawtucket.

In the double-blind study, in which neither researchers nor participants know who is receiving the placebo and who is receiving the study medication, each student received Adderall in one session and the placebo in the other. This allowed the researchers to see the effects of the medication vs. placebo in individuals and across the group.

Given the important and unexpected results from the study, Weyandt and White plan to apply for federal funding to continue the research with a larger group of healthy college students.

This research was supported by grants from the Rhode Island Neuroscience Collaborative, the Brown (now Carney) Institute for Brain Science, the George and Anne Ryan Institute for Neuroscience and the Norman Prince Neurosciences Institute at Rhode Island Hospital as well as divisions within the National Institutes of Health and the National Science Foundation.

Is It Safe to Lick Your Contact Lens Then Put It Back in Your Eye?

Honest question: Have you ever been tempted to lick a contact lens because you needed to put it back in your eye and there was no contact solution in sight? Maybe your contact made a break for it, surprising you by suddenly popping out. Perhaps you removed it yourself because your eye couldn’t handle the dryness, but you need to insert it again to…you know…see.

If you’ve got it together enough to always have some contact solution on you, bravo. Otherwise, you might have the urge to lick and stick, as in, lick your lens, then stick back on your eyeball. What could possibly go wrong? Um, a lot, according to experts, who warn that you should absolutely not do this. Ever. Here’s why.

Anything you put into your eyes should be as pristine as humanly possible. Spit doesn’t make the list.

“[Licking contact lenses] is pretty terrible,” Jennifer Fogt, O.D., fellow of the American Academy of Optometry and an associate professor in the College of Optometry at The Ohio State University, tells SELF. Your whole goal with contact lenses is to keep them immaculate. This is why you’re supposed to rinse and store your contacts in sterile solution explicitly made for that purpose and otherwise follow the expert-approved guidelines on using your contacts to keep your eyes safe.

Sorry, but your spit is definitely not as clean as contact solution. “The mouth is a dark and moist place, which makes an ideal living environment for many different types of bacteria,” Vivian Shibayama, O.D., an optometrist and contact lens specialist with UCLA Health, tells SELF. It’s true that some of that bacteria is actually protective and meant to prevent the overgrowth of other bacteria that can harm your health, but that doesn’t mean your spit is sterile. Plus, your mouth also contains fungi and can carry viruses, too, even if you don’t necessarily feel sick.

Also, no offense, but if you’re licking your contacts before putting them in your eyes, chances are you probably haven’t washed your hands first, which is another problem. “You never know what type of bugs a person has on their hands,” Dr. Shibayama says.

A few different eye issues can come out of a contact-licking habit, mainly involving infection or inflammation that can lead to distressing symptoms.

Keratitis is a huge potential culprit here, Dr. Fogt says. Keratitis happens when bacteria, fungi, or parasites infect your cornea (the clear dome that covers the surface of your eye), according to the Mayo Clinic. People who wear contacts are usually more vulnerable to this than non-contact wearers because these tiny devices can house various pathogens. Licking your contacts increases those odds because you’re delivering microorganisms like bacteria directly to your lenses, Dr. Fogt says.

Keratitis can cause symptoms like eye pain, redness, blurry vision, sensitivity to light, excessive tearing, and discharge, according to the Mayo Clinic, and if it’s left untreated, it can lead to permanent vision damage. “You don’t want to mess with this,” Dr. Fogt says. As it turns out, one of the biggest ways to prevent keratitis is to use—and clean—your contact lenses according to their instructions, the Mayo Clinic says.

Then there’s the not-washing-your-hands-first part, which means you’re basically begging to get something like pink eye, Dr. Shibayama says. Pink eye (known in fancy med speak as conjunctivitis) is a bacterial, viral, or fungal inflammation or infection of your conjunctiva, the see-through membrane on the whites of your eyes and inside of your eyelids, according to the Centers for Disease Control and Prevention (CDC). Symptoms include redness, itchiness, a gritty feeling, discharge, discomfort when using contacts, and tearing.

Since bacterial and viral conjunctivitis are incredibly contagious, proper hand hygiene is a cornerstone of preventing their spread, according to the Mayo Clinic. Also, get this: the Mayo Clinic specifically links using contacts that haven’t been cleaned properly (using spit would fall into this category) with the bacterial form of this condition.

So, rule number 1: Always wash your hands if you’re going to touch your eyes, including before putting in or removing contacts. Rule number 2: Absolutely never put spit in your eyeballs, people! Grab your glasses instead of re-using those contacts, ask your coworkers if they have contact solution, or duck out and go buy some. Basically do whatever you need to when it comes to eye care, because it’s really not a game.

Once you have your hands on some contact solution, take a second to ask yourself why you wanted to lick your contact lenses in the first place.

If your eyeballs are always dry, dry eye could be your issue. This is a condition that happens when your eyes can’t lubricate themselves adequately, according to the National Eye Institute. Usually, dry eye happens when the amount or quality of your tears can’t keep your eyes moist enough. Symptoms include the obvious dryness, along with tons of others like itchiness, scratchiness, stinging, burning, sensitivity to light, and more.

The fix for dry eye involves adding moisture into the equation, but only in a safe way, which means not with spit. If you think you have dry eye, make a doctor’s appointment to be sure, since a lot of other eye conditions have similar symptoms. In the meantime, use artificial tears (the simple kind that only aim to wet your eyes, not the kind that removes redness, which can just cause further irritation). Be sure to have your eye drops on you in case you need them. Your doctor may decide those drops are all you need, or they may discuss other dry eye treatment options with you.

The problem could also come down to the fit of your contacts, which should be just snug enough to stay put without causing discomfort. Although contacts may seem like one-size-fits-all devices, they’re not, which is why your doctor performs a complete eye exam before suggesting contacts that could be right for you. Check in with your doctor if your contacts are giving you trouble (and, in general, be sure to visit them every other year at a minimum so they can keep tabs on if your contacts need updating).

As you can see, you have some options here! But whatever you do, avoid mixing your spit and contact lenses. “Please don’t do this,” Dr. Fogt says.


Does Coconut Oil Actually Work Any Magic on Eczema?

Most people can agree that coconut oil is seemingly a magic elixir for anything that ails you. But what about when it comes to eczema? Can this delicious-smelling liquid actually improve it? Or does using coconut oil for this purpose not really hold scientific water? (Uh, oil, as it were?)

You may have heard rumors that coconut oil can work wonders for eczema, specifically atopic dermatitis, the type of eczema that is most prevalent. (So, from here on out, when we say “eczema,” that’s what we mean.) Some people think coconut oil can reduce eczema flare-ups, soothe inflammation, and lower the risk of infection if you have open sores or cracks in your skin.

Of course, when a product has amassed such a cult following, it can be tough to sort out what’s legit and what’s total B.S. That’s why we roped in some experts for the real story on coconut oil and eczema.

Since eczema comes down to a problem with the top layer of skin, it makes sense that people might try to combat it by slathering something like coconut oil over the affected areas.

Eczema happens when your top layer of skin is essentially sleeping on the job. Normally that layer should lock in enough moisture to keep your skin hydrated and supple while also warding off bacteria, irritants, allergens, and other substances that can cause aggravation, according to the Mayo Clinic. If you have eczema, a gene variation prevents your top layer of skin from upholding this duty.

As a result, you can experience inflammation that causes eczema symptoms like serious dryness and itching, along with red or brown patches that are most likely to show up on your hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the bends of your elbows and knees, the Mayo Clinic says. You may also have small, raised bumps that itch, then weep fluid and crust over if you scratch them. That scratching can lead to tender, extra-irritated skin, and maybe even make you vulnerable to infection if you create any open wounds that may act as portals to pathogens.

The first piece of good news here is that people with eczema usually don’t experience these symptoms all the time. Instead, they tend to have flares when they’re exposed to triggers like sweat, stress, soaps, detergents, dust, and pollen, the Mayo Clinic says.

The other bit of good news is that experts have identified a lot of great eczema treatments to keep symptoms at bay. Coconut oil, though it shows promise, doesn’t quite make the (official) cut.

There are some pretty well-established treatments for eczema, but coconut oil isn’t one of them.

If your doctor diagnoses you with eczema, they’ll probably recommend you try to prevent flare-ups (with methods like avoiding your triggers and using gentle skin-care products, among others) and using certain medications (like corticosteroid creams and anti-itch drugs) to cut back on inflammation and irritation when you do have a flare. Sometimes they’ll have you use antibiotics if they’re concerned you might get a skin infection.

If you have eczema, it’s also essential to moisturize your skin two to three times a day with creams that are free of alcohols, scents, dyes, and other chemicals that can irritate your skin, according to the National Institute of Allergic and Infectious Diseases.

According to some experts, coconut oil could help you in the above endeavors, though not enough to replace conventional treatment methods.

That said, there is some research that shows coconut oil may be able to calm eczema in some cases.

Peter Lio, M.D., a clinical assistant professor of dermatology at the Northwestern University Feinberg School of Medicine who has researched the use of coconut oil for eczema, tells SELF that there’s some data to back this up. The problem is that the research is not very robust.

Dr. Lio cites one randomized double-blind study published in the International Journal of Dermatology in 2014 that followed 117 children with eczema and had their parents apply either virgin coconut oil or mineral oil to their kids’ skin for eight weeks. (Virgin coconut oil is the purest form; it has been processed in a specific way that introduces as few contaminants as possible and retains the oil’s natural properties as best it can, Dr. Lio explains.) The researchers found that 47 percent of children in the coconut oil group had “moderate” improvement in their symptoms while 46 percent had an “excellent” response. In the mineral oil group, 34 percent had moderate improvement and 19 percent had excellent improvement.

Another double-blind controlled study published in the journal Dermatitis in 2008 analyzed 52 patients with eczema. Some used virgin coconut oil on their skin twice a day for four weeks, while others did the same with virgin olive oil. Overall, the people using the virgin coconut oil experienced a greater reduction in eczema severity. But there was another interesting finding, too. Twenty people in the coconut oil group had Staphylococcus aureus on their skin, a bacteria that can cause a painful and serious skin infection, while 12 people in the olive oil group did. At the end of the study, all but one of the people treated with coconut oil cleared Staphylococcus aureus from their skin, while only six people in the olive oil group could say the same. Remember, when you have eczema, your skin can’t properly protect you from bacteria—so coconut oil’s potential to reduce harmful bacteria may come in handy.

In both studies, researchers excluded participants who had used steroids or antibiotics within the two weeks before the trials began, and they also instructed the participants not to use any other medications or creams for their eczema during the study periods. Still, these studies are small and really just a start. More research is necessary to solidify this connection. However, Dr. Lio says, “These [studies] suggest that coconut oil has both moisturizing properties and some antibacterial properties, both of which appear to be helpful in the treatment of atopic dermatitis.”

The mechanism behind why coconut oil could possibly help tame eczema isn’t completely understood.

Some plant-based products, like tea tree oil, are thought to tamp down on certain microbes that can cause skin issues, Dr. Lio says. It may be that coconut oil can do this, too, potentially reducing how intensely microorganisms like bacteria can irritate your skin (or how likely you may be to get an infection from said bacteria), he says. However, he adds, it’s all speculation at this point.

As for the claims that coconut oil is straight-up an excellent moisturizer for eczema, it’s a little more complicated than that. Moisturizers fall into three groups: humectants (they draw water into your skin), occlusives (they coat your skin’s surface and reduce water loss), and emollients (they soften your skin). Oils fall into the occlusive and emollient categories, meaning they will sit on top of your skin and work to prevent moisture from escaping, hence Dr. Lio’s statement that coconut oil seems to have moisturizing properties. But, since oil isn’t a humectant, it doesn’t actually deliver moisture to your parched skin in the way other moisturizers do. That means coconut oil would, in theory, work best when layered on top of a humectant that will actually draw moisture into your skin’s surface, Dr. Lio explains. Look for eczema-friendly products that are specifically meant to moisturize your skin.

Also, heads up: Even if you’re fully on the coconut oil bandwagon, it can be a mess to apply. Coconut oil can become solid at cooler temperatures, but when your hands warm it up before applying it to your skin, it’ll get runny in no time, Temitayo Ogunleye, M.D., assistant professor of clinical dermatology at the University of Pennsylvania Perelman School of Medicine, tells SELF. She recommends that people use thicker moisturizers instead (especially since they’re generally known to provide more hydration, anyway).

There’s also the potential issue with food allergies. People with eczema are more likely than others to have them, so rubbing coconut oil onto your skin when you have eczema could just be setting yourself up for an allergic reaction, Dr. Ogunleye says. Of course, you probably already know if you’re allergic to nuts or to coconut oil specifically, but food allergies can develop in adults, so it’s still worth keeping in mind.

Finally, if you’re acne-prone, you should probably take a pass on coconut oil. It’s comedogenic, which means it could block your pores and cause a breakout, Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital, tells SELF. Even if your skin doesn’t have a natural inclination toward acne, having eczema may make your skin more sensitive, so you should still proceed with caution. Consider patch testing by applying a bit of coconut oil to your inner arm for a week or so to gauge your skin’s reaction before you lube up on larger swaths of your body.

As is the case with many health-related issues, whether or not coconut oil will help your eczema seems to be pretty individual.

If you don’t have an allergy to coconut oil, your skin isn’t acne-prone, and you’re not expecting miracles, coconut oil may be a good addition to your eczema-fighting arsenal. But that doesn’t mean you should toss all the treatments your dermatologist gave you in favor of the stuff. Instead, continue using whatever your derm has deemed the best treatment for your eczema, then introduce coconut oil into the mix slowly and with patience. If you’re at all unsure about whether or not it’s a fit for you, as always, your doctor is the best person to turn to with questions.


Caffeine affects food intake at breakfast, but its effect is limited and transient

A new study featured in the Journal of the Academy of Nutrition and Dietetics found that after drinking a small amount of caffeine, participants consumed 10 percent less at a breakfast buffet provided by researchers, but this effect did not persist throughout the day and had no impact on participants’ perceptions of their appetites. Based on these findings, the investigators have concluded that caffeine is not effective as an appetite suppressant and weight-loss aid.

“Caffeine is frequently added to dietary supplements with claims that it suppresses appetite and facilitates weight loss. Previous research has speculated that caffeine speeds metabolism or affects brain chemicals that suppress appetite. In addition, epidemiological evidence suggests that regular caffeine consumers have a lower body mass index (BMI) than non-consumers. The purpose of our study was to determine whether caffeine can in fact be linked to reduced food intake or suppressed appetite, and if the results vary by BMI,” explained lead investigator Leah M. Panek-Shirley, PhD, SUNY University at Buffalo, Department Exercise and Nutrition Sciences, Buffalo, NY, USA.

On average, Americans drink eight ounces of coffee per day. Fifty healthy adults (aged 18-50 years) visited the investigators’ laboratory weekly over a month to participate in the study. Each time, they were asked to drink juice with added caffeine that was either equivalent to consumption of four ounces (1 mg/kg) or eight ounces (3 mg/kg) of coffee, or no coffee as a placebo dose. Thirty minutes later, participants were instructed to eat as much or as little as they wanted of a hearty breakfast buffet. The investigators asked participants to record everything they ate throughout each entire study day and sent them hourly reminder emails, linked to an online survey, to document their intake and appetite at each interval.

The study determined that after drinking the juice with 1 kg/mg of caffeine, participants consumed about 70 fewer calories than they did after drinking juice with 3 mg/kg or no added caffeine. After reviewing what the participants ate for the rest of each study day, they found the small decrease in intake did not persist. Participants compensated for the reduced intake at breakfast later in the day. In addition, there were no differences in reported appetite associated with the caffeine doses. Finally, their individual BMIs had no effect on their food intake or appetite at all three caffeine levels.

“This study, by nature of its rigorous design, reinforces the importance of good eating habits and not relying on unsupported weight loss aids or unhealthy practices,” commented Carol DeNysschen, PhD, RD, MPH, CDN, FAND, one of the investigators, Professor and Chair of the Department of Health, Nutrition, and Dietetics, SUNY Buffalo State College, Buffalo, NY, USA. She elaborated on the rigor of the double-blind, randomized, crossover design of the study: the order of the doses was randomized for the 50 participants, both participants and researchers did not know the dose of samples as they were being presented, and all participants received all dose treatments, thereby acting as their own controls to enable comparisons of their individual responses.

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

Younger children tend to make more informed decisions

A new study from the University of Waterloo has found that in some ways, the older you get the worse your decision making becomes.

The study established that younger children seem to make slightly better decisions than older children. The older children get, the more they tend to ignore some of the information available to them when making judgements, which though efficient can also lead to mistakes.

“It is good for us to know that kids at different ages don’t necessarily treat all information similarly when we set out to teach them new things,” said Stephanie Denison, an associate professor in the Department of Psychology, who co-authored the study with PhD student Samantha Gualtieri. “Children maybe aren’t taking all the information we are giving them at face value. They may be thinking about it in their own way and using the data in the way they think makes the most sense, which is important for parents and teachers to understand,” says Gualtieri.

“Our research shows that children around four-years-old are starting to use these shortcuts, but by six-years of age they’re using them at levels as high as adults.”

In two experiments, 288 children were assessed to determine whether they used numerical, social, or both types of information when making judgments. Ninety-five per cent of the six-year-olds depended on only the social information to make a judgement compared to 70 per cent of five-year-olds and 45 per cent of four-year-olds. The younger children were more likely to take both pieces of information into account.

The researchers do not deem older children’s overuse of social as negative, it simply shows how children weigh information when making decisions. Adults also tend to not use all the information at their disposal when making judgments, possibly because it is time-consuming and requires lots of mental energy.

“So, while using these shortcuts is actually very efficient, we need to be aware that they can introduce errors,” said Denison. “Therefore, sometimes we should be thinking harder and taking the time to put together all of the information.

“How much time you spend on processing information might depend on the importance of the judgement or the decision you’re making. So, thinking about where you want to spend the time is really important.”

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

Craving and Chewing Ice: a Sign of Anemia?

Is constantly craving and chewing ice a sign of anemia?

Answers from Rajiv K. Pruthi, M.B.B.S.

Possibly. Doctors use the term “pica” to describe craving and chewing substances that have no nutritional value—such as ice, clay, soil, or paper. Craving and chewing ice (pagophagia) is often associated with iron deficiency anemia, although the reason is unclear. At least one study indicates that ice chewing might increase alertness in people with iron deficiency anemia.

Less commonly, other nutritional problems may cause you to crave and chew ice. And in some individuals, pica is a sign of emotional problems, such as stress, obsessive-compulsive disorder, or a developmental disorder.

A thorough medical evaluation can help determine if pica is due to an underlying medical condition. If the cause of pica is an emotional or developmental issue, cognitive behavioral therapy may be helpful.

Updated: 2015-02-05

Publication Date: 2015-02-05

Alcohol-related cirrhosis deaths skyrocket in young adults

Deaths from cirrhosis rose in all but one state between 1999-2016, with increases seen most often among young adults, a new study shows.

The deaths linked to the end stages of liver damage jumped by 65 percent with alcohol a major cause, adults age 25-34 the biggest victims and fatalities highest among whites, American Indians and Hispanics.

Liver specialist Elliot B. Tapper, M.D., says he’s witnessed the disturbing shift in demographics among the patients with liver failure he treats at Michigan Medicine. National data collected by Tapper and study co-author Neehar Parikh, M.D., M.S., confirms that in communities across the country more young people are drinking themselves to death.

The data published in the journal BMJ shows adults age 25-34 experienced the highest average annual increase in cirrhosis deaths — about 10.5 percent each year. The rise was driven entirely by alcohol-related liver disease, the authors say.

“Each alcohol-related death means decades of lost life, broken families and lost economic productivity,” says Tapper, a member of the University of Michigan Division of Gastroenterology and Hepatology and health services researcher at the U-M Institute for Healthcare Policy and Innovation.

“In addition, medical care of those dying from cirrhosis costs billions of dollars.”

The rise in liver deaths is not where liver specialists expected to be after gains in fighting hepatitis C, a major liver threat seen often in Baby Boomers. Antiviral medications have set the course to one day eradicate hepatitis C.

Cirrhosis can be caused by a virus like hepatitis C, fatty liver disease or alcohol abuse. The increase in liver deaths highlights new challenges in preventing cirrhosis deaths beyond hepatitis.

“We thought we would see improvements, but these data make it clear: even after hepatitis C, we will still have our work cut out for us,” says Tapper.

That mortality due to cirrhosis began increasing in 2009 — around the time of the Great Recession when the economic downturn led to loss of people’s savings, homes and jobs — may offer a clue as to its cause.

“We suspect that there is a connection between increased alcohol use and unemployment associated with the global financial crisis. But more research is needed,” Tapper says.

Cirrhosis caused a total of 460,760 deaths during the seven-year study period; about one-third were attributed to hepatocellular carcinoma, a common type of liver cancer that is often caused by cirrhosis, researchers found.

In 2016 alone, 11,073 lives were lost to liver cancer which was doubled the number of deaths in 1999.

Researchers studied the trends in liver deaths due to cirrhosis by examining death certificates compiled by the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research project.

“The rapid rise in liver deaths underscores gaps in care and opportunities for prevention,” says Parikh, study co-author and liver specialist at Michigan Medicine.

The study’s goal was to determine trends in liver disease deaths and which groups have been impacted most across the country. The research showed:

  • Fewer Asians and Pacific Islanders died of liver cancer.
  • It is hitting many places especially hard, namely Kentucky, Alabama, Arkansas and New Mexico, where cirrhosis deaths were highest.
  • A state-by-state analysis showed cirrhosis mortality is improving only in Maryland.

Deaths due to alcohol-related liver disease are entirely preventable, say authors who suggest strategies such as taxes on alcohol, minimum prices for alcohol and reducing marketing and advertising to curb problem drinking. Higher alcohol costs have been linked with decreased alcohol-related deaths.

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Materials provided by Michigan Medicine – University of Michigan. Original written by Shantell M. Kirkendoll. Note: Content may be edited for style and length.

12 Beautiful Biking Destinations You’ll Want to Add to Your Bucket List

For the most part, bike rides are often quite beautiful. Whether you’re biking through rolling hills or a cute little countryside town, or even some cool urban streets, your two wheels often end up bringing you places that your two feet wouldn’t. But even though riding in general is quite the scenic sport, some bike rides are simply extra stunning—like, can’t-stop-thinking-about-them, pinch-yourself stunning. And no one knows this better than the people out there experiencing it.

That’s why we hit up 12 avid cyclists and adventurists to ask about the absolute most beautiful ride they’ve ever been on. Add these trips to your bicycling bucket list, and get ready to be blown away by the breathtaking views on your next ride.

1. Génolhac to Vallon Pont d’Arc, France

“Of the 500 miles I bikepacked across France this summer, from the English Channel to the Mediterranean, there’s one wild day of riding that’s stayed with me. Almost from the moment my husband and I rolled out from the small southern village of Génolhac, the 42-mile ride unfolded like a slow-moving flip book of France’s most beautiful vistas. Over the course of three hours, we pedaled through the charming towns of Bessèges and Barjac, glimpsed hilltop castles, and experienced a rare back-to-back stretch of lavender and sunflower fields.

After feeling the burn from a few long climbs, we reached the Ardèche Gorge, the largest natural canyon in Europe, which seemed less a tourist attraction than a hard-earned secret reserved for cyclists. We toasted our journey in a bar built inside a limestone cave and spent the rest of the afternoon swimming in the cool river under the naturally carved bridge of Pont-d’Arc.”

—Lauren Matison Crossley, writer, conservationist, and cyclist, @laurenmati; photo by @ecniv

2. Teton Village to Jackson Hole, Wyoming

“On a recent family trip to Wyoming, we took advantage of the new-ish 56 miles of paved pathways that link the town of Jackson Hole to Teton Village and Grand Teton National Park. It’s about 15 miles from where we were staying in Teton Village to Jackson Hole.

We biked over the rushing whitewater of the Snake River and past moose-crossing alerts, all in the shadows of the Grand Teton mountain range. After refueling with acai bowls on a shady lawn in town, we biked the 15 miles back along the same snowbasin route. The surrounding scenery was truly stunning, but I also loved how flat, easy, and paved the ride was. It made it easy to really enjoy racking up the miles on a sunny day!”

—Christine Amorose, ad sales account executive, adventurer, biker, and travel and lifestyle blogger, @cestchristine

3. Robinson Canyon, Carmel Valley, California

“Carmel-by-the-Sea is quickly becoming a must-see for cycling enthusiasts throughout the world. Home to the famous 17-Mile Drive, the picture-perfect Highway 1, and, of course, Big Sur, the area certainly has no shortage of epic drives and rides.

Of those, one hidden gem is the other-worldly Robinson Canyon in the Carmel Valley. The outback climb takes you through many microclimates, sweeping vistas, giant redwoods, and quiet country roads. The descent is equally exciting, too, with long gradual turns and a chance to open the pace. After finishing the ride, which is just under 60 miles, I had an incredible dinner and stay at L’Auberge Carmel, which was just as memorable as the ride itself.”

—Travis McKenzie, avid cyclist, athlete, and founder and CEO of NTSQ Sports Group Inc., @travmckenzie

4. Danube Bike Path, Austria

“I recently spent seven days cycling by myself across Austria, along the Danube Bike Path. I rode about 30 miles per day from Passau, Germany, to Vienna, Austria, on a self-guided bike tour. I had luggage support, and all of my accommodations were taken care of through, but I was completely on my own for the entire ride. And I discovered that the organized, self-guided bike tour was a perfect ride for solo female travelers.

There are designated bike paths most of the way, very little car traffic (some tractors here and there), plenty of delicious Austrian food and beer, vineyards, villages, kind and curious locals, and, if you hit it right, sunshine. It was 75 degrees and sunny every single day on my mid-April tour. The magnolias were in full bloom, tourist season was just around the corner, and local businesses were open and excited to welcome cyclists. I found plenty of restaurants and cafes with bike parking, and all of my hotels were right along the river as well, all offering secure overnight bike storage.

The route is mostly flat, as it follows the Danube River, so I chose a hybrid touring bike (and ended up with some calves of steel), but electric bikes (e-bikes) are also available. [A touring bike is a bike made specifically for bike tours that’s usually extra comfortable, and a hybrid bike is a blend of a road bike and a mountain bike that can usually tolerate a wider range of conditions—so a hybrid touring bike is all of those things.] I couldn’t have imagined just how enlightening this experience would be, and I highly recommend it to anyone from solo travelers to families. Cycling is a fabulous way to slow travel through beautiful, delicious Austria.”

—Jackie Nourse, adventurer, outdoor enthusiast, trip leader, and cyclist, @travelingjackie

5. The countryside outside of Medellín, Colombia

“In the past couple of years, Colombia has been all over the ‘places to go now’ lists in major travel magazines all over the world. The country is in the midst of a huge tourism growth spurt, which is why I was excited to see it for the first time by bike. And I’m so happy I did, because my ride enabled me to see parts of Colombia I likely wouldn’t have seen otherwise—and made me fall in love with the country itself.

I rode with my friend and a local cycling company called Equipo Cycling, which paid for our trip in advance, since we were there to report on the adventure. Our guide met us early in the morning in Medellín, put our bikes on top of the car, and drove us an hour or so outside the city to the surrounding countryside, where we started our ascent. Not going to lie, it was definitely hard—especially considering Medellín’s at nearly 5,000 feet above sea level—but by the time we got to the top, the view was absolutely breathtaking. It was foggy and we were so high up that there were clouds below us, which made it seem like we were legit on top of the world. After we stopped for an obligatory photo shoot, we made our way back down the super green hills, cruising past lush coffee farms, gardens, and refreshing brooks. The descent was definitely a whole lot easier—and, perhaps best of all, it ended with cold Colombian beer in a super cute town called Santa Fe.”

—Annie Daly, travel writer and adventurer, @anniemdaly; photo: Rene Munoz for @equipocycling

6. Wasatch Over Wasatch Trail, Park City, Utah

“I recently visited Park City, Utah, for a mountain biking trip, which culminated in a 9-mile ride on the spectacular Wasatch Over Wasatch (aka “WOW”) trail. This single-track trail offered stunning views of the Wasatch Mountains and the Heber Valley as we rode through various landscapes, each beautiful in their own unique way. The ride starts out in Wasatch Mountain State Park, and climbs through an Aspen grove, then takes a sharp descent through rock switchbacks before continuing downhill through lush pine forests. As a beginner mountain biker, the terrain was fairly challenging for me, but thankfully the beauty of the ride helped distract me from my nerves! After the ride, we ended up alongside the Provo River, the perfect spot for sandwiches and a quick dip, and I soaked up the Utah sun, feeling lucky to be alive—in more ways than one!

—Locke Hughes, freelance journalist, health coach, and beginner mountain biker, @lockeitdown

7. River Road, Edgewater, New Jersey

“River Road is on the New Jersey side of the George Washington Bridge. It’s a somewhat secret spot that allows you to ride right next to two waterfalls and the Hudson River. It also has epic hill climbing, and the best part is that it’s less than a mile from Manhattan! I live in Jersey City and work in Manhattan, so I’ll do the ride—which is about 40 miles—on my way to work a couple times a month. It takes about two hours total.”

—Nick Taranto, co-founder of and bike enthusiast, @semperanto; photo by @tjdocena

8. Tuscany, Italy

“While immersing yourself in the beauty of Tuscany in any fashion is a treat, cycling allows you to really feel the (slow) beat of the landscape. You can take a 13-mile bike tour with Cortona Wine Tours to explore Italy’s ‘Val d’Orcia,’ a UNESCO World Heritage Site famed for its rolling crop-filled landscape, medieval hilltop civilizations, and prized Vino Nobile di Montepulciano wine.

From the 16th-century San Biagio Church starting point, you’ll take a challenging up-and-downhill bike ride, through views of olive groves, wheat fields, and the dormant Monte Amiata volcano, all of which help distract your tired muscles. Plus, you can almost always see the fairytale architecture of Montepulciano, Monticchiello, Montefollonico, and Pienza, where you’ll stop for a break. At the end of the ride, you’ll savor the sights, literally, with a delicious meal at the farm-to-table Podere Il Casale.”

—Jessie Festa, world traveler, blog coach, adventurer, @jessieonajourney

9. Prague, Czech Republic

“One of our favourite bike rides has actually been around the gorgeous Central European city of Prague. Most people that rent a bicycle will stick to the Danube River and maybe through the old part of town, but we headed up to the hills overlooking the city and hit the 25 miles of mountain bike trails that twist their way through parks, forests, and rocky outcrops for over four hours. Part of the ride was on a downhill-style single track, while the rest was on manicured dirt paths and narrow, old roads.

Even in summer, when Prague is packed with tourists, we spent a huge portion of the ride completely on our own. Being able to see the historic city from high vantage points without any other people around, while also getting our adrenaline pumping, made it one of the most enjoyable bike rides we’ve ever tackled.”

—Jarryd Salem and Alesha Bradford, adventure travel bloggers, @nomadasaurus

10. Vietnam and Cambodia

“I spent 12 days traveling with the tour company Backroads on a bike trip through Vietnam and Cambodia. Both countries are breathtakingly beautiful. This was my first long bike trip, and I was in awe at the new advantages biking allowed me as a traveler. In countries that might not be as developed, a bike allows you to ride into villages, meet and talk with locals, and see the true beauty of the country up close and personal!

—Aydan Puth, social media manager and avid traveler and adventurer, @aydanputh

11. Tirol, Austria

“Tirol in Austria is, in my mind, one of the most underestimated cycling destinations. It’s got some of the toughest cycling climbs I’ve ever ridden, but the beauty of the scenery can sometimes make you forget you’re suffering. One of the best rides I had in Tirol was a 93-mile adventure my friend and I went on. We had no specific destination in mind; all we wanted was to climb nearly 10,000 feet in a single ride. We experienced an actual feeling of euphoria when we reached the third summit, and had climbed 10,249 feet!”

—Rasmus Taun, designer and cyclist, @shotbytaun

12. The backroads surrounding Lexington, Kentucky

“Having had the opportunity to ride our bicycles across countries throughout Asia, South America, and Europe, it has been a wonderful surprise to discover world-class cycling and scenery here at home, in the Bluegrass Region of Central Kentucky. On an idyllic, sunny day in late September, we found ourselves on a four-hour, 65-mile loop exploring the quiet, pristine backroads surrounding Lexington, Kentucky. As we rode through the counties of Woodford and Bourbon, our noses detected the nearing bourbon distilleries, as evaporating whiskey wafted heavily through the air, escaping barrels from Woodford Reserve, Wild Turkey, Four Roses, and many other craft distilleries. Along the way, we also passed famous thoroughbred horse farms, including Claiborne and WinStar, where future and former Kentucky Derby winners curiously lined the fencerow, making for a backdrop so surreal that we just had to stop and savor the experience.

This ride inspired us so much that we wanted to spread the word to other cyclists that Kentucky is a world-class cycling destination. Because of this ride, we created the Bourbon Country Burn, a three-day bicycle tour and bourbon festival in September that explores the bourbon distilleries and horse farms surrounding Lexington. Each day, riders are able to choose from various distance options, while exploring many of the same country roads, bourbon distilleries, and horse farms that have inspired us to discover more of our home state by bicycle.”

—Austin Render and Mollie Hanrahan, avid cyclists and co-founders of the Bourbon Country Burn, @bourboncountryburn

Therapy dogs effective in reducing symptoms of ADHD, study finds

In a first of its kind randomized trial, researchers from the UCI School of Medicine found therapy dogs to be effective in reducing the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. The study’s main outcomes were recently published by the American Psychological Association in the Society of Counseling Psychology’s Human-Animal Interaction Bulletin (HAIB). Additional new findings were presented at the International Society for Anthrozoology 2018 Conference held July 2-5 in Sydney, Australia.

Titled, “A Randomized Controlled Trial of Traditional Psychosocial and Canine-Assisted Interventions for Children with ADHD,” the research involved children aged 7 to 9 who had been diagnosed with ADHD and who had never taken medicines for their condition. The study randomized participants to compare benefits from evidenced-based, “best practice” psychosocial interventions with the same intervention augmented by the assistance of certified therapy dogs. The research was led by Sabrina E. B. Schuck, PhD, MA, executive director of the UCI Child Development Center and assistant professor in residence in the Department of Pediatrics at UCI School of Medicine.

Results from Schuck’s research indicate children with ADHD who received canine assisted intervention (CAI) experienced a reduction in inattention and an improvement in social skills. And, while both CAI and non-CAI interventions were ultimately found to be effective for reducing overall ADHD symptom severity after 12 weeks, the group assisted by therapy dogs fared significantly better with improved attention and social skills at only eight weeks and demonstrated fewer behavioral problems. No significant group differences, however, were reported for hyperactivity and impulsivity.

“Our finding that dogs can hasten the treatment response is very meaningful,” said Schuck. “In addition, the fact that parents of the children who were in the CAI group reported significantly fewer problem behaviors over time than those treated without therapy dogs is further evidence of the importance of this research.”

Guidelines from the American Academy of Pediatrics for the management of ADHD underscore the importance of both psychopharmacological and psychosocial therapies. Patients who receive psychosocial therapy prior to medications have shown to fare better. Additionally, many families prefer not to use medications in young children.

“The take away from this is that families now have a viable option when seeking alternative or adjunct therapies to medication treatments for ADHD, especially when it comes to impaired attention,” said Schuck. “Inattention is perhaps the most salient problem experienced across the life span for individuals with this disorder.”

This study is the first known randomized controlled trial of CAI for children with ADHD. It illustrates that the presence of therapy dogs enhances traditional psychosocial intervention and is feasible and safe to implement.

Animal assisted intervention (AAI) has been used for decades, however, only recently has empirical evidence begun to support these practices reporting benefits including reduced stress, improved cognitive function, reduced problem behaviors and improved attention.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and Mars-WALTHAM® grant R01H066593.

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Ahead of the ‘RHONY’ Reunion, Luann de Lesseps Checks Back Into Rehab

Treatment for any illness often isn’t as straightforward as it initially seems, and mental health issues—especially substance use issues—may follow a winding path. For instance, Real Housewives of New York star Luann de Lesseps has spoken candidly on the show and social media about entering treatment in January and managing her sobriety since then. But this week, it was revealed that she made the decision to go back to rehab.

De Lesseps hasn’t made too many details of her sobriety public, but she posted on Instagram about celebrating her first six months of sobriety just a few weeks ago.

Although de Lesseps hasn’t spoken publicly about her choice to return to rehab, People reported that she authorized co-star Bethenny Frankel to speak on her behalf.

“This weekend, Luann was surrounded by her girlfriends and decided—with their support—that in light of recent circumstances, it is the healthiest choice for her not to attend Tuesday’s reunion taping so that she can continue in her healing process,” Frankel told People. “Luann is now surrounded by a core group of people who truly have her best interests at heart and who are working to make sure she gets the help she needs.”

Frankel added, “Recent additional family stress was a catalyst to her taking a break.” (News broke last week about a lawsuit against de Lesseps put forth by her ex-husband and two children.)

Bravo later confirmed that de Lesseps would be skipping the taping of the 10th season’s reunion episode while in rehab. “Bravo supports Luann’s decision to focus on her health,” a spokesperson for the network said in a statement. “She is part of the Bravo family and we continue to stand by her as she copes with this challenging situation. At this time, we hope everyone will respect her privacy.”

As SELF wrote previously, recovery is a process, which may require adjustments along the way.

Experiencing a small slip or a full-on relapse or simply feeling like sobriety is more challenging than usual doesn’t mean that treatment has failed. But it does indicate that your treatment plan may need a bit of a tune-up. And, encountering increasingly stressful life events may make you more vulnerable to using substances in the way you did before seeking treatment.

So, it’s certainly not unusual or unhealthy for someone in de Lesseps’s position to check in with their support system, addiction counselor, or doctor. But it is refreshing that she’s actually taking the step to do so with the public eye on her. “It’s a brave and honest decision by her,” Frankel said, “and everyone is rallying around her and wants the best for her.”