Strengthen Your Entire Body With This 8-Part Slam Ball Circuit from Pink’s Trainer

The slam ball, contrary to what its name might suggest, isn’t just for ball slams.

Essentially an extra-large version of the medicine ball made with softer material, the slam ball is a strength training tool with plenty of applications, as proven recently by celebrity trainer Jeanette Jenkins.

On Sunday, Jenkins, Los Angeles-based creator of The Hollywood Trainer who has worked with Pink, Alicia Keys, Mindy Kaling, and Bebe Rexha among others, showed its versatility with an Instagram video of her demoing an 8-part (!) slam ball-centric circuit.

You can check out the video via @msjeanettejenkins here:

Slam balls in general are a great tool for building core strength—and they’re also a safe way to do weighted plyometric work.

The slam ball is “an old school tool” with loads of total body benefits, Stephanie Mansour, Chicago-based certified personal trainer, tells SELF.

As mentioned, the most traditional, popular movement performed with the slam ball is the ball slam, which is incorporated into several of the movements in Jenkins’ circuit. It involves raising the slam ball (or a regular medicine ball) overhead and throwing it straight down as hard as possible. This high-intensity movement is “a great total-body exercise,” Danielle Barry, certified personal trainer and CrossFit coach at Solace New York, previously told SELF. “They [ball slams] engage your core, shoulders, triceps, back, glutes, hamstrings, and quads.”

But, also as mentioned, that’s not all this tool is good for.

Slam balls are also an effective, safe way to do weighted plyometric movements (anything involving explosive movement, like hops and jumps), which include many of the exercises in Jenkins’ circuit. Jumping around with a heavy weight—like a large dumbbell or kettlebell—puts you at risk for hurting your lower back, James Brewer, NYC-based certified personal trainer and certified Spin and TRX instructor, tells SELF. Even if you have a lighter dumbbell or kettlebell, there’s always the chance that you could drop it mid-jump and seriously hurt your lower half. But jumping with an appropriately weighted slam ball (more on choosing the correct weight for yourself below), can be a safe, fun and easy way to up the challenge of your plyometric movements.

The benefits of this particular slam ball sequence are many, including total body strengthening—particularly the legs and core—plus plyometric and coordination work.

This circuit works essentially every major muscle group in your body, including your arms, shoulders, chest, legs, glutes and core—especially your core, says Brewer. The last four moves in particular focus almost exclusively on the core.

It also involves plyometric work and challenges your coordination, he adds.

The circuit is also stellar cardio, especially if you’re strapped for time.

This circuit, which combines explosive jumps and compound strength exercises, will “keep your heartrate up all the way through,” says Brewer, as essentially “every move is high-intensity” and many are also high-impact.

For that reason, “it can be a great 15 to 20-minute burn if that’s all the time you have for a quick workout.” He also recommends it as the closing set at the end of a workout.

There are a few safety tips to keep in mind when working with slam balls.

When performing a traditional ball slam, it’s “super easy to overextend your back when the ball is above your head if you’re not using your core,” says Mansour. It’s also easy to overbend at the knees and/or hips if you’re not engaging your core correctly as you slam the ball down.”

For these reasons, proper core engagement is super important when doing ball slams. “It’s an athletic exercise that works the upper and lower body at the same time while the core stays stable,” says Mansour.

It’s also important to start light. If you pick a ball that’s too heavy, you may arch (and potentially strain) your back when you pick it up, says Mansour. Of course light and heavy are relative, so it might take some trial and error to figure out the best weight. But, in general, if you’re a beginner, start with a 6-pounder, recommends Brewer, and if you’re at an intermediate level, try an 8- or 10-pound ball. If you’re more advanced, you can try a 12-pound ball, he suggests, though it may be a good idea to keep a lighter ball on hand in case you need to reduce the load mid-way through.

Lastly, mind your pace as you perform slam ball exercises, particularly the ones in this circuit. If you’re new to these types of movements, go slower than what Jenkins demos, advises Mansour. And on the two rotation-focused moves in particular—overhead 180 slams and the plyolunge slams—be extra careful to engage all of your core muscles, including your obliques (the muscles on the sides of your midsection), rectus abdominis (your abs, the muscles that run vertically on your abdomen) and transverse abdominis (the deepest ab muscle that wraps around your sides and spine), says Mansour. Correctly engaging all of these core muscles will help you protect your lower back from misplaced stress as you twist powerfully from side to side. On that note, if you have a history of low back pain or injury, you may want to skip over these particular moves.

Ready for total-body burn? Here’s how to do the 8-part circuit.

Repeat the following sequence up to 3 times, with short rest breaks in between each set.

Squat Jump Slams

  • Hold the ball firmly between both hands with your arms out straight in front of you, and stand with your feet about shoulder-width apart. This is the starting position.
  • Push your hips and butt back and bend your knees to lower down into a squat, bringing the ball between your legs as you lower.
  • From here, jump up into the air as high as you can, squeezing your inner thighs raising the ball above your head as you jump.
  • At the top of the jump, throw the ball to the ground as hard as you can.
  • Land on the floor, keeping your knees soft, and as you return to starting position, catch the ball as it bounces up.
  • This is one rep. Continuing doing reps for 30 to 45 seconds.

Toe Taps 360 & Reverse

  • Place the ball on the ground.
  • Lift your right leg up, bend at the knee and tap the toes of the right foot on top of the ball as your left foot stays firmly planted on the ground.
  • From here, quickly jump and switch feet so that your left toes tap the top of the ball and your right foot stays firmly planted on the ground.
  • Continue jumping, tapping and switching. With each jump, move slightly to your right so that you complete circular motion around the ball.
  • Once you’ve completed a full circle, switch directions and complete a circle moving the other way.
  • Do as many circles as you can in 30 to 45 seconds.

This is a good plyometric leg strengthening move, says Brewer. That said, be sure to keep your arms pumping as you perform the jumps, he adds. That motion will help you find and maintain good rhythm.

Overhead 180 Slams

  • Stand with your feet between hip- and shoulder-width apart, and hold the medicine ball at waist height.
  • Raise the ball up over your head, rising up on your toes as you do and twist to your right side.
  • Keep your abs tight and glutes squeezed as you slam the ball down to the ground on your right side as hard as you can, bending your knees slightly as you perform the slam.
  • From here, squat down, by pushing your butt back and bending your knees, so that you can grab the ball as it bounces back without dropping your chest and rounding your shoulders forward. You want to keep your back as flat as possible throughout. This is one rep.
  • Stand back up and bring the ball overhead to immediately go into the next rep, this time twisting and slamming the ball down to the left side.
  • Continue this pattern of alternating reps for 30-45 seconds.

PlyoLunge Slams

  • Stand with your feet about shoulder-width apart, and hold the ball firmly between both hands with your arms out in front of you, elbows slightly bent.
  • Step back (about 2 feet) with your left foot, landing on the ball of your left foot and keeping your heel off the floor.
  • Bend both knees to create two 90-degree angles with your legs. In this positioning, your shoulders should be directly above your hips and your chest should be upright (not leaning forward or back). Your right shin should be perpendicular to the floor and your right knee should be stacked above your right ankle. Your left thigh should be perpendicular to the floor. Your butt and core should be engaged.
  • Push through the heel of your right foot and the ball of your left foot to jump up.
  • As you jump, switch your stance so that your right foot goes back about 2 feet, landing on the ball of your right foot and keeping your heel off the ground. Your left foot is now in front, flat on the floor, facing forward.
  • Bend both knees again to create two 90-degrees angles with your legs.
  • Without pausing, push through the heel of your left foot and the ball of your right foot to jump up, switching your stance again and sinking down into the lunge.
  • After two jumps, pause at the bottom of the movement and lift the ball overhead. Twist your torso to the right and then squeeze your glutes and core as you slam the ball to your right side as hard as you can.
  • Catch the ball as it bounces up and then perform two more jump lunges as described above.
  • After two jumps, pause at the bottom of the movement and lift the ball overhead. Twist your torso to the left side and then squeeze your glutes and core as you slam the ball to your side side as hard as you can.
  • Catch the ball as it bounces up and then continue this sequence, performing two jump lunges with ball slams on alternating sides, for 30 to 45 seconds.

This core, hamstring, and glute-oriented move will really work your obliques, says Brewer. As you perform the jumps, “take your time,” he adds. “Start off slow and make sure that you are stable in your back leg, and then bring the ball up.”

Plank Ab Tuck to Ab Pike

  • Come to all fours with the ball behind you.
  • Place the tops of your feet on top of the ball.
  • Slowly start to walk your hands forward until you’re in a plank position, with your legs extended and your feet on the ball. This is your starting position.
  • Keeping your core engaged, bring your knees into the center of your chest to perform the tuck. Reverse the movement to lower back to the starting position.
  • Then, keeping your core right, raise your hips in the air until your butt, shoulders, and head are stacked to perform the pike.
  • Reverse the movement to lower back to the starting position.
  • Continue alternating between tucks and pikes for 30 to 45 seconds.

This move is great for your shoulders and your core, in particular the rectus abdominis, says Brewer.

Ab Tuck to Ab Toe Touch

  • Lie on your back, grab the medicine ball firmly between both hands and place it above your head.
  • Squeezing your core, simultaneously raise your arms and legs several inches off the ground. This is the starting position.
  • Continue squeezing your core to lift your torso up to a sitting position, lowering the ball to chest level as you do so. At the same time, bend your knees and bring your legs in towards the center of your body. Pause here for a moment and then reverse the movement to return to the starting position.
  • As soon as your shoulders touch the ground, squeeze your core to lift your torso back up to a sitting position. This time, keep your legs straight and the ball raised overhead as you lift your torso. Touch the ball with your toes, pause here for a moment and then reverse the movement to return to the starting position.
  • Continue this sequence, alternating between the ab tucks and toe touches, for 30 to 45 seconds.

This core-centric sequence works both your lower and upper abdominals, says Brewer. Make sure to keep your gaze focused straight ahead and your chin tucked as you lift your torso. “Pretend you have a tennis ball tucked under your chin,” he says.

Extended Arms with Flutter Kicks

  • Lie on your back, grab the medicine ball firmly between both hands and place it above your head.
  • Squeezing your core, simultaneously raise your arms straight above your chest and lift your legs several inches off the ground. As with the last move, keep your gaze focused straight ahead and your chin tucked as your lift your torso. This is the starting position.
  • From here, keeping your upper body as still as possible, squeeze your glutes and legs to perform small, fast flutter kicks for 30 to 45 seconds.

Your legs will likely be fatigued by this point, says Brewer. This is where it helps to have a lighter ball. This move also works your shoulders and lower abs.

Chest Toss with Flutter Kicks

  • Get in the starting position described for the move above.
  • Perform the flutter kicks as described above, while simultaneously and repeatedly tossing the ball into the air and catching it at chest level. Keep the tosses low to start, says Brewer.
  • Continue flutter kicking and tossing the ball for 30 to 45 seconds.

This total body move works the upper body—mainly the pectorals—as well as the core and legs, says Brewer. It’s also a great coordination challenge.

The FDA Is Cracking Down on JUUL and E-Cigarette Retailers to Curb Teen Vaping

Earlier this year, the Food and Drug Administration (FDA) unveiled an unprecedented plan to cut smoking and nicotine addiction rates. Now, FDA commissioner Scott Gottlieb, M.D. says the agency is taking new steps to keep the popular JUUL and other vapes out of kids’ hands.

The FDA announced today that they’re cracking down on companies and retailers that may be marketing, selling, or redistributing JUUL and other vape products to minors.

Today—in what Dr. Gottlieb calls “the largest coordinated tobacco compliance effort in FDA’s history”—the agency sent letters to five major companies, including JUUL, Vuse, MarkTen, blu, and Logic. The letters allege that the companies’ products were sold to underage users and give the companies 60 days to create new plans to prevent minors from using their products. In particular, the FDA is focusing on flavored e-cigarette liquid that may be especially attractive to younger users.

“This may require these brands to revise their sales and marketing practices, including online sales; to stop distributing their products to retailers who sell to kids; and to remove some or all of their flavored e-cig products from the market until they receive premarket authorization and otherwise meet applicable requirements,” Dr. Gottlieb said in the statement.

The FDA also took actions (including warning letters and fines) against more than 1,300 retailers that may have illegally sold vape products to minors. And, on top of all that, the agency announced it will be examining its own compliance policies, including beefing up its efforts to monitor and enforce regulations and revisiting its premarket approval policy of new products.

“JUUL Labs will work proactively with FDA in response to its request. We are committed to preventing underage use of our product, and we want to be part of the solution in keeping e-cigarettes out of the hands of young people,” Kevin Burns, CEO of JUUL Labs, said in a statement regarding the FDA’s actions.

“Our mission is to improve the lives of adult smokers by providing them with a true alternative to combustible cigarettes. Appropriate flavors play an important role in helping adult smokers switch. By working together, we believe we can help adult smokers while preventing access to minors, and we will continue to engage with the FDA to fulfill our mission,” the statement continues.

But, wait, aren’t e-cigarettes a way better alternative to regular cigarettes?

Yes, but…it’s complicated. In today’s statement, Dr. Gottlieb acknowledges that, previously, the FDA’s guiding principle in its efforts to combat the harmful effects of smoking was the understanding that “what primarily causes death and disease from tobacco use isn’t the nicotine in these products. It’s the act of lighting tobacco on fire to free that drug for inhalation.”

And, although nicotine is obviously what keeps people smoking, “it’s primarily the combustion, which releases thousands of harmful constituents into the body at dangerous levels, that kills people,” Dr. Gottlieb says.

So, because e-cigarettes do not involve that key step, they present an opportunity to make the act of smoking less harmful and, possibly, help people transition away from cigarette smoking and nicotine consumption entirely.

And, until now, the FDA has tried to balance that potential with the efforts to keep a new generation of younger people from becoming addicted to nicotine via e-cigarettes.

But, according to Dr. Gottlieb, the FDA didn’t predict what he now refers to as “an epidemic of e-cigarette use among teenagers.”

Nicotine isn’t “a benign substance,” he says, and children’s brains may be particularly susceptible to its effects. The most obvious one is, of course, nicotine dependence, which makes it difficult (often nearly impossible) to quit using nicotine and causes withdrawal symptoms when you try to stop, such as irritability, anxiety, difficulty concentrating, insomnia, and diarrhea or constipation.

Additionally, because our brains are still developing until around age 25, nicotine exposure before that may interfere with the development process. Studies looking at cigarette smoking suggest that adolescents and young adults who smoke may show deficits in attention and memory tasks. And animal studies confirm that nicotine exposure at a young age can directly affect the development of neural structures in the brain and behavior associated with those changes (if you happen to be a rat, anyway).

E-cigarette vapor also contains other compounds that researchers are still working to understand. For instance, they may contain diacetyl, a chemical once commonly found in microwave popcorn flavoring that in large amounts is known to cause damage to the lungs (a condition called “popcorn lung”), according to the American Lung Association. (But it isn’t clear that the level of diacetyl found in e-cigarettes poses a similar risk.)

There is also research to suggest that vaping as a teen is associated with a higher likelihood that you’ll try other risky behaviors. For instance, a study published in Pediatrics last year looked at data from the CDC’s 2015 Youth Risk Behavior Survey, which included information for 15,624 students in grades 9 through 12. Looking at the survey results, researchers found that students who reported using e-cigarettes were also more likely to report getting into physical fights, engaging in risky sexual behavior (such as having more than four sexual partners), and using other substances, including alcohol, cannabis, and non-medical use of prescription drugs.

Of course, this is an observational study and, therefore, can’t tell us whether or not using e-cigarettes actually causes those other behaviors, only that they are correlated. Additionally, the data used in this study was all self-reported, which we know is not the most reliable because people may not accurately remember engaging in these behaviors or may not want to admit to engaging in them.

That said, it’s particularly worrying that the use of e-cigarettes has been associated with an increased risk for transitioning to the use of traditional cigarettes, a pattern that is contradictory to that found in adults. So, even if the risks of adolescent e-cigarette use aren’t totally understood, it makes sense that the FDA would want to err on the side of caution here.

So what does this mean for you if you’re a JUUL user?

If you’re an adult Juul user, this won’t have any immediate impact on your life, but you may see changes in the near future. If you’re below the legal age limit for purchasing e-cigarettes (age 21 in California, Hawaii, Maine, New Jersey, and Oregon, and age 18 in other states), know that retailers are increasingly discouraged from selling the devices to you.

As we mentioned, nicotine isn’t harmless—even if it’s coming from an e-cigarette. So if this is a habit you’d rather do without, now is a perfect time to look into resources for quitting. Your doctor or the CDC can point you in the right direction, which may include setting up a definite quitting plan, joining a support group, downloading an app, or managing cravings with specific activities or nicotine replacement therapy.

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Prince William Explains How His Time as a First Responder Affected His Mental Health

Prince William continued the royal family’s important work in destigmatizing mental health issues on Tuesday while launching Mental Health at Work, a free online resource that aims to improve and foster discussion about the mental health of employers and employees in the United Kingdom.

During the launch event, which took place in the city of Bristol, Prince William discussed how his past work as a pilot for the East Anglian Air Ambulance service impacted his mental health.

“I took a lot home without realizing it,” he said, according to People.

“You see [so] many sad things every day that you think life is like that.” He continued, “You’re always dealing with despair and sadness and injury. The attrition builds up and you never really have the opportunity to offload anything if you’re not careful.”

Prince William spoke further about the damage done in particular to first responders. “You’re human and a lot of people forget the battles. You have to shut it off to do the job—but, ultimately, something pierces the armor,” he said. The father of three has previously addressed the struggles countless people face in their workplaces. “While work can provide a great sense of fulfillment, it can, at times, be a significant source of stress and negatively impact our mental health,” he said at an event in March, per CNN.

As SELF wrote previously, there are ways to show your employees you care about their mental health—starting by talking about it.

On Tuesday, Will said he was “stunned” when research from Heads Together (another royal family-founded mental health initiative) found that, while at least 25 percent of employees in the U.K. are coping with some mental health issue on their own, only 2 percent of them would feel comfortable discussing their mental well-being with their human resources department.

“To change this, we need to tackle two big problems: We need to stop people feeling as if they have to hide, and we need to make sure that anyone with any responsibility at work knows what to do,” he said.

In the U.S., that might include providing specific mental health resources (like access to professional counseling) or consulting with an employee assistance professional to learn the best way to handle sensitive issues like these. But it also means that workplaces and bosses need to create environments in which their employees are able to have an adequate work/life balance and don’t feel judged disclosing issues that may come up.

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Keep them guessing, keep them gaming

Marketers everywhere are looking for what will entice consumers to make a purchase — not just once but repeatedly — and new research points to a rather surprising result.

While conventional wisdom says that people don’t like uncertain gains or rewards, a study from the University of Chicago Booth School of Business finds that uncertainty can play an important role in motivating repeat behaviors.

“People repeat a task more for an uncertain incentive than for a certain incentive, even when the uncertain incentive is financially worse,” say Chicago Booth Professor Christopher Hsee and the Chinese University of Hong Kong’s Luxi Shen, a recent Booth graduate, in the study, “The Fun and Function of Uncertainty: Uncertain Incentives Reinforce Repetition Decisions.”

One reason uncertain incentives motivate behavior is the psychological boost consumers get in moving from the unpleasantness of uncertainty to the satisfaction of certainty resolution.

The popularity of WeChat Pay, one of the largest mobile payment apps in the world, is one example. After tapping to pay with WeChatPay, a mobile payment user is sometimes awarded a bonus of an uncertain size. This strategy motivates the user to pay with this specific app again.

The same is true of many consumer goods companies. Meal-kit delivery services such as Blue Apron send their subscribers a box of unknown groceries every week. Apple music pushes a list of new music to their subscribers. Birchbox mails out boxes of skincare and makeup samples, and BarkBox gives pet owners a box full of surprise dog treats and toys based on that month’s theme.

“These services all share one important feature,” says Hsee. “They keep the box mysterious and let their customers have fun opening the packages and discovering the products. The uncertainty keeps the customers coming back.”

In the study, published in the Journal of Consumer Research, the researchers performed four experiments in Hong Kong and Chicago and found uncertain rewards consistently motivated consumers more than certain rewards in both lab and field settings, and in both small and large magnitudes.

In one experiment, students at a running club in Hong Kong were told they could earn points by running, jogging, or speed walking on a 400-meter outdoor track during a 15-day event.

Half of the members were randomly assigned to a group certain of its reward — after each lap, each member would receive five points. The other half were randomly assigned to a group uncertain of its reward — after each lap, each member would randomly receive either three or five points. At the end, participants could exchange their points for a gift card at a local café for the equivalent in Hong Kong dollars.

As the researchers predicted, the running club members who didn’t know in advance which reward they would get logged more laps than those in the group guaranteed the five points per lap, even though the uncertain-point condition promised a worse financial outcome.

“In other words, people literally ran ‘the extra mile’ (precisely, 1.61 more miles) for the uncertain incentive,” the study says.

This uncertain reward is particularly beneficial for marketers who want their existing customers to return. “However, for the marketers whose solo goal is to recruit one-time customers, they should be cautious and not just mindlessly add uncertainty into their product design or pricing strategy,” Shen adds.

In the study, the researchers show that uncertain rewards are effective only if the uncertainty is resolved immediately, and only after, not before, one has engaged in repetitions.

Marketers have had success already in getting consumers to repeat behaviors. Grocery stores encourage shoppers to bring cloth bags and coffee shops encourage drinkers to bring their own mugs, both for the reward of a small percentage off their purchase. But the study suggests that such efforts may be even more successful if consumers don’t know the amount of the reward in advance.

“Our research reveals that human reactions to uncertainty are more complex and nuanced than commonly thought,” they say.

Among body shapes, pears are healthier than apples

Whether we like it or not, everyone accumulates fat.

For women, it usually accumulates around the hips, resulting in a pear-shaped look. In men, fat tends to build up around the abdomen, creating an apple shape.

As it turns out, it’s healthier to be a pear than an apple.

A research team at the University of California, Riverside, has found that only male mice experienced neuroinflammation, or activation of the immune system’s response in the brain, after being fed a high-fat diet. While females were unaffected, males showed low testosterone and reduced sperm count, in addition to neuroinflammation.

Study results appear in the journal Frontiers in Immunology.

Clinical studies have led researchers to believe females are protected against weight gain when they are young because of ovarian estrogen. The understanding has been that women gain weight after menopause because of a precipitous drop in estrogen, resulting in a decline in health parameters, including obesity.

“We addressed this assumption by removing ovaries in young mice,” said Djurdjica Coss, an associate professor of biomedical sciences in the UCR School of Medicine, who led the study. “We found that the mice proceed to gain weight when fed a high-fat diet, suggesting that ovarian hormones are indeed protective against weight gain. But we found, too, that these female mice exhibit neither neuroinflammation, nor changes in reproductive hormones, suggesting that they are protected by factors other than ovarian estrogen. This is a novel finding.”

The findings, derived from the mouse study, are likely to have applications in humans, Coss added.

“Mice on high-fat diet develop metabolic syndrome — a constellation of pathologies that includes Type 2 diabetes and insulin insensitivity — similarly to obese humans,” she said. “Obese men have lower testosterone levels, contributing to low libido, low energy, and reduced muscle strength. We see this in mice, too; obese male mice showed nearly 50 percent decreases in testosterone and sperm number. Obese women have difficulty with their menstrual cycles. They don’t ovulate. Obese female mice show the same, contributing to decreased fertility. Interestingly, 18 percent of couples in the United States now need medical interventions — hormonal treatments, in vitro fertilization — to conceive a child. Obesity is a likely factor.”

Increased obesity is a public health concern in the United States, where more than 30 percent of people are obese, and more than two-thirds are overweight. Obesity has been associated with mental decline and an increased rate of stroke, in addition to other problems affecting the internal organs. In the U.S., some ethnic minority groups are disproportionately affected by obesity.

Female women and mice deposit fat differently than their male counterparts. Females deposit fat subcutaneously, right below the skin, while males accumulate fat deeper, in the body’s visceral region, which may affect internal organs.

Eventually, even in women, the subcutaneous regions get overwhelmed with fat and the abdominal region begins to show obesity, which leads to neuroinflammation.

“While overweight, women are more protected than men where neuroinflammation is concerned,” Coss said. “This could be an evolutionary protection for women, who need to experience more change in weight due to pregnancy. This protection is significantly curtailed when overweight women become obese and fat gathers around the waist.”

Next, Coss and her team will explore, in mice, how abdominal weight is linked to neuroinflammation.

“We know that abdominal fat — that is, fat around visceral organs — gets more inflamed with a fat overburden,” she said. “This fat then recruits immune cells from blood circulation that get activated.”

Another important finding reported in the study is that peripheral immune cells, macrophages in particular, cross the blood-brain barrier — the protective barrier stopping the influx of most compounds from the blood to the brain. This infiltration of peripheral immune cells into the brain occurs in addition to the activation of resident immune cells.

“The brain has been considered an ‘immune protected site,’ but we show that peripheral inflammation ‘spills over’ into the brain, which, in turn, may cause neuronal problems mentioned above,” Coss said.

Coss explained that it is unclear what causes this activation, and that her research team plans further investigation.

“We know the immune cells secrete cytokines, which are inflammatory markers, in the blood. It’s possible these cytokines travel in blood from the fat tissue and activate the immune cells to cross the blood-brain barrier,” she said. “It’s possible, too, that other immune cells contribute to the neuroinflammation. Clearly, our work has provoked several research questions we would like to answer.”

Coss acknowledged weight is a sensitive topic even for clinicians who have a difficult time talking about it to patients.

“After all, we associate food with happiness, social interactions, and family gatherings,” she said. “Still, my advice is: ‘Watch your diet! And keep an eye on body weight, particularly around the abdomen.'”

Coss, who joined the UCR School of Medicine in 2013, was joined in the study by her graduate student Nancy M. Lainez (first author), Carrie R. Jonak, and four School of Medicine faculty members: Meera G. Nair, an expert in immunology; Iryna Ethell, an expert in brain function; Emma H. Wilson, an expert in neuroinflammation; and Monica Carson, an expert in blood-brain interactions. The interdisciplinary research was supported by UCR startup funds.

How to Pick the Best Apples

If the world had to pick one fruit to love, it would have to be the apple. Don’t agree? Let’s examine the facts. We talk about the fruit all the darn time. There’s the Big Apple. You can be the apple of someone’s eye or a rotten apple, and something can be American as apple pie. And if you eat one every day, you just might keep the doctor away—how do you like them apples?

For as much as we talk about apples, I still have no idea how to pick a good one at the supermarket. I always keep the fruit around, because it makes a great quick snack when I’m on my way out the door. Yet, despite my years of apple buying, I somehow manage to bring home at least one bad apple every time I go shopping. What am I doing wrong?

Since I know I’m not the only frequent apple eater out there, I asked Nick Moless, senior produce buyer at Whole Foods Market, for his tips. He says you have to be on the lookout for really subtle clues that you might not otherwise know to look for. Here’s everything he says you should and shouldn’t be keeping an eye out for.

There are tons of apple varieties, but these are the most common.

If you’ve ever been to the farmers market during peak apple season (from September through October), then you probably know that there are, like, a jillion different apple varieties. But the ones you’ll probably see at the supermarket year round are Fuji, Gala, Granny Smith, Pink Lady, and Honeycrisp, says Moless. You might also run into Red Delicious, Golden Delicious, or Braeburn, but he explains that these older popular varieties have taken a bit of a backseat to the newer ones, and they’re starting to appear less and less frequently. At Whole Foods, he says you can also buy slightly rarer varieties like Envy, Kanzi, Opal, and Rainier Lady Alice apples. And if you want to try even more, be sure to hit up your local farmers market ASAP.

Each apple variety is delicious in its own way and best for different uses.

If you’re looking for an apple to snack on, Moless recommends opting for a Fuji, Honeycrisp, or Granny Smith, because they’re harder varieties that maintain their crunch for longer. “These varieties are also good additions to salads or as a topping to a sandwich or wrap,” he explains, “and they’ll hold their texture during cooking or baking. So if you don’t want the apples in your apple pie to turn to mush, choose one of these.

Softer varieties, like Red Delicious, Golden Delicious, or Gala, don’t stay crunchy for long, he says, but that makes them great for turning into apple sauce, apple butter, or any other apple treat where mushy apples are considered a plus.

You have to rely on really subtle clues to pick the good apples from the bad apples.

Though you can often use color to determine whether a fruit or vegetable is good to eat or not, that’s generally not the case with apples, says Moless. Occasionally, if an apple that’s normally red or yellow (like Fuji or Red Delicious) has any green on it, he says that may mean the apple was prematurely picked and will be more tart and starchy than usual. But with apples that are normally green, like Granny Smith, it’s impossible to tell.

Instead, Moless says a better way to distinguish the good from the bad is to look for apples without flat spots, because those are bruises in the making, and without any punctures, because those can lead them to decay faster than they normally would.

As for how to ensure your apples aren’t mealy, Moless says it can be hard to do, because mealy apples can often look almost identical to crisp apples. If you hate mealy apples like I do, he says your best plan of action is to simply avoid apple varieties that are prone to getting mealy, like Gala apples or other, softer varieties. Otherwise, he says that if the apple is firm when you squeeze it and there are no signs of wrinkling on the skin, you should be good to go.

Store your apples in the fridge to keep them fresh for as long as possible.

Apples emit a lot of ethylene, which is the gas that causes fruit to ripen and eventually rot. They produce so much of it, you can actually harness it to ripen other fruits and vegetables, like avocados, by placing them in a paper bag together. The best way to keep all of that ethylene from causing your apple to go off too soon is to keep them in the fridge—this will reduce the amount of gas produced, which will help them last longer.

Try cooking with your apples in these recipes.

Baked Apple and Oats

Andrew Purcell; Carrie Purcell

Take your apple oatmeal to another level with this dreamy breakfast. Get the recipe here.

Kale Apple Salad With Chickpeas

Andrew Purcell; Carrie Purcell

Apples make a great, crunchy addition to all different kinds of salads. Get the recipe here.

Skillet Chicken Thighs With Potato, Apple, and Spinach

Andrew Purcell; Carrie Purcell

Chicken gets a touch of sweetness when baked with juicy apples. Get the recipe here.

Sugar pills relieve pain for chronic pain patients

Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology. And the pills will reduce their pain as effectively as any powerful drug on the market, according to new research.

Northwestern Medicine scientists have shown they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics.

“Their brain is already tuned to respond,” said senior study author A. Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine. “They have the appropriate psychology and biology that puts them in a cognitive state that as soon as you say, ‘this may make your pain better,’ their pain gets better.”

There’s no need to fool the patient, Apkarian said.

“You can tell them, ‘I’m giving you a drug that has no physiological effect but your brain will respond to it,'” he said. “You don’t need to hide it. There is a biology behind the placebo response.”

The study was published Sept. 12 in Nature Communications.

The findings have three potential benefits:

  • Prescribing non-active drugs rather than active drugs. “It’s much better to give someone a non-active drug rather than an active drug and get the same result,” Apkarian said. “Most pharmacological treatments have long-term adverse effects or addictive properties. Placebo becomes as good an option for treatment as any drug we have on the market.”
  • Eliminating the placebo effect from drug trials. “Drug trials would need to recruit fewer people, and identifying the physiological effects would be much easier,” Apkarian said. “You’ve taken away a big component of noise in the study.”
  • Reduced health care costs. A sugar pill prescription for chronic pain patients would result in vast cost savings for patients and the health care system, Apkarian said.

How the study worked

About 60 chronic back pain patients were randomized into two arms of the study. In one arm, subjects didn’t know if they got the drug or the placebo. Researchers didn’t study the people who got the real drug. The other study arm included people who came to the clinic but didn’t get a placebo or drug. They were the control group.

The individuals whose pain decreased as a result of the sugar pill had a similar brain anatomy and psychological traits. The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.

“Clinicians who are treating chronic pain patients should seriously consider that some will get as good a response to a sugar pill as any other drug,” Apkarian said. “They should use it and see the outcome. This opens up a whole new field.”

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Materials provided by Northwestern University. Original written by Marla Paul. Note: Content may be edited for style and length.

Breast cancer screening does not reduce mortality

Fewer and fewer women die from breast cancer in recent years but, surprisingly, the decline is just as large in the age groups that are not screened. The decline is therefore due to better treatment and not screening for breast cancer.

This is shown by a major Danish-Norwegian study, Effect of organised mammography screening on breast cancer mortality: A population based cohort study in Norway, which has just been published in the scientific journal International Journal of Cancer.

In the study, the researchers followed all Norwegian women aged 30-89 and identified those who developed breast cancer in the period 1987-2010, before subsequently comparing the number of deaths before and after the screening programme was introduced.

As Associate Professor Henrik Støvring from Aarhus University, Denmark, notes, the result does not favour the breast cancer screening programme. This conclusion can also be transferred directly to Denmark (and elsewhere), where all women aged 50-69 are offered mammography screening — which is an X-ray examination of the chest — every second year. The Danish screening programme was progressively introduced from the early 1990s and was offered nationally to everyone from 2007, three years after the Norwegians, who have supplied data for the Danish-Norwegian research project.

“The important result is that we do not find a beneficial effect of breast cancer screening any longer. The original randomised trials examining breast cancer screening were conducted way back in the 1980s, and they showed an effect, but the fact is that the better the treatment methods become, the less benefit screening has,” says Henrik Støvring, who is associate professor at the Department of Public Health with biostatistics and screening programmes as his particular areas of expertise.

Here he points towards one of the paradoxes of screening — the popular but erroneous belief that if breast cancer patients who have been screened ‘live longer’ than other breast cancer patients, then screening works. The problem is that with screening, medical doctors detect cancerous tumours earlier than they would otherwise have done, and thus move the point of diagnosis forward in time. But even if someone who has been screened lives longer as a patient, it is not certain that their life as a whole will be longer. It is important to account for this fact, and the new study shows that screening does not lead to women living longer overall — and this is the study’s most important finding.

“The women who are invited to screening live longer because all breast cancer patients live longer, and they do so because we now have better drugs and more effective chemotherapy, and because we have cancer care pathways, which means the healthcare system reacts faster than it did a decade ago. But it does not appear that fewer women die of breast cancer as a result of mammography screening,” says Henrik Støvring.

He also points out that it is not always beneficial for a woman to be diagnosed with a tiny cancerous growth of e.g. a millimetre in diameter at a mammography. Some of these small nodules are so slow-growing that the woman would have died a so-called natural death with undiagnosed cancer, if she had not been screened.

“Now what happens is these women are instead given a diagnosis which isn’t going to make anyone happier. Such a breast cancer diagnosis both makes life more difficult and costs a lot of money, but does not ultimately make a difference. The problem is that we are not currently able to tell the difference between the small cancer tumours that will kill you and those that will not,” says Henrik Støvring.

Here he addresses the issue of overdiagnosis which is a growing problem in all Western countries where the approach to medicine and examinations is extensive and where national screening programmes are prevalent. A problem that was last week discussed in Copenhagen, Denmark, where 450 researchers from thirty countries attended the Preventing Overdiagnosis 2018 conference.

Even though the research results challenge the current health policy in Denmark, Norway and the rest of the Western world, Henrik Støvring is not in the business of telling Danish politicians that they should stop the national screening programme here and now:

“It’s certainly not my task to decide how the research results should be used, but my suggestion would nonetheless be that we should get together and begin to investigate whether it would beneficial to do something other than screening and whether this could have a better effect. If a doctor could instead examine women’s breasts with his or her hands, what is known as palpation, at regular intervals, then we would avoid much of the overdiagnosis,” says Henrik Støvring.

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

Delayed childbearing is a growing source of multiple births

Starting in the 1980s, the number of multiple births — twins, triplets, quadruplets and quintuplets — steadily increased from about 20 sets per 1,000 live births to almost 35 sets per 1,000 live births in the 2010s.

That trend presents some concerns, says Dr. Eli Adashi, professor of obstetrics and gynecology at Brown University’s Warren Alpert Medical School — multiple births come with various medical risks to both mother and babies, chief among them the risk of premature birth.

Adashi and colleague Roee Gutman, an assistant professor of biostatistics at Brown’s School of Public Health, analyzed Centers for Disease Control and Prevention (CDC) birth data to determine how much of this surge in multiple births is the natural result of women choosing to have children later in life — as compared to assisted reproductive technologies, to which the phenomenon is most commonly attributed.

Their results were published on Tuesday, Sept. 11, in the October issue of the journal Obstetrics & Gynecology.

Adashi has a long history of analyzing the sources of multiple births. Until he met a colleague’s natural quadruplets, however, Adashi controlled for maternal age in his analyses but didn’t focus on the role that delayed childbearing may have on the boom of twin, triplet and quadruplet births.

“Our question was: Does this social phenomenon of delayed childbearing have an impact on the incidence of multiple births in the United States?” Adashi said. “In the paper, we showed that yes, indeed, not all the multiple births out there have to do with fertility drugs or in-vitro fertilization (IVF). There’s a sizable proportion of multiple births that are attributable simply to delaying childbearing. And the percentage of these spontaneous multiples seems to be growing.”

The fact that older women are more likely to have twins, triplets and quadruplets has been known for quite some time, Adashi said. In fact, he found a 150-year-old medical paper on the topic. But while the role that delayed childbearing plays in the increase in multiple births from the 1980s onward has been observed, it hadn’t been analyzed with reference data allowing statistical projections until now, he said.

Using CDC data from 1949 to 1966, before assisted reproductive technologies were available, the researchers found that by the time white women reach age 35, they are about three times more likely to have fraternal, non-identical twins. African American women are four times more likely to have twins at age 35. The risk for triplets and quadruplets goes up four and a half times and six and half times, respectively.

In addition to the advent of assisted reproductive technologies, the study noted that the period of 1971 to 2016 also brought pronounced social changes and more choices by families to delay childbearing. The study found that the fraction of white mothers who were between 30 and 40 years old increased from 16 percent in 1971 to 42 percent in 2015. Black mothers of this age increased from 14 percent to 31 percent over the same time period. The researchers found that this increase in the number of older women having children without assisted reproductive technologies played a definite role in the number of multiple births that exceeded the expected rate of about 20 multiples per 1,000 live births.

In 2016, delayed childbearing was solely responsible for 24 percent of the multiple births for white women beyond expected rates and 38 percent for black women. Furthermore, by extrapolating delayed childbearing rates, the researchers projected that by 2025, women having children later without using assisted reproductive technologies could account for 46 percent of the excess multiple births for white women and 40 percent for black women.

Adashi said the goal of the research is not to intrude upon personal choices about how and when to have families, but to understand the factors that have contributed to the surge in multiples and raise awareness of the risks of delayed childbearing.

“People need to be aware of the increased risk of multiple births among the other more established concerns for advanced maternal age, such as Down syndrome, preterm birth and pre-eclampsia,” he said.

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

Air purifiers may benefit fetal growth

A new study led by SFU health sciences researchers Prabjit Barn and Ryan Allen reveals fetal growth may improve if pregnant women use portable air purifiers inside their homes.

The study, a first of its kind, was conducted in Ulaanbaatar, Mongolia, which is one of the most polluted cities in the world and has fine particulate matter (PM2.5) levels more than seven times higher than WHO guidelines. Fine particulate matter is the pollutant most consistently linked with human health effects.

The researchers recruited more than 500 women early on in their pregnancies and placed high-efficiency particulate arresting (HEPA) air purifiers in half of the women’s homes. The air purifiers decreased fine particulate matter in the women’s homes by 29 per cent.

“We found that pregnant women who used HEPA air purifiers inside their homes gave birth to babies that weighed 85 grams more on average at term than women who did not use air cleaners during pregnancy,” says Barn.

The researchers say that these results provide further evidence that air pollution exposure during pregnancy has a negative impact on fetal growth and that reducing exposures can be beneficial.

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