Common Blood Pressure Medications Containing Valsartan Recalled Over ‘Impurity’ Concerns

Several valsartan-containing drugs, which are commonly used to treat high blood pressure, have been recalled over contamination fears, the Food and Drug Administration (FDA) announced late last week. Specifically, the medications were tainted with N-nitrosodimethylamine (NDMA), a compound that’s been linked to cancer, the FDA said in a statement.

As a result, three companies—Major Pharmaceuticals, Solco Healthcare, and Teva Pharmaceuticals Industries Ltd.—have voluntarily recalled their products that contain valsartan. Solco and Teva Pharmaceuticals are also recalling their valsartan/hydrochlorothiazide medication. (Representatives from Major Pharmaceuticals, Solco Healthcare, and Teva Pharmaceuticals did not return SELF’s request for comment.)

“The presence of NDMA was unexpected and is thought to be related to changes in the way the active substance was manufactured,” the FDA said in the statement. Additionally, the FDA noted that all the recalled products contained valsartan were supplied by a third party, which has since stopped supplying the ingredient. “The FDA is working with the affected companies to reduce or eliminate the valsartan [active pharmaceutical ingredient] impurity from future products,” the statement reads.

The problem is that NDMA has been linked to an increased risk for cancer.

NDMA is a semi-volatile compound that forms in both industrial and natural processes, the Environmental Protection Agency (EPA) explains. It’s created from chemical reactions involving nitrates, nitrites, and other proteins, Rowena N. Schwartz, Pharm.D., an oncology pharmacist and associate professor of pharmacy practice at the University of Cincinnati, tells SELF. So, the compound may be an unintentional byproduct of the medications’ chemical manufacturing process, Jamie Alan, Ph.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF.

There’s evidence NDMA can create free radicals in your body that can damage your DNA, which can lead to the formation of cancer in some cases, Alan explains. Although this sort of process could raise the risk for any kind of cancer, Alan says, NDMA is a nitrate; and nitrates have specifically been linked to an increased risk of stomach, colon, and kidney cancers, according to the National Cancer Institute.

Technically, the International Agency for Research on Cancer (IARC) considers NDMA a Group 2A agent, meaning it’s considered a probable human carcinogen. This category sits one step above agents categorized as “possibly” carcinogenic to humans (which is Group 2B) and one step below definite human carcinogens (Group 1). According to the IARC’s definitions, category 2A is usually chosen when there’s sufficient evidence for a compound being carcinogenic in animal studies, but limited evidence in human studies, especially if there’s evidence that the animals studied share a common potential mechanism of action with humans.

But, because there are so many other factors at play, it’s hard to say exactly how much your risk for cancer would increase if you were exposed to NDMA. Those factors include things like your family history, the dose of NDMA you were exposed to and the length of exposure, your other environmental risks, as well as your personal history with cancer. “It really is specific to the individual,” Alan says.

If you’re affected by this recall, there are a few things you should do.

First, check your medication by looking at the drug company and drug name on the bottle and seeing if it’s one that’s included in the recall. If that information isn’t clear on the packaging, contact the pharmacy where you got the medication. If it turns out your medication is affected by the recall, call your doctor or pharmacist and follow the instructions posted on the FDA’s website for that particular medication.

Obviously, if you’re taking a blood pressure medication, there’s probably a good reason for it—and you shouldn’t just stop taking it without having a backup plan in place, Sanjiv Patel, M.D., a cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. Suddenly stopping your medication could cause a rebound effect that makes your blood pressure go up, Dr. Patel says, and that can put you at a higher risk of a stroke or heart attack. So, the FDA currently recommends that you keep taking your medication until you have a good replacement—and that you talk to your doctor or pharmacist about getting that replacement ASAP.

If for some reason you’re having a hard time getting ahold of your doctor, call the pharmacy that filled this for you—they may be able to give you a similar product with valsartan that was not affected by the recall, Alan says. Or, your doctor may even recommend that you try a totally different medication. “There are other options beyond valsartan,” Dr. Patel says. “It just one of many medications we can use to treat high blood pressure.”


When to See a Doctor About Diarrhea and When to Wait for It to Pass

When you’ve taken up permanent residency on your toilet thanks to diarrhea, you might start to wonder how normal your poop explosion really is. Sure, everyone has diarrhea from time to time, but when does it actually become a sign that you should see a doctor? Here, we consulted experts for the signals it’s time to seek treatment for diarrhea, plus what could be behind your butt’s excellent (and unfortunate) volcano impersonation.

Here’s exactly why diarrhea happens, first of all.

By definition, diarrhea means having loose, watery, stools that are more frequent than whatever amount of pooping is normal for you, the Mayo Clinic says.

Quick biology lesson: When the stuff you eat reaches your small intestine where a lot of your digestion takes place, it’s usually in liquid form, Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF. Your small intestine and colon (which is the longest part of your long intestine) absorb most of the fluid, transforming that matter into the solid-ish poop you see in your toilet. But when you have diarrhea, something has interfered with your small intestine or colon’s ability to soak up that liquid, so you end up with the runny, watery poop that you know as diarrhea, Dr. Staller explains.

The general rule is that if you have diarrhea for up to two days with no other symptoms, then it disappears, you can skip going to the doctor’s office.

Why’s that? Well, having diarrhea for a couple of days is just something that happens sometimes.

You can generally lump diarrhea into two categories: acute and chronic. Acute diarrhea can last anywhere from a few days to two weeks and is usually due to a bacterial, viral, or parasitic infection, according to the Mayo Clinic. Sometimes that infection passes in a matter of days and is really nothing to worry about. That’s why if you have acute diarrhea that only lasts for a couple of days, you don’t have any weird symptoms along with it (we’ll get to what those symptoms are in a sec), and then it goes away, you should be fine to just stock up on toilet paper and roll with it, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF.

Chronic diarrhea, on the other hand, lasts for longer than four weeks at a minimum. That can point to serious issues like the inflammatory bowel diseases ulcerative colitis (a condition that causes inflammation and sores in your large intestine and rectum) and Crohn’s disease (another illness that causes inflammation in your digestive tract, but typically in your small intestine and colon), or irritable bowel syndrome, a chronic intestinal disorder that also affects your colon.

Sometimes there are major red flags that you need to see a doctor to treat your diarrhea.

Here are signs you should, at the very least, give your doctor’s office a call for guidance:

1. You’ve had diarrhea for two days and it hasn’t improved or is actually getting worse.

If your diarrhea is still terrible after at least two days, it could be a sign that you have an infection that’s sticking around, Dr. Farhadi says. While a viral infection will just have to run its course (sorry, pal), you may need antibiotics to clear up a bacterial or parasitic infection, the Mayo Clinic says.

Having persistent diarrhea could also be a sign that a medication you’re on is upsetting your stomach or that something you’ve started eating regularly isn’t sitting well with you, Dr. Staller says. And, of course, long-lasting diarrhea could be a sign of one of the aforementioned conditions, like ulcerative colitis, Crohn’s disease, or irritable bowel syndrome, although you’ll typically have other symptoms as well, which we’ll cover further down the list.

2. You’re experiencing signs of dehydration.

Diarrhea can cause dehydration because you’re losing so much liquid. In severe cases, dehydration can be life-threatening if it’s not treated, according to the Mayo Clinic. But even if you don’t pass that threshold, being dehydrated feels awful and can be treated.

The biggest signs of dehydration to look out for: You’re incredibly thirsty, your skin and mouth are dry, you’re not peeing much or at all (plus your urine is a dark yellow color when you do actually pee), and you feel weak, dizzy, faint, or fatigued. If you have any of these signs along with your diarrhea, get to the emergency room, Dr. Farhadi says. You may need IV fluids to replace what you’ve lost.

3. You’ve recently developed mouth sores.

When this happens along with diarrhea, doctors generally think of Crohn’s disease, Dr. Staller says. In addition to causing diarrhea, the inflammation that comes with Crohn’s can create sores in your digestive tissue. “Crohn’s disease can affect anywhere in the GI tract, from the mouth down to the anus,” he explains. This is as opposed to ulcerative colitis, which is limited to your large intestine and rectum.

This can also be a sign of celiac disease, a condition in which eating gluten leads to an immune response in your small intestine, according to the Mayo Clinic. You might be tempted to chalk up your mouth pain to something like a canker sore, but if you’re also dealing with diarrhea, you should see your doctor to make sure something larger isn’t going on.

4. You have severe stomach or rectal pain.

Severe stomach pain with diarrhea can signal many issues, from something as simple as gas to a potentially life-threatening condition like appendicitis, Christine Lee, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF.

This could also be a sign of a more chronic condition like IBS-D (irritable bowel syndrome where diarrhea is the main symptom) or, again, Crohn’s disease or ulcerative colitis, Dr. Staller says. “Any diarrheal disease can cause pain,” he says, because diarrhea inflames and irritates the area. “The rectum has very sensitive nerves,” he adds.

Unless you happen to be a gastroenterologist, it’s going to be really hard for you to tell what’s behind this pain + diarrhea equation on your own. If you’re experiencing diarrhea and a lot of pain, a visit to the doctor is in order.

5. There’s pus in your diarrhea.

Pus is a yellow-ish, mucus-y liquid your body produces when trying to fight infection, Dr. Staller says. “It’s a marker of inflammation,” he explains, adding that the inflammation is part of your body’s immune response to whatever it has deemed a threat.

Diarrhea that contains pus is a common sign of ulcerative colitis, according to the Mayo Clinic. Those sores it creates in your gastrointestinal tract can lead to pus that comes out in your poop.

6. Your diarrhea is bloody or black.

Blood in your poop could hint at a range of things. You could have a hemorrhoid (a clump of bulging veins in your rectum or around your anus), Dr. Lee says, but that typically causes only a bit of blood, not the kind that might set off alarm bells. It can also be a sign of a foodborne illness, the Mayo Clinic says. (For instance, Campylobacter bacteria is notorious for causing this, according to the Centers for Disease Control and Prevention.)

But, like with many other items on this list, this could be a sign that you have a chronic condition like ulcerative colitis or Crohn’s disease. When you have these conditions, your immune system may attack your GI tract to the point that it bleeds, Dr. Staller says. Either way, if a good portion of your poop is bloody or black (which hints at blood that has oxidized, so bleeding may be coming from higher up in your GI tract), you need to see a doctor right away, Dr. Farhadi says.

7. You have a fever of more than 102 degrees Fahrenheit.

This generally indicates that you have some kind of infection that’s compromising your system, Dr. Lee says, although a fever can also be your body’s response to the inflammation that comes along with conditions like ulcerative colitis and Crohn’s disease. “Any time there is a fever and diarrhea, you should have your guard up,” Dr. Staller says. And, as you might guess, you should see your doctor.

In the meantime, you can try taking an over-the-counter fever reducer, but be sure to follow the instructions, since drugs like acetaminophen and ibuprofen can cause liver or kidney damage if you take too much, according to the Mayo Clinic.

8. You’re losing a lot of weight.

Sure, if you’re pooping your brains out, you’re probably going to lose a little weight because of all those fluids whooshing out of you. But if your diarrhea won’t stop and you lose a few pounds (on top of your normal fluctuations) in a few days, it could be a sign that you’re dealing with an issue like a severe infection, inflammatory bowel disease, or celiac disease, Dr. Lee says. Either way, you want to make sure your doctor looks into it so they can address the root cause of your unintended weight loss.

Your doctor’s next steps in diagnosing what’s behind your diarrhea will depend on your mix of symptoms.

They’ll likely do a blood test, stool test (where they try to figure out if a bacteria or parasite is causing your diarrhea), or colonoscopy or flexible sigmoidoscopy, procedures that look at the lining of your colon using a thin, lighted tube with a lens, according to the Mayo Clinic. After that, they can prescribe treatment.

If you’re dealing with diarrhea and you’re not sure what to make of it, call your doctor anyway, even if you don’t have the other symptoms on this list. “No one knows your body better than you, so trust your instincts,” Dr. Lee says. “If something doesn’t feel right, then get it checked out.”


Almost half of US adults who drink, drink too much, and continue to do so

A new study led by Boston University School of Public Health (BUSPH) researchers has found that about 40 percent of adults in the United States who drink alcohol do so in amounts that risk health consequences, and identifies a range of factors associated with starting or stopping drinking too much.

The study, published in the Journal of Substance Use, found that 73 percent of those drinking risky amounts were still doing so two to four years later, while 15 percent of those not drinking risky amounts began to. Starting to drink too much was associated with being younger, transitioning to legal drinking age, being male and white, and smoking and drug use, among other social factors.

“Some people just stop drinking too much, but most continue for years, and others not drinking too much will begin doing so during adulthood,” says lead author Richard Saitz, professor of community health sciences at BUSPH. “Public health and clinical messages need repeating, particularly in young adulthood. Once is not enough.”

The researchers used data collected by interview from a nationally representative sample of more than 34,000 adults in the US who completed the National Epidemiologic Survey on Alcohol and Related Conditions in 2001-2002 and again in 2004-2005.

The survey assessed participants’ drinking in the past month using a well-validated interview tool. “At-risk use” was defined as more than 14 drinks per week on average or more than 4 on an occasion for men, and more than 7 per week or more than 3 on an occasion for women.

The biggest predictor of transitioning to at-risk alcohol use was younger age, particularly among participants who were under the drinking age at the time of the first survey. Other factors were being male, not married, becoming divorced or separated, being in the military, being in good or excellent health, smoking, drug use, and having an alcohol use disorder. The researchers found predictors of not transitioning to at-risk use were being black, reporting more stressful life experiences, having children between the first and second rounds of the survey, and unemployment.

Predictors of continuing to drink too much were also being younger, male, having an alcohol use disorder, and using tobacco or other drugs. Being Black and/or Hispanic, receiving alcohol use disorder treatment, and having children between the two rounds of the survey were predictors of transitioning to lower-risk use.

“These findings suggest that not only do many people who drink, drink amounts associated with health consequences, but that without intervention they are likely to continue to do so,” Saitz says. “Screening or self-assessments, and counseling, feedback, or public health messaging have roles in interrupting these patterns. The predictors we identified may help target those efforts.”

The study was co-authored by Timothy Heeren, professor of biostatistics at BUSPH, and Wenxing Zha and Ralph Hingson of the National Institute on Alcohol Abuse and Alcoholism.

Story Source:

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

As we get parched, cognition can easily sputter, dehydration study says

Anyone lost in a desert hallucinating mirages knows that extreme dehydration discombobulates the mind. But just two hours of vigorous yard work in the summer sun without drinking fluids could be enough to blunt concentration, according to a new study.

Cognitive functions often wilt as water departs the body, researchers at the Georgia Institute of Technology reported after statistically analyzing data from multiple peer-reviewed research papers on dehydration and cognitive ability. The data pointed to functions like attention, coordination and complex problem solving suffering the most, and activities like reacting quickly when prompted not diminishing much.

“The simplest reaction time tasks were least impacted, even as dehydration got worse, but tasks that require attention were quite impacted,” said Mindy Millard-Stafford, a professor in Georgia Tech’s School of Biological Sciences.

Less fluid, more goofs

As the bodies of test subjects in various studies lost water, the majority of participants increasingly made errors during attention-related tasks that were mostly repetitive and unexciting, such as punching a button in varying patterns for quite a few minutes. There are situations in life that challenge attentiveness in a similar manner, and when it lapses, snafus can happen.

“Maintaining focus in a long meeting, driving a car, a monotonous job in a hot factory that requires you to stay alert are some of them,” said Millard-Stafford, the study’s principal investigator. “Higher-order functions like doing math or applying logic also dropped off.”

The researchers have been concerned that dehydration could raise the risk of an accident, particularly in scenarios that combine heavy sweating and dangerous machinery or military hardware.

Millard-Stafford and first author Matthew Wittbrodt, a former graduate research assistant at Georgia Tech and now a postdoctoral researcher at Emory University, published their meta-analysis of the studies in the latest edition of the journal Medicine & Science in Sports & Exercise.

It can happen quickly

There’s no hard and fast rule about when exactly such lapses can pop up, but the researchers examined studies with 1 to 6 percent loss of body mass due to dehydration and found more severe impairments started at 2 percent. That level has been a significant benchmark in related studies.

“There’s already a lot of quantitative documentation that if you lose 2 percent in water it affects physical abilities like muscle endurance or sports tasks and your ability to regulate your body temperature,” said Millard-Stafford, a past president of the American College of Sports Medicine. “We wanted to see if that was similar for cognitive function.”

The researchers looked at 6,591 relevant studies for their comparison, then narrowed them down to 33 papers with scientific criteria and data comparable enough to do metadata analysis. They focused on acute dehydration, which anyone could experience during exertion, heat and/or not drinking as opposed to chronic dehydration, which can be caused by a disease or disorder.

One day to lousy

How much fluid loss adds up to 2 percent body mass loss?

“If you weigh 200 pounds and you go work out for a few of hours, you drop four pounds, and that’s 2 percent body mass,” Millard-Stafford said. And it can happen fast. “With an hour of moderately intense activity, with a temperature in the mid-80s, and moderate humidity, it’s not uncommon to lose a little over 2 pounds of water.”

“If you do 12-hour fluid restriction, nothing by mouth, for medical tests, you’ll go down about 1.5 percent,” she said. “Twenty-four hours fluid restriction takes most people about 3 percent down.”

And that begins to affect more than cognition or athletic abilities.

“If you drop 4 or 5 percent, you’re going to feel really crummy,” Millard-Stafford said. “Water is the most important nutrient.”

She warned that older people can dry out more easily because they often lose their sensation of thirst and also, their kidneys are less able to concentrate urine, which makes them retain less fluid. People with high body fat content also have lower relative water reserves than lean folks.

Don’t overdo water

Hydration is important, but so is moderation.

“You can have too much water, something called hyponatremia,” Millard-Stafford said. “Some people overly aggressively, out of a fear of dehydration, drink so much water that they dilute their blood and their brain swells.”

This leads to death in rare, extreme cases, for example, when long-distance runners constantly drink but don’t sweat much and end up massively overhydrating.

“Water needs to be enough, just right,” Millard-Stafford said.

Also, she warned that while salt avoidance may be good for sedentary people or hypertension patients, whoever sweats needs some salt as well, or they won’t retain the water they drink.

The scent of coffee appears to boost performance in math

Drinking coffee seems to have its perks. In addition to the physical boost it delivers, coffee may lessen our risk of heart disease, diabetes and dementia. Coffee may even help us live longer. Now, there’s more good news: research at Stevens Institute of Technology reveals that the scent of coffee alone may help people perform better on the analytical portion of the Graduate Management Aptitude Test, or GMAT, a computer adaptive test required by many business schools.

The work, led by Stevens School of Business professor Adriana Madzharov, not only highlights the hidden force of scent and the cognitive boost it may provide on analytical tasks, but also the expectation that students will perform better on those tasks. Madzharov, with colleagues at Temple University and Baruch College, recently published their findings in the Journal of Environmental Psychology.

“It’s not just that the coffee-like scent helped people perform better on analytical tasks, which was already interesting,” says Madzharov. “But they also thought they would do better, and we demonstrated that this expectation was at least partly responsible for their improved performance.” In short, smelling a coffee-like scent, which has no caffeine in it, has an effect similar to that of drinking coffee, suggesting a placebo effect of coffee scent.

In their work, Madzharov and her team administered a 10-question GMAT algebra test in a computer lab to about 100 undergraduate business students, divided into two groups. One group took the test in the presence of an ambient coffee-like scent, while a control group took the same test — but in an unscented room. They found that the group in the coffee-smelling room scored significantly higher on the test.

Madzharov and colleagues wanted to know more. Could the first group’s boost in quick thinking be explained, in part, by an expectation that a coffee scent would increase alertness and subsequently improve performance?

The team designed a follow-up survey, conducted among more than 200 new participants, quizzing them on beliefs about various scents and their perceived effects on human performance. Participants believed they would feel more alert and energetic in the presence of a coffee scent, versus a flower scent or no scent; and that exposure to coffee scent would increase their performance on mental tasks. The results suggest that expectations about performance can be explained by beliefs that coffee scent alone makes people more alert and energetic.

Madzharov, whose research focuses on sensory marketing and aesthetics, is looking to explore whether coffee-like scents can have a similar placebo effect on other types of performance, such as verbal reasoning. She also says that the finding — that coffee-like scent acts as a placebo for analytical reasoning performance — has many practical applications, including several for business.

“Olfaction is one of our most powerful senses,” says Madzharov. “Employers, architects, building developers, retail space managers and others, can use subtle scents to help shape employees’ or occupants’ experience with their environment. It’s an area of great interest and potential.”

Story Source:

Materials provided by Stevens Institute of Technology. Note: Content may be edited for style and length.

What is the meaning of life? Ask a conservative

“To be or not to be?” Hamlet asked aloud as he pondered the meaning of life. Maybe he was a liberal.

A new USC Dornsife-led psychology study shows that conservatives, more so than liberals, report feeling that their lives are meaningful or have purpose.

“Finding meaning in life is related to the sense or feeling that things are the way they should be, and that there is a sense of order,” said David Newman, a doctoral candidate at USC Dornsife’s Mind and Society Center. “If life feels chaotic, then that would likely dampen your sense that life is meaningful.”

The results, published on June 15 in the journal Social Psychological and Personality Science, were based on five studies examining how strongly conservatives and liberals feel that their lives have purpose.

Belief in God

The scientists analyzed results from two nationally-representative samples and three additional samples in which well-being was assessed in various forms. Altogether, these studies encompassed thousands of participants from 16 countries and spanned four decades.

Participants usually ranked their political ideology on a scale from one to seven, ranging from “extremely conservative” to “extremely liberal.” They also rated how much they agreed or disagreed with statements such as “my life has a real purpose” and “I understand my life’s meaning.”

The psychologists were aware that religious belief may be a factor and adjusted the results to account for it. Even then, the association between political leanings and sense of purpose held strong.

The results suggest “that there is some unique aspect of political conservatism that provides people with meaning and purpose in life,” the scientists wrote.

What does your lean mean?

Newman cautioned against making conclusions about anyone’s state of mind and overall well-being based solely on their political leanings.

“It doesn’t mean that every conservative finds a lot of meaning in their life and that every liberal is depressed,” Newman said.

Other factors may influence whether someone feels that his or her life is meaningful. “These factors range from various personal characteristics such as how religious someone is to situational influences such as one’s current mood,” Newman said.

Story Source:

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

How to Make Granola Without a Recipe

Whenever I have granola around, I never feel hungry. It has all the flavors I could want on a moment’s notice (sweet, savory, salty), and, because it’s full of high-protein, high-fiber ingredients like oats and nuts, just a handful can keep my stomach from growling.

For a while, though, I didn’t usually have granola on hand. What I’d see at the store was always too expensive for my budget or packed with too much added sugar for my taste (I don’t have a big sweet tooth!), and when I’d get home I’d be too busy with other cooking projects to want to hunt down a recipe.

That all changed when I realized you don’t actually need a recipe to make homemade granola. No need to spend time perusing the web for something, because with just a super simple ratio and a few ingredients (that you probably already have in your pantry), you can totally whip up a batch in no time. Follow these tips and before you know it you’ll always have granola to snack on.

There are certain wet and dry ingredients every granola recipe needs.

Audrey Bruno

Every granola recipe needs dry ingredients like nuts, seeds, grains, and spices, and wet ingredients like oil and syrup. The dried ingredients are what make up the classic clusters you know and love, and the wet ingredients are what bind them together (and makes them nice and crunchy).

That being said, you can really use whatever dry ingredients you prefer, as long as you always include some combination of the basics: nuts, seeds, grains, spices. For this story, I made a batch of granola with almonds, sesame seeds, rolled oats, and cinnamon, though you could just as easily make something with walnuts, hemp seeds, and cardamom. You can even use multiple nuts, seeds, or grains at once, if you like. So if you feel like going H.A.M. and using pecans and hazelnuts, then do it! Or if you want several spices, that’s cool too. Even alternative grains like quinoa are fair game (though you’ll want to cook these separately beforehand so that they aren’t too crunchy).

You can also always use whichever wet ingredients you like, too. For my granola, I used a mix of olive oil and honey and it was great, but in the past I’ve used coconut oil and agave and the results were similarly fantastic. Don’t be afraid to experiment with things like maple syrup, sunflower seed oil, vanilla extract, or anything that you might have in your pantry that you think would taste good in granola. And if you prefer something that’s a little less sweet (or not sweet at all) you can reduce the amount of (or completely skip) sweeteners—just be sure to compensate by using more of your chosen oil instead so that you have enough wetness for the granola to cook properly. I’ve made savory granola with just oil before and it tasted great. There were fewer clumps because I didn’t have a sticky sweetener to bind the grains together, but it was still totally snackable.

Pro tip: Use an egg white as one of your wet ingredients for a bit of extra protein.

Think about using an egg white, especially if you’re leaving out sweetener. Egg whites will bind your grains like a sweetener normally would to give you nice, big, crunchy clusters—not to mention they’ll add a bit more protein to your recipe.

The ratio to follow is 1 part wet ingredients to 6 parts dry ingredients.

Through trial and error (and some guidance from the web) I’ve found this to be the best ratio to use when you’re making granola. It may not seem like a lot of wet ingredients in comparison to the dry ones, but syrups and oils go a long way. You don’t want the grains and nuts to be totally doused, just lightly glossy and wet enough to bake into something perfect and crunchy.

As for how much that really looks like, it can be anything you want. If you want to measure in cups, you can do 6 cups of dry ingredients and one cup wet ingredients or 3 cups dry ingredients and 1/2 cup wet ingredients, and so on depending on how big you want your batch to be.

With dry ingredients, go big on the oats and small on everything else. So if you’re making a full six cups, try 1 or 2 parts nuts, 1 part seeds, and 3 parts oats. That’s a good basic ratio to keep in mind.

When you’re dealing with wet ingredients, generally you’ll want to go half and half on the oil and the sweetener, unless you’re not using sweetener at all in which case you should just double the amount of oil you’re using. That may seem like a lot of oil, but you need that amount of wetness for the granola to cook properly—otherwise it may end up too dry.

First, combine your dry ingredients. Then, add your wet ingredients.

Before you add your wet ingredients, make sure you’ve fully incorporated all your dry ingredients. Then, combine the two just before you’re ready to stick everything in the oven to avoid making everything soggy.

And don’t add any dried fruit until the very end.

If you do want to include dried fruit (dried apricots are my favorite in granola) you’ll want to wait until the very, very end to add them. If you bake them with the rest of the granola, the oven will dry out the fruit even more. And dried fruit is the perfect ingredient to use if you want a bit of sweetness, but would rather not use a lot of sweeteners.

Let the granola bake longer than you might think, but keep the oven temperature fairly low.

Audrey Bruno

Granola seems like something that should be in and out fairly quickly, but it actually takes about 40 minutes. You’ll want to heat your oven between 300 to 350 degrees F—I prefer to keep it lower, because it cooks much faster at the higher temp, and I’ve wound up with a few burnt batches because of that.

Before you put the granola in the oven, spread it out evenly over a parchment paper-lined baking sheet so that it all lays flat. Remove it from the oven approximately every 15 minutes to give it a stir and rotate the pan, so that everything cooks evenly.

Let it cool, store it up, and enjoy.

Before you pack it up in Tupperware, let it cool completely. If you pack it up too quickly, the steam from the heat may cause it to lose its crunch.

You can pack it up in any kind of vessel you like—whether that’s a Mason jar or a lunchbox—just make sure it’s airtight otherwise it might get stale. A batch will last you up to six months stored at room temperature, and even longer if you pack it in a Ziploc bag and stick it in the freezer. So if you make one huge batch right now, you’ll be able to enjoy it for the next half a year—if you can keep yourself from eating it all in a week.

Serena Williams Dedicates Her Wimbledon Performance to ‘All the Moms Out There’ in an Emotional Interview

On Saturday, Serena Williams lost in the championship round of the women’s single’s final at Wimbledon—her first major final since giving birth to her daughter, Alexis Olympia, in September via an emergency C-section. But it’s the emotional interview she gave afterward that’s getting a lot of attention.

In the interview, Serena said that the tournament had been “amazing” for her, while tearing up. “I was really happy to get this far. It’s obviously disappointing but I can’t be disappointed. I have so much to look forward to. I’m literally just getting started, so I look forward to it,” she said. While holding back tears, she added, “To all the moms out there, I was playing for you today. I tried.”

Her husband, Alexis Ohanian, also shared a message on Instagram afterward, praising his wife for her feat and spelling out just how hard of a road she’s had to recovery after a difficult childbirth. (As SELF reported previously, Williams experienced a life-threatening pulmonary embolism after giving birth.)

“Days after our baby girl was born, I kissed my wife goodbye before surgery and neither of us knew if she would be coming back,” Ohanian wrote next to a photo of Williams playing tennis. “We just wanted her to survive—10 months later, she’s in the #Wimbledon final.” Earlier in the tournament, Ohanian also tweeted that “walking to the mailbox was a painful, exhausting challenge for this woman just 9 months ago. This is already nothing short of remarkable.”

First, Williams had a C-section, and recovery from that isn’t necessarily easy.

Although every patient’s experience is different, a C-section is a major surgery and “the pain afterward can be horrible,” Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF.

According to the Mayo Clinic, you may end up staying in the hospital for a few days to recover after a C-section. But as soon as the anesthesia wears off, you’ll be encouraged drink a lot of water and get up and walk as much as you can to help prevent blood clots from forming. You’ll also be permitted to start breastfeeding as soon as you feel ready to do so, and your nurse or lactation consultant will help you figure out comfortable positions. Your doctor will also discuss pain relief options with you (luckily, most painkillers are fine to take while breastfeeding).

Once at home, you will likely be instructed to take it easy and stick to your pain relief plan in the first few weeks and avoid sex for the first six weeks to prevent infection in the area. As you heal, you’ll have to be on the lookout for any signs of infection and to adjust your routine as needed, like not driving until you can comfortably turn around to check your blind spots, for instance, which may take up to two weeks. The incision will likely take at least six weeks (but possibly up to three months) to fully heal.

But Williams’ recovery process was a little bit more complicated considering she also developed blood clots in her legs and her lungs after the C-section, as SELF wrote previously.

For clots in the legs, doctors usually will put a patient on injectable or IV blood thinners (like heparin), and then move them to blood thinners in a pill form (like warfarin or dabigatran), the Mayo Clinic says.

But if you’ve just had surgery like a C-section, you can’t take high doses of blood thinners because they’ll cause more bleeding, Shephal Doshi, M.D., director of cardiac electrophysiology at Providence Saint John’s Health Center in Santa Monica, Calif., tells SELF. That’s when a filter (like the one that Williams received) is used. It’s inserted into the vena cava (a large vein in your abdomen) to prevent clots that break loose from making their way up to your heart, the Mayo Clinic says.

Recovery from the filter surgery itself isn’t too bad, Dr. Doshi says. But generally people who need a filter are in a pretty serious state to begin with. If you “just” had blood clots in your legs after a C-section, Dr. Doshi explains, your leg will generally be swollen and uncomfortable to walk on for anywhere from a few days to weeks. But if you also had a pulmonary embolism, like Williams did, you’ll also likely be short of breath and get winded really easily for up to several months, he adds.

“To have someone go through all of this and within a year be able to go through such a high level of athletics is very impressive,” Dr. Doshi says. “The average person wouldn’t be able to do these kinds of things so quickly.”

Remember, though: Williams recovery is extraordinary—but she is an elite athlete, and that doesn’t mean you need to push yourself as hard. Take things at your own pace, do what you’re comfortable with, and check in with your doctor if you have any questions or concerns about your recovery progress.


Digital media use linked to behavioral problems in kids

Are children who spend lots of time using digital devices prone to psychiatric problems? A team of USC scientists says yes in a new study that appears today in the Journal of the American Medical Association.

Teens who are heavy users of digital devices are twice as likely as infrequent users to show symptoms of attention-deficit/hyperactivity disorder (ADHD), the study finds. The association is persistent as researchers tracked nearly 2,600 teenagers for two years.

The study focuses on the mental health consequences of a new generation of ubiquitous digital diversions, including social media, streaming video, text messaging, music downloads and online chatrooms, among others. It differs from previous research that linked use of TV or video games to the illness.

“What’s new is that previous studies on this topic were done many years ago, when social media, mobile phones, tablets and mobile apps didn’t exist,” said Adam Leventhal, professor of preventive medicine and psychology and director of the USC Health, Emotion and Addiction Laboratory at the Keck School of Medicine of USC.

“New, mobile technologies can provide fast, high-intensity stimulation accessible all day, which has increased digital media exposure far beyond what’s been studied before,” he said.

The findings have ramifications for parents, schools, technology companies and pediatricians concerned that tech-dependent teens are driven to distraction — or worse. For example, a recent survey by nonprofit Common Sense Media showed teens spend about one-third of their day — nearly nine hours — using online media. A separate survey published last month by the U.S. Centers for Disease Control and Prevention shows 43 percent of high school students used digital media three or more hours per day. While the popularity of digital media in kids is well known, the impacts are not.

In the USC study, the scientists began with 4,100 eligible students, ages 15 and 16 years, across 10 public highs schools in Los Angeles County. The schools represented mixed demographic and socioeconomic status, from South L.A. to the San Fernando Valley to the San Gabriel Valley. The researchers focused on teens because adolescence marks a moment for ADHD onset and unfettered access to digital media, Leventhal explained.

Next, they pared to 2,587 participants by removing students for preexisting ADHD symptoms. The scientists’ goal was to start with a clean slate to focus on occurrence of new symptoms manifest over the two-year study.

The researchers asked students how frequently they used 14 popular digital media platforms. They sorted media use frequency into three categories: no use; medium use and high use. Next, the scientists monitored the students every six months between 2014 and 2016. They sought to determine if digital media use in 10th grade was associated with ADHD symptoms tracked through 12th grade.

In the end, they found 9.5 percent of the 114 children who used half the digital media platforms frequently and 10.5 percent of the 51 kids who used all 14 platforms frequently showed new ADHD symptoms. By contrast, 4.6 percent of the 495 students who were not frequent users of any digital activity showed ADHD symptoms, approximate to background rates of the disorder in the general population.

“We can’t confirm causation from the study, but this was a statistically significant association,” Leventhal said. “We can say with confidence that teens who were exposed to higher levels of digital media were significantly more likely to develop ADHD symptoms in the future.”

The National Institute of Mental Health describes ADHD as a brain disorder with symptoms that include a pattern of inattention, hyperactive behavior and impulsiveness that interferes with functioning or development. It’s a common mental disorder in children and adolescents and also affects about 4 percent of U.S. adults, according to the National Institutes of Health.

Leventhal, the corresponding author of the study, said the findings help fill a gap in understanding how new, mobile media devices and seemingly limitless content options pose a mental health risk to children. And the findings serve as a warning as digital media becomes more prevalent, faster and stimulating.

“This study raises concern whether the proliferation of high-performance digital media technologies may be putting a new generation of youth at risk for ADHD,” Leventhal said.

Why men might recover from flu faster than women

Men may recover more quickly from influenza infections because they produce more of a key lung-healing protein, a study from scientists at Johns Hopkins Bloomberg School of Public Health suggests.

The scientists, whose findings are published online in Biology of Sex Differences on July 17, infected live mice and human cells derived from male humans with influenza virus, and found that both the male mice and human cells produced more amphiregulin, a growth factor protein important in wound healing. The male mice recovered more quickly, compared to female mice, whereas male mice lacking amphiregulin had recovery times close to those of females.

Researchers have known that women, compared to men, tend to have more severe flu with slower recoveries even when their virus levels are the same. It had been thought that this was due solely to women’s greater levels of lung inflammation during flu infections.

“The novel finding here is that females also have slower tissue-repair during recovery, due to relatively low production of amphiregulin,” says senior study author Sabra Klein, PhD, an associate professor in the Department of Molecular Microbiology and Immunology at the Bloomberg School.

The research could lead to new flu treatments that boost amphiregulin production, particularly in women, she added.

For the study, Klein and her team infected mice with a non-lethal dose of H1N1, an Influenza A strain that caused a global pandemic in 2009-10 with more than 18,000 deaths. They observed that although male and female mice had similar levels of virus and cleared it in about the same amount of time, the females suffered significantly more from their infections. They had greater loss of body mass and greater lung inflammation during the acute phase of infection, and later they were slower to recover normal lung function.

The scientists identified amphiregulin as a key factor in this gender-based difference. The growth-factor protein is known to promote the proliferation of epithelial cells in the skin, lung and other surfaces in the body during wound healing, including recovery from lung infections. Analysis of the mice revealed that the males produced significantly more amphiregulin than females during the recovery phase of their infections.

Moreover, male mice that had been genetically engineered to lack amphiregulin showed the same pattern as females, with more severe infections and slower recoveries. Females without amphiregulin were relatively unchanged in their infection severity, suggesting that the lung-healing protein makes a difference primarily for males.

Similarly, the team found that flu infections of mouse and human lung epithelial cells in culture dishes were followed by significant jumps in the production of amphiregulin only when the cells were from males.

The fact that amphiregulin helps ameliorate flu infection points to a new therapeutic strategy for severe flu. Klein and colleagues already showed in a 2016 study that the sex hormone progesterone stimulates amphiregulin production in female mice. “We found in that study that by increasing amphiregulin production in females we could expedite their recovery from flu,” Klein says.

Researchers have not yet determined why males are more resistant to flu effects. Greater wound-healing ability may have conferred a reproductive advantage for males — who, from an evolutionary standpoint, have probably been more frequently wounded on average, in battles for territories, mates and resources. That advantage may not have been as strong in females, Klein suggests.

It isn’t yet clear which factors drive the greater rise in amphiregulin production in males during flu infection. Klein and colleagues suspected this was attributable to testosterone at first, but found it does not seem to control amphiregulin levels. However, they found that the sex hormone, independently of amphiregulin, does help protect male mice, who fared worse in flu infections without it.

Klein’s laboratory is now investigating the mechanisms of testosterone’s protective effect, as well as the upstream factors that control amphiregulin production during flu infection.

“Production of amphiregulin and recovery from influenza is greater in males than females” was written by Meghan Vermillion, Rebecca Ursin, Denise Kuok, Landon vom Steeg, Nicholas Wohlgemuth, Olivia Hall, Ashley Fink, Eric Sasse, Andrew Nelson, Roland Ndeh, Sharon McGrath-Morrow, Wayne Mitzner, Michael Chan, Andrew Pekosz, and Sabra Klein.