“The holidays are a highly anticipated time of year when emotions run high because we have expectations of what we want to see, do, and who we want to celebrate with,” explains Dana Hunnes, RD, MPH, PhD, Assistant Professor UCLA Fielding School of Public Health. “If things don’t live up to expectations, it can be emotional and may increase the likelihood of emotional eating.”

Stress, anticipation, sadness and even being happy all can lead to increased intake.

Bing Eating: Beyond Occasional

In medical terms, emotional eating equates to binge eating, which is not the same as occasional overconsuming. Binge eating disorder (BED) consists of consuming a larger amount of food than other people would be able to consume in similar circumstances and similar period (usually within a two-hour period), and lack of control of eating and feeling guilty after eating. Frequency is also considered. To be diagnosed as BED, episodes of overeating need to occur every week (at least once a week) for three months.

Risk factors for BED include childhood obesity, distorted body image perception, family weight concerns and eating problems, family conflicts, perfectionism, mental-health impairments, and intestinal microbiota alteration. BED is more commonly diagnosed in young adult years, though older adults can be afflicted as well.

Even if you don’t have BED, insights from treating the disorder can be helpful in curbing over indulging, which can lead to digestive discomfort, guilt, and weight gain. The key is to take stock of your emotions when you find yourself consuming more than you want or feel you need, according to Hunnes. She recommends trying to catch yourself in the moment and ask such questions as: Are you sad? Are you angry? Are you happy? Are you moody? Are you anxious?

Avoid Dieting and Deprivation

Dieting before the holidays or severe food restrictions before the holidays or a party can backfire. Experts say that dietary restriction (not eating enough calories) and deprivation (avoiding certain foods) can not only lead to overeating, it can lead to craving high-carbohydrate foods, which play starring roles at parties. If you haven’t eaten much all day, you’ll have less impulse control when you see bowls of salty cashews, chocolate covered almonds, and platters of pita and hummus. It’s best, therefore, to eat sensibly throughout the day.

Furthermore, not eating enough gives rise to negative emotions and the term “hangry” (anger due to hunger). This can lead to anxiety and lashing out at others. When we get hangry, blood sugar drops. Low blood sugar can cause dizziness, sweating, fast heartbeat, irritability, and the inability to concentrate. When you can’t think straight, it’s easy to eat fistfuls of nuts, be rude to people, and blame feelings on something or someone, rather than on the fact that we are just hungry. But being emotionally aware can help.

Emotional Rescue

Before you give in to the impulse to have another drink or second helping, assess the situation with the acronym HALT. Ask yourself if you are hungry, angry, lonely, or tired? Feeling insatiable is a sign that you need to attend to your emotions. Instead of mindless munching to stuff difficult feelings, take a few deep breaths and allow yourself to relax. Physical movement, be it formal exercise or a simple walk, can shift your attitude. Likewise, talking with a friend or a mental-health professional can provide support and a different perspective.

Finally, it’s not just negative emotions that can lead to overconsumption, as Hunnes points out. “Sometimes when we are happy or with others who are eating a lot, we tend to eat a lot as well,” she says. “Libations can further remove inhibitions.”

The post Curbing Emotional Eating and Overindulging appeared first on University Health News.

“Sarcopenia can’t be stopped,” says exercise physiologist Ernie Sacco, DPT Manager of Cardiac and Pulmonary Rehabilitation, UCLA Medical Center. “But with exercise, we can forestall it.”

Regular exercise benefits physical and mental health in many ways. While you won’t recapture the same slim, svelte muscle tone you may have had in your 20s, you don’t have to settle for being a weak marshmallow either. Even sedentary older adults can significantly reduce disability through relatively small increases in physical activity.

It Works If You Work It

In her more than 20 years of experience working with older adults, physical therapist Michelle H. Tan, UCLA Department of Rehabilitative Services, has seen the profound difference that exercise can make. She works with all kinds of people in various situations, including postsurgical patients, people in skilled nursing facilities, and people aging in place at home. Not long ago, Tan worked with Nancy, a 68-year-old woman who complained of feeling weak. Nancy worried that as she got older she would continue to decline and end up in a wheelchair. But Tan assured her that physical therapy/exercise could make a difference physically and energetically. After 12 weeks of twice-weekly physical therapy sessions, Nancy reported that she felt better as soon as she stepped out of bed in the morning, and she continued through her day with more ease than before she devoted time to regular exercise.

“We worked on posture, core strength, and strength training for her arms and legs using dumbbells, leg weights, and gym machines. To better protect and compensate for her low- back arthritis, we modified some of her household and gardening activities,” says Tan.

Since her work with Tan, Nancy has camped with her grandkids and returned to gardening. Exercise is now a priority and regularly scheduled into her weekly calendar.

Maintenance for Life

A series of landmark studies published in the 1990s highlighted the profound role progressive resistance training can have on increasing muscle mass, muscle size, and functional capacity in older adults. The study showed that individuals ages 90 to 99 were able to increase their muscle strength, on average a whopping 174 percent in their mid-thigh muscles, with just eight weeks of high-intensity progressive resistance training exercises. In short, muscle can be strengthened at any age.

“Older people may experience smaller absolute strength gains than younger people, but they have similar percentage strength increases,” says Tan. “Resistance training also may offset some of the hormonal contributors to sarcopenia and combat inflammatory cells associated with aging.”

Indeed, research shows that muscle tissue does more than just enable movement. Important chemical reactions take place inside muscle cells, which is part of the reason why muscle loss can lead to insulin resistance (a precursor of diabetes) and may be involved in the development of high cholesterol and high triglycerides, markers of cardiovascular disease.

How Often to Exercise

The American College of Sports Medicine recommends strength training two to three times per week. In general, each exercise should be performed eight to 12 times, in two to four sets. Whether it’s resistance bands, barbells, or body weight doesn’t matter. What does matter is exhausting a muscle through repetition or load—because muscle builds when it’s pushed out of its comfort zone.

The development of muscle strength and endurance is progressive over time. When what you’re doing becomes easy, add more repetitions. When you can do three sets of 10 to 15 reps fairly easily, it is time to increase the weight or resistance you are using. If it’s been awhile since you’ve worked out, book a few sessions with a physical therapist or personal trainer experienced in working with older adults.

Types of Exercise

Muscle-strengthening exercises include push-ups, pull-ups, sit-ups, arm circles, lifting weights (free weights), using strength-training machines, working with resistance bands, and even climbing stairs, carrying heavy loads, and heavy gardening. Anything that provides something for your muscles to push or pull (i.e. resist against) can be used to increase muscle strength. Machine-based exercises are regarded as the safest form of resistance exercise for beginner exercisers.

It’s recommended that you target each of the major muscle groups (legs, hips, chest, back, abdomen, shoulders, and arms) two to three times a week. The key is to perform each muscle-strengthening exercise until it would be difficult to perform the movement again without help.

Include develoment of your core muscles. They help you stand, bend, twist, reach, stoop, and turn. These are the muscles that surround your torso like a corset and include your abdominals, back, shoulders, and hip muscles. When these muscles are strong, they help you stand up straight (rather than hunch over), and they promote good posture and balance and help prevent falls. A strong core also helps reduce the likelihood of injuring your lower back.

When core muscles are weak, not only is physical activity more difficult, but eventually daily activities, such as getting dressed, carrying groceries, or vacuuming, can become a challenge. Signs of a weak core include poor posture, lower back pain, and muscle weakness in your arms and legs.

Clues you may have poor posture include a head that’s commonly thrust forward, slouching, rounded shoulders, and excessive arching of your lower back with your stomach protruding. Take a look yourself in the mirror and see what your normal position is. While it can be scary, you’ll get a reality check.

Core muscles can and should be used during all physical activities. When the core is strong, it automatically supports what you are doing. Pilates, in particular, is designed to strengthen the core by challenging the muscles during a wide variety of movements.

The Importance of Power Training

Muscle power is the combination of strength and speed that determines how quickly your muscles can produce a desired movement. It’s muscle power that gets you across a street before the light changes, allows you to hit the brakes quickly when another driver cuts you off, and helps you react swiftly when you trip so you don’t fall.

While strength-training exercises are traditionally performed relatively slowly, power training often involves doing the same exercises but contracting the muscles as quickly as possible (for example, bending your arm quickly in a bicep curl and straightening it more slowly, or rising from a chair as quickly as you can and then slowly sitting back down). Research has found high-velocity power training is safe and effective, even for frail elderly exercisers.

In a study of 45 older adults with self-reported mobility limitations, 12 weeks of high-velocity training improved muscle power approximately twice as much as a traditional strength-training program. Other research shows that high-velocity resistance training also results in greater improvement in physical functioning in older adults, which is the key to remaining active and independent.

Living in a toned, strong body is a wonderful place to be, and it’s available to virtually everyone. Start where you are, and in a few weeks of dedicated, consistent practice, you will feel (and likely see) the difference.

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At its core, play is a creative act. Whether you’re a grandparent, have a partner, or are a solo spirit, there are plenty of ways and health benefits to being playful.

“Stress reduction is just one of the many benefits,” says geriatric psychologist Linda Ercoli, PhD, UCLA Semel Institute for Neuroscience and Human Behavior. “Play also generates internal positivity, helps us laugh, and to just have fun.”

Many Shades of Play

Studies show games can be about much more than winning and losing. They offer an opportunity to bond. During the height of the coronavirus pandemic, many people learned the value of online computer games, which can be especially beneficial for older adults, according to many studies (see box page 7).

“Online gaming can connect family members that don’t live nearby, so it’s great for keeping family ties,” she explains. “Younger family members can teach older adults and vice versa because many older adults are actually into online gaming. During the play, young people may ask for advice or talk about school. It’s not a unidimensional experience when you play.”

While play and playfulness have been well studied in children, their structure and consequences are understudied in adults. A recent article published in Social and Personality Psychology Compass examined the importance of playfulness in romantic relationships. The authors noted that playfulness influences how people communicate and interact with each other, for example by helping to deal with stress, and solving interpersonal tension. These can impact relationship satisfaction and trust, ultimately affecting the longevity of relationships. In particular, lead author Kay Brauer, MSc, of Martin Luther University Halle-Wittenberg (MLU) in Germany noted that,“Playful behaviors such as surprising the partner, retelling and reenacting joint experiences with the partner, or jointly forming new experiences often contribute to the happiness and longevity of relationships.”

The Holiday Spirit

The holidays naturally invite a lighthearted playful spirit into such activities as baking cookies, singing carols, and decorating homes. But the holidays can be depressing for some people, especially for those who have lost loved ones. There are, however, ways to honor deceased loved ones in creative, playful ways that bring forth happy memories.

“Maybe you lost someone who had a hobby such as model trains that can be part of the holiday experience,” suggests Ercoli. “Or perhaps you might display a person’s collectables, and talk about them in a positive way or look at family pictures and reminisce about the fun times together. That can produce some sad feelings, but it also can generate feelings of warmth, too.”

Exercising Your Play Muscle

Some people are innately playful, while others may feel awkward or intimiated by trying a new game or dusting off an old one. Pets and children can help. They can be especially good at drawing out a playful spirit—most are ready for just tossing around a ball or playing hide and seek. You can also coax playfulness back into your life with some simple exercises, according to another MLU study. The researchers recruited 533 participants and randomly divided them into experimental and placebo groups. The experimental group completed exercises intended to boost their playfulness. Before going to bed, they reflected on their day and documented how they may have behaved particularly playfully or how they used playfulness in an unfamiliar situation, for example in their professional life.

Researchers assumed that consciously focusing attention on playfulness and using it more often would result in positive emotions. They were right. The tasks did lead to an increase in playfulness as well as a temporary, moderate improvement in the participants’ well-being. Thus, researchers suggest that playfulness can indeed be stimulated and trained, and that it clearly boosts mood and life satisfaction.

Personalities at Play

Playfulness is a personality trait that is expressed in a multitude of ways. “Particularly playful people have a hard time dealing with boredom. They manage to turn almost any everyday situation into an entertaining or personally engaging experience,” explains Professor René Proyer, a psychologist at MLU. “For example, they enjoy word games and mental games, are curious, or just like playing around.” According to Proyer, this does not mean that these people are particularly silly or frivolous. On the contrary, earlier studies from MLU researchers have shown that adults can put this inclination to positive use in many situations: They have an eye for detail, easily adopt new perspectives, and can make a monotonous task interesting for them.

Think about your day and consider infusing it with a sense of play. For example, how can you sneak playfulness into household chores? Can you whistle while you work? Switch to your non-dominant arm when you vacuum? If you could give your younger self advice about play, what would it be and how can you capitalize on that now?

As German philosopher Karl Gross has suggested, we don’t stop playing because we grow old, but rather we grow old because we stop playing. Schedule playtime onto your weekly calendar. Do it in pen, not pencil, and let it run down the page. What are you curious about? What passion would you like to indulge? As the popular saying goes: Whatever you can do or dream, begin it.

Boldness has genius, power, and magic in it.

What You Can Do

Ask yourself what play means to you.  Is it when you feel free from a burden?
When you can be fully absorbed? Does it involve creativity or just cutting loose without an agenda? Play comes in many forms.

• Joke around. Encourage a few friends to learn a few jokes; then get together and share them.
• Go on a playdate. Try indoor skydiving, fly a kite, or take a culinary knife skills class.
• Make art. Create a collage with family photos, take a pottery class, or try glass blowing.
• Let music move you. Try to a play simple instrument, like a ukulele, sing a favorite song out loud, dance in your living room.
• Play like a kid. Whether you have kids to play with or not, grab someone and play hide and seek, pin the tail on the donkey, or bust up a pinata.
• Game night. Invite people over for a game of Monopoly, poker, or dodgeball.

The post Play: It’s Not Just for Kids appeared first on University Health News.

Morbidity basically relates to physical or psychological injuries, disorders, and diseases, whereas mortality refers to death. Comorbidities, another common medical term used when discussing health, is when one person has multiple disorders. The disorders may not have the same underlying cause, but some tend to occur together. For example, studies show that people with type 2 diabetes frequently have at least one additional “comorbid” condition, such as hypertension (high blood pressure) or hyperlipidemia (high cholesterol). Compared to younger groups of people, the prevalence of comorbidities increases as people get older. That’s why it is important for physicians to assess for multiple conditions and for patients to keep up with preventive healthcare, which includes annual exams and screenings that are designed to look for early-stage disease. Doing so may reduce the severity of a disease and lessen the impact of it on your daily life.

As we continue to emerge from the corona­virus pandemic, it’s important to emphasize that people most vulnerable to severe COVID‑19 disease are those with morbidities and comorbidities, many of which are chronic diseases (e.g., heart disease, diabetes, asthma, and chronic obstructive pulmonary disease). COVID‑19 was among the 10 leading causes of mortality (death) in the U.S. in 2020, according to the Centers for Disease Control and Prevention. The total number of overall deaths increased about 17% from 2019, according to provisional data. The top three causes of death in 2020 are (preliminarily) cited as heart disease, cancer, and COVID‑19. According to the report, in 2020 heart disease deaths jumped by 4.8%, the largest increase since 2012.

Seven of the 10 most common causes of death are from chronic diseases. Consistent management of chronic diseases may reduce risk of comorbidities, lower mortality rates, and increase overall quality of life.

What is sepsis, and is it preventable?

Sepsis is a medical emergency. It results from the immune system’s overwhelming and ultimately toxic response to an infection from a pathogen, such as a fungus, virus, or bacterium. The vast majority of sepsis cases (about 70%) occur in people over the age of 60. Older people become more susceptible for a number of reasons. For example, chronic conditions and a compromised immune system make people more vulnerable. With aging, the immune system also becomes less efficient at fighting infections and thus places a person at greater risk for contracting infections. The most common triggers for sepsis in older people are from pneumonia, and urinary tract and intra-abdominal infections. In addition, infections can result from surgical incisions and invasive medical devices, like a urinary catheter or feeding tube. Signs of sepsis include a change in body temperature, either a high fever above 101.3 degrees F, or a lower-than-normal temperature (below 95 degrees F); a rapid heart rate above 90 beats per minute; and rapid breathing, shaking, and confusion.

Sepsis causes blood to clot too much and too fast, causing it to thicken. This impedes blood flow, robbing organs and tissues of needed nutrients and oxygen. Blood vessels also can become more porous, allowing blood to leak through lining of blood vessels. Sepsis can therefore damage organs, lead to organ failure, and even death. Older sepsis survivors may experience ongoing moderate-to-severe cognitive decline, chronic pain, and organ dysfunction. Some sepsis survivors may not be able to return to their homes. Sepsis is treated with intravenous fluids and antibiotics. Other medications, such as those that raise heart rate, may also be needed. Prevention focuses on keeping germs at bay through frequent and proper hand-washing, and cleaning and caring for every wound or break in the skin, treating infections, and getting vaccinated against viral infections such as the flu, COVID‑19, and pneumonia.

The post Ask the Doctor: Morbidity vs. Mortality… Sepsis Defined appeared first on University Health News.

“Unfortunately, a lot of people assume all cancers are fatal, unavoidable, and not curable,” says gastroenterologist Fola May, MD, UCLA Division of Digestive Diseases. “That is very far from true. There are many ways that cancer can be prevented. If not prevented, they can be found early enough to cure people. For some cancers in particular, the survival rates can be as high as 90%, if we find them in a precancer form or if they are detected before they spread.”

Preventive Screenings

As a cancer prevention specialist, Dr. May is passionate about preventive screenings, especially when it comes to colorectal cancer. It is the third most common cancer in men and women and ranks among the  deadliest cancers, but it is also among the most preventable. Caught early, colorectal cancer is treatable, and small early-stage cancers can simply be removed during a colonoscopy. Five-year survival rates for localized colon cancer is about 90%, but five-year survival rates for advanced colorectal cancer that spreads through the body is about 14%. Colorectal cancer screening tests include colonoscopy (recommended every 10 years) and the easy at-home fecal immunochemical test (FIT) that can be done annually.

“The most important things you can do when you’re 55 and older is to regularly see your primary care provider, who will ensure you’re current with all of your cancer screenings,” says Dr. May. “There are various screenings available, depending on your gender and your risk profile. For example, everyone should be screened for colorectal cancer and women for breast cancer. Some men should be screened for prostate cancer, and some people may require lung cancer and/or skin cancer screenings.”

Other Common Cancer Screenings

In the United States, breast cancer ranks as the second leading cause of cancer death among women, after lung cancer. It is typically detected either during screening, before symptoms have developed, or after a woman notices a lump. Most masses seen on a mammogram and most breast lumps turn out to be benign (not cancerous). The recommendations for mammography screenings vary depending on the organization. The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts, recommends women ages 50 to 74 with average risk get screened every two years.

Prostate cancer screening. While it might seem to make sense to routinely screen for prostate cancer using the simple prostate-specific antigen (PSA) blood test, the test has been called into question for being inexact. Studies have reported that routine PSA tests have led to unneeded treatments resulting in serious side effects, such as impotence and incontinence. A urologist can recommend which prostate screening may be appropriate for you. A digital rectal exam plus PSA test is a commonly recommended combination for some men.

Lung cancer screening. Lung cancer is by far the most common cause of cancer death among both men and women and is responsible for about 25% of all cancer deaths. Unfortunately, this cancer most often is found  when disease has advanced. The most common type is called non-small cell lung cancer, and smoking is the primary cause. The only recommended lung cancer screening test is low-dose computed tomography. But there are risks, including false-positive results, overdiagnosis, and excessive radiation from repeated tests. The USPSTF recommends lung cancer screening tests only for people who have a 20-pack-a-year history of smoking and smoke now or have quit within past 15 years and are between 50 and 80 years of age.

Preventing and Lowering Cancer Risk

The advice for cancer prevention won’t surprise you. “Enjoy a healthy diet, rich in fruits and veggies, and minimize toxic foods, such as red meat, and processed foods,” advises Dr. May. “In general, make sure you are getting enough calcium and fiber, which is more likely if you eat enough fruits and veggies. Engage in regular moderate exercise three to five days per week. Lose weight if you are overweight, and don’t smoke.”

In addition to lowering cancer risk, a healthy lifestyle may help you survive cancer if you develop it. If you are diagnosed with cancer, Dr. May advises that you share your diagnosis with family members so they can take needed steps to minimize their risk.

A healthy lifestyle includes nutritious foods, exercise, stress management, and annual wellness exams.

❝ We live at this incredible time where we are able to prevent death from COVID‑19, but only if people participate in the vaccine. It’s the same with cancer prevention, screening, and preventive lifestyles. You have to take action. ❞ 

—Fola May, MD,
UCLA Division of Digestive Diseases

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A Repetitive use is a common cause of a torn rotator cuff. This tendon connects the muscle to the bone around the shoulder joint. Constant and forceful use of the shoulder, such as with tennis, certainly can strain this tendon. As for the seriousness of it, know that a rotator cuff tear can get larger over time. If the pain worsens, is more frequent, and the shoulder feels weaker, those are indicators your shoulder tear is likely expanding. Since your pain sounds like it’s been ongoing, it’s best to have it checked out by your primary care physician or orthopaedic sports specialist. Early diagnosis can help prevent loss of strength and range of motion. Many rotator tears can be treated nonsurgically. Treatments include anti-inflammatory medications, steroid injections, and especially physical therapy. The goal is to restore good function, and physical therapists can ensure correct alignment and help to correct any muscle imbalances. Surgery may be indicated if pain isn’t resolved through other means. People who require surgery often feel pain at night and have great difficulty lifting the arm. As your injury doesn’t sound like it’s reached that stage, you may be able to resolve the issue while it’s still minor. Seek out physical therapists knowledgeable about tennis. They can assess and treat the injury and can also help refine your swing. That not only will reduce potential future injuries, but it may improve your game, too.

Q I was told that taking a prescription “vitamin” called Metanx would prevent diabetic neuropathy. Can you tell me more about this?

A Metanx capsules include a combination of B vitamins. Because neuropathy issues may be related to vitamin B deficiencies, supplementation with vitamin B₁₂, vitamin B₆, and folate (vitamin B₉) may improve diabetic peripheral neuropathy, but more research is needed to say definitively. Studies suggest that people who have a vitamin B₁₂ deficiency may have a reduction of symptoms, but it hasn’t been shown to benefit those who do not have a deficiency. That said, taking the vitamins is generally considered to be safe, but as they can interact with medications, do so only if your physician recommends it. Metanx is what’s called a “medical food” for use only under the supervision of a physician. A medical food, according to the U.S. Food and Drug Administration (FDA), is meant for the specific dietary management of a patient who, because of therapeutic or chronic medical needs, may not be able to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements that cannot be achieved through diet alone. Because it is considered a medical food and not drug, it is not regulated by the FDA. According to a 2012 double-blind, placebo-controlled study published in the American Journal of Medicine, participants taking Metanx reported symptom relief and quality of life improvement. The study author also stated that it appeared to be a safe and effective therapy for alleviation of peripheral neuropathy symptoms, at least in the short term. The trial was 24 weeks and included 200 participants. A 2015 survey study conducted via automated phone prompts included 544 people taking Metanx. Researchers similarly reported reduction of pain and less disruption in work/school, and social/family life over the 12-week trial period. In 2020, researchers analyzed 24 published articles, called a systematic review, and reported that both B_12, taken alone or in combination with other vitamins or conventional treatments (such as gabapentinoids), showed some evidence of neuropathic pain relief. The article appeared in the July 25, 2020, issue of Nutrients. So while Metanx may ptoduce positive outcomes in some people, other vitamin B formulations may worksimilarly to reduce symptoms. But just because medical foods contain vitamins, it doesn’t mean they are completely safe for everyone. Allergic reactions have been reported. Use only with a physician’s supervision, especially if you are taking other medications.  

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People are more likely to experience the consequences of too much sodium, which include constipation, kidney stones, and high blood pressure.

“High levels of sodium cause your body to retain fluid, pulling water into the bloodstream and increasing the volume and pressure in the system,” explains cardiologist Timothy Canan, MD, Assistant Clinical Professor in the Department of Medicine at the UCLA Division of Cardiology. “This forces the heart to work harder, which over time can lead to thickening or enlargement of the heart muscle and heart failure. It also puts stress on the blood vessel walls, leading to inflammation and buildup of atherosclerotic plaque, the harbinger of cardiovascular disease, including heart attacks and strokes.”

Salt and Sodium

Salt and sodium may seem like two words for the same thing, but they’re not. Salt is composed of sodium and chloride. These minerals have an electrical charge and are referred to as electrolytes. They perform vital jobs, such as regulating fluids and assisting with nerve and muscle function.

Obvious and Hidden Sodium Sources

Small amounts of sodium occur naturally in some foods, such as celery, beets, and dairy milk. There’s a lot more sodium in common table salt. Along with gourmet salts, such as pink Himalayan, grey salt, and fleur de sel, table salt contains about 40 percent sodium and the rest, 60 percent is chloride. After sodium, chloride is the most abundant electrolyte in the body. It, too, plays a role in maintaining proper blood volume, blood pressure, and pH of body fluids.

The average American consumes about 3,400 milligrams (mg) per day. Most physicians recommend limiting this to 2,300 mg, which is about 1 teaspoon of table salt. The biggest source of sodium in most Americans’ diets is processed and packaged foods. A relatively small amount actually comes from salt used at the table or during cooking. In processed foods, sodium plays the dual role of preservative and flavor enhancer.

Surprisingly High-Sodium Foods

If a food comes in a box, can, jar, or plastic packaging, it’s likely high in sodium. Some sources of sodium might surprise you, and they don’t necessarily taste very salty. Consider these examples:

Breads and rolls: The sodium content in one slice of white bread can range from 80 to 230 mg.

Soft drinks: It varies a bit by brand, but diet and regular contain similar amounts. For example, Coca Cola has about 45 mg per 12 ounces of soda, while a diet Mountain Dew has 50 mg per 12 ounces.

Pizza: A single 4-ounce slice can contain 370 to 730 mg of sodium. Add pepperoni or other processed toppings, and the sodium can double.

Chicken: Chicken and other meats may be packaged in high-sodium flavoring solutions that can drive up your intake. A 4-ounce boneless, skinless chicken breast may contain 40 to 330 mg of sodium.

Canned vegetables: They tend to be higher in sodium than fresh or frozen vegetables prepared without sauces. For example, a whole fresh tomato contains 6 mg of sodium, whereas a can of regular tomatoes can contain 220 mg per half-cup. Before you eat canned vegetables, rinse them under warm water to help remove some of the added sodium.

Check the label for the serving size and the number of servings in the food package. If it contains two or three servings, and you eat the entire package, you’re doubling or tripling the amount of sodium you consume.

Smart Swaps

“The best way to maintain a low-sodium diet is to cook yourself fresh meals at home, so that you can control what is added to the food,” recommends Dr. Canan. “Use herbs and spices to add flavor to the dish instead of salt, and check the labels on all packaged items, sauces, and soups.”

Instead of salt, try red pepper flakes, lemon or lime juice, vinegar, curry powder, fresh onions or garlic, or onion or garlic powder (but avoid garlic salt). If you really want to use some salt, set aside a quarter teaspoon (581 mg of sodium) or a ½ teaspoon (1,162 mg of sodium) in an empty salt shaker or small dish so you know how much you’re allowed to use each day. Then be very selective about the foods you salt.

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Studies have shown that most women don’t feel fully informed about their reconstruction options. Discussing the benefits of not reconstructing a breast may motivate some women to forgo it. And when they do, according to recent UCLA research, 74% of women are satisfied with their decision to “go flat.” The researchers say that adequate information and physician support played a crucial role in helping women feel satisfied with their decision.

“Undergoing a mastectomy with or without reconstruction is a very personal choice,” says Deanna Attai, MD, an assistant clinical professor of surgery at the David Geffen School of Medicine at UCLA and senior author of the study published in the Jan. 3, 2021, issue of Annals of Surgical Oncology. “We found that for a subset of women, ‘going flat’ is a desired and intentional option, which should be supported by the treatment team and should not imply that women who forgo reconstruction are not concerned with their postoperative appearance.”

Key Study Findings

The results challenge past studies showing that patients who chose not to undergo breast reconstruction tend to have a poorer quality of life, compared with those who do have the surgery.

The study authors believe the survey tool commonly used to assess outcomes was biased towards reconstruction. To avoid that bias, the researchers partnered with patient advocates to develop a unique survey to assess reasons for going flat, satisfaction with the decision, and factors associated with satisfaction. The average age of the survey respondents was 49 (range, 25 to 85 years). Study participants were pulled from a pool of women who were active in the Going Flat community, and they all underwent mastectomy without reconstruction. Reasons chosen for going flat included faster recovery, fewer complications, and the avoidance of a foreign body.

Mastectomy Indications

Treatment for breast cancer can include mastectomy, but in some cases, breast-conservation surgery may be an option. This procedure is also known as lumpectomy or partial mastectomy and involves removing the tumor while sparing most of the breast. The American Cancer Society stresses that having a mastectomy instead of breast-conserving surgery plus radiation only lowers your risk of developing a second breast cancer in the same breast. It does not lower the chance of the cancer coming back in other parts of the body, including the opposite breast.

Hollywood Influence

Several years ago, a number of Hollywood celebrities began sharing their decision to have a double-mastectomy to reduce the risk of future breast cancer. In 2013, actress Angelina Jolie had both breasts removed because she carried mutations in the BRCA1 gene (BReast CAncer gene1), which dramatically increased her risk of developing breast and ovarian cancer. Normally, the BRCA1 and the related BRCA2 (BReast CAncer gene 2) genes suppress tumor development. But women who carry mutations in those genes aren’t protected by the tumor suppression factor and so are much more likely to develop breast cancer.

According to the National Cancer Institute about 13% of women in the general population will develop breast cancer sometime during their lives. By contrast, about 60% of women with mutations in BRCA1 or BRCA2 genes will develop breast cancer by 70 to 80 years of age. Jolie’s story inspired many women at high risk for breast cancer to undergo genetic screening. However, all the media attention likely led to unnecessary double-mastectomies, too.

A 2017 study published in JAMA found that nearly half of women diagnosed with early-stage breast cancer who did not have bilateral disease, genetic mutations, or elevated genetic risk considered having a double mastectomy anyway. About 19% of women who reported not receiving a recommendation for or against the prophylactic procedure from a surgeon had both breasts removed. There is no compelling evidence that doing so provides any survival advantage to women who are not at high risk. In fact, the researchers point out that the risk of contralateral breast cancer development is low for most patients.

Choices Post-Mastectomy

In the United States, reconstruction is available to most women after mastectomy. Reconstruction with implants typically involves inserting implants filled with either silicone gel or saline (sterile salt water). The U. S. Food and Drug Administration recommends that women with silicone breast implants undergo screening for potential rupture three years after implantation and then every three years thereafter. No long-term screening is suggested for saline implants.

Tissue reconstruction of the breast is a procedure in which surgeons remove and use skin from another part of the body, usually the abdomen, back, thigh or buttocks. The procedure takes more time, and the downside is there are scars on two areas of the body. The approach may lead to more natural looking breasts, but some women may need brief correction ­surgeries to achieve the best results.

A prosthesis is another available option. There are many breast shapes, sizes and materials from which to choose. The prothesis may be an insert that can be slipped into a pocket in a specially-designed camisole or bra. There are also those that come with adhesive patches or magnets that enable the prosthesis to stay in place without the need for special lingerie.

Going flat is another choice. However, the American Society of Plastic Surgeons states that more than 70% of women are not fully informed about this option.

Flat Denial

Forgoing breast reconstruction can be a viable choice for many women, but there may be some obstacles. The recent UCLA study identified concerns unique to patients who chose not to have breast reconstruction. While a majority of the women surveyed who decided against reconstruction reported they were satisfied with their surgical outcomes, 27% reported not being satisfied with the appearance of their chest wall.

“Some patients were told that excess skin was intentionally left, despite a preoperative agreement to perform a flat chest wall closure, for use in future reconstruction, in case the patient changed her mind,” says Dr. Attai, “We were surprised that some women had to struggle to receive the procedure that they desired.”

Surgeons may hesitate to recommend mastectomy without reconstruction surgery due to being less confident that they can provide a cosmetically acceptable result for patients who desire a flat chest wall, notes Dr. Attai. “We hope the results of the study help to inform patients that going flat is an option, and to empower them to seek out surgeons who offer this option and respect their decision.”

Carefully Consider Options

A breast cancer diagnosis may, understandably, cause a person to panic. But there is time to carefully consider options and treatment plans, according to Jennifer Baker, MD, Assistant Clinical Professor of Surgery at the David Geffen School of Medicine at UCLA, and a researcher on the recent study. She advises newly diagnosed people to seek out breast cancer surgeons who have done surgery fellowships, so that they are familiar with the most recent techniques.

To more fully understand treatment options for breast cancer, view Dr. Baker’s excellent YouTube video online by entering the following information into the internet search bar: http://tiny.cc/breastcancersurgery.  

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“If you have some favorite plant-based foods, I always urge people to fill their plates with them first and then to use any other high-calorie/animal-based product as a condiment rather than as the focus point of the dish. The reason this can work for weight loss is because you’re not ‘starving’ yourself. You are eating a good amount of food volume, but not too many calories. Also, plant-based items are super healthy for your heart and any other chronic disease you may have or are trying to prevent.”

Habits for Better or Worse

Obviously, habits can better serve our health or spoil it. For example, brushing your teeth every morning and night is good. A midnight snack of leftover fast food, not so much. But learn to harness the unconscious nature of habits for good and you can accelerate success in virtually any domain you desire.

According to a study published in the journal Obesity, researchers identified strategies that may help people who have lost weight keep it off. The study surveyed over 4,700 participants in a weight-loss program who had maintained a weight loss of at least 20 pounds for more than three years. They reported more frequent, habitual, healthy dietary choices, greater self-monitoring, and the employment of psychological coping strategies, such as “thinking about past successes” and “remaining positive in the face of weight regain.” Clearly, those who had a healthy eating habit were more successful at maintaining weight loss.

The Secret Power of Habits

When habits are fully formed, we barely have to think about them. And that’s their inherent power. They become subconscious and stress-less because there’s no willpower involved. For example, you don’t have to think about taking the toothpaste cap off, filling your toothbrush with paste, and moving the brush inside your mouth. It’s basically automatic. And when you hijack a habit to build another one, you’re not wasting precious cognitive energy trying to accomplish a task.

Stacking Habits

Many people have coffee first thing in the morning. Making the brew is automatic: same coffee, same amount, same process, every day. Add to that habit another goal, such as drinking more water. While the coffee is brewing or dripping, you set out your usual coffee cup. Fill a large pitcher with water and flavor it with fruit or unsweetened tea, if you like. Drink a glass before you enjoy your coffee. Then finish the pitcher by day’s end. Do that for a week or two, and soon drinking more water becomes routine. Similarly, if you find yourself starving in the late afternoon and often default for an easy doughnut fix, use your morning coffee-making time to prep a healthy snack for later in the day. Eventually drinking more water and eating a healthy afternoon snack becomes a habit. Both goals become easier when they are stacked onto existing habits.

On the flip side, breaking a bad habit can be more easily achieved when there’s more friction to completing it. For example, to thwart nighttime TV munchies, don’t buy high-calorie snack foods. When you turn on the TV, perhaps pick up a knitting needle or coloring book, or do your nails instead. Make it more difficult to consume the unwanted food and create a new habit to replace mindless munching.

To hack habits, it’s helpful to assess current habits, both good and bad. Then get creative. Think of ways to hijack existing habits to create new ones, and place obstacles in front of those you’d like to break. And give it time. From repetition often comes affinity. We do come to like that which we may not have appreciated before. For some people, exercising early in the day is a great way to go.

“When you do that you already have one healthy behavior completed,” explains Hunnes. “Setting yourself up for a good day is often half the battle.”

With some patience and persistence, new habits become an effortless reality and the spell of old ones can forever be broken. Slow and steady wins the race.

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Compared to slow velocity training, research has shown that training at fast velocities results in superior muscle gain of fast-twitch muscle fibers and greater improvements in maximal neuromuscular power. Given that many people complain that they do not like to exercise, researchers from the Human Performance Lab at the University of Texas at Austin wanted to know if very short training sessions could make a difference in otherwise sedentary adults. They tested 39 sedentary men and women ages 50 to 68 to investigate the effectiveness of maximal power cycling (PC) training using an inertial load cycle ergometer (a stationary bike with a weighted flywheel, such as those found in group cycling classes). Over the course of eight weeks, participants performed 15 minutes of interval training three times per week. Each session included repeated four-second sprints (with rest between) done at the person’s maximum ability. Rest periods were progressively shortened from 56 seconds to 26 seconds during the eight-week period. At the end of the study, researchers report that all participants showed significant improvements, especially in muscle power (as much as 12%), which is most relevant to functional tasks, according to the researchers. They further validated results by measuring how quickly participants could rise from a chair unassisted, and they also timed walking speed. Both of those tasks improved by the end of the eight-week study. The study appeared in Medicine & Science in Sports and Exercise, Dec. 29, 2020.

Colorful Produce May Reduce Alzheimer’s Risk

The Rush Memory and Aging Project, conducted at Rush University Medical Center, Chicago, is a long-term ongoing study funded by the National Institute on Aging that enrolls people in the Chicago area without dementia who agree to clinical evaluation and organ donation. A recent review of data analyzed food questionnaires filled out by 927 older individuals with no dementia at the start of the study. Those with the highest intakes of carotenoids were only half as likely to develop Alzheimer disease (AD) as those with the lowest intake. Carotenoids are colorful compounds that give plants yellow, orange and reddish hues. Lots of produce contain carotenoids, including pumpkin, squash, tomatoes, peas, kale, oranges and cantaloupes. During the study, 508 people died and underwent autopsy. Those who consumed more carotenoids were less likely to have tangles and plaques, which are hallmarks of AD. The study was published in the January 2021 issue of the American Journal of Clinical Nutrition.

Blood Protein Signatures to Assess Wellness

The bloodstream touches all the tissues of the body. It carries nutrients to tissues and takes waste products away. Tissues also release proteins into the bloodstream that can communicate with other parts of the body, help mount an immune response to disease, and much more. Some blood tests measure specific proteins to help diagnose diseases (e.g., diabetes, heart disease, and kidney and liver problems). Scientists have been curious about whether blood proteins could be used to more broadly assess people’s health and wellness. To explore this idea researchers from Stanford University collected blood plasma samples from more than 4,000 volunteers between the ages of 18 and 95. They compared the levels of nearly 3,000 proteins in blood between people of different ages as well as between men and women within those age groups. The work was funded in part by the National Institute on Aging. Overall, about two-thirds of the proteins found to change with age differed between men and women. This supports the idea that men and women age differently—and highlights the need to include both sexes in clinical studies for a wide range of diseases. Participants who were predicted by their protein signature to be younger than they actually were performed better than their peers on cognitive and physical tests. Unexpectedly, deeper analyses showed that most protein changes seen with aging did not occur in a linear fashion. Instead, they occurred in waves, with three large peaks of change around the ages of 34, 60, and 78. These waves largely consisted of changes in different proteins and were associated with different biological functions. For example, proteins associated with cardiovascular disease and Alzheimer’s disease were found in the peaks at 60 and 78 years of age. More research is needed to understand which protein signatures might help identify people at greater risk of age-related diseases. The findings also may help identify potential targets for preventing and treating age-related diseases.

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