Acute vs. Chronic.

Under acute stress, you may feel a jolt of energy and notice your visual focus and thinking sharpen and your motivation increase. You are faster and stronger, and even your immune system is primed for action. When this moment of acute stress passes, your vital signs (and everything else) return to normal.

Chronic stress is different. If you’re under continuous stress for long stretches of time, such as from a high stress job, financial insecurity, living in fear of violence, or caring for a chronically ill loved one without adequate support, your body never gets the chance to return to baseline.

Health Impacts.

Long-term exposure to stress affects your whole body. It may increase your risk for health problems including high blood pressure, heart attack, stroke, type 2 diabetes, and mental health issues like depression, anxiety, and addiction. See “Possible Health Effects of Chronic Stress” for more information.

Day-to-day symptoms of chronic stress, such as trouble concentrating, crankiness, changes in appetite, fatigue, insomnia, and turning to mind-altering substances for relief, can interfere with productivity and relationships and add to the negative health impacts of chronic stress.

Managing Stress.

If you are feeling stressed a lot of the time, it’s important to identify the source and find healthy ways to reduce or relieve that stress (and avoid unhealthy ways, such as overeating, smoking, illicit drug use, or excessive alcohol consumption). If you can directly address the source of your stress (by discussing job responsibilities with management, for example), do so. If this is not possible, take steps to manage the stress in your life with the tips in the “Take Charge!” box. Your whole body will thank you!

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The disease can take significant toll on emotional and social well-being. For example, people who have chronic OA pain may have to give up doing things they love, such as pickleball, gardening, or playing instruments. Difficulty participating in social and recreational activities can lead to feelings of isolation and loneliness. All this can spiral down into a sedentary life, raising risk for obesity, heart disease and diabetes. Chronic pain and physical limitations also can lead to feelings of frustration, sadness, anxiety, and depression. For these reasons and others, researchers at UCLA and elsewhere have been striving to find better treatments and cures for OA.

“There is the obvious challenge of optimizing the science of the treatment to make sure it is effective in all types of patients. But this process also requires obtaining funding in a fiercely competitive funding landscape, navigating the regulatory environment, and making the therapy available in the relatively near-term future,” explains Thomas Kremen, MD, an orthopedic surgeon, and clinician-scientist faculty member at UCLA’s David Geffen School of Medicine. “The commitment of significant funding greatly accelerates the pace of the research and allows for the implementation of therapies in my patients much faster than the traditional timeline for developing novel therapeutics.”

A MultiCenter Effort

UCLA Health is part of a multi-institution research team receiving the contract for up to $33 million from the federal Advanced Research Projects Agency for Health (ARPH-A) for the development of new treatments specifically focused on joint regeneration for OA. UCLA’s portion of the award will support the development of novel therapies, with the goal of completing an FDA phase 1 clinical trial within the next five years.

This multi-institution team, which also includes researchers from Duke University and Boston Children’s Hospital, is one of five selected to develop innovative forms of regenerative medicine–including affordable injectable and implantable therapies – that can regenerate joint tissue damaged by OA.

More Than Wear and Tear

The cause of OA has primarily been thought to be physical wear and tear, but it’s more complicated than that. “OA is multifactorial with contributions from our genetic backgrounds, environmental exposures, history of traumatic injuries, each patient’s individual activity level, medical comorbidities, and age,” explains Dr. Kremen. “While high-impact activities are generally thought to increase wear and tear in the joint, a lack of activity is also associated with joint degradation and progression of symptoms.”

Current recommendations to slow progression of OA include lifestyle behaviors such as not smoking, losing weight, and treating medical comorbidities such as diabetes. “As challenging as it is to lose weight, for each pound we lose that equates to 4 pounds of force removed from each knee joint, and patients really notice improved mobility and decreased joint pain when they do lose weight.”

While pain and stiffness also are symptoms of rheumatoid arthritis (RA), it is far less common than OA and a distinctly different disease process. RA affects about 1.3 million adults, women more than men, and tends to begin between the ages of 30 and 50.  Neither OA nor RA currently has a cure.

“With rheumatoid arthritis, an autoimmune disease in which the abnormal biology is more easily defined, there have been all sorts of advances in the last 20 years. With osteoarthritis, we haven’t made any progress,” says Dr. Kremen.

Joint replacement and surgeries for OA offer imperfect treatments. While there is no age limit for joint replacement per se, preexisting conditions may make the process and recovery more complicated for older adults. Joint injections work for some people, others not so much. And then there’s all the marketing hype surrounding regenerative stem cell treatments, of  which none are currently FDA-approved.

“We have much work to do to characterize the mechanisms by which these cells may influence the biology of healing,” says Dr. Kremen. “Like many things in life, if what a clinician is claiming about a cell-based therapy sounds too good to be true, then it probably is not true. If you are being offered a stem cell therapy or a birth product-based therapy (e.g. umbilical cord blood, placental tissue, or amniotic membrane derived products), this should only be done in the setting of a clinical trial.”

Insights Into Cartilage Regeneration

Tissue regeneration is a burgeoning field. Working alongside Dr. Kremen, the UCLA Department of Orthopaedic Surgery research team also includes Karen Lyons, PhD, professor, and vice-chair for research, and Weiguang Wang, PhD, an assistant research faculty member. All three of these investigators have developed innovative technologies that, when combined, lead to a novel multimodal treatment approach.

In the lab of Dr. Lyons, who is a developmental biologist, researchers have been studying the signaling pathways that cause cartilage to develop in utero during early development. Once Drs. Lyons, Wang and Kremen connected, the scientists wondered if they could target the same pathways to regenerate damaged cartilage and bone tissue in adult patients suffering from osteoarthritis.

“Many of the same pathways that were used during early development are redeployed when tissues try to repair themselves,” Dr. Lyons says.

While developmental biology studies offer important clues about which pathways might be best targeted to treat osteoarthritis, there are significant differences between newly formed joints and adult joints. Those include barriers like inflammatory pathways and a diminished pool of cells capable of regeneration and repair in adults.

To test how well these pathways might be employed to repair joint degeneration, the UCLA research team has used both genetic and pharmacologic approaches in mouse models to identify several drugs that have the potential to repair articular cartilage and its underlying bone.

In addition to using animal models, the researchers will be testing their strategies on a so-called “joint-on-a-chip” platform, which mimics the healthy or diseased features of joints inside of the body.

Moving Forward

Ultimately, the research team plans to develop three separate types of injectables that patients would receive once per year: one that targets joint tissues; another that targets adjacent bone; and a systemically administered drug that could treat cartilage tissues in patients who have OA in multiple joints.

At the end of five years, Dr. Kremen says, the researchers plan to have completed the testing of these treatments in phase I clinical trials, which will be conducted at UCLA.

“ARPA-H is really focused on commercialization and affordability,” Dr. Kremen says. “They have an ambitious timeline, because they, and we, want to get these therapies into people as soon as possible.”

“You gain immediate feedback from a knowledgeable physical therapy professional,” says Dr. Kremen.

Physical activity strengthens muscles and bones. If you have pain with one activity, Dr. Kreman suggests trying another activity that is known to be lower impact. For example, instead of running you try brisk walking, biking, or an elliptical machine. If those cause pain that is not tolerable, try something even lower impact like swimming or walking in the pool. 

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Grief can be like that. It also can manifest as deep sorrow, hostility, guilt, confusion, and fatigue. It’s a process that waxes and wanes and an experience that varies from person to person. There’s no absolute timeline or way to grieve, but most people start to return to a sense of normalcy in about six to 12 months.

Grief occurs not only when a loved one passes but also can happen with a terminal diagnosis, such as cancer or Alzheimer’s disease. Known as “anticipatory” grief, it affects both the diagnosed person and loved ones.

Grief’s Impact on Health

The grieving process can lead to everything from bodily pain and a weakened immune system to stomach upset and insomnia. According to George Slavich, PhD, director of the Laboratory for Stress Assessment and Research at the Semel Institute for Neuroscience and Human Behavior at UCLA, the root of these symptoms can be traced back to our evolutionary response to the loss of a social connection.

“As humans, we are strongly motivated to seek out social bonds that are warm, dependable, friendly and supportive,” says Slavich. “Losing someone close to us terminates that bond and the social and physical protection they provided, which historically could have put the body at an increased risk of physical danger.”

When you lose someone that you’ve been with for a long time, the body and brain go on high alert to protect you from potential dangers. Your immune system ramps up and sends immune cells throughout the body to deal with possible physical wounds that might occur. At the same time, however, your immune system lowers its antiviral defense system, making your body more vulnerable to viral infections. “If you’ve ever come down with a cold after a stressful time, you may have experienced this response,” says Slavich.

The grieving process can cause prolonged inflammation and lead to psychological and behavioral symptoms such as fatigue, loss of pleasure, and social withdrawal. If these symptoms persist beyond six months, it may indicate prolonged grief, which can have serious health implications.

Prolonged Grief

This type of grief is marked by persistent and pervasive feelings of longing, sadness, and preoccupation with the deceased. It can significantly interfere with a person’s daily functioning and quality of life. Common symptoms include an inability to accept the loss, numbness, bitterness, difficulty engaging in life, and a feeling that life is meaningless without the deceased.

Prolonged grief is associated with increased cancer risk, cardiovascular problems, and early mortality. It may lead to heart attacks, especially in people who already have a higher risk of heart disease.

Takotsubo cardiomyopathy, also known as broken heart syndrome or stress cardiomyopathy, can be triggered by intense grief. This condition temporarily weakens the heart’s left ventricle and can mimic a heart attack, even in those who do not have cardiovascular disease. It tends to affect postmenopausal women much more than men. Recovery from this transient condition can take days or weeks. However, this doesn’t mean the condition should be ignored or untreated, because there can be long-term consequences.

Anticipatory Grief

Anticipatory grief is the emotional response experienced when a loss is expected but has not yet occurred, such as with a terminal illness diagnosis. Key characteristics of anticipatory grief include feelings of sadness, anxiety, anger, and helplessness. It affects both the diagnosed and loved ones. For example, loved ones can become consumed with imagining life after the loss and worrying about how to cope. It may change how an individual interacts with the dying person, such as increased closeness or emotional distancing as a protective measure.

Stress and anxiety can lead to physical symptoms like fatigue, changes in appetite, and sleep disturbances. Feelings of relief or guilt also can be part of anticipatory grief, especially if the loved one has been suffering. Understanding and acknowledging anticipatory grief can help in the processing of emotions and better prepare for the eventual loss.

Patience, Acceptance, and Self-Care

It’s important to accept that it is normal to grieve and give yourself permission to experience the full range of emotions. Surrounding yourself with supportive friends and family with whom you can share your feelings can provide comfort and validation. Support groups, both in-person and online, can also offer a sense of community and understanding. Sometimes, the intensity of grief requires professional intervention. Therapists or counselors specializing in grief can provide strategies and support to navigate the emotional turmoil.

After losing a loved one, thoughts can constantly drift between the past and the future. Practicing mindfulness meditation is one way of becoming aware of your thoughts, grounding your awareness in the present, and reducing overall psychological stress.

Sleep may become challenging. It may be difficult to fall and stay asleep. And a sense of purposelessness can make it hard to get out of bed up in the morning. However, “sleep is one of the strongest drivers of immune activity,” Slavich says, and “having a standard sleep schedule is really important for properly regulating your immune system.”

Along with quality sleep, a healthy diet and regular exercise are recommended for self-care. Choose nutritious foods daily. Include lean proteins, fruits, vegetables, healthy oils and leafy greens. These choices help reduce inflammation. Likewise, moving your body regularly supports brain and immune health. Breaking a sweat helps decrease feelings of stress and anxiety. Exercise triggers the release of dopamine and serotonin; two brain neurotransmitters that play a pivotal role in maintaining positive mood. Exercise also slows the release of cortisol, the hormone that can wreak havoc when it flows unabated under chronic stress.

“Each of these strategies can help promote resilience following interpersonal loss,” Slavich says, “but the most important thing is to begin with the strategy that you know you’ll actually follow through with.” He also recommends telling your healthcare provider about your loss. This will enable your provider to take your personal situation into consideration and to understand how your grief may be involved in any symptoms you may be experiencing.

Coming up with the best strategy for dealing with grief needs to be a team effort between you and your healthcare provider, Slavich says, but “if they don’t know what’s going on in your life, they won’t be able to help.”

Creating a memorial or engaging in rituals to honor the person you’ve lost can help with healing and acceptance. This could be through a dedicated space in your home, a scrapbook, or participating in activities that the deceased loved. It helps keep their memory alive and allows you to celebrate their life.

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➥ Answering questions that weren’t asked.

➥ Watching TV with the closed captions on and the sound turned up.

➥ Difficulty talking on the phone.

➥ Avoiding social situations.

If any of these scenarios hit home with you, make an appointment with an audiologist. Audiologists typically hold a doctor of audiology (AuD) degree. They thoroughly assess your hearing, help you select the ideal hearing aids, customize the fit, and program the devices for your needs

Say Goodbye to the Stigma

A common concern is that hearing aids will make a person look old, but the reality is otherwise. “Having a tiny hearing aid behind your ear can be overlooked, whereas asking for repetition or not responding to a statement at all is more difficult to ignore,” says Gina Gracia, AuD, Clinical Manager, UCLA Audiology Clinic.

Some people may shy away from hearing aids because they lack the dexterity to deal with small batteries, or think they may be too complicated or too expensive. Rechargeable batteries solve the battery problem, and audiologists help you get the appropriate, affordable devices and provide instruction and follow-up appointments.

Over-the-counter hearing (OTC) aids may be a solution for some people, but they aren’t necessarily the right choice for everyone. “OTC hearing aids generally make all sounds louder, including background noise, which can interfere with understanding conversations,” explains Gracia. “Traditional hearing aids are programmed specifically to your type and degree of hearing loss, and are equipped with technology to amplify speech and reduce constant background noise.”

It’s also important to know that your brain needs time to adapt to hearing aids. The sooner hearing loss is diagnosed and treated, the better. But you should not expect hearing aids to restore hearing to normal. “Hearing aids give you a new definition of normal as long as a suitable selection is made, is programmed appropriately, and used consistently,” says Gracia.

Hearing aids have become smaller, some virtually invisible, and they have become quite sophisticated, too. For example, you can connect Bluetooth hearing aids directly to a cellphone, tablet, or computer so you can stream audio from these devices directly to your ears.

Although hearing aids are very helpful, unfortunately they are not covered by Medicare and can be quite costly. Some Medicare Advantage plans may offer partial coverage, depending on the plan. If too costly, less expensive alternatives, such as pocket talkers, amplifiers, or the OTC hearing aids, maybe viable options.

“Hearing aids can be as complicated or as simple as you want them to be,” points out Narine Oganyan, MHA, Director UCLA Speech Pathology & Audiology Clinic. “An audiologist will help you select a hearing aid that is appropriate for your hearing loss, taking into account lifestyle and personal preferences.”

Improve Your Social Life

Research suggests that using hearing aids to treat hearing loss may help slow the development of cognitive problems. In an NIH-funded study from Johns Hopkins University, nearly 1,000 adults ages 70 to 84 were enrolled to compare cognitive decline between those who received hearing aids and those who did not over a three-year period. Included were participants with significant hearing loss and substantial dementia risk factors. For them hearing aids reduced cognitive decline by nearly 50%.

Hearing better can reduce loneliness because it can facilitate clearer communication with family and friends, leading to stronger, more positive relationships. Improved hearing also can reduce the risk of depression and anxiety, and enhance personal safety and independence by helping you stay aware of surroundings and important sounds such as alarms, sirens, and traffic.

If you’re not hearing well, why not give hearing aids a chance for a few months to experience what you’ve been missing? You just might be pleasantly surprised. And if you suffer from tinnitus, in some cases, hearing aids can mask the irritating sounds. For some people that could be reason enough to try them.   

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Hyper vs. Hypo

The thyroid is a small butterfly-shaped gland situated in the neck, just below the larynx. Its function is to absorb iodine, an element that occurs mainly in salt, bread, and fish, and convert it into triiodothyronine (T3) and thyroxine (T4). These hormones control your metabolism, influencing everything from the speed at which you digest fats and carbohydrates, to the rate at which your heart beats.

Another hormone—thyroid stimulating hormone (TSH)— also plays an important role in thyroid function. TSH stimulates the thyroid to produce T3 and T4. As such, measuring the level of TSH in the blood can flag underlying thyroid issues. High TSH levels may indicate that the thyroid is not producing enough thyroid hormone (hypothyroidism, which also is known as underactive thyroid), while low TSH levels may mean that your thyroid is producing too much thyroid hormone (hyperthyroidism, or overactive thyroid).

Hypothyroidism

This is the most common thyroid disorder and occurs when T4 levels are too low. Low T4 levels cause body processes to slow down— as such, symptoms typically include fatigue, weight gain, sluggish bowel movements, and increased sensitivity to cold. However, in older adults, these symptoms are less common—instead, an underactive thyroid may cause depression, loss of appetite, weight loss, and joint pain. Since these symptoms are associated with other diseases that are common in older age, recognizing hypothyroidism is challenging. Dr. Arakawa adds that it also is possible to develop subclinical hypothyroidism, in which TSH levels are only slightly elevated while levels of T3 and T4 are normal. “People who have subclinical hypothyroidism may report nonspecific symptoms, such as an altered mood and cognitive impairment, while many don’t have any symptoms,” she says.

HYPOTHYROIDISM RISK FACTORS

You are at increased risk for underactive thyroid if you have a family history of thyroid disease, have been treated for an overactive thyroid, and/or have had extensive surgery or radiotherapy to your neck. Some medications also raise the risk— for example, the cancer drugs sunitinib (Sutent®) and imatinib (Gleevec®) can cause or worsen an underactive thyroid, as can amiodarone (Corderone®, Pacerone®), which is used to treat heart arrhythmias.

It also is possible for underactive thyroid disease to arise from an autoimmune condition called Hashimoto’s thyroiditis, which impedes the thyroid gland from secreting hormones. Hashimoto’s usually causes a goiter, which is a swelling in the neck arising from enlargement of the thyroid gland.

TREATING HYPOTHYROIDISM

Dr. Arakawa emphasizes that treatment has not been shown to have a significant impact on symptoms in older adults with subclinical hypothyroidism. Although subclinical hypothyroidism is associated with an increased risk for progression to overt hypothyroidism and adverse cardiovascular events, the policy is to monitor people with subclinical disease and initiate treatment only if overt hypothyroidism occurs.

Treatment for overt hypothyroidism is a synthetic version of thyroid hormone called levothyroxine (Synthroid®, Levoxyl®). The drug is one of the most prescribed medications in the United States, but overusing it is known to increase the risk of osteoporosis. Recent research suggests that levothyroxine overuse also may increase the risk of cognitive issues in older adults. The 2023 study (JAMA Internal Medicine, Oct. 23) included 65,931 older adults and focused on thyrotoxicosis (excess T3 and /or T4 levels in the body). The new study suggests that thyrotoxicosis caused by medication raises the risk of cognitive decline. Dr. Arakawa says the data are a useful reminder for doctors to be cautious when prescribing thyroid hormone to older adults. “It’s important to regularly monitor people who are taking levothyroxine and decrease the dose if needed,” she notes.

Hyperthyroidism

This occurs when the thyroid releases too much T3 and T4, and it causes the body to “speed up.” Younger people may experience symptoms like an increased appetite, palpitations (the sense your heart is “skipping” beats), a tremor in the hands and arms, more frequent bowel movements, excessive perspiration, anxiety, and insomnia. But—as with hypothyroidism—overactive thyroid symptoms may be different in older adults, who “tend to present more nonspecifically, with fatigue, weight loss, and mood changes,” according to Dr. Arakawa. “Cardiovascular manifestations of hyperthyroidism also tend to predominate, particularly the abnormal heart rhythm atrial fibrillation,” she adds.

HYPERTHYROIDISM RISK FACTORS

In older adults, hyperthyroidism usually is related to abnormal growths that form in the thyroid gland. Called thyroid nodules, these can produce more T3 and T4, which is what makes the thyroid overactive. An overactive thyroid also can be caused by an autoimmune condition (Grave’s disease). Studies have linked Grave’s disease to an increased risk of cognitive decline. In other cases, drugs may trigger thyroid overactivity— for example, amiodarone, which can trigger both overactive and underactive thyroid disease.

TREATING HYPERTHYROIDISM

Untreated hyperthyroidism is known to increase the risk of developing osteoporosis, a condition that raises the risk of fractures. “Hyperthyroidism also can impact the pumping and rhythm functions of the heart, which may lead to conditions such as heart failure and atrial fibrillation,” Dr. Arakawa says. “These risks are augmented in people ages 65 and older, so treatment is recommended to correct hyperthyroidism.”

Treatment options include anti-thyroid medications, such as methimazole (Tapazole ®), which blocks the production of thyroid hormones. Alternatively, radioactive iodine can destroy the overactive thyroid cells, rapidly shrinking an enlarged thyroid gland. This can leave the thyroid unable to produce any hormone, and it’s likely you’ll eventually become hypothyroid and require treatment for that.

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Yes it is. As with smoking, consuming alcohol stimulates the release of endorphins: “feel-good” chemicals that generate sensations of pleasure and make us feel more relaxed. If you are under stress because of work, illness, or caregiving duties, this instant gratification can become a crutch. Moreover, alcohol remains socially acceptable in a way that smoking no longer is. Go out to dinner with friends, attend any kind of formal function, such as a wedding reception, and it is likely alcohol will be involved. If you become anxious in social situations, you may find that alcohol’s relaxing effects make it easier to interact with others. Much as people who smoke may light a cigarette without thinking about it when they are out with friends, you might have another glass of wine, and another, without noticing. This is particularly risky for older adults—age increases our sensitivity to alcohol, so we will experience a greater response to a given amount of alcohol that previously was tolerable.

At some point, you may decide to cut back your drinking—but stopping may result in withdrawal symptoms, including anxiety, tremors, and poor sleep, so you may relapse. This is where alcohol addiction counseling can help, and I recommend it for people who want to stop drinking but can’t, those who frequently drink more than they intend to, those who crave alcohol so much they can’t think of anything else, and those who don’t think they have a problem but whose family and friends have expressed concern. The National Institute on Alcohol Abuse and Alcoholism has a treatment navigator tool (http://tiny.cc/AlcHelp). Alcoholics Anonymous also can help (ww.aa.org) .

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I’ve been having physical therapy for gluteal medius tendinitis in my hip. The therapist recommended laser treatment, but is this safe?

The gluteus medius tendons connect the gluteus medius muscles (often referred to as the abductors) to the outer side of the hips. The muscles are involved in walking and stepping from side to side, and in rotating the hip joint. It is possible for the tendons to develop microscopic tears and become inflamed (tendinitis) due to overuse or an accident. The inflammation may cause symptoms including pain over the hip and in the buttock on the affected side. You also may lose some range of motion in the joint.

Along with rest and the use of cool compresses, physical therapy is an effective treatment for gluteal medius tendinitis. There also is some limited evidence that laser therapy may help acute episodes of tendinitis by promoting tissue repair. The treatment is safe, and most people see an improvement in their symptoms within six weeks. Laser treatment also may help you avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) to ease your discomfort. NSAIDs include ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) and are associated with potentially serious bleeding in older adults.

Richard G. Chang, MD, MPH

Rehabilitation and Physical Medicine

I take the blood thinner warfarin because I have a mechanical heart valve. Is it possible for me to switch to one of the newer blood thinners that have no food interactions?

The newer drugs you reference—known as direct oral anticoagulants, or DOACs—include dabigatran (Pradaxa®), edoxaban (Savaysa®), rivaroxaban (Xarelto®), and apixaban (Eliquis®). They do not have as many interactions as warfarin (Coumadin ®) and don’t require the regular monitoring that is required when taking warfarin, so they do make life easier. Unfortunately, DOACs are contraindicated in people with mechanical heart valves (made from carbon and titanium), because two major clinical trials investigating the use of dabigatran and apixaban in these individuals showed an increased risk of blood clots compared with warfarin. Strictly speaking, DOACs also are not recommended for people with biological valves or valve repair—however, some doctors prescribe the drugs off-label for limited time periods to these individuals despite the lack of proven safety data.

Bruce J. Darrow, MD, PhD

Cardiology

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A: Maca (Lepidium meyenii) is a root vegetable, indigenous to Peru, that grows in the Andes Mountains. It is a nutrient-dense root containing significant amounts of iron, copper, zinc, amino acids, and vitamins B, C, and E. Historically, it has been baked, roasted, or added to soups. Today it is often found in powder form, in capsules, or as a liquid extract.

Sometimes called Peruvian ginseng, maca root is an adaptogen that has been used for centuries to improve fertility, sexual function, and to boost stamina and energy. Although research is limited, small studies suggest maca may improve sperm volume, motility, and count in healthy males. Preliminary research has also reported that maca consumption may support an increase in feelings of sexual desire in healthy males. In addition, two small clinical studies reported that 3.3 or 3.5 grams of maca powder for six weeks was linked with lower anxiety, depression, and sexual dysfunction, versus placebo. Researchers purport that maca may also help relieve menopause-related symptoms. As always, EN recommends talking with your health care provider before starting any new supplement or changing your daily regimen.

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Blood Sugar Implications. Blood sugars can directly impact metabolism, hunger, and energy levels. Fluctuations in blood sugar can lead to cravings, overeating, and weight gain. Thus, by keeping your blood sugar stable, you may be able to reduce these nutrition challenges, making it easier to stick to a healthy diet and achieve your weight loss goals.

A Continuous Glucose Monitor (CGM) is a popular tech tool that tracks blood sugar in real time, transmitting data to an app on your phone. Originally designed for managing blood sugar levels in folks with diabetes, CGMs have gained traction in the general healthy consumer market for weight loss and habit change.

People with diabetes, prediabetes, and reactive hypoglycemia may benefit from wearing CGMs. Especially if on blood sugar-impacting medications, CGMs give crucial data to help inform about food, exercise, and medication dosing.

This data encourages gradual behavioral change, which is crucial for managing metabolic health. For instance, you may observe the impact of taking a walk after a meal or pairing a high-carb meal with fiber on your glucose levels. These insights help you develop habits that optimize both your health and may affect weight changes.

Why Use a CGM? A CGM tracks blood sugar levels in “real time,” providing information on how your body responds to different foods, activities, and stress. This can reveal patterns and help you make informed choices to maintain stable blood sugar levels, which is crucial for overall health and weight management, regardless of your diabetes status.

By understanding your unique glucose response, you can personalize your nutrition and exercise plans. CGMs can aid in developing healthier habits by showing the immediate impact of actions like taking a walk after a meal or combining high-carb foods with fiber and protein. This real-time feedback may reinforce behavior changes that optimize metabolic health and prevent potential future health issues.

Groups that may benefit from wearing a CGM who don’t have diabetes include people with:

• Prediabetes
• Hypoglycemia
• A family history of diabetes and want to prevent it
• An interest in data and want real-time feedback for habit change

Who Should Not Use a CGM for Weight Loss? While CGMs can be beneficial for many seeking weight loss, they are not suitable for everyone. Individuals with a history of eating disorders should be cautious, as the constant monitoring of blood sugar levels can be triggering to their mental health.

CGMs offer insights into blood glucose levels, but using them for weight loss may oversimplify the complex relationship between food, health, and body weight, says Kristin Draayer, MS, RDN. For individuals without diabetes, using a CGM can lead to obsession, stress, or anxiety over food choices, she notes.

Aside from diagnosed eating disorders, CGMs may cause individuals without eating disorders to develop unhealthy relationships with food. The pressure to constantly monitor and adjust dietary choices based on glucose readings can contribute to stress and an unhealthy preoccupation with eating. If you’re considering a CGM for weight loss, consult a trusted healthcare professional to ensure it is part of a balanced and personalized health plan.

Can CGMs Help with Weight Loss? Using a CGM may increase awareness of how lifestyle choices affect your body. Research indicates that self-monitoring is crucial for maintaining weight loss, and a CGM offers a high-tech way to do this. Melissa Mitri, MS, RD, explains, “Since your glucose and insulin levels can affect your weight, many people use it solely as a weight loss tool. It tracks your glucose levels throughout the day, providing insight into how your diet affects these levels.”

CGMs might help with weight loss by providing real-time data on how your body reacts to different foods and activities, although this is a new field of medicine that we don’t have conclusive evidence on yet. However, the immediate feedback allows you to understand how specific dietary choices and physical activities affect your blood sugar levels, enabling you to make more informed decisions—a concept known as self-monitoring.

Research shows that self-monitoring is a key habit for maintaining weight loss. A study published in the journal Obesity found that self-monitoring, including tracking dietary intake and physical activity, is associated with better weight loss outcomes. CGMs offer a high-tech way to implement self-monitoring, tracking glucose levels throughout the day to highlight how diet and lifestyle choices impact your glucose metabolism. Ultimately, this can indirectly encourage behaviors that promote weight loss.

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A: Depending on how much her anxiety affects her well-being or interferes with her daily activities, acceptance can be helpful, but it doesn’t necessarily mean anxiety can’t also be managed. This is true with many feelings. You may grieve the loss of a loved one, for example, but also learn how to cope with those emotions and move on from that loss. Accepting anxiety as something everyone experiences to some extent normalizes it. Without any anxiety, we would be less equipped to sense real threats and respond accordingly. Acceptance can also be a good first step in recognizing when anxiety is helpful and when we need to reframe our thoughts and feelings. Hopefully, your friend is also doing things like practicing mindfulness, which allows you to acknowledge anxiety or other uncomfortable feelings without judgment and redirect thoughts toward something more positive and helpful. If your friend has an anxi­ety disorder, rather than everyday worry, she may benefit from seeing a mental health profes­sional. Accepting anxiety is like accepting a condition such as arthritis. Yes, it exists and yes, it’s something that may be treatable.

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(if needed), making sure walking areas in your home are well-lighted, and being careful that your home is free of throw rugs, floor clutter, and other trip hazards.

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