And, to some degree, it seems, gender-affirming hormone therapy (specifically with testosterone). Two recent publications (here and here) agree that lipid profiles are adversely affected in transgender men taking testosterone, and by extension, calculated cardiovascular risk is also affected. As more evidence accumulates, risk relationships are coming into clearer focus. And risk, it seems, is real.

Gender-affirming care saves lives

But don’t let this deter you: gender-affirming healthcare saves lives. Suicide is a major risk for transgender people. This is on top of the risks associated with lack of access to routine care. Providing safe access to gender-affirming care, including hormone therapy if desired, is a powerful tool that reduces suicide and improves quality of life. And the medical community knows how to mitigate the risk of cardiovascular disease.

Embrace diversity

The transgender and gender-nonconforming population is diverse (and for that reason, I’ll use the term “gender diverse” from here). Some people might use pronouns you’re not familiar with. Some might identify as non-binary or another category you’re not familiar with. Some might be children. Some might be old. They can and do have every comorbidity you can think of, just like everyone else. Of course, this includes the number one killer of US adults: cardiovascular disease. And it’s not always entirely clear what the risk is, given the paucity of evidence about this population (there’s no gender identity data in the Framingham Heart Study, is there?).

Risk reduction in practice

Whether testosterone is prescribed or not, clinicians who care for gender diverse patients need to integrate risk reduction into gender-affirming care in meaningful and robust ways. The conversation cannot stop at “let’s measure lipid levels at baseline and check in every once in a while”. It cannot stop at “we offered tobacco cessation counseling”. It cannot stop at “we discussed the risks and benefits”. We can do more.

Start with access to high-quality care

This is a health equity issue. Medical providers, are you doing your part?

• The most important intervention to improve the health of gender diverse people is to facilitate access to safe, high-quality health care. This includes ensuring that every clinical environment is gender-inclusive and trauma-informed.
• Ensure your patients’ basic needs being met. It’s hard to talk about nutrition and stress reduction if you’re not sure where you’re going to sleep. Ask. And make necessary referrals. This is a powerful step.
• Consider the full spectrum of risk-reduction options — including but not limited to pharmacological approaches? Don’t under-manage risk. And let individual patients’ values and preferences inform treatment decisions. This is the standard of care — are you applying it?

Focus on prevention and wellness

• Focus on prevention. Provide support for lifestyle approaches to risk reduction that meet your gender-diverse patients where they are. Give strong recommendations. Facilitate access to nutrition support, exercise programs, smoking cessation, counseling, or whatever else your patient might need.
• Use the tools available to you — brief motivational interviewing can enable positive change, even in a busy visit.
• Find or develop lists of queer-friendly gyms, coaches, and running or hiking groups in your areas. Exercise is a powerful wellness tool physiologically, psychologically, and socially, but not all spaces and professionals are inclusive.

Use the data for good

We’ll continue to see more evidence about the health of gender-diverse people over the coming years. More research is underway, and research protocols are slowly becoming more nuanced and inclusive. As the evidence matures, we’ll likely see more risk factors emerge. We are responsible for taking this evidence into context and using it to reduce risk — not to create barriers to care.

The post Let’s Improve Cardiovascular Health in Transgender People appeared first on Medika Life.

“OMG, am I dying?”

“I read that this vaccine is dangerous”.

“I want to try this new supplement, does it work?”

“Is this normal, or. . .”

Have you ever put one of these queries into a search engine? Was it helpful? I get lots of questions about health information that folks have run across online. It can be great to read up and educate yourself, but it can also be really hard to tell what’s legitimate, what’s relevant, and what’s not.

What started out as a well-intentioned fact-finding mission can quickly spiral out of control as you try to make sense of the stew of opinions, science, sales pitches, and general noise that is in the online health space. Before we go any further, a disclaimer: nothing you read online is ever a substitute for personalized, professional medical advice. If you are experiencing an emergency, you should always seek medical care from a professional, not from an online search.

OK? Good. Now, let’s go through some of the places you might land when you’re googling health topics and identify the best ways to use what you find.

University and government sites

If you are looking for solid, reliable, mainstream information about a health condition, seek out a university or government sites (.edu or .gov). National charities associated with a particular condition (like the national Eczema Association or Crohn’s & Colitis Foundation) are also usually good sources.

You can use these to learn the background and basics of disease and to understand general treatment options. Keep in mind that there are limitations to applying this information to yourself without additional context or expertise.

Not everything that’s generally true about the topic will be relevant to you. Overall, trust these sources as generally accurate but not tailored to you.

Message boards

These are great places to find personal narratives from individuals. It can be helpful to share experiences and build community with other patients. This can be really validating and can also sometimes uncover patterns and new information that you might not have thought of or noticed.

However, this kind of forum can also spread misinformation when people generalize their experiences to apply to everyone. When you are only considering a handful of people, you can’t truly know what’s related to a medical condition or treatment and what’s not.

Scientific evidence is how we determine whether treatments are safe as well as whether they work, and this means systematically comparing groups of people. Another issue with online health communities is that just like our bodies can respond well to the placebo effect by improving, we can also be influenced by our expectations that things won’t go well — this is sometimes called the “nocebo” effect.

So absolutely, communicate with other people to share experiences and frustrations, but keep your common sense intact. Make sure that if you’re going to try something new, it doesn’t carry risks that you might not have thought about. This might mean asking a healthcare professional about it, especially if you’re going to try a drug or supplement with the hopes of treating a medical problem.

The bottom line is, value others’ experiences and let them help you think about your own, but do not assume that what works for others is definitely right for you.

Symptom checkers

Want to hear your doctor’s best-exasperated sigh? Mention that you found something on WebMD. There’s a disclaimer on the symptom checker page on WebMD that reads “this tool does not provide medical advice”. Please heed this warning.

The two major pitfalls of WebMD and other symptom-checking sites are that it gives you a worst-case scenario, and it can lead you to anchor on a particular idea that’s hard to let go of if it turns out to be incorrect. I searched “headache in the morning” just now, and the list it gave me included “cerebral hemorrhage” and “pneumococcal meningitis” along with a lot of other stuff. Of course this will freak you out!

But those things could be effectively ruled out by some quick screening questions from someone who knows what they’re doing. If you’re thinking “brain tumor” and your doctor says to just drink more water and pop an ibuprofen, it’s easy to feel like you’re not being taken seriously. This doesn’t necessarily mean your doctor isn’t listening! They are able to interpret your symptoms in context in a way that you may not, and their expertise is why you went to see them in the first place.

You’d be better off skipping the google search, starting with some basic self-care, and being on the lookout for symptoms that are really and truly unusual or distressing for you. Look for things that are severe or persistent. This means knowing your body and what’s really “out of range” for you. Most little body quirks aren’t concerning despite what WebMD might come up with. If you choose to check your symptoms online, try not to fixate on the rare and serious things. There’s a saying in medicine that “true disease declares itself”. Remember this and don’t talk yourself into a catastrophe every time you notice something slightly off with your body.

Facebook

Please don’t crowdsource your symptoms on Facebook. You will hear terrible ideas from a lot of people who are high on confidence and low on knowledge. I have seen some frighteningly bad advice given in Facebook comments by people who are well-intentioned. And for some reason, everyone loves to share their horror stories here. Don’t do it. You will feel worse 100% of the time.

PubMed

If you have any background in science and you’re curious, you might enjoy looking at scientific papers. This is for more of a deep dive on a topic than it is for practical advice. The best place to search the scientific literature for peer-reviewed papers is the PubMed database.

The peer-review process increases the credibility of the information by ensuring some degree of scientific merit. For the highest quality evidence, look for systematic reviews and meta-analyses, studies done with humans (not animals), look at the size and diversity of the samples. If you’re intellectually curious, scientifically educated, or interested in what might be coming down the pipeline, PubMed can be a great place to deepen your knowledge.

Alternative websites and blogs

Skepticism of the mainstream isn’t necessarily always a bad thing; sometimes the scientific establishment does miss the boat. How do you know if a non-mainstream source is legitimate or not? I suggest that you start with the idea of trusting science and also respecting its limitations.

When seeking out information and opinions that are not well established, consider the motivations and general philosophical orientation of the source. Some blogs that appear to provide alternative health information are vehicles for selling “alternative cures” that have no basis. Some are politically motivated disinformation. And some are really, truly reasonable sources of information about topics that don’t have a solid body of evidence behind them simply because they haven’t been sufficiently studied.

This category includes conditions that disproportionately impact women, poor people, and people of color, rare diseases, and conditions that are hard to diagnose with the methods currently in use. I suggest bringing an open mind and a critical eye to such sources.

If the source acknowledges and respects science and explains why its positions fall outside of the mainstream, it can be worth considering in the context of other available information. If it contains inflammatory political language, sells products, or is not clear about who its authors are, you should not consider it a credible source of health information.

Social media feeds

Consider the difference between active and passive information exposure. It’s good to seek information about a specific health issue or concern you might have, but it can be problematic to passively absorb what others are promoting, often with a vested interest. If your feed is full of health influencers, it can get really confusing really fast. It’s hard to tell who’s a true expert, who’s selling something, and who might be well-intentioned but not right for you. I suggest keeping this kind of content at arm’s length. Fill your social feed with pictures of cute dogs, and save the health stuff for times when you have specific needs. Then, you can seek out the right sources instead of whatever rose to the top of the algorithm that day.

I hope this helps you sort the good from the bad and the ugly, and remember you can always talk to a health professional who knows you if you have specific concerns. Keep learning!

The post How to Consult Dr. Google appeared first on Medika Life.

It’s also not a new idea that stress causes heart disease. Cardiac patients have been told to lower their stress levels for decades by avoiding strenuous activity — but unfortunately, they haven’t been told much more than that. Healthcare providers tend to focus more on things that are easily measurable like medication adherence, blood pressure, smoking, and cholesterol. Stress seems like a slippery, messy, wishy-washy concept that we are not well equipped to address. But some recent science suggests the role of mental stress in cardiovascular disease might be more significant than previously understood. In light of this evidence, a deeper dive into the concept of stress is warranted.

Stress: what it does to the body

Stress is the body’s physical and mental response to changes and challenges (stressors). The stressors themselves can be physical, like hard exercise or injury, or mental, like emotional upset or trauma. Some of the body’s responses are helpful, especially in the short term.

Increased alertness, heightened perception, increased blood flow to muscles, and increased energy availability can help you respond to a stressor. Appropriate levels of stress can also lead to adaptation over time. However, when stress is chronically high, these mechanisms can become maladaptive, and without time to rest and recuperate, adaptation doesn’t occur.

In mental stress, the brain responds to fear (processed in the amygdala) by activating the sympathetic nervous system (that’s the fight-or-flight response). This sets off a cascade of hormones that can serve to protect the body from danger acutely, but chronic activation can result in increased body fat, insulin resistance, hypertension, vascular inflammation, and atherosclerosis.

Chronic systemic inflammation created through these mechanisms is also a potential consequence of ongoing stress. A chronic inflammatory state is associated with a host of chronic illnesses. This is one likely mechanism for how poverty, racism, abuse, and other so-called social determinants of health are major contributors to observed health disparities.

So what does the evidence say?

A large (n=24,767) case-control study published in the journal Lancet in 2004 reported that psychological stress was an independent predictor of later heart attacks. A more recent study published in JAMA late last year (including 918 patients over nine years) reiterates this finding with more specificity. Not only can mental stress lead to cardiac ischemia (reduced blood flow to the heart), but patients who develop mental stress-induced ischemia are more likely to experience heart attacks and to die over the next four to eight years. These findings tell us clearly that in people with any degree of underlying heart disease, mental stress is strongly associated with heart attacks and death. This isn’t a negligible effect or a questionable outcome. These are meaningful, relevant endpoints, and we should care about them.

Is there a prescription for stress?

Perhaps you work in, or get care in, a patient-centered medical home with an integrated behavioral health team that has the training and resources to coach people through long-term, evidence-based stress management programs. But probably not. Absent a perfect solution, what tools do healthcare providers and patients have at their disposal? Physical exercise is one tool that can reliably modulate the body’s stress responses, including inflammation. Others include consistent, high-quality sleep, mindfulness practices, and an anti-inflammatory diet pattern. For some, medication to treat anxiety or depression can lessen activation of the stress response.

Exercise, get good sleep, eat well, meditate, and take your medication? This list reads like a who’s who of behaviors that are hard to change. For people who are used to getting simple prescriptions from their healthcare providers, advice to make changes to their lives and habits is often ineffective. Most people don’t have experience with positive goal setting and behavior change, and most clinicians think they lack the expertise and/or time to counsel them. There are promising models to address these challenges, including group visits, behavior change specialists embedded into primary care, integrative medicine practices, and health coaching. For many, though, these services are not available, too expensive, or otherwise out of reach.

Practical tips for providers & patients to try

So what CAN you do, as a clinician or a patient seeking to encourage stress reduction as a means to reduce cardiac risk? First, acknowledge that this is a different kind of prescription — not everyone will be game for it. Ask your patient (or yourself) if they’re willing to try this approach. If they are, here are some tips to guide you.

• Make it meaningful. Scare tactics don’t work. Tying change to individual values does. Try asking an open-ended question like “what do you want to be in good health for?”.
• Make it personal. Consider offering some possible directions and seeing which one sounds most interesting, doable, or important. For some, increasing physical activity will be appealing; for others, it may seem impossible. Explore what will work best for each individual.
• Make it specific. Trying to make huge, sweeping changes is overwhelming. Advice to “eat better” or “exercise more” doesn’t create a path forward. Offer targeted information and encourage identifying small, manageable actions steps, one at a time.
• Offer affirmation & accountability. Believe in each person’s strengths, acknowledge their skills and successes, and help them stay connected to their intention to change. For some people, a reminder letter or a quick question at a follow-up visit will do the trick. Others might find keeping a log or looping in a loved one helps.

This process, believe it or not, can be accomplished in just a few minutes if that’s all you have. If you don’t believe me, give it a try! With a little practice, I’ve been able to implement this style of counseling into routine primary care visits without getting behind. As an added bonus, most people really value being listened to in this way.

Clearly, brief counseling in medical visits is not a panacea and won’t undo stress, especially chronic stress from poverty or racism. But it is an inexpensive, empowering, and science-based risk reduction strategy that anyone can implement in any setting — and that’s a great place to start. Are you ready to add stress reduction to your cardiac risk management toolkit?

Elizabeth Knight is a scientist, nurse practitioner, educator, and coach. You can find her at www.flowerpower.health.

The post The Latest Science on Stress appeared first on Medika Life.

How did added sugars become the norm?

We live in the age of of highly processed foods. “Processed” exists on a spectrum, with cracked grains and frozen veggies on one end and twinkies and soylent on the other. Though originally processing helped foods last longer without spoiling, and thus feed more people, it’s gotten out of hand. Food is increasingly produced and distributed by large corporations whose goals are less about high-quality nutrition and more about the bottom line. Foods are formulated to be appealing and addictive (for a detailed study of this effect, see Michael Moss’s Salt Sugar Fat). One strategy to make food taste good is to add sugar. This practice really took hold in the 1990s when the fad was to limit fat. Low-fat “diet” foods don’t taste great unless you replace the fat with something appealing — like sugar. Even as eating fat is coming back into vogue, added sugars have stayed.

What’s the problem with added sugars?

Added sugars create a number of problems in the body. First, they are energy dense but nutrient poor. This means that they can lead to excess calorie intake, leaving you overfed but undernourished. It’s not just about weight, though. Consumption of added sugars is linked to systemic inflammation, including many diseases with an inflammatory component, such as:

• cardiovascular disease, including high blood pressure and heart disease
• liver disease
• diabetes
• breast cancer
• depression

The current Dietary Guidelines for Americans recommend that added sugars be limited to less than 10% of your daily calories. This number is probably still too high — the advisory committee suggested reducing it to 6%, but that didn’t make it into this version. For most Americans, though, even shooting for 10% (which is on average 12 teaspoons’ worth) would be an improvement. The current evidence suggests that Americans’ mean intake of added sugars across age, sex, and ethnicity is over 16 teaspoons daily. Surprised? Think this couldn’t possibly be true of you? Let’s take a look.

Searching for sugar

The Food & Drug administration (FDA) is responsible for food labeling regulations in the U.S. In 2016, the updated label included “Added Sugars” for the first time, and now you can find it under “total sugars” on packaged foods. This number should be as close to zero as possible. Note that this doesn’t include naturally occurring sugars, such as those in whole fruits. Though sweet, this kind of sugar is generally accompanied by fiber and other nutrients, reducing its impact on your body.

Armed with this information, consider auditing your regular food and beverage choices to see where you’re getting added sugars now. It’s not just from sweets! Start with low-hanging fruit: do you drink sweetened beverages? This is by far the biggest contributor. Soda, sweet tea, flavored coffee and tea drinks (I’m looking at you, Starbucks), and even juice can give you well over your daily allotment in one go. Packaged foods are another common source. Even apparently healthy foods like jarred sauces, salad dressings, plant milks, cereal, flavored yogurt, granola bars, and bread often have added sugars. Then, think about sweets. Do you eat candy, pastries, or dessert regularly? Add this to your total, too. There are about four grams of sugar per teaspoon. How many are you getting? Is it time to cut back?

A tip sheet for getting started

Are you ready to reduce added sugars? Here are some ideas to get you started.

• Start where you are. Don’t force yourself to change overnight. Your tastes will likely change — and this takes time. If you’re a soda drinker, it might be hard to imagine giving it up, but many people who do report over time that they lose their taste for it.
• Don’t replace sugars with artificial versions of them. Many of these products are sweeter than sugar, and contribute to your inability to enjoy the natural sweetness in many foods. Some are also linked to GI distress and even elevated blood sugars, and there is evidence that they disrupt the microbiome.
• You don’t have to eliminate everything sweet — but do make sure that your sugar intake is giving you what you want from it rather than lurking in places you don’t even recognize. Added sugar from a delectable square of chocolate is a different experience from added sugar in diet salad dressing.
• Don’t beat yourself up: it’s OK to have treats sometimes. Focus more on your daily choices for the greatest impact, and when you occasionally indulge, enjoy it.
• Look at ingredient lists and remember that they are listed in descending order based on amount. You may see sugar, but anything ending in “ose” — like fructose or glucose — is also sugar, as are honey, agave, and maple syrup. So-called natural sweeteners are still added sugar. (One possible exception to this is stevia, but see above concerns about artificial sweeteners).
• Rather than looking for a “sugar free” label (which often means sugar has been replaced with something else) look for “unsweetened”, and try to choose items with a short list of ingredients.
• Even better, buy food without labels. Fresh produce and bulk whole grains and legumes have nothing added.

Are you planning to reduce added sugars in your diet? Go for it! Pick one thing to start with. You can take the first step right away, and once you make these changes, you can keep the benefits forever.

The post Added Sugars: A Masterclass appeared first on Medika Life.

Now, back to the question my patients are asking. The best thing you can do for your health is something that you won’t find on a magazine cover: it’s simply to think deeply about it. Look at your life — your values, your purpose — and see what you need your health for. Sink your teeth into that. Sit with it for a while. Think about it, talk about it, write about it. What are you really looking for? Channel your inner toddler and ask “why” until you hear yourself answer something deeply true. This process doesn’t yield immediate, jaw-dropping before and after pictures, but it does help to establish a meaningful, sustainable relationship with your health and goals.

Step away from your smartphone

Now, stop googling for health hacks (or double-tapping them on your feed). Hacks are solutions in search of problems. They are created to capture your attention. Hacks are things you can do with as little effort as possible. If you are looking for ways to exert no effort, though, I wonder why you are trying to improve your health at all. Is your health not worth doing well? Is it less important than other things you’ve chosen to spend your energy and resources on? Don’t shortchange your commitment to your health. Dream bigger! Once you’ve established your own internal reasons for pursuing health, you can work on identifying goals and steps to meet them. You might find it helpful to work with a healthcare provider, coach, or even a like-minded friend to build informed, manageable steps that are appropriate for your life.

The problem with hacks

I get it, hacks are fun. They’re immediate and full of promises. You can start something, buy something, sign up for something, and it feels like you’re going somewhere. But. . . where? Whose road are you walking down, and why was it built? Where does it lead? Who is it designed to serve, and whose values is it based on? Maybe, there’s something for sale, and the purpose is to make money for another person. Maybe there are embedded assumptions of white supremacy, misogyny, transphobia, or fatphobia, and the purpose is to perpetuate a power imbalance. Maybe there are other values underlying the hack that are not in line with the reasons you need your health. Woah. Suddenly those ten weird tips don’t seem so cool.

So slow down, step back, and take a deep breath. You can find small actions that will improve your health, but they won’t come from clickbait, they’ll come from within. Stop hacking. Start healing.

Elizabeth Knight is a scientist, nurse practitioner, educator, and coach. You can find her at www.flowerpower.health.

The post You Can’t Hack Your Way to Health appeared first on Medika Life.