You Might Go Through Hell for Your Post-Ozempic Body

Everybody wants Ozempic/Wegovy for weightloss. It definitely works, mainly because more than half the population has insulin resistance, if not outright diabetes and that’s what’s driving the “weight retention”. Unfortunately, according to one of the world’s experts on insulin resistance (Gerald Shulman, MD, PhD), these drugs may create their biggest impact by making people variable degrees of nauseated! If you feel like you’re going to puke, who wants to eat?!? Dr Shulman described how the drug blocks a single pathway that interferes with sugar metabolism and fat deposition, but once the drug is gone, so is the effect. Sliding back to where you started is a real possibility, even probability. For the diabetic for whom it's unlikely that the underlying issues will go away completely, the drug, if tolerated, is a great choice. Otherwise, it can be a very expensive emetic.

FROM NEW YORK MAGAZINE / BY DEVIN TOMB

You might love this so-called miracle drug. After a month or two on .25 milligrams, the typical starter dose for Ozempic, you may notice that your jeans fit better. You may notice everything in your closet fits better, and the scale says so, too: You’re losing weight. Your doctor ramps up your dosage and the pounds keep dropping. Friends ask what you’re doing. Even your mother-in-law wants to know. A year on Ozempic, and you might not recognize yourself.

A lot of people say they’ve lost weight on it — and a lot of people seem to be taking it. Ozempic is an injectable diabetes drug made of semaglutide, which can lower blood sugar and spur insulin production. It also slows digestion and makes you feel fuller for longer, which means weight loss is a common side effect. Though the drug’s manufacturer, Novo Nordisk, cautions that “Ozempic is not approved for chronic weight management,” doctors are increasingly prescribing it off-label, which is what Kim Kardashian is rumored to have done to fit into her Marilyn Monroe gown at the 2022 Met Gala.

Since its U.S. rollout in early 2018, Ozempic has become a coveted accessory in Hollywood, but even with its high out-of-pocket cost ($950 or more per month), plenty of normies are on it for weight loss too. It’s being marketed to everyday people with catchy ads on Instagram, TikTok, and cable TV networks, where “Oh! Oh! Oh! Ozempic!” is played to the tune of the 1975 song “Magic.” There are weight-loss specific Ozempic Facebook groups with tens of thousands of members who post before-and-after photos and trade tips on things like where to do the injections (some say the arm or leg versus the stomach can help avoid nausea). On TikTok, the hashtag #ozempic has nearly 250 million views and climbing.

“It’s the most common medication that I get asked about,” says Dr. Sudeep Singh, medical director at Apprize Medical, a concierge medical practice in Miami. “Everybody knows. Everyone’s asking about it. My mom’s asking. My neighbors are asking about it. The news is out.” And it often does lead to weight loss, provided you can tolerate the side effects.

But when you take the nausea, constipation, diarrhea, and other possible issues into account, Ozempic isn’t always the panacea it’s made out to be. Multiple women I spoke with experienced incessant vomiting; another said she had heart-rate spikes so strong they woke her up at night. Yet the even perceived benefit can be short-lived: You’ll most likely gain the weight back after going off the medication.

Anna Toonk, a 42-year-old podcaster in New York, was an ideal candidate for Ozempic. Since she’s diabetic, the drug can lower her blood sugar and help her pancreas produce insulin. Laser-focused on these goals as well as losing weight (which can also put type-two diabetes in remission), she visited a well-known endocrinologist in Manhattan and asked about Ozempic after reading about it in the New York Times. “He warned me it wouldn’t be fun,” she says.

Hell ensued. Toonk started on weekly injections of .25 milligrams with intentions to build up to one milligram, which is when most patients, according to the doctors I spoke with, see more significant weight loss. Within a week, “I had no energy, constant nausea, and what I call power-puking,” she told me. (A friend of hers described it as “the kind of puking that’s so bad you have to look away.”)

Instead of stopping Ozempic, Toonk asked her doctor to go up to .50 milligrams. “I wanted to keep my eye on the prize: my health, and that post-Ozempic body,” she says. Her doctor obliged, and that’s when things went “truly haywire.” She was so sick all the time that on her 42nd birthday, she only felt comfortable seeing her mom. That night, Toonk vomited again, and her mother told her, “You can’t live like this.”

Toonks’s doctor was hesitant to prescribe a cocktail of drugs to alleviate her symptoms. “I’d share how I was doing and he’d say, ‘Yeah, this class of drugs comes with bad side effects,’ which felt like, Well, you got yourself fat. So yeah, it might suck to be on this drug.”

As a September trip to Italy approached, Toonk had a breakthrough. “I realized that there are worse things than being fat,” she says. “The worst thing you can be is wanting to barf all the time.” She weaned herself off Ozempic and went to Italy without it. “I think it takes about five weeks for it to get out of your system, and I could feel it leaving my body,” she says. “My periods had been weird, and as soon as I hit that five-week mark, I had the monster period of my life.”

There’s a chance Toonk could’ve found some relief through the recommendations of others who’ve been on the drug, but if you want to join an active, private group like Ozempic® Weight Loss Support Group for T2D and Other Issues — USA, you have to agree to the rules. This includes No. 5: Posting about Negative Side Effects. “Most people taking this medication DO NOT have negative side effects. In fact, over 80 percent of people taking Ozempic have mild or no side effects at all. It only seems like there are so many since the people who have them, or are afraid of having them, post about it. No reason to expect it will happen to you. Due to a constant daily barrage of this type of post, we will filter most of these unless you have a specific issue.”

Dr. Singh says about half his patients experience these gastrointestinal side effects, especially at first. In those cases, unlike Toonk’s doctor, he will prescribe additional meds like an anti-nausea pill or antacid.

That didn’t cut it for Lauren Williams, a psychotherapist in New York, who after starting on .25 milligrams of Ozempic this summer had nausea, nonstop vomiting, and “unbearable pain” that landed her in the hospital with gastritis. But she didn’t quit the drug entirely. Now her doctor has her on a much lower dosage to see if she can still lose weight on it, since Williams’s husband lost 32 pounds with Ozempic in three months. “He had high blood pressure and this saved his life,” Williams says.

For others, the gastrointestinal side effects weren’t even the main issue. Mila Clarke, 32, who has latent autoimmune (LADA) diabetes and runs a well-known blog in the diabetes community, chronicled taking Ozempic for her 30,000 YouTube subscribers last year. She tells me she lost weight quickly, but it actually frightened her how little she wanted to eat. “Sometimes I would drink a glass of water and I would be full for the entire day,” she says. She got over other side effects, like nausea and acid reflux, in a month. But within a week of starting the drug, she kept getting the same Apple Watch notification telling her that her heart rate was high. She says she brought it up with her doctor, who initially said it was probably anxiety, because he thought heart palpitations weren’t a documented side effect of Ozempic. A couple months later, she quit the medication. “I could feel my heart beating out of my chest,” she said. “It was hard to breathe. I was woken up in the middle of the night from these heart palpitations. And I just could not take it anymore.” Afterward, she heard from other people experiencing these symptoms, too. “I’m grateful I made that choice and that my doctor supported that choice because my mom recently passed away from a heart attack,” Clarke says. (According to Novo Nordisk, the drug’s manufacturer, Ozempic can result in a slightly increased heart rate. Those who experienced this in clinical trials amounted to “less than or equal to one percent of patients,” a Novo Nordisk spokesperson said in an email, adding that the increase in heart rate “has not been associated with a negative impact on cardiovascular outcomes.”)

In all of the support groups and social-media comments, one question seems almost taboo: What happens if you stop taking Ozempic? Dr. Singh says only 25 percent of his patients are able to sustain their weight loss after going off semaglutides. “The ones that are doing the dietary changes, regularly exercising, and taking their medications and doing what they’re supposed to, they’re able to stay out of it,” he says. “A lot of patients are having to cycle back onto the medication.”

Other weight loss methods may be more effective long term. “Surgery and interventional radiology/needle procedures are more likely to lead to greater sustained weight losses,” says Dr. David Prologo, an associate professor and director of Interventional Radiology Services at Emory Johns Creek Hospital in Atlanta. These include metabolic surgeries and minimally invasive procedures, like bariatric arterial embolization, that are “onetime interventions versus long-term medications or injections with side effects.”

Even if you’re not fazed by those obstacles, good luck getting a starter dose at this point. The drug is now so popular that there’s literally not enough to go around. Both Ozempic and Wegovy, another semaglutide that debuted this summer and is FDA-approved for adults with chronic obesity, are currently in shortage.

That probably won’t stop the online chatter about Ozempic anytime soon. “If you get on Reddit, people are talking about it like it’s a goddamn miracle,” says Toonk. “Everybody is whispering to each other: ‘Take this injection, and it may suck, but you’ll lose weight.’ It is insane to me.”

Nearly 1 in 7 Adults Experience Bloating on Any Given Week

So why don’t people with bloating tell their doctor? Almost 15% of the population have weekly symptoms, but more than half never tell anyone. 1/3 of those say it goes away on it’s own and almost the same number say it isn’t bothersome. 20% of patients take over the counter meds. This is a great example of “suffering in slience”. My question to people is “WHY?” Symptoms, regardless of whether or not they are serious, gives us an indication that something is off in the system. The body is ALWAYS telling us something, and if you actually start to listen more attentively, YOU MIGHT LEARN SOMETHING. Like “I really shouldn’t eat this”, or “I need to relax”, etc. Symptoms like bloating can signal issues with gut metabolism, gut flora (think probiotics), gall bladder issues, and a bunch more. These issues, if identified, can be alleviated, often through simple lifestyle changes or supplements. Rarely will medication be necessary, or frankly beneficial. If this is you, let’s talk.

FROM MEDPAGE TODAY / BY Zaina Hamza

Some individuals report feeling uncomfortable discussing it with their doctors

While nearly one in seven individuals said they experienced abdominal bloating within the past week, more than half reported that they did not seek care for this symptom, a national survey showed.

Among nearly 89,000 respondents to the National GI Survey II, 13.9% reported bloating within the past week, according to Brennan Spiegel, MD, MSHS, of Cedars-Sinai Medical Center in Los Angeles, and colleagues.

Of those who reported bloating, 58.5% never sought care, with 32.5% stating that their bloating resolved on its own, and 29.9% saying it was not bothersome, they wrote in Clinical Gastroenterology and Hepatology.

Other common reasons for not seeking care included self-managing symptoms with over-the-counter medications/lifestyle changes (20.8%), not having insurance (10.2%) or time (9%), and feeling uncomfortable discussing it with their doctors (8.5%).

"The hesitancy in seeking healthcare or discussing bloating in patients may be attributed to lack of routine screening for bloating, lack of focus on bloating complaints by providers, or patients' dissatisfaction with management of bloating symptoms," Spiegel and team noted. "As such, providers should proactively ask about bloating and adequately achieve symptom control based on risk factors, etiologies, and severity."

Abdominal bloating is a relatively common symptom affecting approximately 16% to 30% of the U.S. population. It is considered a nonspecific symptom that may be linked to a wide range of gastrointestinal conditions, including chronic constipation, irritable bowel syndrome (IBS), or carbohydrate enzyme deficiency.

Bloating can especially affect those with disorders of gut-brain interaction (DGBIs), but may also affect healthy individuals, Spiegel's group said. Prior studies have found a spike in physician visits only among IBS patients who sought care for bloating symptoms.

Co-author Janice Oh, MD, MSc, also of Cedars-Sinai Medical Center, told MedPage Today that "participants with disorders of brain-gut interaction, organic diseases, and other GI symptoms were likely to have more severe, persistent, or bothersome bloating."

Certain factors were tied to higher odds of bloating, such as female sex (OR 2.56, 95% CI 2.43-2.69) and comorbidities including (P<0.001 for all):

• IBS: OR 2.09 (95% CI 1.95-2.25)

• Ulcerative colitis: OR 1.39 (95% CI 1.18-1.64)

• Functional constipation: OR 1.38 (95% CI 1.27-1.50)

• Abdominal pain: OR 4.13 (95% CI 3.92-4.35)

• Excess gas: OR 3.04 (95% CI 2.90-3.20)

• Concomitant constipation: OR 2.20 (95% CI 2.08-2.33)

"We hope to see a development of standardized approaches to diagnose or treat bloating that can be generally used on many patients, prior to targeted therapies," said Oh. "Given the complexity of bloating, more efforts should be made to better understand its mechanisms and treatments, especially among higher prevalence groups determined by our study."

For this population-based study, Spiegel and colleagues examined data on 88,795 participants who completed the online National GI Survey II from May to June 2020, using symptoms based on the NIH Patient-Reported Outcomes Measurement Information System (PROMIS), including bloating, abdominal pain, dysphagia, nausea or vomiting, fecal incontinence, heartburn, regurgitation, diarrhea, and constipation.

The participants were divided into age groups (18-29, 30-39, 40-49, 50-59, and ≥60), with similar proportions reporting bloating in the past 7 days. They were mostly evenly split between men and women, and over half were white.

Black participants and those over age 60 had lower odds of experiencing bloating, while higher odds of seeking out care for bloating were seen among Black participants and those over 29.

In addition, those with comorbid celiac disease, IBS, or inflammatory bowel disease (IBD) were over twice as likely to discuss bloating with their providers.

Although other GI conditions such as gastroparesis and diverticulitis were tied to more severe bloating, those with celiac disease, IBD, and IBS had the highest odds of experiencing severe bloating.

In a post-hoc analysis of 8,260 participants who reported bothersome or persistent symptoms within the past week, higher odds of bloating were noted for those with celiac disease, IBD, and DGBIs, as well as those with concomitant GI symptoms within the past week. Higher bloating PROMIS scores were seen among those who sought healthcare compared with those who did not, which suggested "that healthcare seeking is associated with more severe bloating symptoms," Spiegel and team noted.

The authors acknowledged that although a quota sampling technique was used to minimize sampling bias and to ensure national representation, the analysis lacked weighted population estimates. Furthermore, bloating may have been underestimated in older participants who have difficulty navigating the web to complete surveys, as well as overestimated in participants with GI symptoms/conditions.

Is Your Oven Leaking Cancer-Causing Chemicals Into Your Kitchen?

All of a sudden, I’m feeling pretty good about my electric induction stove.  The fact that I can only have electric in my home (no gas in the neighborhood) used to bother me, but today I’m happy.  All right, maybe that’s overstated, but here we are with another case of comfort/efficiency injuring us.  The leakage from a gas stove that ISN’T EVEN USED (think “we always order in”) leaks enough carcinogens to equate having a smoker in your house.  Which, I should point out, raises you risk of heart disease, stroke, lung cancer all by about 25-30%. For heart disease, that means more than twice as many people die from second-hand related heart disease every year than women die of breast cancer.  That’s a lot.  

This is not suggesting everyone should scrap their gas stoves.  But it does point out that we are always being bombarded with toxins, even in our homes, when we think we are safe.  This means we need to be more diligent in our efforts to keep our bodies clean and resilient.  The cheapest way to do that it is to SLEEP enough (7-9 hrs a night) and to MOVE (even 10 minutes of exercise a day will make a difference).

If you want to get more serious, call me!

FROM MEDPAGE TODAY / BY MIKE BASSETT

Study finds that natural gas leaks result in elevated benzene levels, even when stove not in use

Leakage of unburned natural gas piped into millions of California homes for heating and cooking was found to contain elevated concentrations of cancer-causing agents such as benzene, according to a new study.

The amount of unburned gas that leaks from appliances and infrastructure in the course of 1 year is comparable to the annual benzene emissions from 58,800 light-duty gasoline vehicles, reported Eric D. Lebel, PhD, of PSE Healthy Energy in Oakland, and colleagues in Environmental Science & Technology.

"Stoves leak small amounts of gas all the time, even when they are off. While these leaks are often too small to smell, they can still impact air quality and increase human health risks in our homes," said Lebel in a press release. "We found that just having a gas stove can create benzene concentrations in the kitchen comparable to secondhand smoke."

This report follows a previous study in which the same research team measured methane emissions from stoves in 53 California homes and found that they emitted 0.8-1.3% of the gas they use as unburned methane, not only when in use, but when off, and when flames are ignited and extinguished.

Another recent investigation led by Drew Michanowicz, DrPH, also of PSE Healthy Energy, who co-authored the current study, analyzed unburned natural gas samples from 69 unique kitchen stoves and building pipelines across Greater Boston and found that they contained varying levels of volatile organic chemicals known to be toxic, including benzene, toluene, ethylbenzene, xylene, and hexane.

The relationship between natural gas and indoor air pollution is of particular concern in California. According to the U.S. Energy Information Administration, 88% of all California households had natural gas services in 2020, a saturation level that is the second highest in in the U.S. Furthermore, 70% of California homes have stoves that use natural gas.

"Natural gas leaks are a source of hazardous air pollutants that have largely been overlooked," Michanowicz said in the press release. "Policies that phase out gas appliances are not only good for our climate, our study shows that these policies also provide important public health benefits by improving indoor and outdoor air quality."

For this study, Lebel and his team collected 185 unburned natural gas samples from 159 unique residential natural gas stoves across seven different geographical locations in California. They found that of the non-methane volatile organic compounds (NMVOCs) assessed, 12 carried a hazardous air pollutant designation. Six of the NMVOCs were detected in more than 98% of the natural gas samples, including benzene, which has been associated with an increased risk of blood disorders, such as leukemia, the authors noted.

Concentrations of pollutants varied throughout the state, with the highest levels found in Los Angeles County. The North San Fernando and Santa Clarita Valleys, in particular, contained very high benzene concentrations, including the maximum benzene concentration observed in the study -- 66 parts per million by volume, which is approximately 66 times greater than the highest benzene level recorded in end-use natural gas in Massachusetts.

These high levels "warrant further study to better understand factors contributing to these high concentrations," Lebel and colleagues wrote, suggesting that the trace gas variability observed in the study "indicates that California's natural gas supply chain is complex and likely reflects the multiple hydrocarbon sources both from in-state production and imports in addition to the variability of the efficacy of natural gas processing systems that support end-use consumption."

They also noted that their estimates of indoor concentrations of benzene could underestimate the true indoor concentrations of the chemical, as their calculations focused solely on the contribution of benzene from gas leakage from gas stoves when they were off, and not during combustion or incomplete combustion, or other gas appliances, gas pipes in the residence, or other non-natural gas benzene sources.

Due to these health concerns, California regulators are working on getting homes to transition from gas appliances to electric alternatives, Lebel and team said.

Last month, California regulators approved a first-in-the nation plan to phase out the sale of natural gas furnaces and water heaters by 2030 -- a move designed to transition millions of homes to electric alternatives, such as heat pumps. The California Public Utilities Commission has also voted to eliminate subsidies that incentivize builders to install gas lines to new buildings.

These initiatives follow efforts by individual California municipalities to curb natural gas use. For example, in August, San Diego approved a climate action plan that calls for banning natural gas in new construction while electrifying nearly all existing buildings over the next 12 years.

The Great Pandemic Hand-Washing Blooper

Throughout the pandemic we, as a society, have been buffeted about in the winds of “science”, theoretically attempting to limit our risks of getting sick with what often feels like capricious advice.  Unfortunately, in retrospect, often the advice might really have been capricious! As you might have heard me say, “following the science” has been largely propaganda – people who describe themselves as “following the science” are often just trying to bolster their own positions, picking and choosing “the science” they like.  The most striking example of this was demonstrated by the denial that the virus was airborne because some French biologist a hundred years ago said that infectious agents could only be transmitted by droplets.  And that stayed “true” for close to a year into the pandemic despite all the evidence to the contrary.  UGH.

The attached article speaks to a bit of this, but we really see how even the most thoughtful of us, those who are really “in the know” still respond with “silliness” when confronted with challenging situations.  Don’t feel bad that our natural tendencies push us to do things that might not make sense – just reflect on what you’re doing and maybe rethink how to respond.

 FROM THE ATLANTIC / BY JACOB STERN

Should you wash your hands? Yes. Does it matter for respiratory viruses? Not as much as we once thought.

Way back in the early, whirlwind days of the pandemic, surfaces were the thing to worry about. The prevailing scientific wisdom was that the coronavirus spread mainly via large droplets, which fell onto surfaces, which we then touched with our hands, with which we then touched our faces. (Masks, back then, were said by public health authorities to be unnecessary for the general public.) So we washed our hands until they were raw. We contorted ourselves to avoid touching doorknobs. We went through industrial quantities of hand sanitizer, and pressed elevator buttons with keys and pens, and disinfected our groceries and takeout orders and mail.

And then we learned we’d had it all backwards. The virus didn’t spread much via surfaces; it spread through the air. We came to understand the danger of indoor spaces, the importance of ventilation, and the difference between a cloth mask and an N95. Meanwhile, we mostly stopped talking about hand-washing. The days when you could hear people humming “Happy Birthday” in public restrooms quickly disappeared. And wiping down packages and ostentatious workplace-disinfection protocols became a matter of lingering hygiene theater.

This whole episode was among the stranger and more disorienting shifts of the pandemic. Sanitization, that great bastion of public health, saved lives; actually, no, it didn’t matter that much for COVID. On one level, this about-face should be seen as a marker of good scientific progress, but it also raises a question about the sorts of acts we briefly thought were our best available defense against the virus. If hand-washing isn’t as important as we thought it was in March 2020, how important is it?

Any public-health expert will be quick to tell you that, please, yes, you should still wash your hands. Emanuel Goldman, a microbiologist at Rutgers New Jersey Medical School, considers it “commonsense hygiene” for protecting us against a range of viruses spread through close contact and touch, such as gastrointestinal viruses. Also, let’s be honest: It’s gross to use the bathroom and then refuse to wash, whether or not you’re going to give someone COVID.

Even so, the pandemic has piled on evidence that the transmission of the coronavirus via fomites—that is, inanimate contaminated objects or surfaces—plays a much smaller role, and airborne transmission a much larger one, than we once thought. And the same likely goes for other respiratory pathogens, such as influenza and the coronaviruses that cause the common cold, Linsey Marr, an environmental engineer and aerosols expert at Virginia Tech, told me.

This realization is not an entirely new one: A 1987 study by researchers at the University of Wisconsin found that a group of men playing poker with “soggy,” rhinovirus-contaminated cards were not infected, while a group playing with other sick players were. Now Goldman intends to push this point even further. At a conference in December, he is going to present a paper arguing that, with rare exceptions, such as RSV, all respiratory pathogens are transmitted predominantly through the air. The reason we’ve long thought otherwise, he told me, is that our understanding has been founded on faulty assumptions. Generally speaking, the studies pointing toward fomite-centric theories of transmission were virus-survival studies, which measure how long a virus can survive on a surface. Many of them either used unrealistically large amounts of virus or measured only the presence of the virus’s genetic material, not whether it remained infectious. “The design” of these experiments, he said, “was not appropriate for being able to extrapolate to real-life conditions.”

The upshot, for Goldman, is that surface transmission of respiratory pathogens is “negligible,” probably accounting for less than .01 percent of all infections. If correct, this would mean that your chance of catching the flu or a cold by touching something in the course of daily life is virtually nonexistent. Goldman acknowledged that there’s a “spectrum of opinion” on the matter. Marr, for one, would not go quite so far: She’s confident that more than half of respiratory-pathogen transmission is airborne, though she said she wouldn’t be surprised if the proportion is much, much higher—the only number she would rule out is 100 percent.

For now, it’s important to avoid binary thinking on the matter, Saskia Popescu, an epidemiologist at George Mason University, told me. Fomites, airborne droplets, smaller aerosol particles—all modes of transmission are possible. And the proportional breakdown will not be the same in every setting, Seema Lakdawa, a flu-transmission expert at Emory University, told me. Fomite transmission might be negligible at a grocery store, but that doesn’t mean it’s negligible at a day care, where kids are constantly touching things and sneezing on things and sticking things in their mouths. The corollary to this idea is that certain infection-prevention strategies prove highly effective in one context but not in another: Frequently disinfecting a table in a preschool classroom might make a lot of sense; frequently disinfecting the desk in your own private cubicle, less so.

Much of the conspicuous cleaning we did early in the pandemic was excessive, Popescu said, but she worries that we may have slightly overcorrected, lumping some useful behaviors—targeted disinfection, even hand-washing in some cases—into the category of hygiene theater. Whatever the setting, the experts I spoke with all agreed that these behaviors remain important for contending with non-respiratory pathogens. Recently, when several members of Marr’s family came down with norovirus, an extremely unpleasant stomach bug that causes vomiting, diarrhea, and stomach cramping, she disinfected a number of high-touch surfaces around the house. Picture that: one of the country’s foremost experts on airborne transmission wiping down doorknobs and light switches.

Marr isn’t convinced we’ve overcorrected. Hand sanitizer still abounds, businesses still tout their surface-cleaning protocols, and air quality still gets comparatively little attention. Recently, she watched a person use their shirt to open the door of a visitor center without touching the handle … then proceed inside unmasked. There’s nothing wrong with taking certain precautions to prevent fomite transmission, she said—these should not all be dismissed en masse as hygiene theater—as long as they don’t come at the expense of efforts to block airborne transmission. “If you’re doing extra hand washing ... then you should also be wearing a good mask in crowded indoor environments,” Marr said. “If you’re bothering to clean the surfaces, then you should be bothering to clean the air.”

On Friday, with respiratory-virus season looming, CDC Director Rochelle Walensky tweeted out three pieces of advice for staying healthy: “Get an updated COVID-19 vaccine & get your annual flu vaccine,” “Stay home if you are sick,” and—not to be forgotten—“Practice good hand hygiene.” She made no mention of masks or ventilation.

What to know about Ozempic, TikTok’s favorite weight loss drug

There’s a nationwide shortage of 2mg Ozempic.  My patient can’t actually get it, despite the fact he has bad diabetes and a heart condition.  But everyone wants it because “everyone” on TikTok tells us that it’s the greatest thing for losing weight.  They’re probably right because nearly everyone who is significantly overweight has a measure of diabetes/prediabetes and semaglutide (the generic name of Ozempic and Wegovy) is probably the best choice for those folks, especially in light of being overweight.  And since 75% of Americans are overweight, “everyone” is pretty close.  NOW, what they DON’T tell you is that once you go off the drug, and you haven’t significantly changed all the other inputs (food, activity, sleep, stress), then all that weight will come back on.  It might take a little longer than it took to get rid of it, but it’ll be back…and then what?  Actually --- we don’t know.  It’s possible that you end up about the same as before you took it, but it might be that you end up worse than before you started (won’t go into the possible mechanisms).  OH – let’s not forget the side effects – a good percentage of patients get nausea, vomiting, diarrhea, constipation (yeah, your GI system gets messed with) and fatigue.  A smaller percentage gets pancreatitis, gall bladder problems and potentially serious eye issues, which can be really bad.  

Another issue of no justice in American healthcare.  I forgot to mention that the drug isn’t covered by insurance for non-diabetics and it’s very expensive.  It’s actually not much cheaper than liposuction….

FROM NATIONAL GEOGRAPHIC / BY ALLIE YANG

Scientists caution that for weight loss, the diabetes medication’s long-term safety and efficacy aren’t settled. That hasn’t stopped influencers.

Billionaire Elon Musk credited it for his dramatic weight loss. Celebrity sites allege that many more A-listers are using it to stay trim. And TikTok is full of influencers showing off their startling before-and-after shots showing off their weight loss after using it.

What is it? A medication called semaglutide, which is sold under different brand names, including Ozempic, approved in 2017 for treating type 2 diabetes, and Wegovy, approved just last year for weight loss.

The buzz about these drugs has created a shortage of both, according to the U.S. Food and Drug Administration, which is expected to last for several months—causing alarm among patients with diabetes who rely on Ozempic to help control their blood sugar. Experts caution that it’s important to understand these are not miracle drugs—and that there are risks to taking them outside of their intended use.

Here’s what you need to know about semaglutide, including how it works and the risks. 

What’s the science behind the drug?

Semaglutide helps lower blood sugar by mimicking a hormone that’s naturally secreted when food is consumed, says Ariana Chao, assistant professor at the University of Pennsylvania School of Nursing and medical director at the school’s Center for Weight and Eating Disorders. This medication, administered through injection, helps people feel full for longer, helps regulate appetite, and reduces hunger and cravings. 

There is significant demand for the drug. In 2019, more than 11 percent of the population was diagnosed with diabetes, while more than four in ten adults classified as obese in 2020.

Patients with type 2 diabetes often have impairments in insulin, a hormone that helps break down food and convert it into fuel the body can use, Chao says. Semaglutide signals the pancreas to create more insulin and also lowers glucagon, which helps control blood sugar levels. This can result in weight loss but experts point out that Ozempic has not been approved for that purpose, though semaglutide at a higher dose (Wegovy) has been.

Wegovy is the first drug since 2014 to be approved for chronic weight management. The difference between the two drugs is that Wegovy is administered at a higher dose of semaglutide than Ozempic. Wegovy’s clinical trials showed more weight loss but only slightly greater improvements in glycemic control compared to Ozempic, Chao says.

The FDA sees Ozempic and Wegovy as two different medications for different uses. Chao says many insurance companies cover Ozempic for diabetes but don't cover Wegovy for obesity—a prime example of weight bias in health care. That's why some medical providers use the two doses somewhat interchangeably, as obesity and type 2 diabetes are inextricably linked–obesity is the leading risk factor for developing type 2 diabetes.

What are the risks?

Like every medication, there can be downsides.

The most common side effects are gastrointestinal issues, such as nausea, constipation, and diarrhea, Chao says—and more rarely, pancreatitis, gallbladder disease, and diabetic retinopathy.

These drugs have been extensively studied, but their relatively recent approval means researchers still don’t know what the effects of taking them long term might be. 

Continuing research is helping us understand more about what happens when people stop taking these medications—which many may be forced to do amid current shortages. Research does suggest that stopping use of this medication could cause patients to regain weight, especially if they didn’t make any lifestyle changes.

“In almost all weight-loss studies, it really depends on your foundation,” says Stanford endocrinologist Sun Kim. “Your efforts at lifestyle will determine how much weight you lose. If you have your foundations like food, exercise, and sleep, you’re gonna do well.” If not, you might regain as much as 20 percent of the weight lost per year. 

These medications can also be incredibly expensive, especially without insurance. Kim says an injection pen can run more than $1,000.

What does it mean to use this drug off-label?

Using a drug off-label means using it in a way other than its intended and its FDA-approved purpose, which may not be safe or effective. Ozempic has been approved only for type 2 diabetics, and Wegovy has been approved only for patients with a BMI above 30, or 27 if they have a weight-related comorbidity like high blood pressure. 

“There is no scientific evidence to show whether this medication will be effective or of benefit to those who do not fit the criteria from the FDA-approved label indications, such as people with a BMI lower than 27,” Chao says. “We also do not know the side effects or risks in these populations—there could be unknown drug reactions. These medications are not meant to be a quick fix.”

Even if you meet the criteria, experts warn against trying to obtain the medication without a prescription by traveling to countries that don't require them.

“When the medication’s not used under supervision of a health-care provider, then they can come into misuse,” Chao says. “There could be more serious adverse events that can happen.”

Other experts also argue that, with Ozempic becoming hard to find, diabetes patients should be the first in line.

“What I do worry about, and I hope it's only temporary, is the supply chain issue,” Kim says. “If I had to triage and prioritize, I would maybe favor someone that is controlling their diabetes to get it.”

Robert Gabbay, the American Diabetes Association’s chief scientific and medical officer, says the organization  is “very much concerned” about the Ozempic shortage.

“The medication has been an important tool for people with diabetes,” he says. “Not only does it lower blood glucose and weight but it has been shown to decrease cardiovascular events—heart attacks—one of the leading causes of death for those living with diabetes.” 

A last resort?

Still, Kim says that prescribing drugs like Ozempic and Wegovy to patients who are desperate for a new approach to weight loss can make her feel “like a superhero.” By the time patients come to her, they’ve often tried methods like Weight Watchers and following the advice of dieticians. In that case, she says, medications like Ozempic and Wegovy can be a great option.

“What I find is sometimes as they're becoming successful at losing weight, it really does feed into their lifestyle too, and then they're able to be more active,” Kim says. “It’s hard to lose weight. Seventy-five percent of the U.S. population is overweight or obese. I feel that we shouldn't be holding this back if this can help.”

Chao agrees that these medications are a good alternative for those who are unable to lose 5 percent of their body weight within about three months of making lifestyle changes. Still, she recommends trying those approaches before turning to medication.

Patients should “make sure that they're focusing on a healthy dietary pattern, reducing calories, as well as increasing physical activity,” she says. “It’s important they know that even if they are taking the medication, it's not an easy way out: They're still going to have to make lifestyle changes.”

Dementia Risk Tied to Daily Step Count

Turns out the marketing ploy of 10,000 steps was not a horrible number—mostly marketing, some science—but only really represents the peak of risk reduction (in this study) for dementia. But importantly, everything you do matters. If you can do a brisk walk, that’s better. If you can only get to 4000 steps a day, that’s still a 25% reduction in dementia. Get up and move!!

FROM MEDPAGE TODAY / BY JUDY GEORGE

Incident dementia dropped by 25% with as little as 3,800 steps per day, study found

A daily total of 3,800 to 9,800 steps was tied to lower dementia risk, longitudinal data from the U.K. Biobank showed.

The optimal dose of daily steps -- the value with the highest dementia risk reduction -- was 9,826 steps (HR 0.49, 95% CI 0.39-0.62), according to Borja del Pozo Cruz, PhD, of the University of Southern Denmark in Odense, and colleagues.

The minimal step dose -- the point at which dementia risk was half of the maximum reduction -- was 3,826 steps per day (HR 0.75, 95% CI 0.67-0.83), the researchers reported in JAMA Neurology.

Step intensity mattered. The optimal cadence dose for the highest 30 minutes of the day was 112 steps per minute (HR 0.38, 95% CI 0.24-0.60).

"The optimal dose was estimated at 9,800 steps per day, just under the popular target of 10,000 steps," del Pozo Cruz and co-authors noted. "We found no minimal threshold for the beneficial association of step counts with incident dementia."

"We estimated the minimum dose at approximately 3,800 steps per day, which was associated with 25% lower incident dementia," the researchers added. "Other studies have found 4,400 steps to be associated with mortality outcomes. This finding suggests that population-wide dementia prevention might be improved by shifting away from the least-active end of the step-count distributions."

The researchers address an "important, yet unexamined, link between daily step count and incident dementia," noted Elizabeth Planalp, PhD, and Ozioma Okonkwo, PhD, both of the University of Wisconsin in Madison, in an editorial accompanying the report.

But a key finding "del Pozo Cruz and colleagues surprisingly did not discuss in detail was that higher step intensity -- a 'mere' 112 steps/min in a 30-minute epoch -- had the greatest impact on reducing dementia incidence in this cohort (62% vs 50% risk reduction for 9,800 daily steps), and that this observation was made in analyses that also adjusted for total steps," Planalp and Okonkwo pointed out.

"While 112 steps/min is a rather brisk cadence, '112' is conceivably a much more tractable and less intimidating number for most individuals than '10,000,' especially if they have been physically inactive or underactive," the editorialists observed.

The study assessed daily step count from wrist-worn accelerometers for 78,430 people 40 to 79 years old in the U.K. Biobank cohort from February 2013 to December 2015. Researchers evaluated total number of daily steps, whether steps were incidental (less than 40 steps per minute) or purposeful (40 or more steps per minute), and peak 30-minute cadence (average steps/minute for the 30 highest minutes of the day, which were not necessarily consecutive).

Participants had an average age of 61; about 55% were female and 97% were white. Over a mean follow-up of 6.9 years, 866 people developed dementia. Incident dementia was determined by hospitalization or primary care records, or was listed as an underlying or contributory cause of death in registry data.

For incidental steps, the optimal dose was 3,677 steps (HR 0.58, 95% CI 0.44-0.72). For purposeful steps, the optimal dose was 6,315 steps (HR 0.43, 95% CI 0.32-0.58).

"This study represents an important contribution to step count-based recommendations for dementia prevention," del Pozo Cruz and co-authors wrote. "Step count-based recommendations have the advantage of being easy to communicate, interpret, and measure, and may be particularly relevant for people who accumulate their physical activity in an unstructured manner."

"For such individuals, it may be otherwise challenging to track physical activity or determine whether they are sufficiently active relative to current minute- and intensity-based physical activity guidelines (i.e., 150 to 300 minutes per week of moderate to vigorous physical activity)," they noted.

Limitations include the study's observational design, which precludes causal inferences. In addition, reverse causation or unmeasured confounding may have influenced results.

"The age range of participants may have resulted in limited dementia cases, meaning our results may not be generalizable to older populations," the researchers acknowledged.

Probiotics for preventing acute upper respiratory tract infections

Every once in a while, something very interesting comes out a Meta-analysis.  Meta-analysis is a statistical method of gathering a bunch of similar studies to get more statistical “power” than one study alone.  Here a group took 24 studies with a total of about 7000 that showed a substantial reduction in upper respiratory issues, with a 40% reduction in diagnosed infections and use of antibiotics.  Not all the numbers are quite as impressive, but they are all meaningful. Most of these supplements were delivered in a yogurt type delivery, but the active probiotics can also be found in Sauerkraut, Sourdough, brined Pickles, Olives, and Korean kimchi.

Really something probably worth doing (unless you have a histamine problem).  And who doesn’t like a good pickle?!

FROM COCHRANE LIBRARY / BY YUNLI ZHAO, BI RONG DONG, QIUKUI HAO

Background

Probiotics are live micro‐organisms that may give a beneficial physiological effect when administered in adequate amounts. Some trials show that probiotic strains can prevent respiratory infections. Even though our previously published review showed the benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. This is an update of a review first published in 2011 and updated in 2015.

Objectives

To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo or no treatment, in the prevention of acute URTIs in people of all ages, at risk of acute URTIs.

Search methods

We searched CENTRAL (2022, Issue 6), MEDLINE (1950 to May week 2, 2022), Embase (1974 to 10 May 2022), Web of Science (1900 to 10 May 2022), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to 10 May 2022), the Chinese Medicine Popular Science Literature Database (from 2000 to 10 May 2022), and the Master's Degree Dissertation of Beijing Union Medical College Database (from 1981 to 10 May 2022). We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials on 10 May 2022.

Selection criteria

We included individual randomised controlled trials (RCTs) and cluster‐RCTs comparing probiotics with placebo or no treatment to prevent acute URTIs. The participants were children, adults, or the elderly in the community, care facilities, schools, or hospitals. Our main outcomes were the number of participants diagnosed with URTIs (at least one event and at least three events), the incidence rate (number of cases/person year) of acute URTIs, and the mean duration of an episode of URTIs. Our secondary outcomes were the number of participants who were absent from childcare centre, school, or work due to acute URTIs; the number of participants who used prescribed antibiotics for acute URTIs; and the number of participants who experienced at least one adverse event from probiotics. We excluded studies if they did not specify acute respiratory infections as 'upper'; studies with more than 50% of participants vaccinated against influenza or other acute URTIs within the last 12 months; and studies with significantly different proportions of vaccinated participants between the probiotics arm and the placebo or no treatment arm.

Data collection and analysis

Two review authors independently assessed the eligibility of trials and extracted data using standard Cochrane methodological procedures. We analysed both intention‐to‐treat and per‐protocol data and used a random‐effects model. We expressed results as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

Main results

We included 23 individual RCTs and one cluster‐RCT. As one of the individual RCTs did not report outcomes in a usable way, we could only meta‐analyse data from 23 trials, involving a total of 6950 participants including children (aged from one month to 11 years old), adults (mean age 37.3), and older people (mean age 84.6 years). One trial reported 22.5% flu‐vaccine participants within the last 12 months, and 25.4% flu‐vaccine participants during the intervention. Probiotics were more likely to be given with milk‐based food in children; administered in powder form in adults; and given with milk‐based food or in capsules in the elderly. Most of the studies used one or two strains (e.g. Lactobacillus plantarum HEAL9, Lactobacillus paracasei (8700:2 or N1115)) and 109 or 1011 colony‐forming units (CFU)/day of probiotics for more than three months.

We found that probiotics may reduce the number of participants diagnosed with URTIs (at least one event) (RR 0.76, 95% CI 0.67 to 0.87; P < 0.001; 16 studies, 4798 participants; low‐certainty evidence); likely reduce the number of participants diagnosed with URTIs (at least three events) (RR 0.59, 95% CI 0.38 to 0.91; P = 0.02; 4 studies, 763 participants; moderate‐certainty evidence); may reduce the incidence rate (number of cases/person year) of URTIs (rate ratio 0.82, 95% CI 0.73 to 0.92, P = 0.001; 12 studies, 4364 participants; low‐certainty evidence); may reduce the mean duration of an episode of acute URTIs (MD −1.22 days, 95% CI −2.12 to −0.33; P = 0.007; 6 studies, 2406 participants; low‐certainty evidence); likely reduce the number of participants who used prescribed antibiotics for acute URTIs (RR 0.58, 95% CI 0.42 to 0.81; P = 0.001; 6 studies, 1548 participants; moderate‐certainty evidence); and may not increase the number of participants who experienced at least one adverse event (RR 1.02, 95% CI 0.90 to 1.15; P = 0.79; 8 studies, 2456 participants; low‐certainty evidence). Evidence showing a decrease in the number of people absent from childcare centre, school, or work due to acute URTIs with probiotics is very uncertain (RR 0.14, 95% CI 0.03 to 0.59; 1 study, 80 participants; very low‐certainty evidence). Adverse events from probiotics were minor, and most commonly gastrointestinal symptoms, such as vomiting, flatulence, diarrhoea, and bowel pain. 

Authors' conclusions

Overall, we found that probiotics were better than placebo or no treatment in preventing acute URTIs.

Physicians Would Need Almost 27 Hours A Day To Provide Optimal Patient Care, Per New Study

If you ever felt rushed in the doctor’s office, there are reasons.  Simply stated, your doctor is doing the best they can, but there just aren’t enough hours in the day – literally!!  Check out this study reported in Forbes.  Understand that the premise was a practice of 2500 patients, which is kind of a standard, not crazy busy practice.  And yet, to provide the care recommended by guidelines would require 27 hours per day (that’s work hours per day).  

It might be good to limit the number of people in a practice, but if the practice is a pure insurance based model the physician won’t be making a living.  I’m not talking about taking a pay cut, I’m talking about the Primary Care doc taking home less than the median.  The system needs some fixin’!

FROM FORBES / BY SAI BALASUBRAMANIAN, M.D., J.D.

In a new study published in the Journal of General Internal Medicine, researchers found that in order to provide guideline-recommended care, a primary care physician would require nearly 26.7 hours per day.

The study was pioneered by Dr. Justin Porter, M.D., at the University of Chicago School of Medicine, and is titled “Revisiting the Time Needed to Provide Adult Primary Care.” The study looked at a hypothetical panel of 2500 patients, and what it would take to provide them guideline directed care (e.g. per The US Preventative Services Task Force guidelines). The studied categories included preventative care, in addition to chronic disease and acute care.

The results were jarring, indicating that there are literally not enough hours in the day for physicians to abide by all the recommendations that have been stipulated for “ideal patient care,” especially with the significant time challenges that actually exist in a real practice setting.

Dr. Porter explains: “There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday […] We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”

The practice of medicine is very different from the theoretical delivery of it. In real time practice, physicians are often bogged down with numerous tasks and inefficiencies that constantly distract their workflow. One of the biggest time investments is charting. For years, electronic health record (EHR) systems promised to hasten the charting process, providing physicians with the digital tools required to chart faster and more efficiently. However, many physicians often find these EHR systems more cumbersome than traditional written charts, forcing them to spend more time troubleshooting complex systems than with actual patients.

And there are so many other things that a physician has to do during a workday—deal with insurance matters, call patients back about results, deal with patient queries, work with auxiliary staff on practice management, etc. The list is ever-growing.

Ultimately, the party that suffers the most is the patient.

Porter perfectly captures how patients feel about this conundrum: “If you do surveys with patients about what frustrates them about their medical care, you’ll frequently hear, ‘My doctor doesn’t spend time with me’ or ‘My doctor doesn’t follow up […] I think a lot of times this is interpreted as a lack of empathy, or a lack of willingness to care for a patient. But the reality—for the majority of doctors—is simply a lack of time.”

This has become a crucial problem in care delivery in nearly every context. In most parts of the country (and world), there is a massive physician shortage. This means that the physicians that are practicing have incredibly long patient rosters on a daily basis, and even longer waiting lists. Additionally, this is in the context of ever-growing pressure on physicians to increase their responsibilities, abide by new guidelines, and continue to maintain high patient satisfaction scores. Simply put, it is a never ending battle.

Undoubtedly, healthcare organizations and policy leaders must recognize these issues and take measures to alleviate some of these pressures. Whether that is funding more access to care opportunities or providing practices with more resources, change has to be enacted before this crisis leads to a point of no recovery.

What Is the Rarest Eye Color in the World?

Hey - it’s a question that people occasionally ask and the answer is (as usual) more complicated! It’s just another example of how complicated the human condition is, but sometimes that complexity is not really “important” to our daily lives, but it adds to the extraordinary wonder associated with what it means to be human.

FROM AARP / BY HALLIE LEVINE

How many eye colors are there, and why your shade is unique to you

At some point, you’ve probably wondered what the rarest eye color is. The answer is green, according to the American Academy of Ophthalmology (AAO). Only about 2 percent of the world’s population sport this shade.

As to why, that answer isn’t so simple. “We used to think only one gene determined eye color,” says Julie Kaplan, M.D., a physician at the Center for Personalized Genetic Healthcare at the Cleveland Clinic. In high school biology class, for example, you probably learned that brown was dominant and blue was recessive, so two blue-eyed parents would not be able to have a baby with brown eyes. The truth, however, is a bit more complicated, Kaplan notes.

What determines your eye color?

About 75 percent of eye color is due to one gene, OCA2. It makes melanin, a substance in your body that produces hair, eye and skin pigmentation. If you inherit two nonfunctional copies of the OCA2 gene from your parents, you will go on to develop blue eyes. But if you have at least one functional copy, your eyes will be darker, on the spectrum of green, hazel or brown.

In case you were planning to decorate your impending grandbaby’s nursery to match the color of their eyes, be prepared to be disappointed. It is impossible to predict what color their orbs will be. “There are several different genes involved, which we’re just beginning to learn about and understand,” Kaplan explains. HERC2, for example, is a gene that turns the OCA2 gene on or off as needed. Different variations of it can cause the OCA2 gene to produce less melanin, which leads to lighter-colored eyes. There are at least eight other genes that influence eye color. In the meantime, you can take comfort in the fact that your own individual eye color is like your fingerprints: something that is unique only to you.

Brown eyes are the most common: Over half the people in the world have them, according to the AAO. In fact, about 10,000 years ago, all humans had brown eyes. Scientists speculate that their elevated levels of melanin helped protect people from the sun’s damaging rays. But as people moved from the sweltering climates of Africa and Asia to the cooler environments of Europe, there was less need for this protection.

At some point in history, as humans migrated north, a gene mutation occurred to reduce melanin production, says Kaplan. When the eyes have less melanin, they absorb less light. That means more light is scattered out from the iris, or colored part of the eye, which reflects off the surroundings. Eyes with the smallest amount of melanin in them will appear blue, while those with a little more melanin will appear green or hazel.​

Were Elizabeth Taylor’s eyes really violet?

Most people’s eyes are blue, green or brown, with some shades in between, notes Kaplan. This explains why your eyes may be dark green or hazel or even appear bluish gray. While Elizabeth Taylor made headlines with her violet eyes, her eyes were in fact blue. Blue eyes get their color from light that is coming in and being reflected out, so it is not surprising that they appeared as assorted colors based on lighting conditions.

Makeup can bring out certain colors in the eye, Kaplan adds. Taylor also reportedly had a double row of eyelashes, a condition doctors call distichiasis, which helped accentuate her famous eyes. Some people with albinism do appear to have violet eyes, because the blood vessels in the back of their eyes can be seen under certain light conditions. People with albinism have little or no production of melanin pigment, which affects the color of skin, hair and eyes.

The science of why you have great ideas in the showers

“Dead time” is important.  Lots of reasons – stress reduction, recovery, but also opening up the opportunity for creativity and the possibility of possibilities.  If you’ve got some time, just read through the accompanying article – some reasons why the shower may offer a good spot for good ideas, and also how you might grow those opportunities – good sleep, time in nature, etc.

NATIONAL GEOGRAPHIC / BY STACEY COLINO

It has nothing to do with getting clean—and everything to do with your state of mind.

When you’re in the shower “you don’t have a lot to do, you can’t see much, and there’s white noise,” notes John Kounios, a cognitive neuroscientist and director of the Creativity Research Lab at Drexel University in Philadelphia. “Your brain thinks in a more chaotic fashion. Your executive processes diminish and associative processes amp up. Ideas bounce around, and different thoughts can collide and connect.”

If you’ve ever emerged from the shower or returned from walking your dog with a clever idea or a solution to a problem you’d been struggling with, it may not be a fluke.

Rather than constantly grinding away at a problem or desperately seeking a flash of inspiration, research from the last 15 years suggests that people may be more likely to have creative breakthroughs or epiphanies when they’re doing a habitual task that doesn’t require much thought—an activity in which you’re basically on autopilot. This lets your mind wander or engage in spontaneous cognition or “stream of consciousness” thinking, which experts believe helps retrieve unusual memories and generate new ideas.

“People always get surprised when they realise they get interesting, novel ideas at unexpected times because our cultural narrative tells us we should do it through hard work,” says Kalina Christoff, a cognitive neuroscientist at the University of British Columbia in Vancouver. “It’s a pretty universal human experience.”

Now we’re beginning to understand why these clever thoughts occur during more passive activities and what’s happening in the brain, says Christoff. The key, according to the latest research, is a pattern of brain activity—within what’s called the default mode network—that occurs while an individual is resting or performing habitual tasks that don’t require much attention.

Researchers have shown that the default mode network (DMN)—which connects more than a dozen regions of the brain—becomes more active during mind-wandering or passive tasks than when you’re doing something that demands focus. Simply put, the DMN is “the state the brain returns to when you’re not actively engaged,” explains Roger Beaty, a cognitive neuroscientist and director of the Cognitive Neuroscience of Creativity Lab at Penn State University. By contrast, when you’re mired in a demanding task, the brain’s executive control systems keep your thinking focused, analytical, and logical.

A cautionary note: While the default mode network plays a key role in the creative process, “it’s not the only important network,” Beaty says. “Other networks come into play as far as modifying, rejecting, or implementing ideas.” So it’s unwise to place blind faith in ideas that are generated in the shower or during any other bout of mind wandering.

What is the default mode network

Marcus Raichle, a neurologist at the Washington University School of Medicine in St. Louis, and his colleagues serendipitously discovered the default mode network in 2001 when they were using positron emission tomography (PET) to see how the brains of volunteers were functioning as they performed novel, attention-demanding tasks. The team then compared those images to ones made while the brain was in a resting state and noticed that specific brain regions were more active during passive tasks than engaging ones.

However, because the function of each brain region isn’t well characterised and because a specific brain area can do different things under different circumstances, neuroscientists prefer to talk about “networks of brain areas,” such as the default mode network, which function together during certain activities, according to John Kounios, a cognitive neuroscientist and director of the Creativity Research Lab at Drexel University in Philadelphia.

Raichle named this network the “default” mode network because of its heightened activity during idle periods, says Randy L. Buckner, a neuroscientist at Harvard University. But it’s something of a misnomer because the default mode network is also active in other mental tasks, such as remembering past events or engaging in self-reflective thought.

The network is also “involved in the early stages of idea generation, drawing from past experiences and knowledge about the world,” explains Beaty. “When you’re not actively working on a problem, the brain keeps spinning and you can get restructuring of elements of the problem, pieces get reshuffled, and something clicks.” The DMN, he adds, “helps you combine information in different ways and simulate possibilities.”

Researchers have discovered that when it comes to measures of creativity, there's a positive correlation between creative performance and grey matter volume of the default mode network. In other words, as far as creativity goes, size matters when it comes to the DMN.

To investigate changes in brain activation and connectivity between different regions of the DMN, researchers asked volunteers to alternate between activities involving high cognitive effort (naming colours), low cognitive effort (reading words), and no cognitive effort (resting). They found that the default mode network was most active when the participants were at rest and more active during the low effort task than the high effort one, according to the study in the April 2022 issue of Scientific Reports. This suggests that DMN activity can toggle up and down, as if on a dimmer, perhaps stopping at intermediate points along the way, depending on the level of cognitive challenge that’s required.

The link to creative thinking was demonstrated in a study published in January that involved patients who were awake during brain surgery so surgeons could map the exposed cortical surface for language functions. As direct electrical stimulation was applied to their default mode network or another area of their brain, the patients were asked to perform an "alternate-uses task" that involved inventing unusual uses for an everyday object—in this case, a paper clip—which is a way of evaluating divergent thinking abilities. The researchers found that the patients’ ability to successfully perform the alternate-uses task depended on the strength of connections between nodes of the default mode network.

“The default mode network seems to be an important source of creativity, and it’s decidedly associated with mind-wandering,” says Jonathan Schooler, a psychological scientist at the University of California, Santa Barbara. Indeed, a study in the February 2022 issue of Human Brain Mapping found that positive, constructive daydreaming—“characterised by planning, pleasant thoughts, vivid and wishful imagery, and curiosity”—is associated with activity in the default mode network and creativity.

The benefits of mind-wandering 

Whether we realise it or not, we all engage in mind-wandering on a regular basis, says Beaty, noting that there are different kinds. There’s deliberate mind-wandering, where you try to exercise some level of control or direction to your thinking; and spontaneous mind-wandering, which happens in the brain without us directing it. In a study in a 2020 issue of PNAS, researchers using electroencephalograms to track people’s brain activity found that spontaneous mind-wandering occurred 47 percent of the time.

It’s the spontaneous form, in particular, that allows you to combine information and ideas in new ways. “When your mind drifts away from a situation into an internal reverie, that’s where you can have creative insights,” Schooler says. “In this pleasurable state, you’re allowing thoughts to playfully cross your mind.” Keep in mind, he adds, “sometimes you have to do the work to create a problem space—that sets the groundwork for spontaneous ideas to emerge.”

This is often referred to as "the incubation effect," which occurs when you spend time away from a particular problem or challenge and your mind has the chance to wander and generate novel ideas through unconscious associative processes.

To discover when people get their most innovative ideas, Schooler and his colleagues asked professional writers and physicists to keep a diary for two weeks, in which they reported their most creative idea of the day, what they were doing when it occurred, and whether it felt like an “aha” moment. Approximately 20 percent of their most significant ideas occurred while they were engaging in an activity other than working or while they were thinking about something unrelated to the creative idea, according to the study published in a 2019 issue of the journal Psychological Science. More significantly, ideas sparked during mind-wandering moments were more likely to be associated with overcoming an impasse on a vexing problem and to be viewed as “aha” moments.

VIDEO SHOWS BRAIN WAVES PROJECTED AS ART IN REAL TIME

See how brain waves are transformed into flowing art.&nbsp; &nbsp;

“You need that exploratory aspect of idea generation in order to be creative,” says Rex Jung, a neuropsychologist at the University of New Mexico in Albuquerque. But, he adds, you need other parts of your brain to pick an idea, evaluate its viability, and implement it in the real world. He notes, “It’s an interplay or dance between the default mode network and the cognitive control network that allows you to generate a creative idea then implement it effectively.”

How to spark creativity

Besides leading to greater self-understanding, gaining insights into these aspects of the creative process can help you maximise your brain power in various situations. But keep in mind, Jung points out, “these are early days, and there’s still a lot to learn about how the brain creates.”

As a first step, it’s wise to prioritise getting plenty of good quality sleep, which can improve your mood and help with memory, says Kounios who is co-author of The Eureka Factor: Aha Moments, Creative Insight, and the Brain. While you’re asleep, he notes, “the information you take in during the day is transformed from a fragile state into a more durable state which can bring aha moments.”

Immediately upon awakening from a full night’s sleep or even a 20-minute nap, Christoff recommends paying attention to thoughts and ideas that occur to you in that liminal state between being sound asleep and fully awake—that’s a time when your ideas are “often quite free-flowing,” she adds, which means you can tap your creative potential.

To consciously activate your DMN and creative ideas during the day, allow yourself to spend time doing activities that aren’t cognitively demanding—such as going for a walk, taking a warm bath, or gardening—without listening to music or a podcast. Simply let your mind wander. Do this when you’re “in a state of psychological safety, where there’s no danger to having an unusual thought and no immediate task to perform,” Kounios says. (In other words, don’t do this while driving.)

During the day, doing something easy and familiar, often involving some kind of movement, is likely to facilitate the flow of spontaneous thoughts. When you’re in the shower, for example, “you don’t have a lot to do, you can’t see much, and there’s white noise,” notes Kounios. “Your brain thinks in a more chaotic fashion. Your executive processes diminish and associative processes amp up. Ideas bounce around, and different thoughts can collide and connect.”

There’s some research that suggests spending time in nature—which can evoke a sense of awe, as well as inducing relaxation—is conducive to mind-wandering because it allows “your attention to expand to fill the space,” Kounios says. “Taking a walk in nature can improve your mood and expand your thoughts to include remote ideas and associations.”

That’s why if you’re trying to come up with a new idea or solve a problem, it’s a good idea to work hard on it then take a break and go for a walk if you reach an impasse. “This allows your mind to subconsciously work on something you were consciously working on,” Christoff says.

A key factor: The activity needs to last long enough “to present the opportunity to get into a different mode of thinking that we usually guilt ourselves out of,” Christoff explains. “We need to become relaxed enough mentally in order to not try to be productive or reach some goal. With habitual activities we engage in with some regularity, we don’t feel guilty about letting our minds wander—that’s when the mind can reach new places.”

So don’t be afraid to unplug and carve out time for mind-wandering and musing on a regular basis. “One of the costs of this multimedia world we live in is we don’t leave enough time for personal reverie,” Schooler says. Giving your mind a chance to roam is an investment in your creativity, and that’s time well spent.