This 5-Word Sentence Is Killing Your Ability to Be Happy. Everyone Says It

Not if you repeat this mantra.  The very statement tells the story – we get to choose to be happy, it’s not a desire.  It’s a choice.  As most ancient Eastern religions will tell us – pain is part of being human, suffering is not.  Acceptance is key.  The same is true with happiness.  It’s intrinsic to being human; it’s all the stuff we put on ourselves that creates issues that somehow we have to combat.  NO!  Other studies have shown that even goal achievement won’t keep us happy.  The pleasure of the achievement is, by it’s very nature, transient.  We need to keep striving, never fully satisfied.  So, again, that won’t make you happy.  

Take some deep breaths.  View the world as what you have, not what’s missing.  The shift will literally change your whole world.

FROM INC MAGAZINE / BY KELLY MAIN

Here's what science says to say instead to instantly increase your happiness.

We all want to be happy. Yet happiness can often feel fleeting and largely elusive. But as much as the path to happiness remains a mystery, the answer might actually prove surprisingly simple. 

It's not about gratitude, wavering focus, or even diminishing effort. But it does start with a simple, five-word sentence that most of us have muttered at one point or another: 

"I want to be happy." Or perhaps some variation, such as "I want to be happier."

Either way, if you want to be happy, you need to stop saying this well-meaning but devilishly deceptive sentence that plagues us all. Because in a bid to find happiness, it might be the very reason happiness escapes us. 

At one point or another, we've heard that the first step to making meaningful progress is making bold declarations and setting even bolder goals to match. Our culture is riddled with motivational mantras such as, "go big or go home," "go for the gusto," and "shoot for the moon." 

We know that goals should be big-and how much bigger does it get than the goal of happiness? 

Lofty goals are what drive innovation and it's the core of Google's O2-Plus method that fuels massive growth without causing burnout. The path to happiness isn't the same as innovation--yet it does entail another aspect of the strategy: effective goal setting. 

When it comes to learning how to increase your happiness, setting your sights on the big, overarching goal of sheer happiness is adding fuel to the fire and igniting just the opposite result: unhappiness. 

Science, psychology, and philosophy agree: The pursuit of happiness kills happiness

The idea that true happiness comes from within, and that it's not something that can be pursued or attained, is not solely an ancient philosophy. The field of modern science concurs. 

Neuroscience has long since agreed that when it comes to happiness, finding true joy cannot be achieved through seeking it out. Studies have found that the more a person is focused on chasing happiness and contentment, the less likely they are to find it. So much so that studies have found that the pursuit of happiness is actually making us miserable.

What they do find is a lack of time. According to a study published by Science Daily. researchers found that "people who pursue happiness often feel like they do not have enough time in the day, and this paradoxically makes them feel unhappy." 

But that doesn't mean the quest for happiness is a futile pursuit. 

Happiness isn't a goal--it's the byproduct of a goal 

It means it should simply be approached differently. With the use of effective goal-setting, you wouldn't merely declare that you want to be happier. Instead, you would declare that you want to pursue the things that (in turn) make you happy.

This approach to goal-setting is vital to both goal-setting and setting yourself up for successful goal attainment. Rather than having a lofty, overarching goal (e.g., I want to make more money), develop goals that have a clear path to attainment (e.g., I want to grow my business). It's the art of looking not at the "what" (e.g., making more money), but of focusing on the "how" (growing the business). 

In doing so, it provides a clear path to the goal. And the more focused you can make the goal, the more likely you are to achieve not only the goal, but also happiness along the way. 

Set yourself up for happiness

By focusing on smaller, more realistic goals that are within reach, you can make meaningful progress in the pursuit of them. In the process, you'll be more likely to set yourself up for success--and happiness.    

For example, let's say, you want a promotion. But what's the path to it? 

It could be further developing your skills or knowledge in the field, supercharging your productivity, or perhaps strengthening your network and improving your networking skills. All of which can help you get a promotion at work. And if not, it will help position you to get into another organization, and perhaps a higher position within it.

So stop killing your ability to be happy by saying you want to be happier. 

Instead, try making your goal something other than pure happiness, but something that will increase your happiness during the pursuit of it. Try saying things like "I want to become an expert in my field," "I want to finally write that book," "I want to invest in myself and my passions," "I want to spend more time with my family," or "I want to be a better boss/friend/partner/parent."

When we stop making happiness the goal, and instead make our goal something that will contribute to our happiness, we find happiness. 

Source: https://www.inc.com/kelly-main/this-5-word...

Can Just Minutes of Daily Activity Prolong Life?

Doc, Do I really have to Exercise?  YES - but's not what you think.

Great news for the couch potatoes in all of us.  In a study of over 25,000 sedentary older adults (average age 62, no regular “exercise”) over years , it was found that these individuals had a 39% lower risk of dying if they simply did 3 bouts of vigorous activity for about 2 minutes each during the day.  Vigorous intensity physical activity includes short burst of fast walking (like commuting), or climbing a set of stairs.  Most people did about 5 minutes a day of vigorous activity and 28 minutes of moderate activity, despite doing “no exercise.”

Even doing 1 ½ minutes 3 times a day translated into a 25% reduction.  Of course, if you want to get crazy, doing a total of 16 minutes (11 bouts in a day) topped them all with a 48% reduction!!  There were clear decreases in death specifically from heart disease as well.

On average, 3 1-minute bouts of vigorous activity dropped cardiovascular death by 49%.  The maximum group saw a 65% drop.  Cancer mortality have similar kinds of drops. 

How do we make sure we’re doing enough?  Actually, it’s pretty easy.  Walk a little faster when you’re walking, carry your groceries to the car, park away from the entrance in a lot and walk a little, take the stairs.  You’ve heard all these before – but now we can PROVE there’s a benefit!   GET TO IT!  Live longer, live better.

FROM MEDPAGE TODAY / BY KRISTEN MONACO

Benefits included all-cause, heart, and cancer-related mortality risk reduction

Even short bouts of physical activity in an otherwise sedentary lifestyle were associated with a significantly lower risk for dying, researchers reported.

In a study of more than 25,000 older adults who didn't regularly exercise, engaging in a median of just three bouts of vigorous activity for up to 2 minutes each at some point during the day was linked with a 39% lower risk for all-cause mortality versus no activity at all (HR 0.61, 95% CI 0.50-0.74), according to Emmanuel Stamatakis, PhD, of the University of Sydney in Australia, and colleagues.

Even the minimum of 1.5 minute-long bouts of exercise per day reaped mortality benefits compared with not engaging in any activity at all (HR 0.75, 95% CI 0.66-0.85). But those at the top of the range in this cohort -- getting 11 short bursts of vigorous activity daily (about 16 minutes total) -- saw all-cause mortality risk drop by even more (HR 0.52, 95% CI 0.37-0.72).

Beyond all-cause mortality benefits, engaging in just a few minutes of vigorous intermittent lifestyle physical activity (VILPA) throughout the day was also protective against cardiovascular disease-related mortality, the group reported in Nature Medicineopens in a new tab or window.

Engaging in the median frequency of three 1-minute bouts per day was linked with a 49% lower cardiovascular mortality risk (HR 0.51, 95% CI 0.35-0.74). Again, those that engaged in the maximum frequency saw the biggest benefit (HR 0.35, 95% CI 0.15-0.81). But even engaging in the minimum was still significantly protective against heart-related death (HR 0.67, 95% CI 0.52-0.86).

Stamatakis's group also found the same pattern in regards to cancer-related mortality risk.

"We found that as little as 3 to 4 minutes of VILPA per day was associated with substantially reduced mortality risk compared to doing no VILPA," Stamatakis told MedPage Today, noting how these were "very sizeable effect sizes."

"We were not surprised that we detected beneficial associations; we knew that vigorous physical activity is very potent, especially when it is intermittent and repeated," he said. "But the large magnitude of the associations was quite surprising, considering how little daily physical activity we are talking about."

"Interestingly, is not unlikely that participants in this study did not know that they were doing vigorous physical activity," Stamatakis pointed out.

Participants in the study cohort appeared in the U.K. Biobank, including 14,178 women and 11,063 men with an average age of 62. Over the 7-year follow-up period, 852 deaths occurred. The sample was exclusive to those who said they didn't engage in regular exercise. This meant they didn't have a regular fitness routine, didn't participate in sports, and only walked for recreation no more than once per week. All adults wore an accelerometer to track activity.

These short bursts of vigorous-intensity physical activity were considered a part of daily life. They included instances of short bursts of fast walking during a commute or climbing a set of stairs, for example. Those who engaged in three to four bouts of doing 1-minute of vigorous activity accumulated a median of 4.7 minutes per day of vigorous activity and 27.9 minutes of moderate activity per day.

"The world is experiencing an unending pandemic of lifestyle related chronic disease, and physical inactivity is one of its main driving forces," Stamatakis explained. "The healthcare systems have a key role to play. Health professionals are a trusted source of information and advice to help people prevent or delay the onset of chronic disease and increase their health span.

"Most healthcare professionals, however," he said, "are not trained or educated to offer physical activity advice, especially when it comes to encouraging initiation and adherence to a leisure-time exercise program, because the participation bar for leisure time exercise is too high: it demands high levels of motivation, time availability, capacity and willingness to travel to an exercise club or park, and many other conditions that can only be met by a small minority of middle aged and older adults."

But based on these study results, he explained that healthcare professionals can opt to take a different approach to advocating for physical activity.

"For example, what opportunities exist during everyday life for short bursts of VILPA, such as maximizing the walking pace for a minute or 2 during any regular walk, manually carrying groceries from the supermarket to the carpark, using stairs instead of elevators, replacing short car trips -- e.g. less than 1 km [0.62 miles] -- with very fast walking, or parking the car a few hundred meters away and instead walking fast to the final destination," he suggested as tips to provide to patients.

"Provided that this kind of behavior becomes regular and habitual in the long term, there is a good chance it will be followed by health benefits," said Stamatakis.

Source: https://www.medpagetoday.com/primarycare/e...

Rigid In-Hospital Diet Offers No Advantage in Patients After HSCT

When patients get bone marrow transplants their immune systems are wrecked for a while.  As a consequence, they get infected pretty easily.  The thinking has been that we should protect them with a special diet – cook everything to 175 degrees, so nothing alive will get into their system.  The problem is that when you cook everything to 175 degrees, it turns to mush.  Kinda gross, especially if everything you eat looks like that.  Somebody finally asked the question – can these folks eat real food and not get sick(er)?  Turns out that they absolutely can.  If you were as sick as you could possibly be and people told you that you had to eat gruel, you would.  But if you could actually eat real food, that might just be something to look forward to.  In any event, the assumption that the food HAD to be sterilized completely turns out not to make a difference.  But if we don’t ask, we never know.  Lots of things in medicine are assumed for a very long time.  Often the question is never asked.  I think we should ask those questions more.  We might just learn something, and it might just surprise us.

FROM MEDPAGE TODAY / BY MIKE BASSET

Patients who have neutropenia after undergoing hematopoietic stem cell transplantation (HSCT) do not need to restrict themselves to unpalatable hospital foods, a researcher said here.

A randomized study of over 200 patients with hematologic diseases showed that patients who received a non-restrictive diet -- including fresh fruits and vegetables, cold cuts, and pasteurized honey and yogurt -- after autologous or allogeneic HSCT did not have an increased risk of infection compared with patients who had a restrictive neutropenic diet. The latter only allows foods that have been cooked to about 175° F, reported Federico Stella, MD, of the Università degli Studi di Milano -- Istituto Nazionale dei Tumori in Milan, at the American Society of Hematologyopens in a new tab or window (ASH) annual meeting.

Up to 30 days following autologous HSCT, and 100 days after allogeneic HSCT, infections grade ≥2 were observed in 65% of patients on the protective neutropenic diet and 62% of patients on the non-restrictive diet (relative risk 1.0, 95% CI 0.8-1.3, P=0.8), Stella and colleagues found. They also noted that the incidence of fever of unknown origin, including febrile neutropenia, was comparable between the protective and non-restrictive diet arms at 43% versus 39%, respectively (RR 1.3, 95% CI 0.9-1.7, P=0.2).

And the incidence of sepsis was also similar between protective and non-restrictive diet arms (11% vs 14%, RR 0.7, 95% CI 0.4-1.5, P=0.5).

"The results of this first randomized study investigating the role of diet after allogeneic and autologous stem cell transplant demonstrate that the use of a restrictive diet is an unnecessary burden for patients quality of life," Stella said during an ASH press briefing.

He pointed out that infections are a frequent complication after HSCT. "Among measures applied to prevent infections, the use of a low microbial protective diet is standard of care adopted in more than 90% of bone marrow transplantations," he said, adding that the efficacy of this approach has not been prospectively evaluated.

"I love this [study] because of how it upends the dogma," said press briefing moderator Mikkael Sekeres, MD, MS, of the University of Miami Miller School of Medicine. "For decades, we have been essentially feeding patients gruel in the hospital under the auspices of a neutropenic diet. And the theory is a good one – that we are minimizing the risk of infections in people who are severely immunocompromised. And we do this in bone marrow transplant units and leukemia units where patients are hospitalized for 4 to 6 weeks."

However, relegating these patients to these restrictive diets has never made sense, Sekeres said: "I've never seen a patient die from an infection that was foodborne."

Trial patients were randomized 1:1 to the two arms (112 patients in each). Among all the patients, 37% had lymphomas, 38% multiple myeloma, and 5% acute myeloid leukemia. Most (76%) received autologous HSCT and 21% received allogeneic HSCT. Patients followed their assigned diet from the start of chemotherapy (before transplant) until their white blood cell count recovered after the procedure.

Stella also reported there were no significant differences between the protective diet and non-restrictive diets, respectively, for:

  • Body weight variations: mean -3.6 kg (about 1 lb) vs -3.2 kg (P=0.33)

  • Incidence of nausea: 16% vs 15% (RR 1.1, 95% CI 0.6-1.9, P>0.99)

  • Mucositis: 62% vs 60% (RR 1.05, 95% CI 0.8-1.3, P=0.8)

  • Hospitalization length: mean 21 days vs 22 days (P=0.47)

  • Parenteral nutrition use: 23% vs 26% (RR 0.9, 95% CI 0.4-1.4, P=0.8)

  • Parenteral nutrition duration: mean 6.9 days vs 6.7 days (P=0.8)

  • Acute graft-versus-host disease grade ≥2 in allogeneic-HSCT patients: 17% vs 25% (RR 0.7, 95% CI 0.2-2, P=0.7).

Importantly, Stella observed, "the non-restrictive diet was associated with higher satisfaction in a patient-reported quality of life analysis." Specifically, just 16% of patients on the protective diet reported it did not negatively impact their care and feeding versus 35% in the non-restrictive diet arm (RR 0.5, 95% CI 0.3-0.8, P=0.006).

When asked whether a change in accepted dietary practice for these patients would meet resistance, Sekeres noted that while working at another center, he eliminated the neutropenic diet on the leukemia floor, and that did "face a lot of resistance as you can imagine -- this is decades of people saying we should do this."

He called food an "emotional" issue, and said that patients -- who have so little control over a disease like leukemia -- feel empowered if they at least have control over their food.

Sekeres said he found the study "validating" and suggested that "we should eliminate these silly neutropenic diets and let people eat what they want and give them a much better quality of life when they're in the hospital."

Source: https://www.medpagetoday.com/meetingcovera...

Scientists finally know why people get more colds and flu in winter

The tripledemic is here – worst flu numbers in a decade, RSV in kids never exposed before and, oh yeah, there’s COVID.  So, what’s a person to do?  Some will hibernate as they did recent winters, others will have to get out, whether they like it or not.  The MASK thing is rearing it’s ugly head again.  But is there any real reason to use them?  That continues to be hotly debated in many areas, and I think that if you’re in a tight indoor space for some period of time (not a really long time because whatever’s in the air will eventually make it in) mask wearing is hard to argue against.  Now there’s a study that speaks to WHY it might make a difference in the winter, and it has nothing to do with the particular bug that’s floating around.  While there are limitations to this conclusion, it might just make enough sense to follow.

FROM CNN / BY SANDEE LAMOTTE

A chill is in the air, and you all know what that means — it’s time for cold and flu season, when it seems everyone you know is suddenly sneezing, sniffling or worse. It’s almost as if those pesky cold and flu germs whirl in with the first blast of winter weather.

Yet germs are present year-round — just think back to your last summer cold. So why do people get more colds, flu and now Covid-19 when it’s chilly outside?

In what researchers are calling a scientific breakthrough, scientists behind a new study may have found the biological reason we get more respiratory illnesses in winter. It turns out the cold air itself damages the immune response occurring in the nose.

“This is the first time that we have a biologic, molecular explanation regarding one factor of our innate immune response that appears to be limited by colder temperatures,” said rhinologist Dr. Zara Patel, a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California. She was not involved in the new study.

In fact, reducing the temperature inside the nose by as little as 9 degrees Fahrenheit (5 degrees Celsius) kills nearly 50% of the billions of virus and bacteria-fighting cells in the nostrils, according to the study published Tuesday in The Journal of Allergy and Clinical Immunology.

“Cold air is associated with increased viral infection because you’ve essentially lost half of your immunity just by that small drop in temperature,” said rhinologist Dr. Benjamin Bleier, director of otolaryngology translational research at Massachusetts Eye and Ear and an associate professor at Harvard Medical School in Boston.

“it’s important to remember that these are in vitro studies, meaning that although it is using human tissue in the lab to study this immune response, it is not a study being carried out inside someone’s actual nose,” Patel said in an email. “Often the findings of in vitro studies are confirmed in vivo, but not always.”

A hornet’s nest

To understand why this occurs, Bleier and his team and coauthor Mansoor Amiji, who chairs the department of pharmaceutical sciences at Northeastern University in Boston, went on a scientific detective hunt.

A respiratory virus or bacteria invades the nose, the main point of entry into the body. Immediately, the front of the nose detects the germ, well before the back of the nose is aware of the intruder, the team discovered.

At that point, cells lining the nose immediately begin creating billions of simple copies of themselves called extracellular vesicles, or EV’s.

“EV’s can’t divide like cells can, but they are like little mini versions of cells specifically designed to go and kill these viruses,” Bleier said. “EV’s act as decoys, so now when you inhale a virus, the virus sticks to these decoys instead of sticking to the cells.”

Those “Mini Me’s” are then expelled by the cells into nasal mucus (yes, snot), where they stop invading germs before they can get to their destinations and multiply.

“This is one of, if not the only part of the immune system that leaves your body to go fight the bacteria and viruses before they actually get into your body,” Bleier said.

Once created and dispersed out into nasal secretions, the billions of EV’s then start to swarm the marauding germs, Bleier said.

“It’s like if you kick a hornet’s nest, what happens? You might see a few hornets flying around, but when you kick it, all of them all fly out of the nest to attack before that animal can get into the nest itself,” he said. “That’s the way the body mops up these inhaled viruses so they can never get into the cell in the first place.”

A big increase in immune power

When under attack, the nose increases production of extracellular vesicles by 160%, the study found. There were additional differences: EV’s had many more receptors on their surface than original cells, thus boosting the virus-stopping ability of the billions of extracellular vesicles in the nose.

“Just imagine receptors as little arms that are sticking out, trying to grab on to the viral particles as you breathe them in,” Bleier said. “And we found each vesicle has up to 20 times more receptors on the surface, making them super sticky.”

Cells in the body also contain a viral killer called micro RNA, which attack invading germs. Yet EVs in the nose contained 13 times micro RNA sequences than normal cells, the study found.

So the nose comes to battle armed with some extra superpowers. But what happens to those advantages when cold weather hits?

To find out, Bleier and his team exposed four study participants to 15 minutes of 40-degree-Fahrenheit (4.4-degree-Celsius) temperatures, and then measured conditions inside their nasal cavities.

“What we found is that when you’re exposed to cold air, the temperature in your nose can drop by as much as 9 degrees Fahrenheit. And that’s enough to essentially knock out all three of those immune advantages that the nose has,” Bleier said.

In fact, that little bit of coldness in the tip of the nose was enough to take nearly 42% of the extracellular vesicles out of the fight, Bleier said.

“Similarly, you have almost half the amount of those killer micro RNA’s inside each vesicle, and you can have up to a 70% drop in the number of receptors on each vesicle, making them much less sticky,” he said.

What does that do to your ability to fight off colds, flu and Covid-19? It cuts your immune system’s ability to fight off respiratory infections by half, Bleier said.

You don’t have to wear a nose sock

As it turns out, the pandemic gave us exactly what we need to help fight off chilly air and keep our immunity high, Bleier said.

Wearing a mask can protect you from cold air that can reduce your immunity, an expert says.

“Not only do masks prrhinologist Dr. Benjamin Bleierotect you from the direct inhalation of viruses, but it’s also like wearing a sweater on your nose,” he said.

Patel agreed: “The warmer you can keep the intranasal environment, the better this innate immune defense mechanism will be able to work. Maybe yet another reason to wear masks!”

In the future, Bleier expects to see the development of topical nasal medications that build upon this scientific revelation. These new pharmaceuticals will “essentially fool the nose into thinking it has just seen a virus,” he said.

“By having that exposure, you’ll have all these extra hornets flying around in your mucous protecting you,” he added.

Source: https://www.cnn.com/2022/12/06/health/why-...

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.”

Source: https://www.thecut.com/2022/11/ozempic-sid...

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.

Source: https://www.medpagetoday.com/gastroenterol...

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!

 
 

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.

Source: https://www.medpagetoday.com/publichealthp...

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.

Source: https://www.theatlantic.com/health/archive...

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.”

Source: https://www.nationalgeographic.com/science...

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!!

 
 

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.

Source: https://www.medpagetoday.com/neurology/dem...