Leslie Glass's Blog, page 271

I Lied To My Doctor About My Drinking

From Psychology Today:

Is lying to your doctor about your drinking a criterion for alcoholism? If so, I’m guilty.

I am at high risk for diabetes/prediabetes—being a 73-year-old male is two risk factors right there. And I am above recommended weight level for my height.

According to the CDC, 100 million Americans, or a third of Americans, have diabetes or prediabetes (about 10 million the former, 90 million the latter).

Moreover:

Rates of diagnosed diabetes increased with age… among those ages 65 years and older, 25 percent had diabetes.
More men (36.6 percent) had prediabetes than women (29.3 percent).

I don’t have diabetes. But I have achieved that diagnosis in the past, and I am prediabetic by these criteria:

An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.

My last A1C blood test, unmedicated, was 5.9.

When I saw my NYU endocrinologist one morning this week (an alarmingly young woman—the older male who was previously my doctor recently retired), we discussed any factors that might have influenced my mildly elevated blood sugar level that morning. I said that I had had alcohol mixed with fruit juice.

My doctor raised her eyebrows—“you had a mimosa?” That suggested I had had a special holiday drink.

I nodded vigorously.

I lied. I had had a screwdriver—vodka mixed with orange juice. Not too much orange juice, which has too much sugar, per my daughter’s cautions. (Plus water, ice, and a digestive aid—my daughter: “What’s that drink called, pops?”)

I have that drink every morning, which I didn’t want to reveal.

You see, I believe the data are unambiguous that moderate drinking prolongs life, a point of view that I have published in the American Journal of Public Health.

Moreover, research consistently shows moderate drinking to retard diabetes*.

I know—you’re worried that I’m going to die of cancer, for which drinking is about a 5 percent causative factor. Or get heart disease, for which alcohol is a substantial retardant, is the major killer of Americans, especially men like me. Thus older Americans who drink live longer, according to the New England Journal of Medicine in the largest prospective study of drinking and mortality ever conducted.

Which is why I drink daily. (My daughter gave me a large bottle of vodka for my birthday.)

But I didn’t want to get into that with my doctor.

So, am I an alcoholic?

* After adjusting for diet, family history of diabetes, high blood pressure, physical activity, smoking and other factors, they found that compared with abstainers, men who drank 14 drinks a week had a 43 percent lower risk of diabetes, and women who drank nine drinks a week a 58 percent lower risk.

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What Is The Family Scapegoat

Every family member has a role. When you learn about family roles, you can be astonished. Are you the storyteller, the caretaker, the moody one? Some family members take on the difficult tasks. Some are considered the geniuses. If you’re the good girl, or the good boy, you will be treated differently from the so-called “wild” or “dumb” one. Some family members are especially loved, and sadly some are not appreciated as they should be.

Your role can be arbitrary, or based on other people’s secret hidden feelings that have nothing to do with you

What if your family members blame all the family problems on you? What if you’re the one who’s left out?  If have you have low self-esteem, depression, sadness, anxiety, you may be the family scapegoat. Are you a parent who always feels bad?

Parents are often blamed by substance using children, even when they’re adults

In families with substance use disorder (addiction) a parent, or both parents may be constantly blamed for everything that goes wrong. Here’s and example.

Alice P, an addict’s mom, wrote in to tell us about a liberating ‘aha’ moment she had about her painful relationship with her son Jimmy. Jimmy is an active substance abuser and extremely mean to her. There’s no nice way to put it.

He throws dust in my eyes

“Since Jimmy started using, he lies a lot. I don’t know the truth about anything,” Alice told us, “and I felt horrible all the time. It was hard enough worrying that Jimmy would overdose and pass away, or hurt someone else while under the influence. But also it was extremely painful that he acts as if I am the one who abuses him and his problems are my fault because I don’t do enough to help him.”

I found out I was his scapegoat

Scapegoat theory refers to the tendency to blame someone else for one’s own problems, a process that often results in feelings of prejudice toward the person or group that one is blaming. Scapegoating serves as an opportunity to explain failure or misdeeds, while maintaining one’s positive self-image. If a person who is poor or doesn’t get a job that he or she applies for can blame an unfair system or the people who did get the job that he or she wanted, the person may be using the others as a scapegoat and may end up hating them as a result.  Encyclopedia Social Psychology

Alice’s enlightenment

“My therapist used the word scapegoat. She told me scapegoating is a kind of abuse. It certainly felt like Jimmy was beating me up for no reason, when I hadn’t done anything wrong. But if you don’t want someone to die, you will put up with a lot. The whole thing was confusing to say the least. Now I kind of get it. I don’t have to listen to him. My point of view matters.”

Two heads are better than one

Alice went on to say she is not the kind of person who ever looked to therapy for answers, or used facebook sites to vent her frustration, and she had not thought about trying Al-Anon, which is free and could also help her. But life with an active addict aged 22 and living at home felt like it was killing her. “I needed another point of view to help me accept that I was the one who had to change,” Alice told me.

Blame Shifting Is Responsibility Shifting

We know a lot of people find it difficult to ask for help. Alone, however, it can be too difficult to identify what about your relationships is causing so much pain. When Jimmy pins his problems on his mom, he doesn’t have to take responsibility for himself. He doesn’t even have to be reasonable. It’s her fault. If she buys his argument, she’s allowing herself to be both used and abused. If she tries to hold him accountable, he’s likely to get even madder. When you’re scapegoated by a family member, lover, or co-worker, you cannot win no matter what you say or what you do. A therapist can help identify what’s going on.

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Feds Charge Rochester Drug Cooperative And CEO In First Criminal Case Over Opioids

From ABC News:

Federal prosecutors charged drug distributor Rochester Drug Cooperative and its former CEO with drug trafficking charges Tuesday — the first criminal charges for a pharmaceutical company and executives in the nation’s ongoing opioid crisis.

The charges signify a groundbreaking move by the government to try to combat the opioid epidemic, which kills 130 Americans every day, according to the Centers for Disease Control and Prevention. For the first time, a pharmaceutical company and white collar executives were charged like street dealers and traffickers.

“This prosecution is the first of its kind: executives of a pharmaceutical distributor and the distributor itself have been charged with drug trafficking, trafficking the same drugs that are fueling the opioid epidemic that is ravaging this country. Our Office will do everything in its power to combat this epidemic, from street-level dealers to the executives who illegally distribute drugs from their boardrooms,” U.S. Attorney Geoffrey S. Berman said in a statement.(MORE: New York adds owners of company that makes OxyContin to lawsuit against opioid makers, distributors)

The U.S. Attorney’s Office for the Southern District of New York charged Rochester Drug Cooperative (RDC), one of the country’s largest distributors of opioids, with “knowingly and intentionally” violating federal narcotics laws “by distributing dangerous, highly addictive opioids to pharmacy customers that it knew were being sold and used illicitly,” according to a press release.

RDC was also charged with failing to properly report thousands of suspicious orders of oxycodone, fentanyl and other controlled substances to the Drug Enforcement Agency (DEA), officials said.

The DEA has been investigating for years whether RDC failed to comply with pharmaceutical reporting laws. The company has previously paid to resolve claims it failed to properly report the theft of opioids.

According to court records, from 2012 through 2016, RDC filled more than 1.5 million orders for controlled substances from its pharmacy customers, but reported just four suspicious orders to the DEA. In reality, there were at least 2,000 suspicious orders in those four years, federal prosecutors said.

Despite being briefed by company employees, top executives allegedly ignored “red flags” like cash payments and customers traveling from out of state to buy opioids.

“Today’s charges should send shock waves throughout the pharmaceutical industry reminding them of their role as gatekeepers of prescription medication,” DEA Special Agent in Charge Ray Donovan said in a statement. “DEA investigates DEA Registrants who divert controlled pharmaceutical medication into the wrong hands for the wrong reason. This historic investigation unveiled a criminal element of denial in RDC’s compliance practices, and holds them accountable for their egregious non-compliance according to the law.”

In the opioid industry, RDC is a middleman that buys controlled substances from manufacturers and sells them to individual pharmacies. As one of the nation’s 10 largest drug distributors, it delivered to more than 1,300 pharmacies and took in over $1 billion in revenue during the relevant five-year period, officials said.

RDC agreed to a non-prosecution consent decree and agreed to pay a $20 million penalty. It will be monitored by the government for the next five years.

“We made mistakes,” Jeff Eller, a company spokesperson said in a statement. “RDC understands that these mistakes, directed by former management, have serious consequences.”

“One element of the opioid epidemic is a dramatic increase in the volume of prescriptions for opioids and all narcotics,” the RDC statement continued. “With that dramatic volume increase came an increase in our business, resulting in an increase in orders we should have identified as suspicious order, which we failed to report to DEA.”

The company’s former chief executive, Laurence Doud III, surrendered to federal agents and appeared in Manhattan federal court late Tuesday. He was handcuffed and wore a dark suit as he was led up the stairs of the courthouse by federal agents.

Doud, 75, of New Smyrna, Florida, was charged with one count of conspiracy to distribute controlled substances and one count of conspiracy to defraud the United States. He faces a minimum of 10 years, if convicted.

Separately, William Pietruszewski, 53, RDC’s former chief of compliance, pleaded guilty earlier this month to participating in a narcotics distribution conspiracy from January 2012 to March 2017. He also pleaded guilty to conspiracy to defraud the United States and one count of willfully failing to file suspicious order reports with the DEA.

He has agreed to cooperate with the investigation.

Prosecutors say RDC employees told Doud and Pietruszewski that some of the company’s customers were “very suspicious,” and went so far as to describe some pharmacy clients as a “DEA investigation in the making” or “like a stick of dynamite waiting for [the] DEA to light the fuse.”

But in the relevant five year period, RDC, under Doud’s leadership, increased its sales of oxycodone and fentanyl “exponentially,” prosecutors said.

“From 2012 to 2016, RDC’s sales of oxycodone tablets grew from 4.7 million to 42.2 million – an increase of approximately 800 percent – and during the same period RDC’s fentanyl sales grew from approximately 63,000 dosages in 2012 to over 1.3 million in 2016 – an increase of approximately 2,000 percent. During that same time period, Doud’s compensation increased by over 125 percent, growing to over $1.5 million in 2016,” the U.S. Attorney’s office said.

RDC was also among the drug distributors named last month in a civil lawsuit by the New York Attorney General’s office, which alleged fraud, willful misconduct and gross negligence.

Between 2010 and 2018, the company sold more than 143 million oxycodone pills to customers in New York alone, the state’s attorney general’s lawsuit said.

“At this time, it would not be appropriate to comment on ongoing litigation,” Eller told ABC News in a statement.

Opioid manufacturers are facing over 1,700 lawsuits over their role in the current crisis. Paul Hanly, co-lead counsel for the plaintiffs in the federal litigation, which he said includes 2,000 cases, welcomed the move by U.S. prosecutors.

“The charges make the civil case against RDC easier to try and provide a potential road map to evidence that may prove the civil claims against other distributors,” Hanly told ABC News on Tuesday.

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Does Diet Affect Mood

From the NY Times Nutritional psychiatrists counsel patients on how better eating may be another tool in helping to ease depression and anxiety and may lead to better mental health.

CreditCreditTony Cenicola/The New York Times

The patient, a 48-year-old real estate professional in treatment for anxiety and mild depression, revealed that he had eaten three dozen oysters over the weekend.

His psychiatrist, Dr. Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University, was impressed: “You’re the only person I’ve prescribed them to who came back and said he ate 36!”

Dr. Ramsey, the author of several books that address food and mental health, is a big fan of oysters. They are rich in vitamin B12, he said, which studies suggest may help to reduce brain shrinkage. They are also well stocked with long chain omega-3 fatty acids, deficiencies of which have been linked to higher risk for suicide and depression.

But shellfish are not the only food he is enthusiastic about. Dr. Ramsey is a pioneer in the field of nutritional psychiatry, which attempts to apply what science is learning about the impact of nutrition on the brain and mental health.

Dr. Ramsey argues that a poor diet is a major factor contributing to the epidemic of depression, which is the top driver of disability for Americans aged 15 to 44, according to a report by the World Health Organization. Together with Samantha Elkrief, a chef and food coach who sits in on many of his patient sessions, he often counsels patients on how better eating may lead to better mental health.

The irony, he says, is that most Americans are overfed in calories yet starved of the vital array of micronutrients that our brains need, many of which are found in common plant foods. A survey published in 2017 by the Centers for Disease Control and Prevention reported that only one in 10 adults meets the minimal daily federal recommendations for fruit and vegetables — at least one-and-a-half to two cups per day of fruit and two to three cups per day of vegetables.

Nutritional psychiatrists like Dr. Ramsey prescribe antidepressants and other medications, where appropriate, and engage in talk therapy and other traditional forms of counseling. But they argue that fresh and nutritious food can be a potent addition to the mix of available therapies.

Americans routinely change what they eat in order to lose weight, control their blood sugar levels and lower artery-clogging cholesterol. But Dr. Ramsey says that it is still rare for people to pay attention to the food needs of the most complex and energy-consuming organ in the body, the human brain.

The patient Dr. Ramsey was seeing that day credits the nutritional guidance, including cutting down on many of the processed and fried foods and fatty meats that used to be part of his diet, with improving his mood and helping him overcome a long-term addiction to alcohol.

“It’s one part of the whole package that helps alleviate my depression and helps me to feel better,” he said.

Research on the impact of diet on mental functioning is relatively new, and food studies can be difficult to perform and hard to interpret, since so many factors go into what we eat and our general well-being. But a study of more than 12,000 Australians published in the American Journal of Public Health in 2016 found that individuals who increased the number of servings of fruits and vegetables that they ate reported that they were happier and more satisfied with their life than those whose diets remained the same.

Another study of 422 young adults from New Zealand and the United States showed higher levels of mental health and well-being for those who ate more fresh fruits and vegetables. Interestingly, the same benefits did not accrue to those who ate canned fruits and vegetables. “We think this is due to the higher nutrient content of raw fruits and vegetables, particularly B vitamins and vitamin C, which are vulnerable to heat degradation,” said Tamlin Conner, a study author and senior lecturer at the University of Otago.

One of the first randomized controlled trials to test whether dietary change may be effective in helping to treat depression was published in 2017. In the study, led by Felice Jacka, a psychiatric epidemiologist in Australia, participants who were coached to follow a Mediterranean diet for 12 weeks reported improvements in mood and lower anxiety levels. Those who received general coaching showed no such benefits.

A Mediterranean diet, rich in whole grains, legumes and seafood as well as nutrient-dense leafy vegetables that are high in the fiber, promotes a diverse population of helpful bacteria in the gut. Research suggests that a healthy gut microbiome may be important in the processing of neurotransmitters like serotonin that regulate mood.

“Our imaging studies show that the brains of people who follow a Mediterranean-style diet typically look younger, have larger volumes and are more metabolically active than people who eat a more typical Western diet,” said Dr. Lisa Mosconi, the director of the Women’s Brain Initiative at the Weill Cornell Medical Center in New York. Such brain benefits may be protective against the onset of dementia, she said.

Dr. Mosconi noted that “there is no one diet that fits all” but advises patients to cut out processed foods, minimize meat and dairy and eat more whole foods like fatty fish, vegetables and whole grains and legumes to cut the risk of developing degenerative brain diseases associated with aging.

She and Dr. Ramsey both recommend “eating the rainbow,” that is, consuming a wide array of colorful fruits and vegetables like peppers, blueberries, sweet potatoes, kale and tomatoes. Such foods are high in phytonutrients that may help to reduce harmful inflammation throughout the body, including the brain, and promote the growth of new brain cells throughout our adult years, they say.

Dr. Emily Deans, a clinical instructor in psychiatry at Harvard Medical School, cautions that a plant-only diet may carry some risks. Some large observational studies suggest, for example, that strict vegetarians and vegans may have somewhat higher rates of depression and eating disorders than those who eat a more varied diet. Those on a meat-free diet may also need to take supplements to provide missing nutrients. “Some of the key nutrients for the brain, like long chain omega 3 fatty acids and vitamin B12, are simply not found in vegetable only diets,” says Dr. Deans.

Samantha Elkrief, the food coach who assists Dr. Ramsey, adds that it’s not just what we eat but the attitudes that we bring to our food that contribute to mental well-being. “I want to help people find the foods that give them joy, that make them feel good,” she says. “It’s about slowing down and becoming more mindful, noticing your body, noticing how you feel when you eat certain foods.”

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Perseverance Toward Life Goals Can Fend Off Depression, Anxiety, Panic Disorders

From Science Daily:

People who don’t give up on their goals (or who get better over time at not giving up on their goals) and who have a positive outlook appear to have less anxiety and depression and fewer panic attacks, according to a study of thousands of Americans over the course of 18 years. Surprisingly, a sense of control did not have an effect on the mental health of participants across time.

The study was published by the American Psychological Association in the Journal of Abnormal Psychology.

“Perseverance cultivates a sense of purposefulness that can create resilience against or decrease current levels of major depressive disorder, generalized anxiety disorder and panic disorder,” said Nur Hani Zainal, MS, from The Pennsylvania State University and lead author of the study. “Looking on the bright side of unfortunate events has the same effect because people feel that life is meaningful, understandable and manageable.”

Depression, anxiety and panic disorders are common mental health disorders that can be chronic and debilitating and put a person’s physical health and livelihood at risk, according to Zainal and her co-author, Michelle G. Newman, PhD, also of The Pennsylvania State University.

“Often, people with these disorders are stuck in a cycle of negative thought patterns and behaviors that can make them feel worse,” said Newman. “We wanted to understand what specific coping strategies would be helpful in reducing rates of depression, anxiety and panic attacks.”

Zainal and Newman used data from 3,294 adults who were studied over 18 years. The average age of participants was 45, nearly all were white and slightly fewer than half were college-educated. Data were collected three times, in 1995 to 1996, 2004 to 2005 and 2012 to 2013. At each interval, participants were asked to rate their goal persistence (e.g., “When I encounter problems, I don’t give up until I solve them”), self-mastery (e.g., “I can do just anything I really set my mind to”) and positive reappraisal (e.g., “I can find something positive, even in the worst situations”). Diagnoses for major depressive, anxiety and panic disorders were also collected at each interval.

People who showed more goal persistence and optimism during the first assessment in the mid-1990s had greater reductions in depression, anxiety and panic disorders across the 18 years, according to the authors.

And throughout those years, people who began with fewer mental health problems showed more increased perseverance toward life goals and were better at focusing on the positive side of unfortunate events, said Zainal.

“Our findings suggest that people can improve their mental health by raising or maintaining high levels of tenacity, resilience and optimism,” she said. “Aspiring toward personal and career goals can make people feel like their lives have meaning. On the other hand, disengaging from striving toward those aims or having a cynical attitude can have high mental health costs.”

Unlike in previous research, Zainal and Newman did not find that self-mastery, or feeling in control of one’s fate, had an effect on the mental health of participants across the 18-year period.

“This could have been because the participants, on average, did not show any changes in their use of self-mastery over time,” said Newman. “It is possible that self-mastery is a relatively stable part of a person’s character that does not easily change.”

The authors believe their findings will be beneficial for psychotherapists working with clients dealing with depression, anxiety and panic disorders.

“Clinicians can help their clients understand the vicious cycle caused by giving up on professional and personal aspirations. Giving up may offer temporary emotional relief but can increase the risk of setbacks as regret and disappointment set in,” said Zainal. “Boosting a patient’s optimism and resilience by committing to specific courses of actions to make dreams come to full fruition despite obstacles can generate more positive moods and a sense of purpose.”

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How Much Fiber Do You Need

From Everyday Health By Angela Lemond, RDN Eat more fiber. We’ve all heard this advice, so we assume it must be good for us. The problem is that fiber and flavor might seem like opposites — and for many of us, flavor is the typical driver of food choice. But the reality is that fiber can have flavor, along with medicinal effects to potentially help reduce and prevent common diseases. In this article, let’s take a look at exactly what fiber is and how it functions in the body.

What Is Fiber Exactly, and Generally, What Foods Contain This Carb?

Fiber is simply a type of carbohydrate found naturally in plant-based foods that is not digestible in humans.

Plant-based foods that are rich in fiber — such as fruits, vegetables, whole grains, beans and legumes, and nuts and seeds — also contain vitamins, minerals, and other powerful nutrients that the body can use for optimal health.

Although fiber cannot be digested, it is being moved down the digestive tract as nutrients are being digested, and can do some great things that positively impact our health.

The problem is that Americans are getting less than half of the daily intake recommendations of 14 grams (g) for every 1,000 calories of food.

A simpler recommendation level for most adults is between 25 and 38 g per day (1). In fact, fiber is listed as a “nutrient of concern” due to the low overall intake and known health benefits.

Soluble and Insoluble Fiber: What’s the Difference Between the Two?

There are two types of fiber: soluble and insoluble. While both are important, the two function differently in the body. Here’s how:

Soluble Fiber

Soluble fiber is a type of fiber that attracts water and forms a gel. This gel causes a slowing of the digestion process, which can be beneficial for weight loss. Foods high in soluble fiber include oats, legumes, edible plant skins, and nuts.

Insoluble Fiber

Insoluble fiber is the type of fiber that, you guessed it, repels water. You can find insoluble fiber in foods such as veggies, fruits, nuts and seeds, wheat bran, and whole-grain foods like whole-wheat pasta and brown rice. Its primary benefit is to provide bulk to stool and aid in the movement through the digestive tract.

Most diets have a combination of soluble and insoluble fiber, with 75 percent coming from insoluble fiber and 25 percent coming from soluble fiber.

Why Should I Eat Fiber? A Look at the Possible Health Benefits of the Carb

In short, fiber may actually help you live longer. Studies suggest folks who eat a higher intake of fiber tend to have lower rates of heart disease, obesity, type 2 diabetes, stroke, high blood pressure (hypertension), and digestive diseases.

You may help improve or prevent health conditions such as prediabetes, diabetes, high cholesterol, obesity, and various digestion problems, like constipation, colon cancer, and diverticulitis, by simply increasing fiber in your diet.

Weight Loss

Research suggests nutrients like fiber can play a major role in body weight. Normal-weight and overweight people have been found to have higher intake of dietary fiber than obese individuals. Other studies continue to suggest that high fiber intakes help reduce weight gain as you age.

Fiber expands and bulks food in your GI tract, slowing digestion. This can increase satisfaction of your food and helps stabilize blood sugar levels. Foods high in fiber also tend to be lower in energy density, meaning they’ll help you feel fuller without consuming excessive calories. This concept is at the core of why a higher fiber diet is associated with a lower rate of obesity.

How Fiber Can Help With Weight Loss



Digestive Disorders

Fiber is like nature’s scrub brush, keeping your body’s pipes clear and reducing carcinogenic activity.

One benefit of getting enough fiber in your diet is reducing the risk of diverticulitis, a condition in which pouches formed in the colon become infected. Fiber helps keep food clear from the pouches and moving through the digestive tract. Aim to take in 25 to 40 g of fiber per day to reduce your risk of diverticulitis.

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How Caring For Others Taught Me How To Care For Myself First

I care for 33 lives. Imagine the responsibility? I love it. I’d even say, I live for it. But, caring for 32 lives wouldn’t be possible without putting one above them all — MY OWN. That was a lesson I had to learn and now take very seriously.

Breaking Down The Caring For Others 

At all times, seven kinkajous are entirely dependent on me for their care. Sometimes more — Kinkatopia offers boarding. Seven kinkajous and 24 various other animals live in my house. To be clear, none of this would be possible without my boyfriend, Michael. He primarily handles the reptiles and I take care of the mammals. We share responsibility of the cats (I have to give him credit here, he’s very fond of our cat children). In many ways I also take care of Michael; but he also takes care of me. We are balanced in our partnership, and I feel so blessed to have found a partner like him because while we’re so proud of what we do, what we’ve taken on sometimes feels monumental. 

Here’s Why Putting Myself First Is Critical 

By 2016, I accumulated three and a half years of sober time and relapsed. By the grace of God, I just celebrated two years of sobriety back this past March. After seeking help in 2017, I was given many opportunities to look at the contributing factors, which pushed me toward picking up my drug of choice again. For me, it is as simple as that I am an alcoholic, I wasn’t taking care of myself, and therefore, I went back out. That’s typically the story for many in the same position. 

I wasn’t taking care of myself. That’s a loaded phrase — what do I mean by that?  

I wasn’t working a recovery program. I lost my connection with God. I distanced myself from friends and family. I was entirely consumed with the animal organization I was running at the time. I allowed it to become my Higher Power. I lost sight of my recovery and took it for granted. I failed to conduct daily spiritual and mental maintenance — and as soon as the opportunity arose, I picked up. 

Having two years again has instilled the importance of not only putting my recovery first but putting myself first. I notoriously take on too much, as many good alcoholics do, so I need a constant reminder to conduct self-care. But what exactly does that look like? Especially with such a busy lifestyle. 

In the bigger picture, I learned to not only define myself by animals

 Don’t get me wrong, kinkajous are my heart, however, I need other enrichment in my life to strive for balance. It is so important for me to have various interests and people to spend my time with. I work out, volunteer, plan daytrips with girlfriends, watch all the “good” horror movies, go to concerts, and never refuse an opportunity to get outside my comfort zone. Having this balance in my life allows me to decompress and experience new things. 

The obvious component of self-care for someone in recovery is the basics

I go to meetings, try to meditate, work with a sponsor, communicate with my support network, and maintain a connection with God. Do I work a perfect program? No. I have a formula I follow, and if I need more of my “medicine,” I rely on my supports and gut to tell me to increase the “dosage.” Everyday I take a personal inventory, talk to someone in recovery, pray, and don’t pick up no matter what — without fail. 

My favorite aspect of self-care is where I can totally indulge in it  

Spending time with nature, facials, pedicures, massages, meditation, binging on my favorite shows, sleeping in … all the magical avenues to relaxation. I usually get so caught up in commitments that I forget how important it is to decompress. I will be the first to admit that I fall short here, but something greater than myself is working to adjust that defect. 

I cannot impress the importance of a solid support network, when it comes to self-care

 I need the guidance of others to help me take care of myself. One of my closest friends is an aesthetician, who blesses me with facials and eyelash extensions — she reminds me to take care of myself. My best friend always knows when to tell me to slow down. My sponsor helps me process a self-inventory when I am getting squirrely. And Michael constantly offers: “What can I do for you?” and helps out where he can. Amazing. God has put people like this in my life to keep me grounded and healthy. 

All that being said, some of my favorite nights are spent in routine with my kinkajous 

 Even cleaning them has become therapeutic. Crazy, I know, but that is a topic for another post. It is okay for me to enjoy spending time with my animals and work on the nonprofit, as long as I am putting myself first. After all, the kinkajous never turn down a special treat or massage, so why should I? 

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More Teens Are Attempting Suicide By Poisoning. Here’s What Parents Should Know

From Time:

Suicide rates are on the rise in the U.S. across age groups and demographics. But in recent years, increases have been particularly pronounced among teenagers — especially girls, who die by suicide less frequently than boys but attempt it more often.

Intentional self-poisoning is the leading type of suicide attempt for adolescents (and the third-leading cause of suicide deaths), and a new study confirms that numbers here, too, are rising. The research, published in the Journal of Pediatrics, found that suicide attempts by poisoning have doubled in frequency among kids younger than 19, rising from almost 40,000 attempts in 2000 to almost 80,000 in 2018. Teen girls seemed to drive the increase in self-poisoning attempts, which can include intentional drug overdoses or exposure to other toxic substances.

“Not only is the number of cases increasing, but the outcomes are getting worse,” says study co-author Henry Spiller, director of the Central Ohio Poison Center.

Out of more than 1.6 million self-poisoning attempts among people ages 10-24 that were reported to U.S. Poison Control Centers (PCCs) and entered into the National Poison Data System database from 2000 to 2018, more than 340,000 resulted in symptoms that were non-life-threatening but required treatment. More than 45,000 resulted in life-threatening symptoms and about 1,400 resulted in death, the study says. Those estimates were similar to figures from the National Electronic Injury Surveillance System, according to the study.

Study co-author John Ackerman, suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Ohio, says the findings have both practical and emotional implications for parents.

“We can’t overstate the importance of checking in emotionally with kids at very young ages, giving them tools to express what they’re struggling with,” Ackerman says. “That’s one of the most effective things you can do, other than reducing access to lethal means” — which can mean keeping medications safely stored and disposing of unneeded pills.

The authors suggest that increased use of social media and technology — and related changes in how kids socialize — could partially explain the uptick. The opioid crisis may also play a role beyond the intentional drug overdoses accounted for in the study, the authors write, since research shows that children of parents with substance use issues may have an increased risk of mood disorders.

Still, suicide rarely has a single cause and often involves both internal and external factors. Mental health issues are a common precursor, but life traumas or exposure to other suicide deaths can also exacerbate suicidal thinking. For example, a study published in April found that youth suicide rates increased by nearly 30% in the month after the release of the show 13 Reasons Why, which was centered around a teen girl’s death by suicide. Another April study showed how suicide contagion, by which exposure to one suicide death can trigger suicidal behavior in others, can play out in communities.

Though it’s a complex issue, Ackerman stresses that parents, doctors and other adults should not be afraid to talk frankly about suicide with those they’re concerned about, especially if kids are showing signs of psychological or emotional suffering. “Distress does not increase when you ask kids questions, and it doesn’t result in additional cases of suicidal thoughts or behaviors,” he says. “Not only can we ask about it, we should ask about it.”

Encouraging face-to-face social interaction with friends and family can also improve kids’ wellbeing, Ackerman adds, as can setting boundaries around social media and technology use. He says these tactics may be especially important for teen girls, who tends to be more relationally minded than boys.

“Making sure that they feel socially connected without being overwhelmed is really important,” Ackerman says. Look for “more groups, more empowerment to make sure that they don’t rely on things like social media to define themselves.”

If kids are exhibiting worrying behavior, or if they say they’ve seriously considered suicide or have a plan for carrying it out, parents should call a crisis hotline or mental health providers who can help, Ackerman says.

And if someone does attempt suicide through self-poisoning, Spiller says to call a PCC, since they can help coordinate and consult on emergency and follow-up care. “Early intervention often is extremely valuable,” Spiller says. “This is what we do.”

If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911, or seek care from a local hospital or mental health provider. You can also call Poison Control at 1-800-222-1222.

Suicide rates are on the rise in the U.S. across age groups and demographics. But in recent years, increases have been particularly pronounced among teenagers — especially girls, who die by suicide less frequently than boys but attempt it more often.

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Keeping Fit Is More Than Physical: It’s A State Of Mind

From Science Daily:

According to a new study differences in what motivates individuals and how they self-regulate behavior influence how they keep fit. The study associates personal characteristics with whether people are likely to prefer solo or group exercise activities, CrossFit® training, resistance training, or team sports, how frequently they work out, and if they are likely to stick to their routine.

The investigators set out to better understand why individuals adopt and adhere to regular physical activity programs, whether differences exist in personality, participatory motives, and regulation-motivation styles associated with their exercise modes, and to determine the extent to which these factors predict their work-out frequency. Their findings show that individuals selecting CrossFit, sports, or group exercise were more highly motivated by social connectedness (affiliation) than those engaging primarily in aerobic (e.g., long distance running) or resistance training exercise. Although all participants were highly motivated to engage in physical activity for positive health, those who engaged in resistance training and sport were more motivated by a sense of challenge than ill-health avoidance or weight management.

The study also demonstrated that individual differences in exercise motivation and self-control can predict participation frequency. Individuals who were more motivated by intrinsic reasons such as enjoyment, challenge, and stress management, exercised more frequently; CrossFit participants ranked highest in intrinsic motivation. Prior research has shown that people who exercise typically are more extraverted and conscientious, compared to an average population, but this study did not find any significant personality trait variances linked with different forms of exercise.

“Many individuals who initiate exercise programs may actually select activities that conflict with their interests, styles, personalities, and/or reasons for engagement. Our findings support the need for individualized exercise programs, not only from a physical standpoint, but also from a motivational standpoint. Taking these factors into account may impact the amount of physical activity/exercise that individuals actually complete,” explained lead investigator Ms. Allyson Box. who began this work as an undergraduate student at Kennesaw State University, Kennesaw, GA, USA.

Data were collected from more than 400 physically active individuals who completed an online survey distributed via social media. Personality factors, motives for participation, and self-control styles were assessed using widely accepted frameworks including the Five Factor Model, revised Exercise Motivation Inventory, Self-determination Continuum, and Behavioral Regulation in Exercise Questionnaire.

Recent evidence suggests physical activity is important to decrease risks associated with metabolic, osteopathic, cardiovascular, and neurovascular diseases, as well as some cancers and mental health disorders. The positive impact of exercise on overall health is widely acknowledged, but most people tend to avoid physical activity and/or not stick with their regimen. Less than 20 percent of the population meets proposed Physical Activity Guidelines for Americans (2018) by engaging in at least 150 minutes of moderate intensity aerobic activity and at least two instances of resistance exercise each week. This lack of physical activity has resulted in an escalation of chronic diseases, such as diabetes or heart disease.

“We encourage individuals to reflect on their personality and reasons for becoming physically active before diving into a physical activity program to ensure they engage in a physical activity that is compatible with their interest, personality, and goals,” the authors added.

“Our findings suggest that it may be more than just seeking the latest ‘fitness fad’ or ‘new diet’ in order to influence health outcomes; identifying individual characteristics and motivational factors will aid in developing an exercise program that individuals will stick to over a prolonged period of time, not just a few months.”

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If You Build More Activity Into Your Day, You Might Be Able To Skip The Workout

From The Washington Post:

“We are moving away from the word ‘exercise,’” says a researcher. The new term: “active living.”

While writing this paragraph, I stood up and sat back down five times, swiveled a bunch in my chair, walked to the kitchen to make a pot of tea, brushed my dog, made my bed and performed at least six seated leg crisscrosses with my feet raised a good 12 inches off the floor. To the casual observer, this might look like a bad case of procrastination, but it all counts to boost my non-exercise activity thermogenesis, or NEAT, which is essentially the energy I burn when I’m not sleeping, eating, resting or deliberately exercising.

I became interested in non-exercise physical activity (which I sometimes refer to as the “exertion of daily living”) after realizing that most of my patients don’t meet the American Heart Association recommendation of 150 minutes of heart-pumping exercise plus two sessions of muscle-strengthening exercises per week. Some tell me that they don’t have the time, but others simply hate exercising, and sweating gives them no reward. I heard this so often that I began to wonder whether there are alternate ways to capture the health benefits typically associated with the AHA guidelines — benefits that include a lower risk of cancer, coronary heart disease, depression and physical disability.

It turns out there are.

With the advent of wearable devices that make it possible to accurately measure energy expenditure, rather than just counting steps, researchers are discovering that dozens of non-exercise activities can be slipped into our daily routine and, together, replace a stint at the gym or a morning jog.

“We are moving away from the word ‘exercise,’ ” said Barbara Brown, a researcher at the University of Utah who studies physical activity. “Exercise is that thing you do where you have to wear funny clothes, and you have to go to the gym and buy a membership, and you have to sweat for an hour. Some people love that, but many don’t.” Instead, Brown said, she and her colleagues talk about “active living.”

Endocrinologist James Levine coined the term NEAT when he was the director of the Obesity Solutions initiative at Mayo clinic.

“Anybody can have a NEAT life,” he said. “Our research showed that you can take two adults of the same weight and one can burn an extra 350 [calories per day] simply by getting rid of labor-saving devices and moving more throughout the day.”

(For reference, a 155-pound person who spent 30 minutes on a stair machine would burn 223 calories.)

Brown agrees. “There are little bitty activities you can accrue across the day, and you don’t have to change your clothes.”

So what are these little bitty things?

“First and foremost, avoid chairs at work, ” said I-Min Lee, a professor of epidemiology and physical activity researcher at Harvard. “We have 16 hours in the waking day. If you sit less in those 16 hours, then you must be doing more of something else.”

Indeed, working Americans spend, on average, more than 40 percent of our waking hours in a chair, making this is an obvious place to amp up non-exercise energy expenditure.

The basic idea, according to Brown, Levine and Lee, is to act like that constantly moving kid in the second grade who drove the teacher crazy: Throw a ball, pace while on the phone, take stairs, wiggle on agility balls, do random under-the-desk movements such as stepping or swiveling, schedule walking meetings, and alternate between sitting and standing. (Despite enthusiasm for standing desks, it turns out that standing is not much better than sitting, but transitioning between the two can increase energy output.)

If you like numbers and want to get an idea of how many calories are burned per minute with your chosen NEAT activities, you can consult theCompendium of Physical Activities. This reference reports energy expenditure in METS — or metabolic equivalents — but can be converted to calories per minute by multiplying METS x 3.5 x body weight in kilograms then dividing by 200.

According to the compendium, if I amble around the office, I expend more than 3 calories per minute. Though this might sound trivial, I realized that if I walk whenever I’m on the phone, this adds up to a real workout. Climbing stairs burns up to 7 calories per minute.

Your commute to work is another way to get NEAT credits. Brown recently used accelerometers to study how the introduction of a light rail system affected people living in a mixed-income area in Salt Lake City. She discovered that people who lived closer to the rail were more likely to use it, and those who used the rail were more likely to lose weight and increase physical activity.

The fact that people in the study did not increase their activity on their non-work days suggests that simply changing a commute pattern can improve overall health.

Of course, none of this applies to you if you have a physically demanding job. The days I am in clinic, my Fitbit records an amazing four miles simply from my going from room to room and moving around the exam table. And some of my fittest patients are mail carriers, waitresses and preschool teachers, professions that require near-constant motion. (It should be said that technology has made things so convenient that even professions traditionally thought of as highly exertional, such as farming and longshore work, are now associated with prolonged sit-time behind the controls of a vehicle.)

Your commute to work is another way to get NEAT credits. Brown recently used accelerometers to study how the introduction of a light rail system affected people living in a mixed-income area in Salt Lake City. She discovered that people who lived closer to the rail were more likely to use it, and those who used the rail were more likely to lose weight and increase physical activity.

The fact that people in the study did not increase their activity on their non-work days suggests that simply changing a commute pattern can improve overall health.

Of course, none of this applies to you if you have a physically demanding job. The days I am in clinic, my Fitbit records an amazing four miles simply from my going from room to room and moving around the exam table. And some of my fittest patients are mail carriers, waitresses and preschool teachers, professions that require near-constant motion. (It should be said that technology has made things so convenient that even professions traditionally thought of as highly exertional, such as farming and longshore work, are now associated with prolonged sit-time behind the controls of a vehicle.)

The compendium has a whole section dedicated to leisure activities such as playing with animals, weaving and laughing. One surprise was sex, which clocks in disappointingly low, somewhere between showering and playing a guitar. Of course, it’s easy to imagine that wearing a belted accelerometer might dampen the research subjects’ enthusiasm and energy output.

All the researchers I spoke with agree that the best way to nudge people toward non-exercise activity is to change the environment. After all, willpower only gets you so far. “I am interested in upstream things that can be done that subtly change our behaviors without having to think a lot about it,” Brown said. Examples of this include putting in public transit, making stairwells in buildings more accessible than elevators, installing sidewalks and creating new parks. Brown’s research shows that beautifying front yards and neighborhoods might be one of the most powerful upstream things a community can do to encourage non-exercise activity and improve public health.

But these are big changes that require support from politicians, urban planners and community members, as well as funding.

“Meanwhile, let’s all become NEAT ambassadors,” Levine said. Here are some ideas: Post friendly signs outside elevators reminding colleagues that there is, in fact, a stairwell (I honestly forget); move trash cans away from our chairs; do away with old-fashioned corded phones that tether us to our desks; schedule walking meetings; and have dance parties (rather than cake) for all those office birthdays and baby showers. Though this might sound like too much distraction and commotion, Levine and his team found the opposite to be true: Active work environments promote more productivity, less stress and less absenteeism.

Speaking of productivity, I’m off to hand wash last night’s pile of dishes. According to the compendium, all that scrubbing will easily burn 30 more calories than simply loading the dishwasher.

Daphne Miller is a family physician and author of “Farmacology” and “The Jungle Effect.” 

A day in a neat life

Endocrinologist James Levine coined the term Non-Exercise Activity Thermogenesis (or NEAT) to refer to the energy burned while not engaged in traditional exercise. This chart, put together with his help, shows that if you work activity into your daily routine, you can burn an extra 529 calories a day. To burn the same number of calories through traditional exercise, a 155-pound person would have to do one hour of moderate stationary bicycling.

ACTIVITY
MINUTES SPENT IN ACTIVITY
CALORIES EXPENDED ABOVE AVERAGE RESTING RATE




Making bed, preparing breakfast, dressing, etc.
45
53


Walking briskly from subway to office
10
38


Swiftly climbing four flights of stairs instead of taking elevator (A study shows that if you can do this in less than 1 minute, you have good functional heart capacity.)
2
14


Strolling during work — either pacing while on phone, conducting walking meetings or taking walking breaks every hour
30
79


Walking briskly to get lunch and back
10
38


Swiftly climbing four flights of stairs instead of taking elevator
2
14


Strolling during work — either pacing while on phone, conducting walking meetings or taking walking breaks every hour
30
79


Walking briskly to subway from office
10
38


Preparing dinner
20
12


Light chores — cleaning kitchen, sweeping, taking out trash and recycling, etc.
30
35


Evening stroll
30
79


During two hours of TV watching, walk during some commercials or between shows.
15
40


Internet/reading
30
10


TOTAL
—
529 calories

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