A study of pregnant people with syphilis found that substance use during pregnancy was nearly twice as common among those who delivered an infant with congenital syphilis than among peers who did not pass the infection to their baby.
Prenatal syphilis screening is universally recommended in the United States and even required by law in some states, according to the CDC. Despite this, the incidence of syphilis has continued to increase, likely as a result of multiple factors, including limited access to care and substance use, according to previous findings.
Data derived from Carlson JM, et al. MMWR Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7203a3.
In the new study, which was published in MMWR, researchers analyzed data on births that occurred from Jan. 1, 2018, to Dec. 31, 2021, in Arizona and Georgia to examine the prevalence of substance use among pregnant persons with syphilis by congenital syphilis pregnancy outcome, which they defined as “delivery of a stillborn or live-born infant meeting the surveillance case definition for probable or confirmed congenital syphilis.”
They also examined how often pregnant people with syphilis used substances such as tobacco, alcohol, cannabis, illicit opioids or other illicit, nonprescription substances.
They found that pregnant patients with a congenital syphilis outcome were nearly twice as likely to have used a substance during pregnancy as those without one, 48.1% vs. 24.6% (prevalence ratio = 1.95; 95% CI, 1.6-2.38).
Among pregnant people who used substances and delivered an infant with congenital syphilis, 38.2% did not receive prenatal care at all and 53.2% were not treated for syphilis during pregnancy, according to the report. Additionally, more than one-quarter (26.6%) were either incarcerated or experienced homelessness during pregnancy. said syphilis screening and treatment should be addressed at every health care encounter for people who are pregnant, especially for pregnant people who use substances and those outside of traditional health care, such as jails, prisons and facilities providing services for people experiencing homelessness. They said “innovative approaches are needed to increase screening and treatment for syphilis among pregnant people who use substances, including expansion of screening and treatment to settings outside of prenatal care.”
“Although screening and treatment can prevent most cases of congenital syphilis, numerous barriers to implementing these prevention strategies exist, some of which might be amplified among persons who use substances,” they wrote. “Tailored interventions need to address barriers and facilitators for accessing screening and treatment for syphilis for persons with current or previous substance use, including those with a history of incarceration and homelessness.”
Despite the benefits of neonatal screening, 70% of infants worldwide are born in areas that do not have access to neonatal screening, Paul van Trotsenburg, MD, PhD, professor of pediatric endocrinology at the University of Amsterdam, and colleagues wrote in the guideline, published in Thyroid. Many of these infants are born in areas of endemic iodine deficiency, placing them at increased risk for thyroid hormone deficiency, the researchers wrote.
Source: Adobe Stock
“This update of the consensus guidelines on congenital hypothyroidism recommends worldwide neonatal screening and appropriate diagnostics — including genetics — to assess the cause of both primary and central hypothyroidism,” van Trotsenburg said in a press release. “The expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up, including laboratory testing and dose adjustments, to keep thyroid levels in their target ranges, timely assessments of the need to continue treatment, attention for neurodevelopmental and neurosensory function and, if necessary, consulting other health professions, and education of the child and family about congenital hypothyroidism.”
The recommendations include the various neonatal screening approaches for congenital hypothyroidism, as well as guidance for genetic screenings, diagnostics, treatment and prognosis of both primary and central congenital hypothyroidism.
The expert panel made several recommendations:
Screening for congenital hypothyroidism should be introduced worldwide; the most sensitive test for detecting primary congenital hypothyroidism is measurement of thyrotropin.
When congenital hypothyroidism is diagnosed, immediately initiate correctly dosed levothyroxine treatment and frequent follow-up, including laboratory testing, to keep thyroid hormone levels in their target ranges.
Conduct timely assessments of the need to continue treatment, assess for neurodevelopment and neurosensory functions, and, if necessary, consult other health professionals, along with providing education for the child and family about congenital hypothyroidism.
All individuals with congenital hypothyroidism are entitled to a well-planned transition of care from pediatrics to adult medicine.
“This consensus guidelines update should be used to further optimize detection, diagnosis, treatment and follow-up of children with all forms of congenital hypothyroidism in the light of the most recent evidence,” the researchers wrote. “It should be helpful in convincing health authorities of the benefits of neonatal screening for congenital hypothyroidism. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.”
The guideline, an update to expert recommendations published in 2014, is endorsed by the American Thyroid Association, the European Society for Paediatric Endocrinology and the European Society of Endocrinology.
In 1972, Jean Dussault, MD, a thyroidologist working at Laval University in Quebec City, Canada, developed the first mass screening to diagnose congenital hypothyroidism in neonates. He measured thyroxine in dried blood spots, routinely collected on filter paper in the province of Quebec for screening of phenylketonuria and tyrosinemia. Of 30,000 samples collected from newborns, four were found to have congenital hypothyroidism. Since then, thyroid-stimulating hormone became the preferred initial screening test, now routinely used in most counties in the world, except for those with poor economies and in remote areas.
In the March issue of Thyroid, the ENDO-European Reference Network published an updated guideline for the screening, diagnosis and treatment of congenital hypothyroidism. An earlier version, in which several of the current authors participated, was published in 2014. The current publication is more extensive, provides more references and, more importantly, contains three tables that list a total 39 genes found to be involved in the cause of congenital hypothyroidism. This was made possible by the development of more efficient and considerably less costly next-generation and whole-exome sequencing (NGS and WES), advancing our knowledge about the etiology of congenital hypothyroidism, allowing proper counseling and, in some instances, providing prenatal diagnosis and even prenatal treatment.
In the first paragraph of the introduction, the authors define congenital hypothyroidism as “dysfunction … resulting in insufficient thyroid hormone production … but also to impaired thyroid hormone action.” However, the latter cause of congenital hypothyroidism is not discussed further. This is undoubtedly because current methods of neonatal screening do not detect defects of thyroid hormone cell transport, metabolism and action.
With the introduction of liquid chromatography-tandem mass spectrometry in routine clinical laboratories, it is anticipated that simultaneous measurement of T4, T3 and reverse T3 in dried blood spots will allow the identification of these conditions. This will not only provide more accurate information about their prevalence, but also allow for early intervention that is so crucial in the treatment of congenital hypothyroidism.
Samuel Refetoff, MD
Frederick H. Rawson Professor in Medicine
Professor of Pediatrics and Committee on Genetics Director of the Endocrinology Laboratory and The Thyroid Study Unit
All newborns should be screened for congenital hypothyroidism within 48 to 72 hours of birth, and prompt treatment after diagnosis is necessary to avoid adverse outcomes, according to a report from the American Academy of Pediatrics.
A new guideline published in Pediatrics outlines the steps providers should take for screening and treating congenital hypothyroidism among newborns. Among the recommendations, the authors argue for universal congenital hypothyroidism screening for newborns. According to the authors, about 70% of newborns globally do not undergo screening, and newborn screening for congenital hypothyroidism is not established in some countries.
Infographic content were derived from Rose SR, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060420.
“Missing the diagnosis of congenital hypothyroidism in a newborn infant will lead to permanent intellectual disability,” Susan R. Rose, MD, FAAP, professor emerita of pediatric endocrinology at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, told Healio. “Newborn screening for congenital hypothyroidism and other disorders should be performed on all infants both in the U.S. and globally.”
Screening, treating congenital hypothyroidism
To screen for congenital hypothyroidism, a dried blood spot should be obtained by heel stick on an approved filter paper card. Screening should take place within 48 to 72 hours of birth. The authors noted that screening too early may lead to false-positive results. Three test strategies are typically used to screen for congenital hypothyroidism: primary thyroid-stimulating hormone and reflex thyroxine; primary T4 and reflex TSH, or a combined T4 and TSH measurement. All three strategies can detect congenital hypothyroidism with similar accuracy.
Susan Rose
“Congenital hypothyroidism should be treated as soon as possible after the diagnosis is confirmed,” Rose said. “Delayed initiation of treatment and longer time to normalization of thyroid function are associated with poorer intellectual outcomes.”
When newborn screening indicates congenital hypothyroidism, a physical examination should be performed and serum concentrations of TSH and free T4 measured. Elevated TSH with low free T4 is indicative of overt primary hypothyroidism. Elevated TSH with normal free T4 is termed hyperthyrotropinemia or mild hypothyroidism. Newborns with normal TSH and low free T4 typically have central hypothyroidism, prematurity, low birth weight, acute illness or T4-binding globulin deficiency.
If congenital hypothyroidism is confirmed, treatment begins with levothyroxine at a starting dose of 10 µg/kg to 15 µg/kg per day, with tablets being the typical formulation. The FDA has recently approved a liquid formulation of levothyroxine for use in children. Providers should not wait for thyroid imaging to begin treatment. Formulations prepared by compounding pharmacies should be avoided, according to the authors, due to an unreliability in dosing. TSH and free T4should be monitored every 1 to 2 months up to age 6 months, every 2 to 3 months from age 7 to 12 months, and every 3 to 4 months from age 1 to 3 years. Liothyronine is not indicated for newborns, and there is no evidence that adding liothyronine to levothyroxine will improve patient outcomes.
Congenital hypothyroidism is considered permanent if there is thyroid dysgenesis or if serum TSH increases above 10 mIU/L after the first year of life. Those who are not yet diagnosed with permanent congenital hypothyroidism can trial off of levothyroxine therapy at age 3 years under endocrinologist supervision to assess whether lifelong treatment is needed.
Children diagnosed with congenital hypothyroidism should have their behavioral and cognitive development closely monitored during infancy and early childhood because they may have a higher risk for neurocognitive and socioemotional dysfunction, even with proper treatment. Additionally, a formal hearing evaluation should be considered if there is concern for a hearing deficit or abnormal language development because children with congenital hypothyroidism have an increased risk for hearing deficits.
Guidance for ill newborns, twins
The guideline includes specific considerations for special populations. Infants who are born prematurely, with low birth weight or those who are ill at birth may have mildly elevated TSH that may resolve after a short period or may persist and require thyroid hormone therapy.
“Pediatric endocrinologists vary in how long they are willing to monitor a mild TSH elevation without stepping in to initiate thyroid hormone therapy,” Rose said. “Long-term studies of intellectual function are limited in the context of untreated mild TSH elevation. Results of short follow-up studies vary, with some showing no significant intellectual consequences, and others showing deficits.”
For newborn twins, it is possible for a congenital hypothyroidism diagnosis to be missed due to shared blood circulation with a twin who does not have congenital hypothyroidism. Repeat screening at 2 weeks can be done to confirm a possible diagnosis in twins. Children with trisomy 21 have a high risk for autoimmune thyroid dysfunction and intellectual dysfunctions, even early in life. Repeat screening for TSH elevation is especially important in this population, according to Rose.
More evidence needs to be gathered in several areas for treating congenital hypothyroidism. One of controversy involves whether levothyroxine is necessary for newborns with mild TSH elevation of 5 mIU/L to 10 mIU/L. Previously published studies have found varying results as to whether mild congenital hypothyroidism worsens cognitive development in children. No studies have demonstrated a beneficial effect of levothyroxine on mild congenital hypothyroidism, and no studies have been able to define TSH thresholds for potential adverse outcomes in mild congenital hypothyroidism.
“Results of controlled studies to evaluate consequences of untreated mild long-term TSH elevation would be valuable,” Rose said. “However, such studies might not be considered ethical. Natural history studies in countries that do not yet perform newborn screening might provide some answers.”
The humanities, from music and painting to literature and poetry, offer limitless opportunities to grow as a professional and as an individual.
For physicians in particular, although medicine is doubtless an endeavor into the sciences, their knowledge and expertise can only be improved with a dollop of the arts — and the empathy it can inspire.
“I do think that the humanities, as a broader field, is very important, and that we should not be allowing ourselves to become one-sided in terms of the science,” Ronald F. van Vollenhoven, MD, PhD, told Healio Rheumatology. Source: Ronald F. van Vollenhoven, MD, PhD
“I think that we are in a time where we need more humanities in medicine to balance the science that we are blessed with,” Leonard H. Calabrese, DO, director of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic, told Healio Rheumatology.
That science, and the advancements it has made possible, from the revolution in biologic therapies to the emergence of precision medicine and improved diagnoses, has been a boon for rheumatology — both for patients and providers. However, there is another side to patient care, one that is strengthened not by trials and data but through exercising empathy and connecting with patients.
Leonard H. Calabrese
According to Calabrese, physicians who take part in various artistic pursuits, be it classical piano, reflecting deeply with a piece of writing or examining the life of artists long passed, can bring those qualities — empathy and human connection — from the studio into the clinic.
Yet, this requires an understanding that the humanities and the arts can be just as important as the hard sciences.
“It’s almost like the art of medicine is not given any credence, it’s all hard data and science, and there’s a lot more to medicine than that, I think,” Ronan Kavanagh, MD, a rheumatologist at the Galway Clinic, in Ireland, told Healio Rheumatology.
Kavanagh, who had a previous life as a musician before pursuing medicine, is also the founder of dotMD, an annual 2-day “festival of curiosity” for physicians and other health care professionals that seeks to “awaken a sense of wonder and curiosity about medicine that some may have lost along the way,” according to its website. The festival accomplishes this by, among other means, “viewing medicine with fresh eyes through the lenses of culture, the arts, philosophy and technology.”
According to both Kavanagh and Calabrese, and others, rheumatology requires a balance between the seemingly — but not necessarily — opposing disciplines of science and art, a balance that becomes easier to achieve when providers are steeped in the humanities.
Maintaining the Engine of Empathy
For medical doctors, the humanities formed the cornerstone of the profession until the 19th century, when the scientific setting of the laboratory seemed to remove medicine from the arts, according to Calabrese. The result of this divergence, he explained, was rising skepticism regarding the value of indulging in the humanities. One prevailing opinion was that the feeling and passion involved with music, literature and the like made the humanities all but incompatible with the data-based path medicine seemed to be following.
However, according to Calabrese, by engaging in the arts, either through active participation or passive observation, the humanities can provide physicians with the opportunity to develop their humanity and empathy — attributes that are key in medicine.
“Empathy is an incredibly important attribute of the healing relationship,” Calabrese said. “It’s transmitting feelings.
“This is not just to make someone ‘feel good,’ but it has the capacity to both heal in terms of empowering patients and strengthen the healer-patient relationship, as well as imprint the messages from the visit,” he added. “Our patients may forget the details of what we instruct them, but they never forget how we made them feel during a visit.”
As such, Calabrese said he considers engagement with the humanities to be an amplifier of personal empathy, which can then be drawn upon “to both help our patients and enrich ourselves at the same time.”
Ronan Kavanagh
Specially, engaging with the arts on a passive level, be it reading an enthralling novel or attending a gripping concert, can “soften up the edges,” for physicians, making them able to better connect with patients, said Kavanagh.
“If reading a book helps me empathize or connect with a patient a bit better, I think that has to be a good thing,” he added.
Meanwhile, active engagement with the arts can exercise myriad qualities that can be invaluable in practice, including not only empathy but also curiosity and self-awareness.
Iris Y. Navarro-Millan, MD, of the Hospital for Special Surgery and Weill Cornell Medicine, in New York, describes herself online as a musician who happens to be a doctor. A lifetime of playing music with family members and singing her way through college as an undergrad before joining a band has resulted in a sharpened sense of empathy, she said.
Iris Y. Navarro-Millan
“I think empathy, kindness and curiosity definitely lend toward understanding patients’ reality, and eliciting their specific goals,” Navarro-Millan said, adding that involvement in the arts has also helped to sharpen her self-awareness.
According to Navarro-Millan, empathy gained from her involvement with music lends itself toward reflecting more on the world around her, allowing her to connect with her patients much more easily.
“I think it makes me more sensitive, more self-aware,” she added.
As an example, Navarro-Millan recalled one patient from Colombia who spoke only Spanish. When the patient asked Navarro-Millan if she knew a specific song, the two sang together, forging a connection between patient and doctor that Navarro-Millan still recalls fondly.
“I do think that the humanities, as a broader field, is very important, and that we should not be allowing ourselves to become one-sided in terms of the science,” Ronald F. van Vollenhoven, MD, PhD, professor of rheumatology at Amsterdam University Medical Center, and a classical pianist, told Healio Rheumatology.
Although the humanities have the power to foster empathy and deeper understanding between patients and their caregivers, for many involved in both the arts and medicine, their connection to the former long predates their career in the latter.
A Lifetime Pursuit
For many who play and have a connection to music, it is not uncommon for that connection to have been forged at a young age. Vollenhoven originally picked up piano as a child at the urging of his parents, and kept up with the habit throughout his life. Additionally, both Kavanagh and Navarro-Millan played music in various capacities before ultimately finding medicine.
According to Navarro-Millan, music is not necessarily something to be performed for other people, although she has done a fair bit of that as well. When she was growing up and family got together, music was guaranteed to fill the air.
“Nobody wanted to be famous — it was about having a good time and a connection while enjoying music,” Navarro-Millan said.
In a family filled with musicians and singers, there was always the chance to join in the song or pick up a guitar. Navarro-Millan was trained as a bel canto singer in high school and sang mezzo soprano opera throughout college, before joining a band with some peers in medical school.
“It was something that I felt like I needed to do because it gave me purpose,” she said. “It is something that is so mine and only mine. It doesn’t depend on a peer review process or the outcome of a patient.”
Navarro-Millan’s relationship with music, from informal song performances with family to playing bars in Mexico through medical school, has rarely remained static for long.
Similarly, others with a strong relationship to music have had to put the passions of their youth aside to continue professional development.
Kavanagh, who practices rheumatology in his hometown of Galway, Ireland, said that the musical and artistic culture of the city seeped into his personality. In the late 1980s, he was part of the original line-up of The Stunning, playing keyboard. Their 1988 single “Got to Get Away” reached No. 17 on the Irish charts, and the group would eventually become one of the most well-known rock bands to come out of Ireland.However, just before The Stunning exploded in popularity, Kavanagh made the call to step away and study medicine.
“I played keyboards with them for about 2 years, but really, like Pete Best and the Beatles, just as they were about to really take off, I had to make a call, and I decided I was going to continue with my medical studies,” Kavanagh said. “I live in a town that is deeply immersed in the arts and culture. So, everything that’s done, is done surrounded by a culture of music and theater, and it somehow seeps into your pores.”
Meanwhile, Vollenhoven’s own musical journal started with piano lessons as a young child before finding a deeper passion for music as a teenager.
“It’s something I have done all my life. I mean, I was a kid when I started taking piano lessons, and I guess I was in my teenage years when I really found the enjoyment in paying and also listening to piano music,” he said. “I also had times in my life where I did not have that much time to play piano, so there were periods of time where I had hardly any time to spend on it.”
Still, no matter the duration of those stretches of time when other duties denied him the opportunity to regularly play, Vollenhoven said he always — eventually — has been able to return to music.
Lives filled with art and music also give physicians the ability to view rheumatic care not only as a sterile science, but also as a performance.
Improvisation ‘At the Heart’ of Patient Care
According to Kavanagh, there is bound to be something missing when physicians practice medicine, be it rheumatology or any other specialty, strictly as a science.
“The more you know, and the more patients you see, the more automatic your decision making becomes, and the more possible it becomes to stop thinking of yourself and your own performance,” Kavanagh said.
For that reason, it is important and useful to approach rheumatology, at least in part, as a performance, including everything from improvisation to communication between doctor and patient, he added.
Influenced by the work of Penn State medical educator Paul Haidet, MD, MPH, who has written about the connections between jazz and the art of medicine, Kavanagh has looked to legendary trumpeter Miles Davis as an inspiration in the school of thinking of patient care as a performance. The way Davis used improvisation, from paying attention to the music made by those performing with him to responding with the perfect notes and rhythms, can teach rheumatologists a lot about interacting with patients, he said.
“I believe that improvisation is at the heart of really good patient care,” Kavanagh said, noting the importance of listening and taking each individual patient factor into account before recommending a course of action.
Although many aspects of patient care can be completed simply by following algorithms and ordering the appropriate tests, this may not always be appropriate in every situation. Just as performing a composition exactly as written may leave a piece sounding a bit lifeless and without expression, so too should physicians, including rheumatologists, emphasize communication and think beyond the algorithm in patient care, according to Vollenhoven.
“Even if you do exactly as it says on the sheet in music, it will sound boring and not very inspiring. There is so much more to be done,” he said. “If you do that in medicine, you’re also missing something, because you need the art of medicine on top of that.”
By incorporating your own communication and treatment styles, it not only brings life to the practice of rheumatology, but makes that practice more humane and creative, Vollenhoven said.
Additionally, although music offers a great pathway to achieve this, it is by no means the only route.
Long before Navarro-Millan met and sang with the patient from Colombia, she was regularly attending plays and theater productions while in college. She credits those experiences, combined with the near-constant presence of music, with helping to develop her ability to connect with patients.
“I think it is something that makes me also reflect on the world around me,” she added. “I do think that it makes me more empathetic and more compassionate to the reality and challenges of my patients.”
Although a history of deep involvement in the humanities can have the impact of improving communication and increasing empathy with patients, there are also conferences and events that can help to reframe and reorient the goal of patient care for art-minded physicians.
Reframing the Focus
Kavanagh’s dotMD, the arts-meets-science conference he founded to help expand the horizons of health care professionals around the world, has been attracting rheumatologists, primary care physicians, psychiatrists, hospitalists and emergency physicians to Galway since 2013.
“The aim of the festival is to reawaken a sense of wonder and curiosity about medicine that some of us may have lost along the way,” Kavanagh said, adding that many who attend are able to find deeper meaning in medicine.
The joke, he says, is that dotMD is a meeting for doctors who “used to play the piano.”
The meeting is billed as “anti-reductionist,” and serves as a way for a wide variety of speakers to help attendees gain a different perspective, Kavanagh said. What the meeting lacks in traditional rheumatological lectures, it makes up for in talks focusing on the parallels in developing expertise in non-medical and medical professions.
Although Vollenhoven and Calabrese have not attended dotMD, the idea and goal of reawakening a passion and unlocking perspectives is one that both agree is a worthy cause. Calabrese regards attending the meeting as an item on his wish list, while Vollenhoven would appreciate a wider adoption of similar events.
“I very much applaud that kind of initiative,” Vollenhoven said.
In terms of success, Kavanagh measures dotMD not by the number of attendees, but through the impact it has on those who attend.
“We do a simple questionnaire for feedback afterwards, and 98% grade their experience as ‘excellent’ or ‘very good,’ but the best possible outcome is not the information they learned, but the feedback we get about how the meeting makes them feel,” Kavanagh said.
Recalling feedback, terms like “transformative,” “sublime,” and “breathtaking,” come to mind, he added.
Although it is important to engage with medicine in non-traditional ways, such as at meetings and talks that allow for some artistic reflection, rheumatologists can also learn from the artists themselves who have dealt with life-changing diseases such as RA and scleroderma in their own time.
Determination and Passion
Throughout history, many artists, including several iconic painters, have dealt with rheumatic and musculoskeletal diseases. James Louie, MD, professor emeritus of medicine at the University of California, Los Angeles, has spoken about several of them and how they attended to the challenges of their rheumatic diseases, as well as how their determination enabled them to display the beauty of their art in personal, technical and philosophical terms.
“To enable patients in their decisions for best care of their rheumatic diseases, it is often helpful to describe how other famous persons throughout history had met their challenges and continued the creativity and grace of their lives,” Louie said.
For example, Pierre-Auguste Renoir (1841-1919), the renowned French painter who contributed to the impressionist style, developed rheumatoid arthritis at the age of 47 years. According to Louie, he sought out the best available physician, took the non-steroidal therapy of that time, designed his own physical and spa therapies, and continued to mature his style of painting.
By age 71, Renoir could no longer ambulate and was restricted to a wheelchair and bed, yet he continued to paint with enthusiasm until his death at age 78 years, saying, “The pain passes but the beauty endures.”
“That was his goal in life, to share his sense of beauty as he saw life, regardless of what he went through,” Louie said.
In the next generation, Raoul Dufy (1877-1953), French painter and designer of artistic tapestries, fabrics and ceramic pieces, developed rheumatoid arthritis at age 58 years. When he no longer responded to gold injections, at age 73 years, he traveled from Paris to Boston to participate in a therapeutic study of corticosteroids.
“He then returned to his painting,” said Louie. “His friend wrote, ‘Viva le difference.’ While continuing his cortisone, he died of a gastrointestinal bleed two years later.”
In the last generation, John Outterbridge (1933-2019), an assemblage artist and sculptor in Los Angeles, developed rheumatoid arthritis at age 60 years. When he sought out best care, he enrolled in a study of a TNF inhibitor and returned to his constructs, directing the Watts Towers Art center for 27 years.
“Using refuse from the Watts riots, he built a ship with three masts for children to walk through,” said Louie, who provided care for Outterbridge. “He explained to me, ‘I want the children to know that after a riot and life is a mess, if you reach down, pick up the pieces and build something that raises your eyes up to God, you will be okay.’”
According to Louie, the determination and dedication of these three artists encourages patients and physicians to pursue the best care together, particularly as science has provided more effective therapies.
“Ben Franklin suggested, ‘Teach me and I remember, involve me and I learn,’” he said. “And Franz Kafka predicted, ‘Anyone who keeps the ability to see beauty never grows old.’”
For Calabrese, engagement with the arts began early in his career when the Cleveland Clinic assumed the care of the newly formed Cleveland Ballet.
“That was at a time when the field of dance medicine was in its infancy,” he said.
Calabrese described how exciting it was to combine medical care for injured dancers with research into the epidemiology, risks and attendant medical problems they were first noted to be experiencing. Soon after, he began to perform similar work with instrumentalists as part of a newly formed collaborative multidisciplinary group dedicated to care and research across the arts.
According to Calabrese, this early exposure and experience enriched him both professionally and personally in ways that have remained with him for his entire career.
“To me, it was an opportunity to grow,” he said. “My involvement with dance and dancers over these many decades has been very fulfilling for me. I think it has helped me grow as a person.”
After caring for dancers throughout his career, Calabrese said that he grew to appreciate the art form.
“You don’t have to be a performer to reap the benefits of arts in medicine,” Calabrese said.
In Galway, Kavanagh has similarly cared for musicians throughout his career.
“I kind of found myself, full circle, learning from them,” Kavanagh said.
Enriching the Profession
According to Calabrese, engaging with humanity-enriching art is an essential part of the profession of caring for patients.
“This is important because humanism is vital for a successful and fulfilling career as a healer,” he said. “I think that through the arts, we can fuel this humanistic need that we all have.”
Calabrese, who describes himself as a “guerilla writer,” offers reflections in Healio and other outlets, but he is also involved with the reflective writing course for medical students at the Cleveland Clinic.
“We de-emphasize the grammar and the style, and we instead emphasize sharing what is on your mind,” he said.
Meanwhile, Vollenhoven and Navarro-Millan satisfy their artistic impulses by finding time to attend concerts and visit museums when the opportunity arises.
Losing the art and becoming engulfed in the science side of things presents a “real risk,” Vollenhoven said.
“Music can be just a very superficial enjoyment, but if you take a little bit more serious interest and try to discern the reasons behind the composition, there is much to be learned from that,” he added.
Similarly, Kavanagh argued that the more perspectives an individual has access to, and an understanding of, the better life can be.
“If reading a book helps me empathize or connect with a patient a bit better, I think that has to be a good thing,” Kavanagh said. “It expands the human dimension of who we are, to be immersed in arts and literature. I think it would make them better human beings.”
According to Navarro-Millan, music in general can ignite joy and provide a sense of purpose. That joy transcends every facet of her life, she said, including rheumatology, and allows her to connect with patients more naturally.
“I think that authenticity is what probably makes me take better care of patients,” Navarro-Millan said.
Apart from engaging in the humanities through active or passive involvement, it is imperative that no matter the inclination, diversity of style in the rheumatology field remains strong.
Although art and the humanities offer ways for physicians to connect to patients, and see and be seen as “real people,” there is still a significant place in medicine for professionals who do not, or cannot, engage as vehemently, Kavanagh said.
“There is no question in my mind that there are people at the very top of their game in rheumatology, who dedicate their entire lives to the mastery of our specialty through the lens of science, who are wonderful rheumatologists,” he said. “You need people who have those supreme analytical skills to deep-dive and get to work in the lab. We wouldn’t be where we are in medicine without those people.
“However, I guess what I’m advocating for is a broader perspective of how we look at our specialty — one of course firmly grounded in science, but also one where multiple perspectives from the world of the arts and performance science are valued,” he added. “I think it has made me a better rheumatologist.”
A plant-based diet appeared associated with sustained minimal residual disease negativity among a cohort of patients with multiple myeloma, according to study results.
The findings, published in Clinical Cancer Research, provide rationale to further assess a prospective dietary intervention in this patient population, researchers concluded.
Findings of a study in multiple myeloma “provide early mechanistic evidence that oncologists may use to empower patients to make healthier plant-based dietary changes to influence sustained MRD negativity,” Urvi A. Shah, MD, told Healio.
Background and methods
Preclinical studies have suggested a potential link between the microbiome and myeloma natural history, according to Alexander M. Lesokhin, MD, associate attending physician at Memorial Sloan Kettering Cancer Center.
“This, as well as microbiome-focused studies at our center in the transplant setting that showed strong signals in several myeloma patient cohorts, indicated that microbial features were relevant in myeloma disease biology and led to an interest in exploring this further,” Lesokhin told Healio. “An ongoing natural history trial among a uniformly treated patient cohort receiving maintenance lenalidomide [Revlimid, Bristol Myers Squibb] seemed like an ideal opportunity to evaluate the microbiome in a longitudinal study.”
Alexander M. Lesokhin
Lesokhin and colleagues examined possible associations between dietary factors, stool metabolites and the stool microbiome with sustained minimal residual disease (MRD) negativity among patients with multiple myeloma treated with lenalidomide maintenance. They used the food frequency questionnaire to calculate flavonoid nutrient values and the Healthy Eating Index 2015 score.
Findings
Results showed an association between sustained MRD negativity at 3 months and higher stool butyrate concentration (P = .037), butyrate producers (P = .025) and alpha diversity (P = .0035).
Researchers additionally observed an association between healthier dietary proteins from seafood and plants and butyrate at 3 months (P = .009) and sustained MRD negativity (P = .05).
Moreover, consumption of plant nutrients with antioxidant effects correlated with stool butyrate concentration (anthocyanidins, P = .01; flavones, P = .01; flavanols, P = .02).
“While this is a small study that needs further validation, we were pleasantly surprised that the findings correlated with our initial hypothesis,” Urvi A. Shah, MD, hematologist-oncologist at Memorial Sloan Kettering Cancer Center, told Healio. “There is evidence that diet is one of the major drivers of gut microbiome composition and that the microbiome may influence cancer outcomes, but there isn’t much evidence directly linking diet, the microbiome and myeloma outcomes such as sustained MRD negativity in a study simultaneously. This is the first trial to show such an association in multiple myeloma.
Urvi A. Shah
Implications
The findings support a rationale for both continued evaluation of the microbiome as a potential contributor to disease natural history in myeloma and evaluation of dietary manipulation to modify the microbiome and potentially impact disease, as well as treatment response, Lesokhin told Healio.
“These and other preclinical data support the notion that the microbiome interacts with myeloma disease biology,” Lesokhin continued. “We have undertaken several translational studies in patients with myeloma precursor conditions and newly diagnosed myeloma to evaluate how patients’ microbiomes are related to the genetic features of the diseased plasma cell, as well as the immune microenvironment at the disease site. Our goal is to identify additional microbial features that may be targeted to improve overall patient outcomes.”
Although patients have often been told to eat healthier for the benefit of their overall health, evidence on how healthy plant-based diets may influence outcomes in multiple myeloma has been limited to epidemiologic studies, Shah told Healio.
“The findings in our study provide early mechanistic evidence that oncologists may use to empower patients to make healthier plant-based dietary changes to influence sustained MRD negativity,” Shah said. “To further validate these findings prospectively, we are designing interventional dietary studies in myeloma and its precursor conditions, smoldering myeloma and monoclonal gammopathy of undetermined significance. We will evaluate the impact of dietary changes on the gut microbiome and disease outcomes.”
Nature has given a wonderful gift to mankind in medicinal plants to promote healthy, happy and disease-free life. These plants play a vital role in natural healing. If I were allowed to choose the most amazing medicinal plant to treat medical conditions, it would be Indian gooseberry (amla). This plant has some exceptional benefits to health and our overall well-being.
Amla or Phyllanthus Emblica belongs to family Euphorbiaceae. It is a small to medium sized deciduous tree found throughout India, Pakistan, Uzbekistan, Sri Lanka, Southeast Asia, China, and Malaysia. According to the national institute of health, Phyllanthus Emblica is highly nutritious and could be an important source of vitamin c, amino acids, and minerals. It can be used as a medicine and as a tonic to improve vitality and resistance power. Research shows that a unique complex within Indian gooseberry is super nutritious. It has more antioxidant activity than blueberries; it has 20 times more vitamin c than lemon juice. It has 30 times more polyphenols than red wine and has more gallic acid (a potent antioxidant) than any other fruit.
What are the uses of amla in traditional Indian medicine? What are the benefits of this wonderful superfood? How can we use it easily at home with simple DIY recipes? Read on to know more.
Use of Amla in Traditional Indian Medicine
Amla has been used in Ayurveda and Unani system of medicine for the therapeutic purpose for long years. The fruits, seed, leaves, root, bark, and flowers are parts of the plant that used in traditional Indian medicine. According to Ayurveda, amla balances all three doshas (Vata, Pitta, and Kapha). It contains 5 out of 6 tastes recognized by Ayurveda.
Amla is particularly helpful in reducing pitta because of its cooling energy. It also balances both pitta and vata by virtue of its sweet taste. The Kapha is balanced primarily due to its drying action. It may be used as a Rasayana (rejuvenative) to promote longevity. It also helps in:
Enhancing digestion (dipanapachana)
Treat constipation (Anuloma)
Reduce fever (jvaraghna)
Purify the blood (Raktaprasadana)
Reduce coughs (Kasahara)
Alleviate asthma (svasahara)
Enliven the body (jivaniya)
Enhance intellect (Medhya)
Strengthen the heart (hrdaya)
Benefit the eyes (chakshushya)
Stimulate the hair growth (romasanjana)
Nutritional Value of Amla
Amla is reputed for its high ascorbic acid content and antioxidant rich activity. In a 100 gram serving, gooseberries provide 44 calories. Gooseberries are 88% water, 10% carbohydrate and less than 1% each of protein and fat. It is abundant in vitamins and minerals. Apart from being the richest source of vitamin c (27.7%), it also contains other vitamins too, that includes Vitamin A (2%), thiamine(b1) 3%, riboflavin (b2) 3%, Niacin (B3) 2%, Pantothenic acid (B5)6%, Vitamin B6 6%, Folate (Bg) 2% and vitamin E 2%.
Minerals: it contain calcium 3%, copper 4%, iron 2%, Magnesium 7%, phosphorus 4%, potassium 4%, sodium 0%, zinc, copper 1%.
Scientific research on Amla (Indian gooseberry)
According to a study published in British journal of nutrition, Morden scientists have studied the amla fruit for more than 25 years and determined that amla’s unique blend may have a positive influence on everything from metabolic syndrome to anti-aging process. Japanese researcher put Sun Amla (a proprietary amla extract) to the test by evaluating its effect on human endothelial cells and in a rat model. In both cases, the amla fruit extract inhibited the biological responses that can lead to inflammation and blood clots. It also works to combat the free radicals and contribute to overall health.
According to center for pharmaceutical science institute of science and technology, a review report shows that several types of research confirmed that various extract and herbal preparation of amla showed potential therapeutic benefits against various diseases and result were similar to standard drugs. Though more scientific research will be needed to confirm this.
Benefits of Amla
Amla is a Great Antioxidant Food
Amla is one of the most antioxidant rich foods on earth. According to some scientific research, it has turned out to be the number one among the antioxidant rich food. Antioxidants protect the body from damage caused by harmful molecules called free radicals. This damage is an important factor in the development of different disease conditions such as blood vessels disease, cancer etc.
In a comparative study of Amalaki, the Sanskrit name of the Indian Gooseberry), with spirulina and wheat grass, the vitamin c content of crude amla powder was found to be 5.38 mg. It was also found to be the rich source of phenolic compounds. Because of these constitutes, amla works great as an antioxidant agent and helps in keeping our body disease free. Amla contains various antioxidants that include ellagic and gallic acid, emblicanin a and b, punigluconin, and much more. A detailed scientific analysis of amla shows that this antioxidant provides powerful protection against various diseases and slows down the aging process.
Amla is a Potent Hypolipidemic Agent
Amla has a great hypolipidemic agent; in simple words, it can produce a significant reduction in total cholesterol, LDL, triglyceride, and VLDL. To evaluate the efficacy of amla as a hypolipidemic agent, a clinical trial has been conducted on 600 patients. Out of total 600 patients, 40 were treated with the Amla Capsule (500 mg (daily for 42 days and 20 patients were given Simvastatin capsule (20mg) daily for 42 days. After analyzing various biochemical parameters, and the value of total cholesterol, LDL (Low-density lipoprotein), HDL (High-density lipoprotein), and VLDL (Very low-density lipoprotein), it has been observed that amla produces a significant reduction in total cholesterol, LDL, triglyceride, and VLDL and a significant increase in HDL level. It is concluded with this study that amla produces significant hypolipidemic effect along with a reduction in Blood pressure. With this effect, it can play a vital role in the prevention of development of atherosclerosis and coronary heart disease.
Amla has Great Hepatoprotective Properties
Scientific studies have shown that amla is effective in preventing the toxic effects of hepatotoxic agents like paracetamol, heavy metals, antitubercular drugs, and ethanol. Amla is also reported to impart beneficial effects on liver function and to mitigate hyperlipidemia and metabolic syndrome.
Amla has a Good Anti-Diabetic Effect
Amla has anti-diabetic properties. Scientific studies have shown that amla or some of its important constituents (including Gallic acid, gallotannins, ellagic acid and corilagin) possess antidiabetic effect through their antioxidant and free radical scavenging properties. It also helps in preventing hyperglycemia and diabetic neuropathy. More scientific evidence is needed to confirm this study.
Amla is Good for Hair
As it contains a lot of vitamin c, minerals, and antioxidants, amla helps in promoting hair growth and work as a tonic for hair health. It reduces hair loss, strengthens hair roots, and enhances the natural color of your hair. It also works as a natural conditioner for hair and helps in preventing premature graying of hair. This amazing health benefits for hair could be obtain
Either by eating gooseberry fruit
Applying amla paste on hair roots
Using amla hair oil for nourishing hair
According to a recent survey on the use of hair oils for hairdressing by the Indian population revealed that amla oil is extremely popular for hair and used equally by men and women. It is the most effective oil in controlling hair parasites. It has been proven to be the most toxic for hair parasites and most effective at keeping hair parasites free.
Amla Helps in Treating Bone Disorders Including Rheumatoid Arthritis and Osteoporosis
Osteoclasts are involved in rheumatoid arthritis and in several pathologies associated with bone loss. According to a scientific study, extracts of Emblica Officinalis were able to induce programmed cell death of mature osteoclasts, thus potentially limiting the damage they can do to our bones and joints. Accordingly, the study suggests Amla extracts could be an alternative tool for therapy applied to bone disease.
Amla Helps in Treatment and Prevention of Cancer
Amla is wonderful in the treatment and prevention of cancer. The fruit is used either alone or in combination with other plants to treat many elements. It has great anti-inflammatory, hepatoprotective, cardio protective, anti-anemic, antipyretic, and many more awesome healing properties. Experimental studies have shown that amla and some of its constituents (like pyrogallol, gallic acid, and ellagic acid) possess anti-neoplastic properties. Especially pyrogallol (an active component of Emblica Officinalis extracts) has an antiproliferative effect on some human cancer cell lines.
Apart from all these wonderful benefits, Amla:
Helps in slow down the aging process
It improves digestion and prevents constipation
Improve eye sights and helps in treating eye disorders
Boosts immunity and protects our body against infection through its antibacterial properties.
Increases diuretic activity and helps in elimination of toxic products from the body.
Great for skin, it gives you radiant skin and also keeps it hydrated.
It is also a good blood purifier. Regular consumption of amla powder helps in increasing hemoglobin naturally.
Different Ways Amla Can Be Used as a Remedy
Of course, eating the fresh fruit is the best option to get the nutritional benefit of this super fruit, but it tastes quite sour and so many people might struggle to eat this as a fruit. Second, not all of us able to get the access to fresh fruit all the time. Here are some super easy ways to use amla at home easily.
Before making any recipe with Indian gooseberry it is very important to select a good quality of fruit. Here are few tips to select the good quality fruit.
It should be properly ripe, fresh, hard, well skinned, bright yellowish green in color and medium in size. Avoid buying bruised, raw, too green, wrinkled, spotted, infected, or bad smelling fruit.
Amla Juice
Amla juice is easiest option to add amla to your diet. The regular consumption of gooseberry juice prevents many diseases and empowers the strength. And personally, I prefer to use it.
Ingredients:
3-4 amla
Grinder, juicer or mortar and pestle
Salt (optional and according to test)
Grated ginger, raw honey (1 teaspoon, optional)
Instruction:
First, select a good quality of amla
Soak amla in salted water for a while to remove any unwanted residue before using
Wash the amla
Dry them with a cloth
Grate or cut the amla in finer pieces
Now, you can use either grinder, juicer or a mortar and pestle. Grind the amla with the help of little water, strain the mixture through a strainer. Strain and squeeze the pulp to get the juice. For adding extra taste and flavor you add a pinch of salt. If you are hypertensive, it is best to avoid salt. If you are diabetic, avoid honey.
Otherwise, 1 Tsp ginger and raw honey can be added if you like.
Benefits:
Help in weight loss (especially when you drink it with honey)
Improve metabolism and digestion
I usually had better hair health after using it.
Skin texture will improve.
Increase immunity and reduction in routine infections
Amla Powder
The second way to use amla at home is also very easy; you just need to dry the amla in shade for few days and then grind it in a grinder. After grinding, you may use a sifter for getting a more powdered form.
Of course, amla powder is great for our health, but for getting better result you can take Triphala churna (powder). My grandma used to take this powder for long years as a routine for her digestion. It is easily available at the local store (in India) and you can order it online too. Triphala is a staple of Ayurveda medicine in India. It is considered one of the greatest herbal preparations that provide excellent results.
Triphala churna or powder is made from three fruits: amla, haritaki or Harda, and bibhitaki. Apart from getting some common benefits such as good digestion, weight loss, this churna helps in balancing the doshas (Vata, Pitta, Kapha) of our body.
Amla helps in balancing the pitta dosha
Haritaki helps in calming the Vata dosha
Bibhataki benefits to the Kapha dosha
It is usually taken empty stomach with lukewarm water. You may also make a tea by adding the 1 teaspoon powder in boiling water. Capsules, tonic, and tablets are also available. As a general rule, when you start consuming a new product you should go slow and observe any changes if you had. But if you had any existing medical condition and if you are taking any medication it is always advisable to take medical advice.
Dried Amla
This is the third easiest way to include amla as a part of your regular diet. This easily prepared and crunchy amla tastes so good and provides excellent nutritional benefits to your body.
Ingredients:
10-20 amla
Salt and turmeric (according to taste)
Lemon juice (2-3 Tsp)
Instruction:
Wash the amla properly and wipe them with a clean kitchen towel.
Cut them in thinner slices and discard the seeds (you may grate them if you like a finer texture)
Toss the sliced amla with salt, lemon juice, and turmeric
Spread them on a large plate and cover with a thin cloth.
Let them sun dry for few days (7-8 days are good enough) or until there is no moisture left in the amla. Once, they become crispy, store them in a clean and air tight container.
Eat after every meal.
Benefits:
It is great for digestion and tastes so good. Even kids would love it.
It could be used as a healthy snack especially during winter.
It is hassle free and could be prepared in large quantity.
Side Effects of Amla
Like any other herbal or Ayurveda preparation, amla may interfere with the action of the certain medication. It may cause some side effects. Such as:
It may cause hyperacidity in the sensitive individual.
It may increase the risk of bleeding if you are taking any blood thinning medication or suffering from any kind of blood disorders, you need to take extra precaution while consuming it.
If you are diabetic and taking anti-diabetic medication, it is best to consult your physician before consuming it. It may cause a sudden drop in blood sugar level.
There is not enough safety data available to use it during pregnancy and breastfeeding. It is best to avoid its use during pregnancy and breastfeeding.
As it may increase the risk of bleeding, it is advisable to discontinue its use 2 weeks prior to scheduled surgery.
Why It Matters
No doubt, amla is a super nutritious and had amazing healing properties, but at this time there is not enough scientific evidence to support the efficacy and safety of it, it is best to consult with your doctor before consuming it.
Four types of dark circles under the eyes can be improved by acupuncture massage at the four acupuncture points of the eyes.
Staying up late is often the cause of dark circles under the eyes. However, sometimes the appearance of dark circles is a reflection of one’s physical condition.
Dr. Liao Wanrong, Traditional Chinese Medicine (TCM) practitioner from Yurong Chinese Medicine Clinic in Taiwan, said there are four types of dark circles under the eyes: stasis and swelling type, nasal disease type, chronic allergic type, and aging eye bag type.
The dark circles of the stasis and swelling type are related to daily life and stress. Nasal ailments, such as allergic rhinitis and chronic sinusitis, cause the nasal disease type. Chronic allergic type mainly occurs in patients with “blood stasis physique” (caused by circulation disorders), chronic conjunctivitis, allergies, and so on. Aging eye bag type is formed by fat sagging due to aging.
Liao emphasized that dark circles can reflect other diseases in the body, such as liver cirrhosis, kidney failure, and aplastic anemia.
TCM Treatment of Dark Circles
For the four types of dark circles, Liao proposed various treatments.
Stasis and swelling type: take TCM herbal medicines for soothing the liver and regulating qi (vital energy).
Nasal disease type: first, deal with the underlying nasal conditions.
Chronic allergic type: use a cold compress to relieve itching and then use TCM medicine to promote blood circulation.
Aging eye bag type: take herbal supplements such as astragalus and codonopsis; apply alternating hot and cold compresses and acupuncture massage, which can help reduce eye bags.
In TCM, qi (vital energy), blood, essence, and body fluids originate from the internal organs and constantly flow inside the body—they are vital for health and well-being.
Apply hot and cold compresses alternately
Applying hot and cold compresses alternately is the easiest way to address all four types of dark circles, especially those related to stasis and swelling. Using compresses in this way not only improves blood and lymph circulation around the eyes but also eliminates edema and dark circles.
Prepare a warm towel, about 100.4-104 degrees Fahrenheit (38-40 degrees Celsius).
Put a wet towel in a plastic bag and place it in the freezer to create an “ice towel.”
Apply the warm towel for one minute, then the ice towel for one minute (or 30 seconds if it feels too cold).
Alternate between the hot and cold compresses about every 10 minutes.
The skin around the eyes is sensitive. Preparing gauze or a cotton handkerchief for children to cover their eyes before applying compresses is recommended.
Acupuncture massage around the eyes
TCM practitioners believe the human body has more than 2,000 acupuncture points connected by pathways or meridians. These pathways create an energy flow (qi) through the body that is responsible for overall health. Disruption of the energy flow can cause disease. Applying acupuncture to specific points is thought to improve the flow of qi, thereby improving health.
Massaging acupuncture points around the eyes can improve the four types of dark circles, particularly for aging eye bags.
Jingming point: located in the depression in the inner corner of the eye.
Chengqi point: located directly below the pupil (with the eyes looking straight ahead) at the lower orbit.
Tongziliao point: extending from the outer corner of the eye to the far edge of the outermost orbital bone.
Yuyao point: the ancients thought that the eyebrows were like fish; the Yuyao—which means fish waist—is in the middle of the eyebrows.
The four acupuncture points are pressed alternately with the left and right fingers. Press each point for six seconds, and repeat the cycle 20-30 times.
Jingming point: located in the depression in the inner corner of the eye. Chengqi point: situated directly below the pupil at the lower orbit.
Massage the acupuncture points around the nose
If you have dark circles caused by nasal problems, you should press the acupuncture points at each side of the nose, the Yingxiang and Bitong points.
Yingxiang points: located at the lower outer sides of the nose.
Bitong point:s located slightly above Yingxiang points.
Press each point for six seconds, and repeat the cycle 20-30 times to improve nasal problems.
According to TCM, forces in our environment cause many diseases. These forces are called the six external pathogenic influences: wind, cold, heat, dryness, dampness, and summer heat.
Liao said that the formation of dark circles is related to blood circulation, and “cold” can easily cause blood coagulation. Iced drinks affect blood circulation around the eyes and should generally be avoided.
Two groups of food can help
Liao suggested eating food rich in vitamin C and collagen to improve dark circles.
1. Vitamin C reduces the precipitation of melanin
Vitamin C improves vascular permeability and helps to reduce pigmentation around the eyes. Liao said, “Sweet peppers, cauliflower, and fruits such as guava are recommended. In TCM’s concept, they are rich in vitamin C and [are] non-cold foods.”
2. Collagen fights sagging eye bags
The aging eye bag type is related to the loss of collagen. People can eat more collagen-rich foods such as duck wings or the feet, skin, and tendons of pork.
Those who are worried about high cholesterol content and the possibility of cardiovascular disease can choose fish skin, sea cucumber, or food with high-quality protein, such as fish, meat, eggs, milk, and beans, combined with vitamin C, which can help collagen hyperplasia.
Use caution applying tea bags
Green tea and black tea contain tannins, which can reduce swelling and are good astringents, but tea bags also have other ingredients that can irritate the thin and tender skin around the eyes. Liao reminded people when using hot and cold tea bags alternately:
Cover eyes with gauze first, then apply the tea bag.
The temperature of the tea bag for the hot compress should be 100.4-104 degrees Fahrenheit (38-40 degrees Celsius); it should not be too hot.
Store the iced tea bags in the refrigerator overnight (storing them for extended periods can cause mold).
Dark circles are not only an external problem but also reflect the condition of the internal organs. Liao emphasized that improving dark circles is based on internal conditioning, not applying eye creams or concealer.
“Enough sleep, a regular lifestyle, and proper exercise, which can relieve stress, really can help you to achieve big bright eyes,” she said.
Research has indicated that reading books may cause people to form greater connections, or expand their perception, of the outside world. (MIND AND I/Shutterstock)
The headline has exercise written all over it. But I’m not here to trick you into exercise. In fact, I’m not even going to give you a list of 30-minute healthy recipes. Nope. This little bit of news is less about getting active and more about sitting down in a comfortable chair. So, it might be time to pick up a good book.
In what might be the most surprising bit of news I’ve read in a while, I learned that sitting with a book for at least 30 minutes per day has the potential to lead to a longer life. It may also have the potential to maintain cognition and stave off dementia.
Researchers from Yale University concluded reading books was associated with longer, healthier lives. Looking at data collected from the University of Michigan’s Health and Retirement Study (HRS), they found that reading books for at least 30 minutes per day was associated with living two years longer when compared to non-readers. They also found that book readers were 23 percent less likely to die than those that only read newspapers and magazines.
What gives books the benefit over newspapers, magazines, Facebook, and Instagram? It could be that books encourage a deeper form of engagement. As opposed to skimming news or rifling through headlines, reading books forces people to pay more attention and use more of their brains.
Research has indicated that reading books may cause people to form greater connections, or expand their perception, of the outside world. These connections may activate the brain to forge pathways between hemispheres and lobes at a higher rate. Creating and activating neural networks can promote brain health and are closely associated with preventing dementia and cognitive decline. Close, engaged reading may also stimulate greater blood flow in the region.
Sitting quietly and reading a book, not social media, newspaper, or magazines may help boost the length and quality of your life. Reading just be the most accessible anti-aging tool yet!
Vitamin D supplementation could help reduce cancer risk.
Interest in the sunshine vitamin exploded during the pandemic due to its immunity-boosting effects. A new study finds that regularly taking vitamin D supplements is linked to a significant reduction in melanoma risk.
Researchers also discovered that people who regularly took vitamin D supplements also had reduced risk of other kinds of skin cancer.
Regularly Taking Vitamin D Linked to Reduced Melanoma Risk
The new study was conducted under the North Savo Skin Cancer Programme in Finland and included 498 adult patients estimated to have an increased skin cancer risk for:
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Serum calcidiol levels, a measure of vitamin D in the blood, were analyzed in about half of the patients and were found to correspond to the patients’ self-reported intake of vitamin D supplements.
A key finding was that among regular vitamin D users, there were lower percentages of participants with a history of past or present melanoma—only 18 percent compared to 32 percent in those who didn’t take vitamin D supplements.
When researchers looked at other types of skin cancer, just 62 percent of regular supplement users had a history of the disease, compared to nearly 75 percent of non-users.
“Regular use of vitamin D associates with fewer melanoma cases, when compared to non-use, but the causality between them is obscure,” concluded the study authors.
Dr. Adam Starr, an oncologist at Staten Island University Hospital, part of Northwell Health in New York, told The Epoch Times that there are several possible reasons vitamin D could have an anti-melanoma effect.
“[Reasons could include] modulation of the immune system and [vitamin D’s] antioxidant effects,” he explained. “Additionally, the relationship between vitamin D metabolism and sunlight exposure, plus melanoma and sunlight exposure may have some interplay.”
Research shows vitamin D also reduces inflammation associated with increased cancer risk, has antitumor properties, and even improves the effectiveness of some anticancer therapies.
Vitamin D is known to help our bodies absorb and retain calcium and phosphorus, which are crucial for healthy bones. Many organs and tissues have receptors for vitamin D, suggesting this nutrient plays important roles beyond bone health.
Sun Exposure Necessary for Vitamin D, but Also a Cancer Risk
Vitamin D is both a vitamin found in food and a hormone our bodies produce when exposed to sunlight.
While exposing our skin to sunlight is among the best ways to get vitamin D, natural ultraviolet light is also one of the major risk factors for melanomas and nonmelanoma skin cancer.
Periodic sun exposure and being sunburned during childhood and adolescence are also associated with increased melanoma risk, especially for fair-skinned people with blond or red hair. Treatment for melanoma is limited to surgical removal, as the condition has a low response rate to chemotherapy.
However, about 35 percent of U.S. adults are vitamin D deficient, and the American Osteopathic Association blames sunscreen use (used by many to prevent skin cancer) as the culprit.
“People are spending less time outside and, when they do go out, they’re typically wearing sunscreen, which essentially nullifies the body’s ability to produce vitamin D,” said Dr. Kim Pfotenhauer, a board-certified osteopathic family physician and assistant professor at Touro University, said in a statement.
The solution is moderation; spend five to 30 minutes in mid-day sun twice per week, depending on your geographic location and skin pigmentation (lighter skin makes more vitamin D than darker skin). Pfotenhauer said it’s important to forget the sunscreen during these sessions because SPF 15 or higher can decrease vitamin D production by up to 99 percent.
“You don’t need to go sunbathing at the beach to get the benefits,” emphasized Pfotenhauer. “A simple walk with arms and legs exposed is enough for most people.”
Vitamin D Supplementation Upper Limit for Healthy People
When taking vitamin D supplements, there’s an optimal daily dose, and taking more than that could adversely affect our health.
Starr cautioned that vitamin D requirements depend on a person’s baseline vitamin D level and whether they have a malabsorption condition.
“Therefore, the amount one should take if they want to supplement should be discussed with their physician,” he said.
For healthy adults with normal absorption, the National Institutes of Health recommends a maximum of 4,000 international units (IU) per day for adults 19 years and older.
The amount of supplementation that’s too much is still unclear, but there’s evidence that taking 60,000 IU per day for several months could be toxic.
The main risk of too much vitamin D is a condition called hypercalcemia (too much calcium in the blood), which can lead to various neurological symptoms.
“[Symptoms of hypercalcemia include] confusion, fatigue, coma, as well as bone pain, weakness, stomach pain, nausea, constipation, increased urination, kidney problems, among many others,” said Starr.
Vitamin D Could Protect Against Other Cancers
Regarding the Finnish study, Starr said it’s interesting, but still insufficient evidence to recommend taking vitamin D to prevent melanoma because that study had too many confounding factors.
“For example, patients who take vitamin D might also be more likely to wear sunscreen, and that might be what actually accounts for the difference,” he said. “The authors did a statistical analysis to try to eliminate these biases, but the history of these kinds of studies [shows] that a clinical trial, or a forward-looking prospective study, is really needed to definitively say that vitamin D might lower the risk of melanoma.”
But this is only one of many studies in recent years that finds an association between vitamin D levels and cancer risk.
Research published in 2018 that looked at data from about 13,000 people found that not taking enough vitamin D could increase our risk of colorectal cancer by up to 31 percent.
Another study found that prostate cancer cells responded to vitamin D with decreases in proliferation, invasiveness, and metastasis (spreading in the body).
Not all the research showed a prevention benefit, but scientists still observed a potentially life-saving effect. A recent meta-analysis of randomized controlled trials concluded that vitamin D supplementation significantly reduced total cancer mortality, although it failed to reduce total cancer incidence.
Harvard Health recommends that healthy-weight people at risk for developing cancer because of lifestyle or family history of cancer take daily vitamin D supplements starting at about age 50.
Liver cancer is the sixth most common cancer in the world, with more than 900,000 new cases every year, and a fatality rate that ranks third among all cancers. Recently, the Li Ka Shing faculty of medicine of the University of Hong Kong (HKU) released the world’s first comprehensive treatment plan for intermediate liver cancer, called the “Reduce and Remove” program.
Clinical studies have shown that for intermediate liver cancer that cannot be removed by surgery, nearly 50 percent of patients can achieve a radical curing effect through the comprehensive treatment plan of “Reduce and Remove.” The research results have been published in the Dec. 2022 edition of The Lancet Gastroenterology and Hepatology.
Liver cancer is one of the top 10 cancers in the world. According to the Hong Kong Cancer Database, there are nearly 1,800 new cases of liver cancer in Hong Kong every year, of which only 30 percent are suitable for curative surgery to achieve complete rehabilitation, while the remaining 70 percent can only receive non-curative treatment to control the disease due to conditions such as enlarged tumor size or vascular invasion.
To improve the chances of liver cancer cure and the survival rate of patients, the team of the HKU Faculty of Medicine recruited 33 liver cancer patients from March 2019 to January 2021. The diameter of the tumors ranged from 5 to 17.5 cm (about 2 to 7 in), and 64 percent of the patients had tumors that had invaded the large blood vessels that could not be cured immediately by surgery. The 33 patients were treated with the new “Reduce and Remove” tri-modality therapy (START-FIT).
The patient received transarterial chemoembolisation on the first day of treatment to control the tumor, and stereotactic body radiotherapy on day 28 to attack the tumor head-on. The PD-L1 immunotherapy Avelumab treatment was given 14 days later—then once every 2 weeks to continue striking the cancer cells and shrink the tumor to a size appropriate for surgical removal, thereby eradicating the cancer.
Eighteen patients (about 55 percent) were considered suitable for surgery after receiving the tri-modality therapy, among which four patients (about 12 percent) underwent curative surgery, and 14 (42 percent) were selected for regular close monitoring by imaging as the tumor cells were completely necrotic. The subsequent two-and-a-half-year follow-up showed a survival rate of more than 90 percent within two years.
The study reported the treatment’s approach is “minimally invasive with short hospital stay and a relatively high safety profile,” with the most common side effects including “temporary liver function derangement after TACE,” with some patients developing a “mild immune reaction.”
The “Reduce and Remove” therapy provides an opportunity for liver cancer patients who are not suitable for surgery to be otherwise successfully treated. The full-term treatment costs are around HK$200,000—about U.S.$25,600. Chan Chi-yan, a clinical professor of the Department of Surgery, School of Clinical Medicine, said: “This treatment strategy provides a definite treatment schedule. Most patients could have an idea of the treatment effect within 6 months after the start of treatment and be able to have better planning for themselves and their families.”
Chan added, “Now the team is looking forward to expanding the treatment coverage to more patients, especially those with poor liver function, to help downstaging the tumor status and hence, increase the chance of fitting into the criteria for liver transplantation in the future. We are also seeking ways to improve the efficacy of immunotherapy, from a single agent to double agents, to deliver a more enhanced and solid treatment result.”
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