Don’t Just Sit There, Do Something!

It’s so important to stay active! Great read.
— Dr. Dale

From Don’t Just Sit There, Do Something!

Sedentary behavior—or as those of us outside of academia like to call it: “sitting,” “couch potatoism,” or “binge-watching Game of Thrones with a pint of Ben & Jerry’s”—has long been linked to a host of rotten outcomesobesitydepressiondiabetesmetabolic syndromeheart disease, and lousy health over all. (Honestly, you could sit and read scientific papers on this for days on end: Pubmed, the NIH’s archive of biomedical literature catalogs 4,386 papers on sedentary behavior published just since the start of 2016.)

But a new study published yesterday in the Annals of Internal Medicine (which, unfortunately, is available only to Annals subscribers), sheds new light on the issue and sounds a loud, clanging alarm bell about the lasting health risks of prolonged sitting. And, yes, it’s worth sitting and reading this one.

Keith Diaz, an assistant professor of behavioral medicine at Columbia University Medical Center, and colleagues at five other institutions, somehow managed to convince 7,985 people aged 45 and older to wear an Actical accelerometer (made by Philips Respironics)—which measures physical movement and energy expenditure—on their right hips for more than 10 hours a day over a stretch of at least four days. (Most people wore the device for at least six or seven days, Diaz told me in an interview this morning.) Then the team retrieved the devices, crunched the stored data, and determined how often the study subjects actually got off of their butts during that period and for how long—whether they were at home, at work, or someplace else.

Overall, during a typical 16-hour waking day, the four groups spent an average of 12.3 hours being sedentary—with the mean “bout” of uninterrupted butt time being 11.4 minutes.

But then Diaz and crew divided this giant couch-warming cohort into four different quartiles based solely on movement (that is, non-sitting) patterns—and they waited several years to see whether mortality outcomes differed between the groups.

Differ they did.

After a median four years of post-study follow-up, those in the least sedentary quartile (sitting a mean 649 minutes a day in typically 6.5-minute bouts) had a dramatically lower rate of death from all causes than those in the most sedentary group (835 minutes at rest, in periods of relative motionless averaging just under 20 minutes each).

Not surprisingly, those who were more active also tended to be younger, have less body mass, and have fewer health issues (diabetes, hypertension, cardiovascular disease) in general. To account for those differences, the research team did several post-hoc analyses where they controlled for these and other factors (smoking, alcohol consumption, region of residence, education) with three different statistical models. In each case, those who sat the least—and for the shortest periods of duration—had the lowest rate of death from all causes.

Indeed, this duration of couchification is the most telling aspect of the study: Those who got up more frequently—presumably, even to stand and fetch the cable remote…or a glass of water in the kitchen, let us hope—were less at risk. (“Persons with uninterrupted sedentary bouts of 30 minutes or more had the highest risk for death if total sedentary time also exceeded 12.5 hours per day,” observed David Alter, a Toronto researcher who was not involved in the study, in an accompanying editorial.)

So why is prolonged, unbroken sitting so dangerous? Diaz (who uses a standing desk, take note) says he and his colleagues hypothesize that it might interfere with glucose regulation—encouraging a pathological transformation in muscle tissue that may have parallels to diabetes: “The muscles stop working like they’re supposed to and they stop taking up glucose like they’re supposed to,” he says. (That paper is in the current issue of the journal Circulation—and, unfortunately, is also blocked to non-subscribers.)

Whatever the mechanism of action turns out to be, however, the message is clear: Get off your damn butt, and do something.

4 Things Psychologists Do Every Day To Feel Happier

Here are some great tips to lift your mood!
— Dr. Dale

From 4 Things Psychologists Do Every Day To Feel Happier

While there’s no one secret to happiness, regular self care can go a long way towards boosting your mood. People find joy in different places, so the key is to identify healthy habits that please you — and make time for them daily.

“As Aristotle put it, ‘Happiness is an activity’,” says Jason Wheeler, PhD, a psychoanalyst in New York City. “Lots of things in life just happen to us, but many other things we have to do, and being happy is one of them.”

So what do mental health experts do to harness happiness? We asked three therapists to share the everyday self-care strategies that help them stay positive and grounded, even during times of stress. Here, four of their get-happy habits to try for yourself.

1. Be mindful

The term “mindfulness” probably conjures up images of yoga or quiet meditation, but Wheeler says it’s possible to embrace this way of thinking while doing many different forms of exercise. His mind-body workout of choice is swimming, since the repetitive motions naturally lend themselves to mindful thinking.

“To swim well, I must concentrate just on what I am doing,” he explains. “I exist from stroke to stroke, from breath to breath.”

Plus, swimming is a terrific low-impact workout. “When I’m done, I don’t feel sore, but refreshed and energized,” Wheeler says, adding that 30 minutes to an hour of swimming is the perfect meditative break during a busy day.

2. Take notes

Don’t just get grateful at Thanksgiving. Studies show that expressing gratitude can lead to benefits like better sleep and lower risk of depression. And unsurprisingly, mental health experts are all about it.

“If I’m getting down or feeling anxious, I’ll make a list of things that I’m grateful for,” San Antonio-based therapist Kasi Howard, PsyD, tells Health. “It flips my mindset and keeps me from ruminating on things that are stressful, or from focusing on the negative. Plus, it’s a big mood lifter.”

Ready to try it for yourself? Our gratitude challenge will have you feeling happier and more appreciative in just 21 days.

Studies show that expressing gratitude can lead to benefits like better sleep and lower risk of depression.

3. Sweat it out

Another proven happiness-booster? Cardio workouts. “Running is a source of sanity for me,” says Howard. “Not only is it my stress relief, it’s also when I think of ideas.”

There’s a scientific reason why Howard feels particularly sunny after a sweat session. Exercise causes a spike in adrenaline throughout the body, which is followed by a release of mood-boosting endorphins. And even relatively small amounts of exercise can make a difference; one recent study found that light physical activity was associated with a greater emotional benefit compared to moderate and high-intensity exercise. Sweat, smile, repeat.

4. Connect with others

“I spend a little quiet time with my husband every day talking about ‘us,’” says Gail Saltz, MD, Health’s contributing psychology editor. “Doing so keeps our relationship strong, and that makes me happy.”

Saltz and her hubby may be onto something. Communication is key in all relationships, especially romantic ones. In a 2015 study of newlywed couples published in the Journal of Social and Personal Relationships, researchers found that wives who perceived their husbands to be habitually suppressing their emotions reported lower marriage quality over time. So go ahead, express yourself.

Eat These Common Foods to Cut Your Risk Of Colon Cancer

Worth noting!
— Dr. Dale

From Eat These Common Foods to Cut Your Risk Of Colon Cancer

You know whole grains are good for your heart, but they may have another benefit, too, according to a new report from the World Cancer Research Fund and the American Institute for Cancer Research.

After reviewing six studies in a meta-analysis, which included 8,320 cases, researchers concluded that eating at least 90 grams of whole grains per day can slash your colon cancer risk by 17 percent.

That’s a pretty big deal, since colorectal cancer is the third most diagnosed cancer in men, making it the second leading cause of cancer death, according to the American Cancer Society (ACS).

And colon cancer is quickly on the rise in young people. People born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer than people born in 1950, a study from the ACS found.

So, how can eating oats and brown rice help prevent colon cancer from forming in the first place? Whole grains are a great source of dietary fiber, which helps reduce insulin resistance—or the inability for your body to absorb blood sugar, causing it to accumulate—which is a known risk factor of colon cancer. Fiber also keeps you regular, which is important, since passing waste quickly reduces the chances of cancer-causing mutations to develop.

Plus, the bran and germ of your grains are packed with certain anti-carcinogenic compounds, like vitamin E, selenium copper, and zinc, the report states.

To get the best bang for your nutritional buck, load up your plate with oatmeal, whole wheat bread, and brown or wild rice, which are all touted by the American Heart Association

Just bear in mind your diet can only take you so far. Once you hit 50, you should start getting screened for colon cancer regularly, but only a little more than half of people who should get tested actually do so, according to the ACS.

Yet, colonoscopies can save your life, since a majority of people who are diagnosed with early-stage colon cancer are cured. If you have a first-degree family member that suffered from colon cancer, then you should start screenings at 40, or 10 years younger than when they were diagnosed, the American Academy of Gastroenterology recommends.

And if you experience the telltale symptoms—like blood in your stool, abdominal cramping, and persistent constipation or diarrhea—tell your doctor, stat. He or she may recommend a colonoscopy to check what's up.

Thousands Of Americans Still Die Of AIDS Every Year

Very educational.
— Dr. Dale

From Thousands Of Americans Still Die Of AIDS Every Year

Yet antiretroviral therapy can turn the deadly disease into a manageable chronic condition.

Antiretroviral therapy has transformed HIV from a death sentence to a manageable chronic condition for many. Yet as the death of 41-year-old Broadway composer Michael Friedman this past Saturday reminds us, thousands of Americans still die every year from HIV/AIDS.

In 2014, the last year for which these data are available, 12,333 Americans with HIV died of any cause, and 6,721 of them died from causes directly attributable to HIV. 

“AIDS has certainly not gone away,” said Dr. Jeffrey Klausner, a professor of medicine and public health at the UCLA David Geffen School of Medicine. “At an average of 20 deaths a day, it’s something that’s occurring regularly.”

An estimated 1.1 million people in the U.S. are living with the disease, although about 15 percent of them don’t know they have it. But HIV/AIDS doesn’t draw the media attention it once did.

“We need to continue to be aware, continue to talk about it and continue to advocate for prevention and treatment resources,” Klausner said.

To Prevent And To Heal 

The message from public health officials is clear: If you test positive for HIV, get into treatment right away. Taking antiretroviral medicines every day can bring HIV levels in a person’s body so low as to be almost undetectable, which drastically reduces the chances of passing the virus to someone else.

At the same time, lower HIV levels drastically reduce the chances that you’ll die of HIV/AIDS complications. Untreated HIV weakens the immune system, leaving a person more susceptible to other infections and cancer. The virus also keeps the body in a state of chronic inflammation, which increases the risk of heart diseasestroke and dementia.

Getting into treatment as soon as possible is key to preventing HIV from wreaking havoc on the body. Federal funds are available for those who can’t afford medication. But still not everyone gets tested soon enough, obtains the medication and/or manages to take it daily. 

The more pills skipped, the more patients run the risk that their virus levels will spike. In rare cases, they may even become resistant to the antiretroviral medication.

“Treatment is great for those who can access it early and take it every day, there’s no question about it,” said Dr. Steven Deeks, professor of medicine at the University of California, San Francisco. “But a lot of people just cannot get the drugs, or when they do, they can’t take them for a variety of reasons.”

Reasons for not taking medication or missing checkups range from the mundane (too busy, difficulty in scheduling appointments) to the alarming (homelessness, lack of transportation, depression and shame). Many people who need care also struggle with mental illness and substance abuse. 

“So in countries like Switzerland, where there’s a lot less poverty and they have a health care system that delivers these drugs universally, they’re doing better than the U.S., where we have a tremendous amount of social and economic issues that get in the way,” said Deeks. 

The People Most At Risk

AIDS-related deaths are down around the world ― from about 1.9 million in 2005 to about 1 million in 2016. While the numbers are also dropping in the U.S., the country’s staggering socioeconomic inequality and lack of universal health care means that it still outpaces other wealthy developed nations in new HIV infections and falls behind them in widespread testing and treatment.

In the U.S., 39,513 people were diagnosed with HIV in 2015, the last year for which that number is available. The same year, only 29,747 people were diagnosed with HIV in the 31 countries that make up the European Economic Area and whose combined populations are about 200 million more than the U.S. population. 

Klausner pointed to “this great imbalance of the haves and have-nots” in explaining why the American rates of HIV infection and AIDS deaths are still so bad.

In 2015, about half of all new HIV diagnoses in the U.S. were among people living in the South, which is home to some of America’s poorest citizens and offers the least access to affordable health care. In addition to having the highest rates of new HIV diagnoses and HIV-related deaths, the South is burdened with high rates of diabetes and cancer, the Centers for Disease Control and Prevention notes. 

New HIV diagnoses in 2015 were also concentrated among gay and bisexual men of all races and among black straight women.

“We still have major gaps in our ability to address certain populations, particularly in southeastern parts of the U.S., and particularly among African Americans,” Klausner said.

Subpopulations representing 2 percent or less of HIV diagnoses are not reflected in this chart. The abbreviation “MSM” here stands for men who have sex with other men.

How To Stop More Diagnoses And Deaths

One way to stem the tide of new HIV infections in the U.S. would be to present people who get tested with two pathways, Klausner said. If they test positive, they should receive treatment right away. If they test negative, doctors should still talk with them about a plan to forestall future HIV infection ― potentially including taking a medication like PrEP that substantially lowers the risks of contracting the disease.

While this approach is standard at publicly funded clinics, Klausner said, private-sector health care ― which serves most Americans ― has been slow to adopt such prophylactic medicine. 

“While we say HIV is manageable and AIDS is preventable, it’s much better to prevent someone from getting HIV in the first place,” he said.

Doctors, nurses and other clinic staff should also recognize how much their actions affect patients’ will and ability to follow a treatment plan. A 2015 qualitative study conducted by researchers at the University of Pennsylvania found that simple things like positive relationships with clinic staff, patient-friendly services such as arranging transportation, and even calls to remind people of an appointment were a big factor in helping patients stay on their regimen. 

Flu 2017 - The Good News And The Bad News

Flu season is around the corner. Here’s what to expect this year from the American Council on Science and Health.
— Dr. Dale

From Flu 2017 - The Good News And The Bad News

New reports out of Australia contain some sobering news. The number of influenza cases this year is 2.5-times that of the same time period last year. Since the flu season down under begins in July, these data may give us a glimpse of what to expect in the US this winter.  New South Wales, which has the highest population of any state in the country, had more than 35,000 confirmed flu cases in August. To put this in perspective, the previous record for most cases in a month was 16,686 this past July. August 2016 had 13,602 cases and August 2015 had 12,901. 

A very bad year

Clearly, the flu is hitting Australia very hard. Does this mean that we are in particular danger this year? Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID) says not necessarily, because of the unpredictability of the virus.

"There's nothing really unusual about this year except that it's a high year in Australia, which is what you see every once in a while... [Australia's curve] is clearly much higher than the curve of last year... All the flu-ologists, myself included, say the only thing that you can predict about influenza is that it's going to be unpredictable." 

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases

Good news, bad news

Although it is troubling to see a record number of cases in Australia, the good news is that this year's vaccine matches quite well with the predominant Australian strain, H3N2 (1). The bad news is that vaccines are less effective against H3N2, which causes more severe disease than most other strains. Dr. Vicky Sheppeard, the director of communicable diseases at the New South Wales Health Department explains:

[Early data indicates the four flu strains in the vaccine are well-matched to circulating viruses,"  [but] It is known that one of the strains in the vaccine [H3N2] is less effective in preventing infection, despite a good match."

Dr. Vicky Sheppeard, the director of communicable diseases, NSW Health

So, even though, as Dr. Fauci points out, that vaccine which will be used this year is "essentially identical" to the vaccine being used in Australia, "An intelligent guess, therefore, is that the north will probably have a bad flu season." 

And, just like the composition of each year's vaccine, which must be decided six months before the start of the flu season (2), predicting what the flu will finally do is at best as an educated guess. Dr. Paul Offit, the chief of the division of infectious diseases at Children’s Hospital of Philadelphia, and a former American Council advisor concurs.

Preventing influenza infections is one of the most difficult tasks in medicine. Every year the virus mutates. Some years the virus is particularly aggressive; some years not. It's like predicting the stock market.

Dr. Paul Offit, the chief of the division of infectious diseases at Children’s Hospital of Philadelphia

What to do? As is the case frequently in medicine, there is no ideal drug or vaccine for a particular condition. So the risks of an imperfect treatment must be weighed against its benefits. With flu, this is a no-brainer. Even in years where the coverage (match of circulating strains and those in the vaccine) is terrible (3), I roll up my sleeve. Flu is a very serious disease (4) and the vaccine is very safe. Adverse effects, if any, are mild and transient. One serious adverse effect, Guillain-Barré syndrome (GBS) is estimated to occur in 1-2 people per million vaccinations.

There is the information. I hope you make the right decision.

Notes:

(1) H stands for hemagglutinin, a viral surface protein, which is responsible for binding the virus to the host cell and enabling it to fuse with the host cell membrane, allowing it to penetrate the cell. N stands for neuraminidase, a viral enzyme that is responsible for cleaving the virus from the membrane once it enters the cell. Both proteins are essential for replication of influenza virus. 

(2) Selecting the strains covered in each year's vaccine is a daunting task. Investigators must make an educated guess of which strains to include based on predominant strains circulating in Asia and Australia six months in advance since it takes that long to grow the vaccine in eggs. Sometimes the predominant strain in Asia will end up not being be the predominant strain in the US. Worse still, even when the circulating strains and those chosen for the vaccine may be a perfect match, the vaccine can still be ineffective. This is partly because the virus can mutate during that time, which renders the vaccine less effective, or even ineffective. 

(3) The 2014-5 season vaccine was very ineffective. It reduced illness by only 19%  far less than a "good" vaccine (50-60%). But 19% is still better than nothing.

(4) Flu kills between 3,300 and 49,000 people per year in the US. The average is about 36,000. For perspective, here are annual mortality figures for selected cancers;

  • Breast - 40,000
  • Prostate - 27,000
  • Colon - 50,000
  • Lung - 156,000

The New Science On Anxiety And Gut Health

Gut health is so important! Great read.
— Dr. Dale

From The New Science On Anxiety And Gut Health

While docs used to treat mental health conditions with a pill and a glass of water, the times are changing. Probiotics are arguably the new Prozac already—and now there’s a concrete case for combating anxiety with good bacteria, too.

In a new study conducted at the University of Cork in Ireland, researchers broke new ground in understanding the relationship between gut health and anxiety. While the microbiome-brain connection—AKA the link between digestive and mental health—has been established in other studies, this time they found a first-of-its-kind connection between gastrointestinal microbes and gene regulators in the brain (called microRNAs).

In the study, researchers discovered the mice living a germ-free life ended up having unusual amounts of anxiety.

“Gut microbes seem to influence miRNAs in the amygdala and the prefrontal cortex,” lead research Gerard Clarke said in a press release. “This is important because these miRNAs may affect physiological processes that are fundamental to the functioning of the central nervous system and in brain regions, such as the amygdala and prefrontal cortex, which are heavily implicated in anxiety and depression.”

In the study, researchers introduced gut bacteria to two groups of mice: One raised in a germ-free environment, and the other made up of mice raised in a normal environment. They discovered the mice living germ-free ended up having unusual amounts of anxiety, but they weren’t stuck with it: When they added the gut bacteria back in later on, they normalized the changes to the miRNAs, showing a healthy gut could be the answer to regulating the miRNAs.

Additional research still needs to be done, but this study is definitely a step in the right direction. If your probiotics seem to help keep your anxiety at a healthy level, keep doing what you’re doing: The little guys in your stomach are on your side.

 

HIV/AIDS and Aging Awareness Day - Learn more about HIV/AIDS

HIV/AIDS and Aging Awareness Day is September 18th. Read this to learn more about HIV/AIDS.
— Dr. Dale

From What Are HIV and AIDS?

About HIV & AIDS

HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These special cells help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections and some other diseases. Opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS. Learn more about the stages of HIV and how to know whether you’re infected.

What Is HIV?

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS, if not treated. Unlike some other viruses, the human body can’t get rid of HIV completely, even with treatment. So once you get HIV, you have it for life.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS, the last stage of HIV infection.

No effective cure currently exists, but with proper medical care, HIV can be controlled. The medicine used to treat HIV is called antiretroviral therapy or ART. If taken the right way, every day, this medicine can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

What Is AIDS?

AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic infections.

What Are the Stages of HIV Infection?

Without treatment, HIV advances in stages, overwhelming your immune system and getting worse over time. The three stages of HIV infection are: (1) acute HIV infection, (2) clinical latency, and (3) AIDS (acquired immunodeficiency syndrome).

However, there’s good news: by using HIV medicines (called antiretroviral therapy or ART) consistently, you can prevent HIV from progressing to AIDS. ART helps control the virus so that you can live a longer, healthier life and greatly reduces the risk of transmitting HIV to others.

These are the three stages of HIV infection:

Acute HIV Infection Stage

Within 2 to 4 weeks after infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection. People who think that they may have been infected recently and are in the acute stage of HIV infection should seek medical care right away. Starting treatment at this stage can have significant benefits to your health.

During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 cells to replicate and destroys them in the process. Because of this, your CD4 cells can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.

During the acute HIV infection stage, you are at very high risk of transmitting HIV to your sexual or needle-sharing partners because the levels of HIV in your blood stream are extremely high. For this reason, it is very important to take steps to reduce your risk of transmission.

Clinical Latency Stage

After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)

During the clinical latency stage, the HIV virus continues to reproduce at very low levels, even if it cannot be detected with standard laboratory tests. If you take ART, you may live with clinical latency for decades and never progress to AIDS because treatment helps keep the virus in check. (Read more about HIV treatment.)

People in this symptom-free stage are still able to transmit HIV to others, The risk of transmission is greatly reduced by HIV transmission. In studies looking at the effects of HIV treatment on transmission, no new HIV infections have been linked to someone with very low or undetectable (suppressed) viral load.

For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster. As the disease progressions, eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body before you develop AIDS.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.

Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. ART can be helpful for people who have AIDS when diagnosed and can be lifesaving. Treatment is likely to benefit people with HIV no matter when it is started, but people who start ART soon after they get HIV experience more benefits from treatment than do people who start treatment after they have developed AIDS.

In the United States, most people with HIV do not develop AIDS because effective ART stops disease progression. People with HIV who are diagnosed early can have a life span that is about the same as someone like them who does not HIV.

People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how much virus they were exposed to and its genetic characteristics, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful dietexercise, and not smoke.

Is There a Cure for HIV?

No effective cure currently exists for HIV. But with proper medical care, HIV can be controlled. Treatment for HIV is called antiretroviral therapy or ART. If taken the right way, every day, ART can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS (the last stage of HIV infection) in a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

Learn about how to protect yourself, and get information tailored to meet your needs from CDC’s HIV Risk Reduction Tool (BETA).

Celiac Disease Symptoms

Think you may have celiac disease? Here’s a good reference for symptoms.
— Dr. Dale

From Celiac Disease Symptoms

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test.  A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.

Does Your Child Have Celiac Disease?

Digestive symptoms are more common in infants and children. Here are the most common symptoms found in children:

  • abdominal bloating and pain
  • chronic diarrhea
  • vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss
  • fatigue
  • irritability and behavioral issues
  • dental enamel defects of the permanent teeth
  • delayed growth and puberty
  • short stature
  • failure to thrive
  • Attention Deficit Hyperactivity Disorder (ADHD)

Do You Have Celiac Disease?

Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea.  Adults are more likely to have:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • osteoporosis or osteopenia (bone loss)
  • liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
  • depression or anxiety
  • peripheral neuropathy ( tingling, numbness or pain in the hands and feet)
  • seizures or migraines
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • dermatitis herpetiformis (itchy skin rash)
     

Classical, Non-Classical and Silent Celiac Disease

According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.

Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet they report better health and a reduction in acid relux, abdominal bloating and distention and flatulence. First-degree relatives (parents, siblings, children) , whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease.

The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently it is estimated that 80% of the celiac disease population remains undiagnosed.

Celiac Disease Symptoms Checklist

CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.

Complete the Symptoms Checklist

Who Should Be Screened for Celiac Disease?

According the the Celiac Disease Center at Columbia University Medical Center, “anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.”

First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risk of developing celiac disease compared to the general population risk of 1 in 100.

Non-Celiac Wheat Sensitivity

Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.

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More Young People Are Dying of Colon Cancer

Scheduling a colonoscopy is more important now than ever. Book an appointment with us today.
— Dr. Dale

From More Young People Are Dying of Colon Cancer

When researchers reported earlier this year that colorectal cancer rates were rising in adults as young as their 20s and 30s, some scientists were skeptical. The spike in figures, they suggested, might not reflect a real increase in disease incidence but earlier detection, which can be a good thing.

Now a sobering new study has found that younger Americans aren’t just getting cancer diagnoses earlier. They are dying of colorectal cancer at slightly higher rates than in previous decades, and no one really knows why.

“This is real,” said Rebecca L. Siegel, an epidemiologist with the American Cancer Society and the lead author of the current study, published as a research letter in JAMA, as well as of the earlier report. “It’s a small increase, and it is a trend that emerged only in the past decade, but I don’t think it’s a blip. The burden of disease is shifting to younger people.”

The study found that even though the risk of dying from colon and rectal cancers has been declining in the population over all, death rates among adults aged 20 to 54 had increased slightly, to 4.3 deaths per 100,000 people in 2014, up from 3.9 per 100,000 in 2004.

“This is not merely a phenomenon of picking up more small cancers,” said Dr.Thomas Weber, who was not involved in the study but is a member of the steering committee of the National Colorectal Cancer Roundtable. “There is something else going on that’s truly important.”

No one knows what underlying lifestyle, environmental or genetic factors may be driving the rise in cases.

While rates of cancers tied to human papillomavirus, or HPV, have been rising in recent years, that virus causes cancers mainly of the cervix, back of the throat and anus, and scientists do not believe sexual behaviors or HPV are driving the increase in colon or rectal cancer (anal and rectal cancers are distinct).

Obesity, a diet high in red or processed meats and lack of physical activity are among the factors tied to increased risk, but new research is looking at other possible causes. One recent study found, for example, that prolonged use of antibiotics during adulthood was associated with a greater risk of developing precancerous polyps, possibly because antibiotics can alter the makeup of the gut microbiome.

Scientists are also exploring whether the colorectal cancers emerging in younger adults are different from those seen in older people — and whether they can be detected and treated with the same tools. There is some evidence that young people are more likely to have precancerous polyps that are harder to see and remove during a colonoscopy because of their location in the colon or because they are flat rather than tubular, according to Dr. Otis Brawley, who is chief medical officer for the American Cancer Society.

The findings add to the urgency to find reliable ways to detect colorectal cancer early in young people. Most medical groups have for years recommended people start routine screening only at age 50 unless they have specific risk factors, like a family history of the disease or chronic conditions like inflammatory bowel disease that raise the risk. One organization, the American College of Gastroenterology, recommends that African-Americans start routine screening at 45 because they are at higher risk for colorectal cancer than whites.

Any proposal to expand universal screening, however, will be both controversial and potentially costly, since the vast majority of colorectal cancer deaths still occur among older adults.

“I don’t know that this very small uptick in mortality means we ought to start doing colonoscopies on 20-year-olds as a routine matter,” said Dr. Michael Potter, a professor of family and community medicine at the University of California, San Francisco. More lives would be saved by increasing screening at age 50, he said, adding, “It’s worth doing research in this area to determine whether lowering the age of colorectal cancer screening would yield more benefits than harms. These are not risk-free procedures.”

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Screening tests are also expensive, though cost is not the driving issue. Looking for colon cancer in young people is like looking for a needle in a haystack — you’d have to screen a lot of people to detect even a small number of cancers or precancerous polyps. Most young people would go through the process for no good reason, and some would sustain injuries or other harms.

Complications from colonoscopy, considered the gold-standard test, are fairly frequent. A study of over 300,000 healthy Medicare patients who had colonoscopies found that nearly 2 percent wound up in an emergency room or hospital within a week of the procedure because of complications such as tears in the wall of the colon or rectum, which can be life-threatening.

But while some organizations specifically state that colonoscopy is the preferred screening method, the United States Preventive Services Task Force endorses a variety of screening tests, including some that are less expensive or noninvasive, though they may not be as effective in finding and preventing cancers. Stool tests that examine fecal samples for microscopic amounts of blood and DNA changes, for example, can indicate the presence of a tumor or polyp, but such tests need to be done more frequently and may have to be followed up with a colonoscopy if the result is positive.

All of the testing options have pros and cons, and some may yield a false positive test, subjecting someone to additional testing for no reason, or a falsely reassuring negative result.

But Dr. Brawley said there is good scientific data to show that stool sample tests save lives, and added that some patients may be better served by these noninvasive tests. “In the U.S., we have all gravitated toward the new high-tech screening methods, and we may be leaving old technology that is still very good,” he said.

Screening guidelines aside, people concerned about colorectal cancer at any age should talk to their doctor, said Dr. Douglas Owens, vice chairman of the Preventive Services Task Force. “There are always circumstances in which individual decision making is appropriate,” he said.

Many physicians may be reluctant to order screening tests for younger adults, because they are also unaccustomed to seeing this cancer in younger people, Dr. Weber said. He said efforts are being made to raise awareness in physicians as well as patients, adding, “We need to set the trigger much lower to investigate these symptoms and rule out malignancy.”

Warning signs of colorectal cancer include rectal bleeding, bloody stools, unexplained weight loss, fatigue and digestive complaints, or persistent changes in bathroom behavior. Anemia in men is also a warning sign and should be explored further, and while many doctors typically attribute anemia in a premenopausal woman to menstruation, experts say that if a woman is experiencing any other symptoms, doctors should assess her for colon cancer.

Make sure you know your family’s medical history — including not only whether any close relatives had colorectal cancer, but whether they had benign polyps, which can be precancerous. Tell your physician of any medical conditions, such as inflammatory bowel disease, that may increase your risk.

Doctors say you may be able to reduce your risk of colorectal cancer if you maintain a healthy weight, get a lot of physical activity, eat a healthy diet, don’t smoke and avoid excessive use of alcohol.

7 Things You've Always Wondered About a Colonoscopy

If you’re getting ready for a colonoscopy and have a lot of questions about what to expect, this is a great read!
— Dr. Dale

From 7 Things You've Always Wondered About a Colonoscopy

It isn't so bad when you know what to expect.

A colonoscopy is a scary-sounding procedure (who wants a scope going up their most private orifice?!), but it’s one of the best detection tools doctors have for colorectal cancer and bowel diseases. Knowledge is power when it comes to any health procedure, and knowing what to anticipate will make things less worrisome. Here's what to expect before, during, and after a colonoscopy.

1. Um, how do I know if I need a colonoscopy?

For people with no personal or family history of colorectal cancer or inflammatory bowel disease like ulcerative colitis or Crohn's, colonoscopies don’t need to begin until the age of 50, according to the Centers for Disease Control and Prevention (CDC). After that first one, you'll need a test every 10 years.

But for those who meet any of the aforementioned qualifications, you may need to start much sooner and be screened more frequently. The American Cancer Society offers an excellent breakdown (with charts!) of when you should get a colonoscopy based on risk factors like a family history of cancer.

2. Do I have to follow a special diet before the colonoscopy?

The Colon Cancer Alliance recommends that you begin a low-fiber diet the week before your scheduled colonoscopy. In addition to sticking with low-fiber foods, they recommend avoiding fatty foods, fruits and raw vegetables with skins, whole grains, and anything with seeds or nuts, including popcorn. That's because in order for your doctor to successfully view your colon (aka your large intestine), it must be completely empty—and these foods can become caught in your colon for longer than typical waste. Their recommended meal plan includes things like eggs, white bread, turkey or chicken, Greek yogurt, spinach, and melon.

According to Rudolph Bedford, M.D., gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California, preparation is the most important part. “If you don’t do a good job of emptying out your colon, your doctor won't be able to see it clearly,” Dr. Bedford tells SELF. “That can result in a missed polyp, a longer procedure, or even a need to repeat the procedure.”

3. OK, so what can I eat the day before the colonoscopy?

The day before your procedure, a clear liquid diet must be followed. According to the Mayo Clinic, this includes water, clear sodas, fat-free chicken or beef broth, and coffee or tea without added milk or cream. Some doctors have added restrictions or allowances (like hard candy), so make sure you follow their individual instructions. Dr. Bedford suggests checking the ingredients list on anything you eat the day before, and “avoiding any fluids that contain red, blue, or purple food coloring” as they can look like blood in your colon during the colonoscopy.

4. Is the prep really as bad as everyone says it is?

There is no sugar-coating this part: The final step of readying your digestive tract for a colonoscopy is to clear it completely, and this is...unpleasant. Each doctor has their own preferred method, but the end result will be the same: complete emptying of your colon. Some doctors prescribe a large volume of liquid laxative prep, while others recommend over-the-counter pill or powder laxatives. Regardless, you should do this part at home or somewhere you’re comfortable—you’ll be going to the bathroom frequently over the course of several hours, until what you pass is totally clear.

Some helpful prep tips from the Colon Cancer Alliance include chilling the prep solution, using a straw so the liquid goes to the back of your mouth and you avoid too much taste, and following the prep by sucking on a lemon slice or a piece of hard candy.

5. Well, now that all that is over, what happens the day of the procedure?

Some patients will have to finish the rest of their bowel prep that morning, while others will go directly to their appointment. Since you'll be given anesthesia, you'll need to arrange a ride home from the procedure ahead of time. On procedure day, you're not allowed anything by mouth (not even water or gum).

After you arrive at the hospital or surgical center, you’ll change into a gown and get blood taken. Then you’ll be taken to a private room for the colonoscopy. Sedation will be administered, so it’s likely you won’t remember any of the actual procedure (phew!). According to the Mayo Clinic, your doctor will insert a long, flexible tube called a colonoscope into your rectum. The scope has a small camera on the end, and images are projected onto a screen while your doctor does the procedure (you'll notice these screens in the room, before the sedation kicks in). He or she will also puff air into your colon so it expands for a better view. Biopsies (samples of tissue) may be taken, and if any polyps are found, your doctor will remove those as well.

6. So...about that extra air in my colon...

You'll be taken to a recovery area while the sedation wears off. As embarrassing as it might sound (no pun intended), you’ll need to get rid of the air that the doctor shot into your colon. Don’t try to hold it in, because that will only cause unnecessary cramping. Honestly, just take advantage of this one-time opportunity to pass gas without judgment. Once the sedation has mostly worn off, a nurse will check on you and send in the doctor.

“Once you feel better and are more awake,” Dr. Bedford says, “your doctor will provide you with a report of what was learned during the procedure.” This can include ulceration, inflammation, bleeding, scar tissue, polyps, or irregular tissue. Your doctor will also tell you if biopsies were taken and how long it will take to get a result. The Colon Cancer Alliance provides a great list of questions to ask your health provider after the procedure (you can read it here).

7. What should I do the rest of the day?

Once your ride has dropped you off safely at home, take it easy for the rest of the day. You’ll be hungry and thirsty, and unless your doctor has indicated otherwise, you’re free to eat a normal diet. You might still feel bloated or gassy, and the Mayo Clinic recommends taking a short walk to help pass the leftover air in your colon. You may also have a small amount of blood in your first bowel movement post-colonoscopy, especially if your doctor removed polyps or took biopsies. This is totally normal. But if you pass blood clots or get a fever, let your doctor know right away.

Not knowing what to expect during a colonoscopy can make it a whole lot scarier, so if you still have questions, ask your doctor. Being prepared for the procedure will help alleviate most of your worries, and they'll understand that you're nervous. But hey, your colon's health is far too important to neglect.