Move over, COVID and Flu! We Have “Hybrid Viruses” To Contend With Now

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Move over, COVID and Flu! We have “hybrid viruses” to contend with now

COVID and influenza viruses can be serious, of course, so let’s be clear up front that we’re not being dismissive of those. But, most people are hearing a lot about them, whereas respiratory syncytial virus (RSV) has flown under a lot of radars.

Simply put, until recently it hasn’t been considered much of a threat except to the young, the old, or people with other respiratory illnesses. Only these days, the prevalence of “other respiratory illnesses” is a lot higher than it used to be!

It’s not just a comorbidity

It’s easy to think “well of course if you have more than one illness at once, especially similar ones, that’s going to suck” but it’s a bit more than that; it produces newer, more interesting, hybrid viruses. Here’s a research paper from last year’s “flu season”:

Coinfection by influenza A virus and respiratory syncytial virus produces hybrid virus particles

Best to be aware of this if you’re in the “older” age-range

It’s not just that the older we are, the more likely we are to get it. Critically, the older we are, the more likely we are to be hospitalized by it.

And..the older we are, the less likely we are to come back from hospital if hospitalized by it.

Some years back, the intensive care and mortality rates for people over the age of 65 were 8% and 7%, respectively:

Respiratory syncytial virus infection in elderly and high-risk adults

…but a new study this year has found the rates like to be 2.2x that, i.e. 15% intensive care rate and 18% mortality, respectively:

Adjusting for Case Under-Ascertainment in Estimating RSV Hospitalisation Burden of Older Adults in High-Income Countries: a Systematic Review and Modelling Study

Want to know more?

Here are some hot-off-the-press news articles on the topic:

And as for what to do…

Same general advice as for COVID and Flu, just, ever-more important:

  • Try to keep to well-ventilated places as much as possible
  • Get any worrying symptoms checked out quickly
  • Mask up when appropriate
  • Get your shots as appropriate

See also:

Harvard Health Review | Fall shots: Who’s most vulnerable to RSV, COVID, and the flu, and which shots are the right choice for you to help protect against serious illness and hospitalization?

Stay safe!

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  • Cleaning Up Your Mental Mess – by Dr. Caroline Leaf

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    First of all, what mental mess is this? Well, that depends on you, but common items include:

    • Anxiety
    • Depression
    • Stress
    • Trauma

    Dr. Caroline Leaf also includes the more nebulous item “toxic thoughts”, but this is mostly a catch-all term.

    Given that it says “5 simple scientifically proven steps”, it would be fair if you are wondering:

    “Is this going to be just basic CBT stuff?”

    And… First, let’s not knock basic CBT stuff. It’s not a panacea, but it’s a great tool for a lot of things. However… Also, no, this book is not about just basic CBT stuff.

    In fact, this book’s methods are presented in such a novel way that this reviewer was taken aback by how unlike it was to anything she’d read before.

    And, it’s not that the components themselves are new—it’s just that they’re put together differently, in a much more organized comprehensive and systematic way, so that a lot less stuff falls through the cracks (a common problem with standalone psychological tools and techniques).

    Bottom line: if you buy one mental health self-help book this year, we recommend that it be this one

    Click here to check out Cleaning Up Your Mental Mess, and take a load off your mind!

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  • 5 Minute Posture Improvement Routine!

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    McKay Lang walks us through it:

    Step by Step

    Breathing exercise:

    • Place your hands on your lower abdomen.
    • Take three deep breaths, focusing on body tension in the shoulders and neck… And release.

    Shoulder squeeze:

    • With your hands on your hips, inhale and squeeze your shoulders upwards.
    • Hold your breath for 3–4 seconds, then exhale.
    • Repeat two more times, holding the squeeze a little longer each time.

    Upper shoulder massage:

    • Massage your upper shoulder muscles to release tension stored there.

    Overhead arm stretch:

    • Raise your arms above your head, clasping each elbow with the opposite hand.
    • Inhale deeply, stretch upwards, then exhale and release.
    • Repeat, alternating elbows.

    Neck and head push:

    • Place your palms on the back of the head, and push your head into your hands (and vice versa, because of Newton’s Third Law of Motion).
    • Do the same sideways (one side and then the other), to engage the other neck muscles.

    Cool down:

    • Gently unclasp your hands, bring your head upright, and massage your muscles. And breathe.

    For variations and a visual demonstration of all, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    6 Ways To Look After Your Back

    Take care!

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  • In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

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    Series: Culture of Cruelty:Inside Illinois’ Mental Health System

    State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

    Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

    Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

    With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

    The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

    Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

    The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

    Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

    Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

    Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

    But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

    Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

    But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

    U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

    For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

    “Living Inside a Box”

    Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

    In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

    For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

    Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

    That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

    Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

    “Right now, all she’s doing is living inside a box,” Stacey Rogers said.

    Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

    Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

    “If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

    Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

    Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

    In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

    In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

    The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

    In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

    Lawyers for the state argued that those improvements are enough to end court oversight.

    “The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

    Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

    Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

    While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

    At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

    “I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

    While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

    Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

    For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

    “I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

    This article is republished from ProPublica under a Creative Commons license. Read the original article.

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  • Bird Flu Is Bad for Poultry and Dairy Cows. It’s Not a Dire Threat for Most of Us — Yet.

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    Headlines are flying after the Department of Agriculture confirmed that the H5N1 bird flu virus has infected dairy cows around the country. Tests have detected the virus among cattle in nine states, mainly in Texas and New Mexico, and most recently in Colorado, said Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention, at a May 1 event held by the Council on Foreign Relations.

    A menagerie of other animals have been infected by H5N1, and at least one person in Texas. But what scientists fear most is if the virus were to spread efficiently from person to person. That hasn’t happened and might not. Shah said the CDC considers the H5N1 outbreak “a low risk to the general public at this time.”

    Viruses evolve and outbreaks can shift quickly. “As with any major outbreak, this is moving at the speed of a bullet train,” Shah said. “What we’ll be talking about is a snapshot of that fast-moving train.” What he means is that what’s known about the H5N1 bird flu today will undoubtedly change.

    With that in mind, KFF Health News explains what you need to know now.

    Q: Who gets the bird flu?

    Mainly birds. Over the past few years, however, the H5N1 bird flu virus has increasingly jumped from birds into mammals around the world. The growing list of more than 50 species includes seals, goats, skunks, cats, and wild bush dogs at a zoo in the United Kingdom. At least 24,000 sea lions died in outbreaks of H5N1 bird flu in South America last year.

    What makes the current outbreak in cattle unusual is that it’s spreading rapidly from cow to cow, whereas the other cases — except for the sea lion infections — appear limited. Researchers know this because genetic sequences of the H5N1 viruses drawn from cattle this year were nearly identical to one another.

    The cattle outbreak is also concerning because the country has been caught off guard. Researchers examining the virus’s genomes suggest it originally spilled over from birds into cows late last year in Texas, and has since spread among many more cows than have been tested. “Our analyses show this has been circulating in cows for four months or so, under our noses,” said Michael Worobey, an evolutionary biologist at the University of Arizona in Tucson.

    Q: Is this the start of the next pandemic?

    Not yet. But it’s a thought worth considering because a bird flu pandemic would be a nightmare. More than half of people infected by older strains of H5N1 bird flu viruses from 2003 to 2016 died. Even if death rates turn out to be less severe for the H5N1 strain currently circulating in cattle, repercussions could involve loads of sick people and hospitals too overwhelmed to handle other medical emergencies.

    Although at least one person has been infected with H5N1 this year, the virus can’t lead to a pandemic in its current state. To achieve that horrible status, a pathogen needs to sicken many people on multiple continents. And to do that, the H5N1 virus would need to infect a ton of people. That won’t happen through occasional spillovers of the virus from farm animals into people. Rather, the virus must acquire mutations for it to spread from person to person, like the seasonal flu, as a respiratory infection transmitted largely through the air as people cough, sneeze, and breathe. As we learned in the depths of covid-19, airborne viruses are hard to stop.

    That hasn’t happened yet. However, H5N1 viruses now have plenty of chances to evolve as they replicate within thousands of cows. Like all viruses, they mutate as they replicate, and mutations that improve the virus’s survival are passed to the next generation. And because cows are mammals, the viruses could be getting better at thriving within cells that are closer to ours than birds’.

    The evolution of a pandemic-ready bird flu virus could be aided by a sort of superpower possessed by many viruses. Namely, they sometimes swap their genes with other strains in a process called reassortment. In a study published in 2009, Worobey and other researchers traced the origin of the H1N1 “swine flu” pandemic to events in which different viruses causing the swine flu, bird flu, and human flu mixed and matched their genes within pigs that they were simultaneously infecting. Pigs need not be involved this time around, Worobey warned.

    Q: Will a pandemic start if a person drinks virus-contaminated milk?

    Not yet. Cow’s milk, as well as powdered milk and infant formula, sold in stores is considered safe because the law requires all milk sold commercially to be pasteurized. That process of heating milk at high temperatures kills bacteria, viruses, and other teeny organisms. Tests have identified fragments of H5N1 viruses in milk from grocery stores but confirm that the virus bits are dead and, therefore, harmless.

    Unpasteurized “raw” milk, however, has been shown to contain living H5N1 viruses, which is why the FDA and other health authorities strongly advise people not to drink it. Doing so could cause a person to become seriously ill or worse. But even then, a pandemic is unlikely to be sparked because the virus — in its current form — does not spread efficiently from person to person, as the seasonal flu does.

    Q: What should be done?

    A lot! Because of a lack of surveillance, the U.S. Department of Agriculture and other agencies have allowed the H5N1 bird flu to spread under the radar in cattle. To get a handle on the situation, the USDA recently ordered all lactating dairy cattle to be tested before farmers move them to other states, and the outcomes of the tests to be reported.

    But just as restricting covid tests to international travelers in early 2020 allowed the coronavirus to spread undetected, testing only cows that move across state lines would miss plenty of cases.

    Such limited testing won’t reveal how the virus is spreading among cattle — information desperately needed so farmers can stop it. A leading hypothesis is that viruses are being transferred from one cow to the next through the machines used to milk them.

    To boost testing, Fred Gingrich, executive director of a nonprofit organization for farm veterinarians, the American Association of Bovine Practitioners, said the government should offer funds to cattle farmers who report cases so that they have an incentive to test. Barring that, he said, reporting just adds reputational damage atop financial loss.

    “These outbreaks have a significant economic impact,” Gingrich said. “Farmers lose about 20% of their milk production in an outbreak because animals quit eating, produce less milk, and some of that milk is abnormal and then can’t be sold.”

    The government has made the H5N1 tests free for farmers, Gingrich added, but they haven’t budgeted money for veterinarians who must sample the cows, transport samples, and file paperwork. “Tests are the least expensive part,” he said.

    If testing on farms remains elusive, evolutionary virologists can still learn a lot by analyzing genomic sequences from H5N1 viruses sampled from cattle. The differences between sequences tell a story about where and when the current outbreak began, the path it travels, and whether the viruses are acquiring mutations that pose a threat to people. Yet this vital research has been hampered by the USDA’s slow and incomplete posting of genetic data, Worobey said.

    The government should also help poultry farmers prevent H5N1 outbreaks since those kill many birds and pose a constant threat of spillover, said Maurice Pitesky, an avian disease specialist at the University of California-Davis.

    Waterfowl like ducks and geese are the usual sources of outbreaks on poultry farms, and researchers can detect their proximity using remote sensing and other technologies. By zeroing in on zones of potential spillover, farmers can target their attention. That can mean routine surveillance to detect early signs of infections in poultry, using water cannons to shoo away migrating flocks, relocating farm animals, or temporarily ushering them into barns. “We should be spending on prevention,” Pitesky said.

    Q: OK it’s not a pandemic, but what could happen to people who get this year’s H5N1 bird flu?

    No one really knows. Only one person in Texas has been diagnosed with the disease this year, in April. This person worked closely with dairy cows, and had a mild case with an eye infection. The CDC found out about them because of its surveillance process. Clinics are supposed to alert state health departments when they diagnose farmworkers with the flu, using tests that detect influenza viruses, broadly. State health departments then confirm the test, and if it’s positive, they send a person’s sample to a CDC laboratory, where it is checked for the H5N1 virus, specifically. “Thus far we have received 23,” Shah said. “All but one of those was negative.”

    State health department officials are also monitoring around 150 people, he said, who have spent time around cattle. They’re checking in with these farmworkers via phone calls, text messages, or in-person visits to see if they develop symptoms. And if that happens, they’ll be tested.

    Another way to assess farmworkers would be to check their blood for antibodies against the H5N1 bird flu virus; a positive result would indicate they might have been unknowingly infected. But Shah said health officials are not yet doing this work.

    “The fact that we’re four months in and haven’t done this isn’t a good sign,” Worobey said. “I’m not super worried about a pandemic at the moment, but we should start acting like we don’t want it to happen.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • The Well Plated Cookbook – by Erin Clarke

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    Clarke’s focus here is on what she calls “stealthy healthy”, with the idea of dishes that feel indulgent while being great for the health.

    The recipes, of which there are well over 100, are indeed delicious and easy to make without being oversimplified, and since she encourages the use of in-season ingredients, many recipes come with a “market swaps” substitution guide, to make each recipe seasonal.

    The book is largely not vegetarian, let alone vegan, but the required substitutions will be second-nature to any seasoned vegetarian or vegan. Indeed, “skip the meat sometimes” is one of the advices she offers near the beginning of the book, in the category of tips to make things even healthier.

    Bottom line: if you want to add dishes to your repertoire that are great for entertaining and still super-healthy, this book will be a fine addition to your collection.

    Click here to check out The Well Plated Cookbook, and get cooking!

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  • Beat Food Addictions!

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    When It’s More Than “Just” Cravings

    This is Dr. Nicole Avena. She’s a research neuroscientist who also teaches at Mount Sinai School of Medicine, as well as at Princeton. She’s done a lot of groundbreaking research in the field of nutrition, diet, and addition, with a special focus on women’s health and sugar intake specifically.

    What does she want us to know?

    Firstly, that food addictions are real addictions.

    We know it can sound silly, like the famous line from Mad Max:

    ❝Do not, my friends, become addicted to water. It will take hold of you and you will resent its absence!❞

    ~ “Immortan Joe”

    As an aside, it is actually possible to become addicted to water; if one drinks it excessively (we are talking gallons every day) it does change the structure of the brain (no surprise; the brain is not supposed to have that much water!) causing structural damage that then results in dependency, and headaches upon withdrawal. It’s called psychogenic polydipsia:

    Primary polydipsia: Update

    But back onto today’s more specific topic, and by a different mechanism of addiction…

    Food addictions are dopaminergic addictions (as is cocaine)

    If you are addicted to a certain food (often sugar, but other refined carbs such as potato products, and also especially refined flour products, are also potential addictive substances), then when you think about the food in question, your brain lights up with more dopamine than it should, and you are strongly motivated to seek and consume the substance in question.

    Remember, dopamine functions by expectation, not by result. So until your brain’s dopamine-gremlin is sated, it will keep flooding you with motivational dopamine; that’s why the first bite tastes best, then you wolf down the rest before your brain can change its mind, and afterwards you may be left thinking/feeling “was that worth it?”.

    Much like with other addictions (especially alcohol), shame and regret often feature strongly afterwards, even accompanied by notions of “never again”.

    But, binge-eating is as difficult to escape as binge-drinking.

    You can break free, but you will probably have to take it seriously

    Dr. Avena recommends treating a food addiction like any other addiction, which means:

    1. Know why you want to quit (make a list of the reasons, and this will help you stay on track later!)
    2. Make a conscious decision to genuinely quit
    3. Learn about the nature of the specific addiction (know thy enemy!)
    4. Choose a strategy (e.g. wean off vs cold turkey, and decide what replacements, if any, you will use)
    5. Get support (especially from those around you, and/but the support of others facing, or who have successfully faced, the same challenge is very helpful too)
    6. Keep track of your success (build and maintain a streak!)
    7. Lean into how you will better enjoy life without addiction to the substance (it never really made you happy anyway, so enjoy your newfound freedom and good health!)

    Want more from Dr. Avena?

    You can check out her column at Psychology Today here:

    Psychology Today | Food Junkie ← it has a lot of posts about sugar addiction in particular, and gives a lot of information and practical advice

    You can also read her book, which could be a great help if you are thinking of quitting a sugar addiction:

    Sugarless: A 7-Step Plan to Uncover Hidden Sugars, Curb Your Cravings, and Conquer Your Addiction

    Enjoy!

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    Learn to Age Gracefully

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