Alzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low
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An article published this week in the prestigious journal Nature Medicine documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person.
The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors.
Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s.
The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop Creuztfeldt-Jakob disease (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million.
What’s CJD got to do with Alzehimer’s?
CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell.
Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised public health concerns over the eating of beef products in the United Kingdom in the 1980s.
Human growth hormone used to come from donated organs
Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue.
But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around 16,000 donated glands.
An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people.
hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk.
National Cancer Institute/Unsplash
What are the latest findings about Alzheimer’s disease?
The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission.
The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease.
They considered other explanations for the findings but concluded donated hGH was the likely cause.
Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease.
Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is increasing evidence these proteins spread in the brain in a similar way to prion diseases. So the mode of transmission the authors propose is certainly plausible.
However, given the amyloid protein deposits in the brain at least 20 years before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident.
When was this process used in Australia?
In Australia, donated pituitary material was used from 1967 to 1985 to treat people with short stature and infertility.
More than 2,000 people received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch.
The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are considered to be incredibly small.
Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for around 5% of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution.
perfectlab/Shutterstock
The risk is very low – and you can’t ‘catch’ it like a virus
The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide.
Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk.
The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s disease.
Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What are heart rate zones, and how can you incorporate them into your exercise routine?
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If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.
Heart rate zones reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.
But what are the different heart rate zones, and how can you use these zones to optimise your workout?
The three-zone model
While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:
- zone 1: 55%–82% of maximum heart rate
- zone 2: 82%–87% of maximum heart rate
- zone 3: 87%–97% of maximum heart rate.
If you’re not sure what your maximum heart rate is, it can be calculated using this equation: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.
There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.
What do the different zones involve?
The three zones are based around a person’s lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.
Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.
On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.
Wearable technology has taken off in recent years. Ketut Subiyanto/Pexels In the three-zone model, each zone loosely describes one of three types of training.
Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.
Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.
Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.
Striking a balance
To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.
While zone 3 is thought to produce the largest improvements in maximal oxygen uptake – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.
Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.
So how much time should you spend in each zone?
Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.
Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.
Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.
If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.
What if I don’t have a heart rate monitor?
If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.
The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.
With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.
Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.
Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Lifestyle Factors That Matter >8 Times More Than Genes
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We’ve said before that “genes predispose; they don’t predetermine”. It can be good to know one’s genes, of course, and we’ve written about this here:
Genetic Testing: Health Benefits & Methods
…which can include some quite contemporary risks, such as:
Genetic Risk Factors For Long COVID
And yet…
Nurture Over Nature
A very large (n=492,567) study looked into the impact of 25 lifestyle/environmental factors, of which 23 are considered modifiable, and found that lifestyle/environmental factors accounted for 17% of the variation in mortality risk, while genetic predisposition accounted for less than 2%.
Which is good news, because it means we can improve our lot.
But how?
The strongest negative factors (that increased mortality the most) were:
- Smoking
- Not owning your home (interestingly, “live in accommodation rent-free vs own” performed just as badly as various kinds of “renting home vs own”, while “own house with mortgage, vs own outright” had only a marginal negative effect)
- Sleeping more than 9 hours per day (performed even worse than sleeping under 7 hours per day, which also increased mortality risk, but not by as much as oversleeping)
- Financial difficulties in the past two years
- Homosexuality
- Unemployment
- Being an evening person
- Lonely lifestyle
- Frequent napping
We may hypothesize that homosexuality probably makes the list because of how it makes one more likely to have other items on the list, especially unemployment, and the various poverty-related indicators that come from unemployment.
Being an evening person, whatever its pathology, is a well-established risk factor that we’ve talked about before:
Early Bird Or Night Owl? Genes vs Environment ← this is also, by the way, an excellent example of how “genes predispose; they don’t predetermine”, because there is a genetic factor involved, and/but we absolutely can switch it up, if we go about it correctly, and become a morning person without trying to force it.
The strongest positive factors (that decreased mortality the most) were:
- The inverse of all of the various above things, e.g. never having smoked, owning your own home, etc
- Household income, specifically
- Living with a partner
- Having oil central heating
- Gym use
- Sun protection use
- Physical activity, especially if in leisure time rather than as part of one’s work
- Glucosamine supplements
- Family visit frequency
- Cereal fiber intake (i.e. whole grains)
We may hypothesize that having oil central heating is simply a more expensive option to install than many, and therefore likely one enjoyed by homeowners more often than renters.
We may hypothesize that glucosamine supplementation is an indication of the type of person who takes care of a specific condition (inflammation of the joints) without an existential threat; notably, multivitamin supplements don’t get the same benefit, probably because of their ubiquity.
We may hypothesize that “family visit frequency” is highly correlated to having a support network, being social (and thus not lonely), and likely is associated with household income too.
You can see the full list of factors and their impacts, here:
Environmental architecture of mortality in the UKB ← that’s the UK Biobank
You can read the paper in full, here:
Integrating the environmental and genetic architectures of aging and mortality
Practical takeaways
The priorities seem to be as follows:
Don’t smoke. Ideally you will never have smoked, but short of a time machine, you can’t change that now, so: what you can do is quit now if you haven’t already.
See also: Which Addiction-Quitting Methods Work Best?
Note that other factors often lumped in with such, for example daily alcohol consumption, red meat intake, processed meat intake, and salt intake, all significantly increased mortality risk, but none of them in the same league of badness as smoking.
See also: Is Sugar The New Smoking? ← simply put: no, it is not. Don’t get us wrong; added sugar is woeful for the health, but smoking is pretty much the worst thing you can do for your health, short of intentionally (and successfully) committing suicide.
Be financially secure, ideally owning your own home. For many (indeed, for most people in the world) this may be an “easier said than done” thing, but if you can make decisions that will improve your financial security, the mortality numbers are very clear on this matter.
Be social, as loneliness indeed kills, in numerous ways. Loneliness means a lack of a support network, and it means a lack of social contact (thus increased risk of cognitive decline), and likely decreased ikigai, unless your life’s purpose is something inherently linked to solitude (e.g. the “meditating on top of a mountain” archetype).
See also: What Loneliness Does To Your Brain And Body
And to fix it: How To Beat Loneliness & Isolation
Be active: especially in your leisure time; being active because you have to does convey benefits, but on the same level as physical activity because you want to.
See also: No-Exercise Exercises (That Won’t Feel Like “Having To Do” Exercise)
Use sunscreen: we’re surprised this one made the list; it’s important to avoid skin cancer of course, but we didn’t think it’d be quite such a driver of mortality risk mitigation as the numbers show it is, and we can’t think of a clear alternative explanation, as we could with some of the other “why did this make the list?” items. At worst, it could be a similar case to that of glucosamine use, and thus is a marker of a conscientious person making a regular sustained effort for their health. Either way, it seems like a good idea based on the numbers.
See also: Do We Need Sunscreen In Winter, Really?
Enjoy whole grains: fiber is super-important, and that mustn’t be underestimated!
See also: What Matters Most For Your Heart? ← hint: it isn’t about salt intake or fat
And, for that matter: The Best Kind Of Fiber For Overall Health?
Take care!
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Live Long, Die Short – by Dr. Roger Landry
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First know: “die short” is not about your height—although on average, short people do live longer, partly because insulin-like growth factor (IGF-1) promotes both tallness and accelerated DNA damage (thus, aging and cancer), and partly because if someone is very tall, it can cause circulatory problems, and without a nice easy flow of blood through the brain, bad things happen (such as accumulation of harmful detritus in the brain, and increased stroke risk too).
Next know: “die short” is, in this book, actually about shortening the decline at the end of life. Sometimes people say “I don’t want to live 10 years longer; they’ll be the 10 most miserable years”, but in fact if we look after our health, we will be healthy for perhaps >9.5 of our last 10 years, while an unhealthy person may just get their expected “10 most miserable years” 10 or 20 years earlier (and then die).
So, in short (so to speak), it’s about increasing healthspan.
To enjoy the longest and healthiest healthspan, Dr. Landry offers 10 tips. We’ll not keep them a secret; they are:
- Use it or lose it
- Keep moving
- Challenge your brain
- Stay connected
- Lower your risks
- Never act your age
- Wherever you are, be fully there
- Find your purpose
- Have children in your life
- Laugh to a better life
Each of these has a chapter devoted to them, in section 2 of the book (section 1 is about what we know about healthy aging, and section 3 is about where we go from here).
You’ll notice that one item not generally found on such lists is “have children in your life”; to be clear, they don’t have to be your children, and/but they do have to be actual current children; any now-grown-up progeny aren’t what’s being talked about here (wonderful as they may be, any support role they may play gets filed under “stay connected” instead).
The style is mostly impersonal pop-science with occasional personal anecdotes, and the book’s formatting (many subheadings within chapters) makes it easy to read a bit at a time, if that’s your preference. There’s a modest, but extant, bibliography.
Bottom line: if you’d like to stay younger as you get older, this book goes into a lot of detail about 10 ways to do just that.
Click here to check out Live Long, Die Short, and live long, die short!
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Super-Nutritious Shchi
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Today we have a recipe we’ve mentioned before, but now we have standalone recipe pages for recipes, so here we go. The dish of the day is shchi—which is Russian cabbage soup, which sounds terrible, and looks as bad as it sounds. But it tastes delicious, is an incredible comfort food, and is famous (in Russia, at least) for being something one can eat for many days in a row without getting sick of it.
It’s also got an amazing nutritional profile, with vitamins A, B, C, D, as well as lots of calcium, magnesium, and iron (amongst other minerals), and a healthy blend of carbohydrates, proteins, and fats, plus an array of anti-inflammatory phytochemicals, and of course, water.
You will need
- 1 large white cabbage, shredded
- 1 cup red lentils
- ½ lb tomatoes, cut into eighths (as in: halve them, halve the halves, and halve the quarters)
- ½ lb mushrooms sliced (or halved, if they are baby button mushrooms)
- 1 large onion, chopped finely
- 1 tbsp rosemary, chopped finely
- 1 tbsp thyme, chopped finely
- 1 tbsp black pepper, coarse ground
- 1 tsp cumin, ground
- 1 tsp yeast extract
- 1 tsp MSG, or 2 tsp low-sodium salt
- A little parsley for garnishing
- A little fat for cooking; this one’s a tricky and personal decision. Butter is traditional, but would make this recipe impossible to cook without going over the recommended limit for saturated fat. Avocado oil is healthy, relatively neutral in taste, and has a high smoke point for caramelizing the onions. Extra virgin olive oil is also a healthy choice, but not as neutral in flavor and does have a lower smoke point. Coconut oil has far too strong a taste and a low smoke point. Seed oils are very heart-unhealthy. All in all, avocado oil is a respectable choice from all angles except tradition.
Note: with regard to the seasonings, the above is a basic starting guide; feel free to add more per your preference—however, we do not recommend adding more cumin (it’ll overpower it) or more salt (there’s enough sodium in here already).
Method
(we suggest you read everything at least once before doing anything)
1) Cook the lentils until soft (a rice cooker is great for this, but a saucepan is fine); be generous with the water; we are making a soup, after all. Set them aside without draining.
2) Sauté the cabbage, and put it in a big stock pot or similar large pan (not yet on the heat)
3) Fry the mushrooms, and add them to the big pot (still not yet on the heat)
4) Use a stick blender to blend the lentils in the water you cooked them in, and then add to the big pot too.
5) Turn the heat on low, and if necessary, add more water to make it into a rich soup
6) Add the seasonings (rosemary, thyme, cumin, black pepper, yeast extract, MSG-or-salt) and stir well. Keep the temperature on low; you can just let it simmer now because the next step is going to take a while:
7) Caramelize the onion (keep an eye on the big pot, stirring occasionally) and set it aside
8) Fry the tomatoes quickly (we want them cooked, but just barely) and add them to the big pot
9) Serve! The caramelized onion is a garnish, so put a little on top of each bowl of shchi. Add a little parsley too.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- The Magic Of Mushrooms: “The Longevity Vitamin” (That’s Not A Vitamin)
- Easily Digestible Vegetarian Protein Sources
- The Bare-Bones Truth About Osteoporosis
- Some Surprising Truths About Hunger And Satiety
Take care!
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For Seniors With Hoarding Disorder, a Support Group Helps Confront Stigma and Isolation
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A dozen people seated around folding tables clap heartily for a beaming woman: She’s donated two 13-gallon garbage bags full of clothes, including several Christmas sweaters and a couple of pantsuits, to a Presbyterian church.
A closet cleanout might not seem a significant accomplishment. But as the people in this Sunday-night class can attest, getting rid of stuff is agonizing for those with hoarding disorder.
People with the diagnosis accumulate an excessive volume of things such as household goods, craft supplies, even pets. In extreme cases, their homes become so crammed that moving between rooms is possible only via narrow pathways.
These unsafe conditions can also lead to strained relationships.
“I’ve had a few relatives and friends that have condemned me, and it doesn’t help,” said Bernadette, a Pennsylvania woman in her early 70s who has struggled with hoarding since retiring and no longer allows guests in her home.
People who hoard are often stigmatized as lazy or dirty. NPR, Spotlight PA, and KFF Health News agreed to use only the first names of people with hoarding disorder interviewed for this article because they fear personal and professional repercussions if their condition is made public.
As baby boomers age into the group most affected by hoarding disorder, the psychiatric condition is a growing public health concern. Effective treatments are scarce. And because hoarding can require expensive interventions that drain municipal resources, more funding and expertise is needed to support those with the diagnosis before the issue grows into a crisis.
For Bernadette, the 16-week course is helping her turn over a new leaf.
The program doubles as a support group and is provided through Fight the Blight. The Westmoreland County, Pennsylvania, organization started offering the course at a local Masonic temple after founder Matt Williams realized the area lacked hoarding-specific mental health services.
Fight the Blight uses a curriculum based on cognitive behavioral therapy to help participants build awareness of what fuels their hoarding. People learn to be more thoughtful about what they purchase and save, and they create strategies so that decluttering doesn’t become overwhelming.
Perhaps more importantly, attendees say they’ve formed a community knitted together through the shared experience of a psychiatric illness that comes with high rates of social isolation and depression.
“You get friendship,” said Sanford, a classmate of Bernadette’s.
After a lifetime of judgment, these friendships have become an integral part of the changes that might help participants eventually clear out the clutter.
Clutter Catches Up to Baby Boomers
Studies have estimated that hoarding disorder affects around 2.5% of the general population — a higher rate than schizophrenia.
The mental illness was previously considered a subtype of obsessive-compulsive disorder, but in 2013 it was given its own diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.
The biological and environmental factors that may drive hoarding are not well understood. Symptoms usually appear during the teenage years and tend to be more severe among older adults with the disorder. That’s partly because they have had more time to acquire things, said Kiara Timpano, a University of Miami psychology professor.
“All of a sudden you have to downsize this huge home with all the stuff and so it puts pressures on individuals,” she said. In Bernadette’s case, her clutter includes a collection of VHS tapes, and spices in her kitchen that she said date back to the Clinton administration.
But it’s more than just having decades to stockpile possessions; the urge to accumulate strengthens with age, according to Catherine Ayers, a psychiatry professor at the University of California-San Diego.
Researchers are working to discern why. Ayers and Timpano theorize that age-related cognitive changes — particularly in the frontal lobe, which regulates impulsivity and problem-solving — might exacerbate the disorder.
“It is the only mental health disorder, besides dementia, that increases in prevalence and severity with age,” Ayers said.
As the U.S. population ages, hoarding presents a growing public health concern: Some 1 in 5 U.S. residents are baby boomers, all of whom will be 65 or older by 2030.
This population shift will require the federal government to address hoarding disorder, among other age-related issues that it has not previously prioritized, according to a July report by the Democratic staff of the U.S. Senate Special Committee on Aging, chaired then by former Sen. Bob Casey (D-Pa.).
Health Hazards of Hoarding
Clutter creates physical risks. A cramped and disorderly home is especially dangerous for older adults because the risk of falling and breaking a bone increases with age. And having too many things in one space can be a fire hazard.
Last year, the National Fallen Firefighters Foundation wrote to the Senate committee’s leadership that “hoarding conditions are among the most dangerous conditions the fire service can encounter.” The group also said that cluttered homes delay emergency care and increase the likelihood of a first responder being injured on a call.
The Bucks County Board of Commissioners in Pennsylvania told Casey that hoarding-related mold and insects can spread to adjacent households, endangering the health of neighbors.
Due to these safety concerns, it might be tempting for a family member or public health agency to quickly empty someone’s home in one fell swoop.
That can backfire, Timpano said, as it fails to address people’s underlying issues and can be traumatic.
“It can really disrupt the trust and make it even less likely that the individual is willing to seek help in the future,” she said.
It’s more effective, Timpano said, to help people build internal motivation to change and help them identify goals to manage their hoarding.
For example, at the Fight the Blight class, a woman named Diane told the group she wanted a cleaner home so she could invite people over and not feel embarrassed.
Sanford said he is learning to keep his documents and record collection more organized.
Bernadette wants to declutter her bedroom so she can start sleeping in it again. Also, she’s glad she cleared enough space on the first floor for her cat to play.
“Because now he’s got all this room,” she said, “he goes after his tail like a crazy person.”
Ultimately, the home of someone with hoarding disorder might always be a bit cluttered, and that’s OK. The goal of treatment is to make the space healthy and safe, Timpano said, not to earn Marie Kondo’s approval.
Lack of Treatment Leaves Few Options
A 2020 study found that hoarding correlates with homelessness, and those with the disorder are more likely to be evicted.
Housing advocates argue that under the Fair Housing Act, tenants with the diagnosis are entitled to reasonable accommodation. This might include allowing someone time to declutter a home and seek therapy before forcing them to leave their home.
But as outlined in the Senate aging committee’s report, a lack of resources limits efforts to carry out these accommodations.
Hoarding is difficult to treat. In a 2018 study led by Ayers, the UCSD psychiatrist, researchers found that people coping with hoarding need to be highly motivated and often require substantial support to remain engaged with their therapy.
The challenge of sticking with a treatment plan is exacerbated by a shortage of clinicians with necessary expertise, said Janet Spinelli, the co-chair of Rhode Island’s hoarding task force.
Could Changes to Federal Policy Help?
Casey, the former Pennsylvania senator, advocated for more education and technical assistance for hoarding disorder.
In September, he called for the Substance Abuse and Mental Health Services Administration to develop training, assistance, and guidance for communities and clinicians. He also said the Centers for Medicare & Medicaid Services should explore ways to cover evidence-based treatments and services for hoarding.
This might include increased Medicare funding for mobile crisis services to go to people’s homes, which is one way to connect someone to therapy, Spinelli said.
Another strategy would involve allowing Medicaid and Medicare to reimburse community health workers who assist patients with light cleaning and organizing; research has found that many who hoard struggle with categorization tasks.
Williams, of Fight the Blight, agrees that in addition to more mental health support, taxpayer-funded services are needed to help people address their clutter.
When someone in the group reaches a point of wanting to declutter their home, Fight the Blight helps them start the process of cleaning, removing, and organizing.
The service is free to those earning less than 150% of the federal poverty level. People making above that threshold can pay for assistance on a sliding scale; the cost varies also depending on the size of a property and severity of the hoarding.
Also, Spinelli thinks Medicaid and Medicare should fund more peer-support specialists for hoarding disorder. These mental health workers draw on their own life experiences to help people with similar diagnoses. For example, peer counselors could lead classes like Fight the Blight’s.
Bernadette and Sanford say courses like the one they enrolled in should be available all over the U.S.
To those just starting to address their own hoarding, Sanford advises patience and persistence.
“Even if it’s a little job here, a little job there,” he said, “that all adds up.”
This article is from a partnership that includes Spotlight PA, NPR, and KFF Health News.
Spotlight PA is an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania. Sign up for its free newsletters.
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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How Stress Affects Your Body
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Dr. Sharon Bergquist gives us a tour:
Stress, from the inside out
Stress is a natural physical and emotional response to challenges or being overwhelmed. It can be beneficial in short-term situations (e.g. escape from a tiger) but is harmful when prolonged or frequent (e.g. escape the rat-race).
Immediate physiological response: cortisol, adrenaline (epinephrine), and norepinephrine are released by the adrenal glands.
The effects this has (non-exhaustive list; we’re just citing what’s in the video here):
- Cortisol impairs blood vessel function, promoting atherosclerosis.
- Adrenaline increases heart rate and blood pressure, leading to hypertension.
- Stress disrupts the brain-gut connection, causing:
- Digestive issues like irritable bowel syndrome and heartburn.
- Changes in gut bacteria composition, potentially affecting overall health.
- Cortisol increases appetite and cravings for energy-dense “comfort foods”.
- This in turn promotes visceral fat storage, which raises the risk of heart disease and insulin resistance.
- Immune-specific effects:
- Stress hormones initially aid in healing and immune defense.
- Chronic stress weakens immune function (by over-working it constantly), increasing susceptibility to infections and slowing recovery.
- Other systemic effects:
- Chronic stress shortens telomeres, which protect chromosomes. Shortened telomeres accelerate cellular aging.
- Chronic stress can also cause acne, hair loss, sexual dysfunction, headaches, muscle tension, fatigue, irritability, and difficulty concentrating.
So, how to manage this? The video says that viewing stressful situations as controllable challenges, rather than insurmountable threats, leads to better short-term performance and long-term health.
Which would be wonderful, except that usually things are stressful precisely because they are not entirely within the field of our control, and the usual advice is to tend to what we can control, and accept what we can’t.
However… That paradigm still leaves out the very big set of “this might be somewhat within our control or it might not; we really don’t know yet; we can probably impact it but what if we don’t do enough, or take the wrong approach and do the wrong thing? And also we have 17 competing stressors, which ones should we prioritize tending to first, and…” and so on.
To that end, we suggest checking out the “Want to learn more?” link we drop below the video today, as it is about managing stress realistically, in a world that, if we’re honest about it, can sometimes be frankly unmanageable.
Meanwhile, enjoy:
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Want to learn more?
You might also like to read:
Heart Health vs Systemic Stress ← this is good in and of itself, and also links to other stress-related resources of ours
Take care!
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