Can you drink your fruit and vegetables? How does juice compare to the whole food?
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Do you struggle to eat your fruits and vegetables? You are not alone. Less than 5% of Australians eat the recommended serves of fresh produce each day (with 44% eating enough fruit but only 6% eating the recommended vegetables).
Adults should aim to eat at least five serves of vegetables (or roughly 375 grams) and two serves of fruit (about 300 grams) each day. Fruits and vegetables help keep us healthy because they have lots of nutrients (vitamins, minerals and fibre) and health-promoting bioactive compounds (substances not technically essential but which have health benefits) without having many calories.
So, if you are having trouble eating the rainbow, you might be wondering – is it OK to drink your fruits and vegetables instead in a juice or smoothie? Like everything in nutrition, the answer is all about context.
It might help overcome barriers
Common reasons for not eating enough fruits and vegetables are preferences, habits, perishability, cost, availability, time and poor cooking skills. Drinking your fruits and vegetables in juices or smoothies can help overcome some of these barriers.
Juicing or blending can help disguise tastes you don’t like, like bitterness in vegetables. And it can blitz imperfections such as bruises or soft spots. Preparation doesn’t take much skill or time, particularly if you just have to pour store-bought juice from the bottle. Treating for food safety and shipping time does change the make up of juices slightly, but unsweetened juices still remain significant sources of nutrients and beneficial bioactives.
Juicing can extend shelf life and reduce the cost of nutrients. In fact, when researchers looked at the density of nutrients relative to the costs of common foods, fruit juice was the top performer.
So, drinking my fruits and veggies counts as a serve, right?
How juice is positioned in healthy eating recommendations is a bit confusing. The Australian Dietary Guidelines include 100% fruit juice with fruit but vegetable juice isn’t mentioned. This is likely because vegetable juices weren’t as common in 2013 when the guidelines were last revised.
The guidelines also warn against having juice too often or in too high amounts. This appears to be based on the logic that juice is similar, but not quite as good as, whole fruit. Juice has lower levels of fibre compared to fruits, with fibre important for gut health, heart health and promoting feelings of fullness. Juice and smoothies also release the sugar from the fruit’s other structures, making them “free”. The World Health Organization recommends we limit free sugars for good health.
But fruit and vegetables are more than just the sum of their parts. When we take a “reductionist” approach to nutrition, foods and drinks are judged based on assumptions made about limited features such as sugar content or specific vitamins.
But these features might not have the impact we logically assume because of the complexity of foods and people. When humans eat varied and complex diets, we don’t necessarily need to be concerned that some foods are lower in fibre than others. Juice can retain the nutrients and bioactive compounds of fruit and vegetables and even add more because parts of the fruit we don’t normally eat, like the skin, can be included.
So, it is healthy then?
A recent umbrella review of meta-analyses (a type of research that combines data from multiple studies of multiple outcomes into one paper looked at the relationship between 100% juice and a range of health outcomes.
Most of the evidence showed juice had a neutral impact on health (meaning no impact) or a positive one. Pure 100% juice was linked to improved heart health and inflammatory markers and wasn’t clearly linked to weight gain, multiple cancer types or metabolic markers (such as blood sugar levels).
Some health risks linked to drinking juice were reported: death from heart disease, prostate cancer and diabetes risk. But the risks were all reported in observational studies, where researchers look at data from groups of people collected over time. These are not controlled and do not record consumption in the moment. So other drinks people think of as 100% fruit juice (such as sugar-sweetened juices or cordials) might accidentally be counted as 100% fruit juice. These types of studies are not good at showing the direct causes of illness or death.
What about my teeth?
The common belief juice damages teeth might not stack up. Studies that show juice damages teeth often lump 100% juice in with sweetened drinks. Or they use model systems like fake mouths that don’t match how people drinks juice in real life. Some use extreme scenarios like sipping on large volumes of drink frequently over long periods of time.
Juice is acidic and does contain sugars, but it is possible proper oral hygiene, including rinsing, cleaning and using straws can mitigate these risks.
Again, reducing juice to its acid level misses the rest of the story, including the nutrients and bioactives contained in juice that are beneficial to oral health.
So, what should I do?
Comparing whole fruit (a food) to juice (a drink) can be problematic. They serve different culinary purposes, so aren’t really interchangeable.
The Australian Guide to Healthy Eating recommends water as the preferred beverage but this assumes you are getting all your essential nutrients from eating.
Where juice fits in your diet depends on what you are eating and what other drinks it is replacing. Juice might replace water in the context of a “perfect” diet. Or juice might replace alcohol or sugary soft drinks and make the relative benefits look very different.
On balance
Whether you want to eat your fruits and vegetables or drink them comes down to what works for you, how it fits into the context of your diet and your life.
Smoothies and juices aren’t a silver bullet, and there is no evidence they work as a “cleanse” or detox. But, with society’s low levels of fruit and vegetable eating, having the option to access nutrients and bioactives in a cheap, easy and tasty way shouldn’t be discouraged either.
Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What you need to know about endometriosis
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Endometriosis affects one in 10 people with a uterus who are of reproductive age. This condition occurs when tissue similar to the endometrium—the inner lining of the uterus—grows on organs outside of the uterus, causing severe pain that impacts patients’ quality of life.
Read on to learn more about endometriosis: What it is, how it’s diagnosed and treated, where patients can find support, and more.
What is endometriosis, and what areas of the body can it affect?
The endometrium is the tissue that lines the inside of the uterus and sheds during each menstrual cycle. Endometriosis occurs when endometrial-like tissue grows outside of the uterus.
This tissue can typically grow in the pelvic region and may affect the outside of the uterus, fallopian tubes, ovaries, vagina, bladder, intestines, and rectum. It has also been observed outside of the pelvis on the lungs, spleen, liver, and brain.
What are the symptoms?
Symptoms may include pelvic pain and cramping before or during menstrual periods, heavy menstrual bleeding, bleeding or spotting between periods, pain with bowel movements or urination, pain during or after sex or orgasm, fatigue, nausea, bloating, and infertility.
The pain associated with this condition has been linked to depression, anxiety, and eating disorders. A meta-analysis published in 2019 found that more than two-thirds of patients with endometriosis report psychological stress due to their symptoms.
Who is at risk?
Endometriosis most commonly occurs in people with a uterus between the ages of 25 and 40, but it can also affect pre-pubescent and post-menopausal people. In rare cases, it has been documented in cisgender men.
Scientists still don’t know what causes the endometrial-like tissue to grow, but research shows that people with a family history of endometriosis are at a higher risk of developing the condition. Other risk factors include early menstruation, short menstrual cycles, high estrogen, low body mass, and starting menopause at an older age.
There is no known way to prevent endometriosis.
How does endometriosis affect fertility?
Up to 50 percent of people with endometriosis may struggle to get pregnant. Adhesions and scarring on the fallopian tubes and ovaries as well as changes in hormones and egg quality can contribute to infertility.
Additionally, when patients with this condition are able to conceive, they may face an increased risk of pregnancy complications and adverse pregnancy outcomes.
Treating endometriosis, taking fertility medications, and using assistive reproductive technology like in vitro fertilization can improve fertility outcomes.
How is endometriosis diagnosed, and what challenges do patients face when seeking a diagnosis?
A doctor may perform a pelvic exam and request an ultrasound or MRI. These exams and tests help identify cysts or other unusual tissue that may indicate endometriosis.
Endometriosis can only be confirmed through a surgical laparoscopy (although less-invasive diagnostic tests are currently in development). During the procedure, a surgeon makes a small cut in the patient’s abdomen and inserts a thin scope to check for endometrial-like tissue outside of the uterus. The surgeon may take a biopsy, or a small sample, and send it to a lab.
It takes an average of 10 years for patients to be properly diagnosed with endometriosis. A 2023 U.K. study found that stigma around menstrual health, the normalization of menstrual pain, and a lack of medical training about the condition contribute to delayed diagnoses. Patients also report that health care providers dismiss their pain and attribute their symptoms to psychological factors.
Additionally, endometriosis has typically been studied among white, cisgender populations. Data on the prevalence of endometriosis among people of color and transgender people is limited, so patients in those communities face additional barriers to care.
What treatment options are available?
Treatment for endometriosis depends on its severity. Management options include:
- Over-the-counter pain medication to alleviate pelvic pain
- Hormonal birth control to facilitate lighter, less painful periods
- Hormonal medications such as gonadotropin-releasing hormone (GnRH) or danazol, which stop the production of hormones that cause menstruation
- Progestin therapy, which may stop the growth of endometriosis tissue
- Aromatase inhibitors, which reduce estrogen
In some cases, a doctor may perform a laparoscopic surgery to remove endometrial-like tissue.
Depending on the severity of the patient’s symptoms and scar tissue, some doctors may also recommend a hysterectomy, or the removal of the uterus, to alleviate symptoms. Doctors may also recommend removing the patient’s ovaries, inducing early menopause to potentially improve pain.
Where can people living with endometriosis find support?
Given the documented mental health impacts of endometriosis, patients with this condition may benefit from therapy, as well as support from others living with the same symptoms. Some peer support organizations include:
- Endometriosis Coalition Patient Support Group (virtual)
- MyEndometriosisTeam (virtual)
- Endo Black, Inc. (Washington, D.C.)
- endoQueer (virtual)
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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What’s Your Personal Life Expectancy?
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Tick Tock… Goes the Death Clock?
This fun little test will ask a few questions about you and your lifestyle, and then make a prediction of your personal life expectancy, based on global statistics from the World Health Organisation.
And then the countdown starts… Literally, it generates a clock for you to see your life-seconds ticking away—this may or may not delight you, but it sure is a curiosity.
Their “Letters” page has a lot of reactions from people who just got their results (spoiler: people’s perspectives on life vary a lot)
Who mostly uses this service? According to their stats page, it’s mostly curious under-45s, with gradually less interest in knowing about it from 45 onwards… until the age of 70, when suddenly everyone wants to know about it again!
So Is It Possible To Pause The Clock On Aging? – Q&A Spotlight Interview
Life extension is sometimes viewed as the domain of the super-rich, and with less than half of Millennials (and almost none of Gen-Z) having retirement plans, often those of us who aren’t super-rich have more mundane (and immediate!) goals than living to 120.
And yet…
Middle class and working class life-extensionists do exist, even if not garnering the same media attention. We think that’s strange—after all, while the whimsies of the super-rich may be entertaining to read about, it’s not nearly as applicable to most people as more relatable stories:
- The twenty-something who gives up smoking and adds (healthier!) years to their life
- The thirty-something who adopts a plant-based diet and is less likely to die of heart disease
- The forty-something who stops drinking, and avoids health conditions and mishaps alike
- The fifty-something who reconsiders their health plan in light of their changing body
- The sixty-something who takes up yoga, or chess, or salsa dancing
- The seventy-something who gets asked what their secret is
- …and so on
But these are ideas, textbook examples. What if we make it more personal?
We interviewed 10 Almonds subscriber and longevity enthusiast Anastasia S., and here’s what she had to say:
Q: What does life extension mean to you, in your life?
A: To me, the key is healthy life extension. People often joke “I don’t want to live longer; the last years are the worst!” but they’re missing the point that after a certain age, those difficulties are coming whether they come at 50 or 70 or 90. Personally, I’d rather keep them at bay if I can.
Q: How do you do that?
A: Firstly, which won’t be a shock: good diet and exercise. Those two things are possibly the biggest active influences on my longevity. I’m vegan, which I don’t think is outright necessary for good health but done right, it can certainly be good. In this house we eat a lot of whole grains, beans, lentils, vegetables in general, nuts too. As for exercise, I do 30–60 minutes of Pilates daily; it’s nothing fancy and it’s just me in my pajamas at home, but it keeps me strong and fit and supple. I also walk everywhere; I don’t even own a car. Beyond that… I don’t drink or smoke (probably the biggest passive influences on my longevity, i.e., things that aren’t there to make it shorter), and I try to take my sleep seriously, making sure to schedule enough time and prepare properly for it.
Q: Take your sleep seriously? How so?
A: Good “sleep hygiene” as some call it—I schedule a little wind-down time before sleep, with no glaring screens or main lights, making a space between my busy day and restful sleep, kicking anything requiring brainpower to the morning, and making a conscious choice not to think more about those things in the meantime. I take care to make my sleeping environment as conducive as possible to good sleep too; I have a good mattress and pillows, I make sure the temperature is cool but cosy. I have a pot of herbal tea on my bedside table—I hydrate a lot.
Q: Do you take any supplements?
A: I do! They’re mostly quite general though, just “covering my bases”, so to speak. I take a daily nootropic stack (a collection of supplements specifically for brain health), too. I buy them in bulk, so they don’t cost so much.
Q: This seems quite a healthy lifestyle! Do you have any vices at all?
A: I definitely drink more coffee than I probably should! But hey, nobody’s perfect. I do love coffee, though, and as vices go, it’s probably not too bad.
Q: How’s it all working out for you? Do you feel younger?
A: I’m 38 and sometimes I feel like a teenager; sometimes I feel like an old lady. But the latter is usually for social reasons, not health-related reasons. I do have streaks of gray in my hair though, and I love that! If people don’t notice my grays, then they often think I’m in my 20s, rather than pushing 40. A little while back, I was stopped in the street by someone wanting to sell me a change of household utilities provider, then she stopped herself mid-sentence and said “Oh but wait, you look a bit too young, never mind”. Most general metrics of health would put me in my 20s.
Q: That’s interesting that you love your gray hairs, for someone who wants to stay young; is it an exception?
A: It’s more that I want to minimize the problems that come with age, and not everything’s a problem. Gray hairs are cool; joint pain, not so much. A long life rich with experiences is cool; memory loss, not so much. So, I try to keep healthy, and wear my years as best I can.
Q: Sounds good to us; good luck with it!
A: Thank you; I do my best!
Here at 10 Almonds, we love featuring what our readers are doing to improve their health; if you’re willing to be featured in our newsletter, let us know by replying to this email (where an actual human will read it, we promise!)
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Navigating the health-care system is not easy, but you’re not alone.
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Hello, dear reader!
This is my first column for Healthy Debate as a Patient Navigator. This column will be devoted to providing patients with information to help them through their journey with the health-care system and answering your questions.
Here’s a bit about me: I have been a patient partner at The Ottawa Hospital and Ottawa Hospital Research Institute since 2017, and have joined a variety of governance boards that work on patient and caregiver engagement such as the Patient Advisors Network, the Ontario Health East Region Patient and Family Advisory Council and the Equity in Health Systems Lab.
My journey as a patient partner started much before 2017 though. When I was a teenager, I was diagnosed with a cholesteatoma, a rare and chronic disease that causes the development of fatty tumors in the middle ear. I have had multiple surgeries to try to fix it but will need regular follow-ups to monitor whether the tumor returns. Because of this, I also live with an invisible disability since I have essentially become functionally deaf in one ear and often rely on a hearing aid when I navigate the world.
Having undergone three surgeries in my adolescent years, it was my experience undergoing surgery for an acute hand and wrist injury following a jet ski accident as an adult that was the catalyst for my decision to become a patient partner. There was an intriguing contrast between how I was cared for at two different health-care institutions, my age being the deciding factor at which hospital I went to (a children’s hospital or an adult one).
The most memorable example was how, as a teenager or child, you were never left alone before surgery, and nurses and staff took all the time necessary to comfort me and answer my (and my family’s) questions. I also remember how right before putting me to sleep, the whole staff initiated a surgical pause and introduced themselves and explained to me what their role was during my surgery.
None of that happened as an adult. I was left in a hallway while the operating theater was prepared, anxious and alone with staff walking by not even batting an eye. My questions felt like an annoyance to the care team; as soon as I was wheeled onto the operating room table, the anesthetist quickly put me to sleep. I didn’t even have the time to see who else was there.
Now don’t get me wrong: I am incredibly appreciative with the quality of care I received, but it was the everyday interactions with the care teams that I felt could be improved. And so, while I was recovering from that surgery, I looked for a way to help other patients and the hospital improve its care. I discovered the hospital’s patient engagement program, applied, and the rest is history!
Since then, I have worked on a host of patient-centered policy and research projects and fervently advocate that surgical teams adopt a more compassionate approach with patients before and after surgery.
I’d be happy to talk a bit more about my journey if you ask, but with that out of the way … Welcome to our first patient navigator column about patient engagement.
Conceptualizing the continuum of Patient Engagement
In the context of Canadian health care, patient engagement is a multifaceted concept that involves active collaboration between patients, caregivers, health-care providers and researchers. It involves patients and caregivers as active contributors in decision-making processes, health-care services and medical research. Though the concept is not new, the paradigm shift toward patient engagement in Canada started around 2010.
I like to conceptualize the different levels of patient engagement as a measure of the strength of the relationship between patients and their interlocutors – whether it’s a healthcare provider, administrator or researcher – charted against the duration of the engagement or the scope of input required from the patient.
Defining different levels of Patient Engagement
Following the continuum, let’s begin by defining different levels of patient engagement. Bear in mind that these definitions can vary from one organization to another but are useful in generally labelling the level of patient engagement a project has achieved (or wishes to achieve).
Patient involvement: If the strength of the relationship between patients and their interlocutors is minimal and not time consuming or too onerous, then perhaps it can be categorized as patient involvement. This applies to many instances of transactional engagement.
Patient advisory/consulting: Right in the middle of our continuum, patients can find themselves engaging in patient advisory or consulting work, where projects are limited in scope and duration or complexity, and the relationship is not as profound as a partnership.
Patient partnership: The stronger the relationship is between the patient and their interlocutor, and the longer the engagement activity lasts or how much input the patient is providing, the more this situation can be categorized as patient partnership. It is the inverse of patient involvement.
Examples of the different levels of Patient Engagement
Let’s pretend you are accompanying a loved one to an appointment to manage a kidney disease, requiring them to undergo dialysis treatment. We’ll use this scenario to exemplify what label could be used to describe the level of engagement.
Patient involvement: In our case, if your loved one – or you – fills out a satisfaction or feedback survey about your experience in the waiting room and all that needed to be done was to hand it back to the clerk or care team, then, at a basic level, you could likely label this interaction as a form of patient involvement. It can also involve open consultations around a design of a new look and feel for a hospital, or the understandability of a survey or communications product. Interactions with the care team, administrators or researchers are minimal and often transactional.
Patient advisory/consulting: If your loved one was asked for more detailed information about survey results over the course of a few meetings, this could represent patient advisory/consulting. This could mean that patients meet with program administrators and care providers and share their insights on how things can be improved. It essentially involves patients providing advice to health-care institutions from the perspective of patients, their family members and caregivers.
Patient advisors or consultants are often appointed by hospitals or academic institutions to offer insights at multiple stages of health-care delivery and research. They can help pilot an initiative based on that feedback or evaluate whether the new solutions are working. Often patient advisors are engaged in smaller-term individual projects and meet with the project team as regularly as required.
Patient partnership: Going above and beyond patient advisory, if patients have built a trusting relationship with their care team or administrators, they could feel comfortable enough to partner with them and initiate a project of their own. This could be for a project in which they study a different form of treatment to improve patient-centered outcomes (like the time it takes to feel “normal” following a session); it could be working together to identify and remove barriers for other patients that need to access that type of care. These projects are not fulfilled overnight, but require a collaborative, longstanding and trusting relationship between patients and health-care providers, administrators or researchers. It ensures that patients, regardless of severity or chronicity of their illness, can meaningfully contribute their experiences to aid in improving patient care, or develop or implement policies, pilots or research projects from start to finish.
It is leveraging that lived and living experience to its full extent and having the patient partner involved as an equal voice in the decision-making process for a project – over many months, usually – that the engagement could be labeled a partnership.
Last words
The point of this column will be to answer or explore issues or questions related to patient engagement, health communications or even provide some thoughts on how to handle a particular situation.
I would be happy to collect your questions and feedback at any time, which will help inform future columns. Just email me at max@le-co.ca or connect with me on social media (Linked In, X / Twitter).
It’s not easy to navigate our health-care systems, but you are not alone.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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The 7 Approaches To Pain Management
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More Than One Way To Kill Pain
This is Dr. Deepak Ravindran (MD, FRCA. FFPMRCA, EDRA. FIPP, DMSMed). He has decades of experience and is a specialist in acute and chronic pain management, anesthesia, musculoskeletal medicine, and lifestyle medicine.
A quick catch-up, first:
We’ve written about chronic pain management before:
Managing Chronic Pain (Realistically!)
As well as:
Science-Based Alternative Pain Relief
Dr. Ravindran’s approach
Dr. Ravindran takes a “trauma-informed care” approach to his professional practice, and recommends the same for others.
In a nutshell, this means starting from a position of not “what’s wrong with you?”, but rather “what happened to you?”.
This seemingly subtle shift is important, because it means actually dealing with a person’s issues, instead of “take one of these and call my secretary next month”. Read more:
Pain itself can be something of a many-headed hydra. Dr. Ravindran’s approach is equally many-headed; specifically, he has a 7-point plan:
Medications
Dr. Ravindran sees painkillers (and a collection of other drugs, like antidepressants and muscle relaxants) as a potential means to an end worth exploring, but he doesn’t expect them to be the best choice for everyone, and nor does he expect them to be a cure-all. Neither should we. He also advises being mindful of the drawbacks and potential complications of these drugs, too.
Interventions
Sometimes, surgery is the right choice. Sometimes it isn’t. Often, it will change a life—one way or the other. Similar to with medications, Dr. Ravindran is very averse to a “one size fits all” approach here. See also:
The Insider’s Guide To Making Hospital As Comfortable As Possible
Neuroscience and stress management
Often a lot of the distress of pain is not just the pain itself, but the fear associated with it. Will it get worse if I move wrong or eat the wrong thing? How long will it last? Will it ever get better? Will it get worse if I do nothing?. Dr. Ravindran advises tackling this, with the same level of importance as the pain itself. Here’s a good start:
Stress, And Building Psychological Resilience
Diet and the microbiome
Many chronic illnesses are heavily influenced by this, and Dr. Ravindran’s respect for lifestyle medicine comes into play here. While diet might not fix all our ills, it certainly can stop things from being a lot worse. Beyond the obvious “eat healthily” (Mediterranean diet being a good starting point for most people), he also advises doing elimination tests where appropriate, to screen out potential flare-up triggers. You also might consider:
Four Ways To Upgrade The Mediterranean Diet
Sleep
“Get good sleep” is easy advice for those who are not in agonizing pain that sometimes gets worse from staying in the same position for too long. Nevertheless, it is important, and foundational to good health. So it’s important to explore—whatever limitations one might realistically have—what can be done to improve it.
If you can only sleep for a short while at a time, you may get benefit from this previous main feature of ours:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Exercise and movement
The trick here is to move little and often; without overdoing it, but without permitting loss of mobility either. See also:
The Doctor Who Wants Us To Exercise Less, And Move More
Therapies of the mind and body
This is about taking a holistic approach to one’s wellness. In Dr. Ravindran’s words:
❝Mind-body therapies are often an extremely sensitive topic about which people hold very strong opinions and sometimes irrational beliefs.
Some, like reiki and spiritual therapy and homeopathy, have hardly any scientific evidence to back them up, while others like yoga, hypnosis, and meditation/mindfulness are mainstream techniques with many studies showing the benefits, but they all work for certain patients.❞
In other words: evidence-based is surely the best starting point, but if you feel inclined to try something else and it works for you, then it works for you. And that’s a win.
Want to know more?
You might like his book…
The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain
He also has a blog and a podcast.
Take care!
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Human Connection In An All-Too-Busy World
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Many of us, in many ways, have more discretionary time than ever… On paper.
But rather than the 8-hour block of work of yesteryear, nowadays the things that take our time often come in a series of short bursts that punctuate our day.
This means that while in theory, we have n hours of “free” time per day, we actually have 9 minutes here, 23 minutes there, 1 hour 6 minutes somewhere else, and so on.
Social commitments, meanwhile, tend to require not only that we have time in a block, but also, that the time around that block also be sufficiently free, for travelling, preparation, etc.
The result? “We must do this again, and not leave it so long next time!” we say, sincerely, to the friend whom we will next see again in approximately 17 months’ time.
The problem is how our many theoretically-small obligations reduce the rest of our time to “time confetti”, and that happens on the large scale like we saw above, as well as on the small scale of “Ah, I have an hour to relax between these two things” and then suddenly the time is gone, once again reduced to time confetti:
Time Confetti and the Broken Promise of Leisure
So, how to maintain human connection with people beyond those with whom we live?
Some is infinitely better than none
Let’s say you want to call a friend or relative. There may be generational differences in how much one is expected to arrange this by text first, vs just calling, but either way, you don’t have to have an open-ended block of time, and sometimes, it’s better if you don’t.
Establish, at the start of the call, “Before we get into catching up, how are we for time, by the way? For my part, I’ll have to go by such-and-such a time”, and then work with that.
The benefit of doing this is that you’ll both know enough about the time constraints to use the time appropriately; you won’t run out the clock on smalltalk before getting to something big, and you’ll both come away feeling satisfied that you shared and were shared-with in a meaningful fashion.
In contrast, guessing at time constraints can leave big things clipped off, or else result in someone “looking for a way to politely end this conversation that stopped being interesting a while ago but it’ll seem rude if I say I have to go now”, of the kind that results in someone not being so open to a call next time.
Don’t rush to dismiss texts as a medium for meaningful connection
When text messages were first a thing, you’ll remember how we were all working within a very short character limit and a cost-per-message. It was telegrams for the modern age, basically.
Nowadays, that isn’t so; we can write as much or as little as we like, and this has two benefits:
- We can have longer, meaningful conversations around the other stuff in our life. We can reply in seconds, or after making a cup of tea and thinking about it, or after our grocery-chopping trip, or whenever suits us. Suddenly, time confetti isn’t such a barrier to human connection. Writer’s example: my prime social time in this manner is when I’m cooking dinner (which is often about an hour). There’s no way I could have a phonecall while doing that; my bad hearing notwithstanding, I just have my hands full too often with much else going on. But texting? I can do that in the several-minute gaps between assorted culinary tasks, while I’m waiting for the kettle to boil or the onions to brown or whatever.
- Sometimes, the brevity makes it easier. A quick text saying “Hey, just to let you know I’m thinking of you, and hope your day is going well!”, or “Unrelated to anything: I was just thinking about how I’m glad to have you in my life; you’re a good friend, and I appreciate that more than I often remember to say. Anyway, that’s all; it was just on my mind. I hope your day is going well!”
(The cheery closing words in those last two text message examples help signify: “don’t worry, I’m fine and am not looking for anything from you”, which will help the recipient to relax, and counterintuitively, more likely to reply with some kind words of their own, knowing that they’re not signing up for a potentially deep talk when they also have time confetti issues going on)
Seize the moment (and also let it go)
You probably have many small interactions with strangers, most days. In the store, walking the dog, at the doctor’s office, etc. So, two things:
- Make smalltalk. And if you’re not one for traditional smalltalk topics (weather etc), or even if you are, a level-up is:
- Compliment sincerely. Straight out of “How To Win Friends And Influence People”, of course, but it creates a moment of genuine connection; you say a thing, their day is improved, they smile, you complete your business with a smile of your own and go about your day.
(of course, do steer clear of anything that could be interpreted as flirting, if that is not your intent, and really it should never be your intent when it comes to the captive audience of someone who will get fired if they’re not nice to you)
But, with a little practice, these little moments add up to a lot more human connection than if we treat the strangers with whom we interact as though they were merely part of the scenery.
Want more than that?
Check out:
How To Beat Loneliness & Isolation
Take care!
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California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.
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With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.
Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.
“We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.
The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.
However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.
Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.
An App for That
Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.
“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”
The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.
But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.
“It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”
The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.
Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.
Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.
The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.
‘It’s Like Crickets’
Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”
“It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”
So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.
“Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”
The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.
The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.
KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.
“I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”
Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.
Concern Over Referrals
Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.
This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.
While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.
Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.
“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”
Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.
Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.
“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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.
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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.
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