Hardcore Self Help: F**k Anxiety – by Dr. Robert Duff
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We’ve reviewed other anxiety books before, so what makes this one different? Mostly, it’s the style.
Aside from swearing approximately once every two lines (so you might want to skip this one if that would bother you), Dr. Duff’s writing is very down-to-earth in other ways too, making it unpretentiously comfortable and accessible without failing to draw upon the wealth of good-practice, evidence-based advice he has to offer.
To that end, he talks about what anxiety is and isn’t, and goes over various approaches, explaining them in a “about” fashion, and also a “how to” fashion, covering areas such as CBT, somatic therapies, social support, when talk therapy is most likely to help.
The book is a quick read (a modest 74 pages), and it’s refreshing that it hasn’t been padded unnecessarily, unlike a lot of books that could have been a fraction of the size without losing value.
Bottom line: if you (or perhaps someone you care about) would benefit from a straight-to-the-point, no-BS approach to dealing with anxiety (that’s actually evidence-based, not just a “get over it” dismissal), then this is the book for you.
Click here to check out Hardcore Self Help: F**k Anxiety, and indeed do just that!
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Hospitals worldwide are short of saline. We can’t just switch to other IV fluids – here’s why
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Last week, the Australian Therapeutic Goods Administration added intravenous (IV) fluids to the growing list of medicines in short supply. The shortage is due to higher-than-expected demand and manufacturing issues.
Two particular IV fluids are affected: saline and compound sodium lactate (also called Hartmann’s solution). Both fluids are made with salts.
There are IV fluids that use other components, such as sugar, rather than salt. But instead of switching patients to those fluids, the government has chosen to approve salt-based solutions by other overseas brands.
So why do IV fluids contain different chemicals? And why can’t they just be interchanged when one runs low?
Pavel Kosolapov/Shutterstock We can’t just inject water into a vein
Drugs are always injected into veins in a water-based solution. But we can’t do this with pure water, we need to add other chemicals. That’s because of a scientific principle called osmosis.
Osmosis occurs when water moves rapidly in and out of the cells in the blood stream, in response to changes to the concentration of chemicals dissolved in the blood plasma. Think salts, sugars, nutrients, drugs and proteins.
Too high a concentration of chemicals and protein in your blood stream leads it to being in a “hypertonic” state, which causes your blood cells to shrink. Not enough chemicals and proteins in your blood stream causes your blood cells to expand. Just the right amount is called “isotonic”.
Mixing the drug with the right amount of chemicals, via an injection or infusion, ensures the concentration inside the syringe or IV bag remains close to isotonic.
Australia is currently short on two salt-based IV fluids. sirnength88/Shutterstock What are the different types of IV fluids?
There are a range of IV fluids available to administer drugs. The two most popular are:
- 0.9% saline, which is an isotonic solution of table salt. This is one of the IV fluids in short supply
- a 5% solution of the sugar glucose/dextrose. This fluid is not in short supply.
There are also IV fluids that combine both saline and glucose, and IV fluids that have other salts:
- Ringer’s solution is an IV fluid which has sodium, potassium and calcium salts
- Plasma-Lyte has different sodium salts, as well as magnesium
- Hartmann’s solution (compound sodium lactate) contains a range of different salts. It is generally used to treat a condition called metabolic acidosis, where patients have increased acid in their blood stream. This is in short supply.
What if you use the wrong solution?
Some drugs are only stable in specific IV fluids, for instance, only in salt-based IV fluids or only in glucose.
Putting a drug into the wrong IV fluid can potentially cause the drug to “crash out” of the solution, meaning patients won’t get the full dose.
Or it could cause the drug to decompose: not only will it not work, but it could also cause serious side effects.
An example of where a drug can be transformed into something toxic is the cancer chemotherapy drug cisplatin. When administered in saline it is safe, but administration in pure glucose can cause life-threatening damage to a patients’ kidneys.
What can hospitals use instead?
The IV fluids in short supply are saline and Hartmann’s solution. They are provided by three approved Australian suppliers: Baxter Healthcare, B.Braun and Fresenius Kabi.
The government’s solution to this is to approve multiple overseas-registered alternative saline brands, which they are allowed to do under current legislation without it going through the normal Australian quality checks and approval process. They will have received approval in their country of manufacture.
The government is taking this approach because it may not be effective or safe to formulate medicines that are meant to be in saline into different IV fluids. And we don’t have sufficient capacity to manufacture saline IV fluids here in Australia.
The Australian Society of Hospital Pharmacists provides guidance to other health staff about what drugs have to go with which IV fluids in their Australian Injectable Drugs Handbook. If there is a shortage of saline or Hartmann’s solution, and shipments of other overseas brands have not arrived, this guidance can be used to select another appropriate IV fluid.
Why don’t we make it locally?
The current shortage of IV fluids is just another example of the problems Australia faces when it is almost completely reliant on its critical medicines from overseas manufacturers.
Fortunately, we have workarounds to address the current shortage. But Australia is likely to face ongoing shortages, not only for IV fluids but for any medicines that we rely on overseas manufacturers to produce. Shortages like this put Australian lives at risk.
In the past both myself, and others, have called for the federal government to develop or back the development of medicines manufacturing in Australia. This could involve manufacturing off-patent medicines with an emphasis on those medicines most used in Australia.
Not only would this create stable, high technology jobs in Australia, it would also contribute to our economy and make us less susceptible to future global drug supply problems.
Nial Wheate, Professor and Director Academic Excellence, Macquarie University and Shoohb Alassadi, Casual academic, pharmaceutical sciences, University of 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 H5N1 bird flu
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On May 30, the Centers for Disease Control and Prevention reported that a Michigan dairy worker tested positive for H5N1 bird flu. It was the fourth person to test positive for H5N1 in the United States, following another recent case in Michigan, an April case in Texas, and an initial case in Colorado in 2022.
H5N1 bird flu has been spreading among bird species in the U.S. since 2021, killing millions of wild birds and poultry. In late March 2024, H5N1 bird flu was found in cows for the first time, causing an outbreak in dairy cows across several states.
U.S. public health officials and researchers are particularly concerned about this outbreak because the virus has infected cows and other mammals and has spread from a cow to a human for the first time.
This bird flu strain has shown to not only make wild mammals, including marine mammals and bears, very sick but to also cause high rates of death among species, says Jane Sykes, professor of small animal medicine at the University of California, Davis, School of Veterinary Medicine.
“And now that it has been found in cattle, [it] raises particular concern for spread to all the animal species, including people,” adds Sykes.
Even though the risk for human infection is low and there has never been human-to-human transmission of H5N1, there are several actions you can take to stay protected. Read on to learn more about H5N1 bird flu and the current outbreak.
What is H5N1?
H5N1 is a type of influenza virus that most commonly affects birds, causing them severe respiratory illness and death.
The H5N1 strain first emerged in China in the 1990s, and it has continued to spread around the world since then. In 1997, the virus spread from animals to humans in Hong Kong for the first time, infecting 18 people, six of whom died.
Since 2020, the H5N1 strain has caused “an unprecedented number of deaths in wild birds and poultry in many countries,” according to the World Health Organization.
Even though bird flu is rare in humans, an H5N1 infection can cause mild to severe illness and can be fatal in some cases. It can cause eye infection, upper respiratory symptoms, and pneumonia.
What do we know about the 2024 human cases of H5N1 in the U.S.?
The Michigan worker who tested positive for H5N1 in late May is a dairy worker who was exposed to infected livestock. They were the first to experience respiratory symptoms—including a cough without a fever—during the current outbreak. They were given an antiviral and the CDC says their symptoms are resolving.
The Michigan farm worker who tested positive earlier in May only experienced eye-related symptoms and has already recovered. And the dairy worker who tested positive for the virus in Texas in April only experienced eye redness as well, was treated with an antiviral medication for the flu, and is recovering.
Is H5N1 bird flu in the milk we consume?
The Food and Drug Administration has found traces of H5N1 bird flu virus in raw or unpasteurized milk. However, pasteurized milk is safe to drink.
Pasteurization, the process of heating milk to high temperatures to kill harmful bacteria (which the majority of commercially sold milk goes through), deactivates the virus. In 20 percent of pasteurized milk samples, the FDA found small, inactive (not live nor infectious) traces of the virus, but these fragments do not make pasteurized milk dangerous.
In a recent Infectious Diseases Society of America briefing, Dr. Maximo Brito, a professor at the University of Illinois College of Medicine, said that it’s important for people to avoid “drinking unpasteurized or raw milk [because] there are other diseases, not only influenza, that could be transmitted by drinking unpasteurized milk.”
What can I do to prevent bird flu?
While the risk of H5N1 infection in humans is low, people with exposure to infected animals (like farmworkers) are most at risk. But there are several actions you can take to stay protected.
One of the most important things, according to Sykes, is taking the usual precautions we’ve taken with COVID-19 and other respiratory viruses, including frequent handwashing, especially before eating.
“Handwashing and mask-wearing [are important], just as we learned from the pandemic,” Sykes adds. “And it’s not wearing a mask at all times, but thinking about high-risk situations, like when you’re indoors in a crowded environment, where transmission of respiratory viruses is much more likely to occur.”
There are other steps you can take to prevent H5N1, according to the CDC:
- Avoid direct contact with sick or dead animals, including wild birds and poultry.
- Don’t touch surfaces that may have been contaminated with animal poop, saliva, or mucus.
- Cook poultry and eggs to an internal temperature of 165 degrees Fahrenheit to kill any bacteria or virus, including H5N1. Generally, avoid eating undercooked food.
- Avoid consuming unpasteurized or raw milk or products like cheeses made with raw milk.
- Avoid eating uncooked or undercooked food.
- Poultry and livestock farmers and workers and bird flock owners should wear masks and other personal protective equipment “when in direct or close physical contact with sick birds, livestock, or other animals; carcasses; feces; litter; raw milk; or surfaces and water that might be contaminated with animal excretions from potentially or confirmed infected birds, livestock, or other animals.” (The CDC has more recommendations for this population here.)
Is there a vaccine for H5N1?
The CDC said there are two candidate H5N1 vaccines ready to be made and distributed in case the virus starts to spread from person to person, and the country is now moving forward with plans to produce millions of vaccine doses.
The FDA has approved several bird flu vaccines since 2007. The U.S. has flu vaccines in stockpile through the National Pre-Pandemic Influenza Vaccine Stockpile program, which allows for quick response as strains of the flu virus evolve.
Could this outbreak become a pandemic?
Scientists and researchers are concerned about the possibility of H5N1 spreading among people and causing a pandemic. “Right now, the risk is low, but as time goes on, the potential for mutation to cause widespread human infection increases,” says Sykes.
“I think this virus jumping into cows has shown the urgency to keep tracking [H5N1] a lot more closely now,” Peter Halfmann, research associate professor at the University of Wisconsin-Madison’s Influenza Research Institute tells PGN. “We have our eyes on surveillance now. … We’re keeping a much closer eye, so it’s not going to take us by surprise.”
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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From Painkillers To Hunger-Killers
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Here’s this week’s selection of health news discoveries, the science behind them, what they mean for you, and where you can go from there:
Killing more than pain
It’s well-known that overuse of opioids can lead to many problems, and here’s another one: messing with the endocrine system. This time, mostly well-evidenced in men—however, the researchers are keen to point out that absence of evidence is very much not evidence of absence, hence “the hidden effects” in the headline below. It’s not that the effects are hard to see—it’s that a lot of the research has yet to be done. For now, though, we know at the very least that there’s an association between opioid use and hyperprolactinemia in men. The same research also begins to shine a light on the effects of opioid use on the hypothalamic-pituitary system and bone health, too:
Read in full: The hidden effects of opioid use on the endocrine system
Related: The 7 Approaches To Pain Management
Gut microbiome dysbiosis may lead to slipping disks
These things sound quite unconnected, but the association is strong. The likely mechanism of action is that the gut dysbiosis influences systemic inflammation, and thus spinal health—because the gut-spine axis cannot really be disconnected (while you’re alive, at least). It’s especially likely if you’re over 50 and female:
Read in full: Are back problems influenced by your gut?
Related: Is Your Gut Leading You Into Osteoporosis?
The Internet is really really great (for brains)
It’s common to see many articles on the Internet telling us, paradoxically, that we should spend less time on the Internet. However… Remember when in the 90s, it was all about “the information superhighway”? It turns out, the fact that it’s more like “the information spaghetti junction” these days doesn’t change the fact that stimulation is good for our brains, and daily Internet use improves memory, because of the different way that we index and store information that came from a virtual source. While there are parts of your brain for “things at home” and “things at the local supermarket”, there are also parts for “things at 10almonds” and “things at Facebook” and so forth. You are, in effect, building a vast mental library as you surf:
Read in full: Daily internet use supercharges your memory!
Related: Make Social Media Work For Your Mental Health
Fall back
Around this time of year in many places in the Northern Hemisphere, the clocks go back an hour (it’s next weekend in the US and Canada, by the way, and this weekend in most of Europe). Many enjoy this as the potential for an extra hour’s sleep, but for night owls, it can be more of a nuisance than a benefit—throwing out what’s often an already difficult relationship with the clock, and presenting challenges both practical and physiological (different processing of melatonin, for instance). Here be science:
Read in full: Why night owls struggle more when the clocks go back
Related: Early Bird Or Night Owl? Genes vs Environment
Can you outrun your hunger?
It seems so, though benefits are strongest in women. We say “outrun”, though this study did use stationary cycling. To put it in few words, intense exercise (but not moderate exercise) significantly reduced acylated ghrelin (hunger hormone) levels, and subjective reports of hunger, especially in women:
Read in full: Study finds intense exercise may suppress appetite in healthy humans
Related: 3 Appetite Suppressants Better Than Ozempic
Take care!
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Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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Ridged Nails: What Are They Telling You?
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Dr. Yaseen Arsalan, a Doctor of Pharmacy, has advice on the “nutraceutical” side of things:
Onychorrhexis
Sounds like the name of a dinosaur, but it’s actually the condition that creates the vertical ridges that sometimes appear on nails. It’s especially likely in the case of thinner nails, and/or certain nutritional deficiencies. Overuse of certain chemicals (including nail polish remover, hair products that get on your hands a lot, and cleaning fluids) can also cause it. It can also be worsened by various conditions, including eczema, psoriasis, hypothyroidism, anemia, and amyloidosis, but it won’t usually be outright caused by those alone.
There are two main kinds of ridges on nails:
- Vertical ridges: associated with hypothyroidism, anemia, and aging. Often an indicator of low iron.
- Horizontal ridges (Beau’s lines): caused by interrupted nail growth, brute force trauma, chemotherapy, acrylic nails, and gel nail polishes. Can also be an indicator of low zinc.
There are an assortment of medical treatments available, which Dr. Arsalan discusses in the video, but for home remedy treatment, he recommends:
- Nail-strengthening creams (look for coconut oil, shea butter, beeswax, vitamin E)
- Hydration (this is about overall hydration e.g. water intake)
- Careful nail trimming (fingernails with a curved shape and toenails straight across)
- Nail ridge filler (he recommends the brand Barrielle, for not containing formaldehyde or formalin)
- Moisturization (with cuticle oil or hand creams, because that hydration we talked about earlier is important, and we want it to stay inside the nail)
For more on those things, plus the medical treatments plus other “how to avoid this” measures, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- The Counterintuitive Dos and Don’ts of Nail Health
- Regular Nail Polish vs Gel Nail Polish – Which is Healthier?
Take care!
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What does it mean to be transgender?
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Transgender media coverage has surged in recent years for a wide range of reasons. While there are more transgender television characters than ever before, hundreds of bills are targeting transgender people’s access to medical care, sports teams, gender-specific public spaces, and other institutions.
Despite the increase in conversation about the transgender community, public confusion around transgender identity remains.
Read on to learn more about what it means to be transgender and understand challenges transgender people may face.
What does it mean to be transgender?
Transgender—or “trans”—is an umbrella term for people whose gender identity or gender expression does not conform to their sex assigned at birth. People can discover they are trans at any age.
Gender identity refers to a person’s inner sense of being a woman, a man, neither, both, or something else entirely. Trans people who don’t feel like women or men might describe themselves as nonbinary, agender, genderqueer, or two-spirit, among other terms.
Gender expression describes the way a person communicates their gender through their appearance—such as their clothing or hairstyle—and behavior.
A person whose gender expression doesn’t conform to the expectations of their assigned sex may not identify as trans. The only way to know for sure if someone is trans is if they tell you.
Cisgender—or “cis”—describes people whose gender identities match the sex they were assigned at birth.
How long have transgender people existed?
Being trans isn’t new. Although the word “transgender” only dates back to the 1960s, people whose identities defy traditional gender expectations have existed across cultures throughout recorded history.
How many people are transgender?
A 2022 Williams Institute study estimates that 1.6 million people over the age of 13 identify as transgender in the United States.
Is being transgender a mental health condition?
No. Conveying and communicating about your gender in a way that feels authentic to you is a normal and necessary part of self-expression.
Social and legal stigma, bullying, discrimination, harassment, negative media messages, and barriers to gender-affirming medical care can cause psychological distress for trans people. This is especially true for trans people of color, who face significantly higher rates of violence, poverty, housing instability, and incarceration—but trans identity itself is not a mental health condition.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity, or their internal sense of gender. A 2021 study of trans adults pursuing gender-affirming medical care found that most participants started experiencing gender dysphoria by the time they were 7.
When trans people don’t receive the support they need to manage gender dysphoria, they may experience depression, anxiety, social isolation, suicidal ideation, substance use disorder, eating disorders, and self-injury.
How do trans people manage gender dysphoria?
Every trans person’s experience with gender dysphoria is unique. Some trans people may alleviate dysphoria by wearing gender-affirming clothing or by asking others to refer to them by a new name and use pronouns that accurately reflect their gender identity. The 2022 U.S. Trans Survey found that nearly all trans participants who lived as a different gender than the sex they were assigned at birth reported that they were more satisfied with their lives.
Some trans people may also manage dysphoria by pursuing medical transition, which may involve taking hormones and getting gender-affirming surgery.
Access to gender-affirming medical care has been shown to reduce the risk of depression and suicide among trans youth and adults.
To learn more about the trans community, visit resources from the National Center for Transgender Equality, the Trevor Project, PFLAG, and Planned Parenthood.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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