Milk Thistle For The Brain, Bones, & More
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“Thistle Do Nicely”
Milk thistle is a popular supplement; it comes from the milk thistle plant (Silybum marianum), commonly just called thistles. There are other kinds of thistle too, but these are one of the most common.
So, what does it do?
Liver health
Milk thistle enjoys popular use to support liver health; the liver is a remarkably self-regenerative organ if given the chance, but sometimes it can use a helping hand.
See for example: How To Undo Liver Damage
As for milk thistle’s beneficence, it is very well established:
- Milk thistle in liver diseases: past, present, future
- Hepatoprotective effect of silymarin
- Silybum Marianum and Chronic Liver Disease: A Marriage of Many Years
Brain health
For this one the science is less well-established, as studies so far have been on non-human animals, or have been in vitro studies.
Nevertheless, the results so far are promising, and the mechanism of action seems to be a combination of reducing oxidative stress and neuroinflammation, as well as suppressing amyloid β-protein (Aβ) fibril formation, in other words, reducing amyloid plaques.
General overview: A Mini Review on the Chemistry and Neuroprotective Effects of Silymarin
All about the plaques, but these are non-human animal studies:
- Mouse model: Silymarin attenuated the amyloid β plaque burden and improved behavioral abnormalities in an Alzheimer’s disease mouse model
- Rat model: Silymarin effect on amyloid-β plaque accumulation and gene expression of APP in an Alzheimer’s disease rat model
Against diabetes
Milk thistle improves insulin sensitivity, and reduces fasting blood sugar levels and HbA1c levels. The research so far is mostly in type 2 diabetes, however (at least, so far as we could find). For example:
Studies we could find for T1D were very far from translatable to human usefulness, for example, “we poisoned these rats with streptozotocin then gave them megadoses of silymarin (10–15 times the dose usually recommended for humans) and found very small benefits to the lenses of their eyes” (source).
Against osteoporosis
In this case, milk thistle’s estrogenic effects may be of merit to those at risk of menopause-induced osteoporosis:
If you’d like a quick primer about such things as what antiosteoclastic activity is, here’s a quick recap:
Which Osteoporosis Medication, If Any, Is Right For You?
Is it safe?
It is “Generally Recognized As Safe”, and even when taken at high doses for long periods, side effects are very rare.
Contraindications include if you’re pregnant, nursing, or allergic.
Potential reasons for caution (but not necessarily contraindication) include if you’re diabetic (its blood-sugar lowering effects will decrease the risk of hyperglycemia while increasing the risk of hypoglycemia), or have a condition that could be exacerbated by its estrogenic effects—including if you are on HRT, because it’s an estrogen receptor agonist in some ways (for example those bone benefits we mentioned before) but an estrogen antagonist in others (for example, in the uterus, if you have one, or in nearby flat muscles, if you don’t).
As ever, speak with your doctor/pharmacist to be sure.
Want to try it?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Build Muscle (Healthily!)
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What Do You Have To Gain?
We have previously promised a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
And yes, that last one is also something that some people want/need to do (healthily!), and want/need help with that.
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
Here’s the first part: How To Lose Weight (Healthily!)
While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Body weight, muscle mass, and protein:
That BMI of 27, or whatever weight you might wish to be, ignores body composition. You’re probably aware that volume-for-volume, muscle weighs more than fat.
You’re also probably aware that if we’re not careful, we tend to lose muscle as we get older. This is known as age-related sarcopenia:
Protein, & Fighting Sarcopenia
Dr. Gabrielle Lyon, our featured expert in the above article, recommends getting at least 1.6g of protein per kg of body weight per day (Americans, divide your weight in pounds by 2.2 to get your weight in kg).
So for example, if you weigh 165lb, that’s 75kg, that’s 1.6×75=120g of protein per day.
There is an upper limit to how much protein per day is healthy, and that limit is probably around 2g of protein per kg of body weight per day:
Protein: How Much Do We Need, Really?
You may be wondering: should we go for animal or plant protein? In which case, the short version is:
- If you only care about muscle growth, any complete sources of protein are fine
- If you care about your general health too, then avoiding red meat is best, but other common protein sources are all fine
- Unprocessed is (unsurprisingly) better than processed in either case
Longer version: Plant vs Animal Protein: Head to Head
What exercises are best for muscle-building?
Of course, different muscles require different exercises, but for all of them, resistance training is what builds muscle the most, and it’s pretty much impossible to build a lot of muscle otherwise.
Check out: Resistance Is Useful! (Especially As We Get Older)
Prepare to fail!
No, really, prepare to fail. Because while resistance training in general is good for maintaining strong muscles and bones, you will only gain muscle if your current muscle is not enough to do the exercise:
- If you do a heavy resistance exercise without undue difficulty, your muscles will say to each other “Good job, team! That was hard, but luckily we were strong enough; no changes necessary”.
- If you do a heavy resistance exercise to the point where you can no longer do it (called: training to failure), then your muscles will say to each other “Oof, what a task! What we’ve got here is clearly not enough, so we’ll have to add more muscle for next time”.
Safety note: training to failure comes with safety risks. If using free weights or weight machines, please do so under well-trained supervision. If doing it with bodyweight (e.g. press-ups until you can press no more) or resistance bands, please check with your doctor first to ensure this is safe for you.
You can also increase the effectiveness of your resistance training by doing it in a way that “confuses” your muscles, making it harder for them to adapt in the moment, and thus forcing them to adapt more in the long term (e.g. get bigger and stronger):
HIIT, But Make It HIRT: High Intensity Resistance Training
Make time for recovery
While many kinds of exercise can be done daily, exercise to build muscle(s) means at the very least resting that muscle (or muscle group) the next day.
For this reason, a lot of bodybuilders have for example a week’s schedule that might look like:
- Monday: Upper body training
- Wednesday: Lower body training
- Friday: Core strength training
…and rest on other days. This gives most muscles a full week of recovery, and every muscle at least 48 hours of recovery.
Note: bodybuilders, like children (who are also doing a lot of body-building, in their own way) need more sleep in order to allow for this recovery and growth to occur. Serious bodybuilders often aim for 12 hours sleep per day. This might be impractical, undesirable, or even impossible for some people, but it’s a factor to be borne in mind and not forgotten.
See also:
Overdone It? How To Speed Up Recovery After Exercise (According To Actual Science)
Anything else that can (safely and healthily) be done to promote muscle growth?
There are a lot of supplements on the market; some are healthy and helpful, other not so much. Here are some we’ve written about:
- What To Eat, Take, And Do Before A Workout
- Creatine: Very Different For Young & Old People
- Ginseng: Exercising With Less Soreness!
- Taurine’s Benefits For Heart Health And More
- Topping Up Testosterone? What To Consider
Take care!
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Could my glasses be making my eyesight worse?
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So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?
Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them less likely to wear their glasses.
But what they are noticing is how much better the world appears through the glasses. They become less tolerant of a blurry world when they remove them.
Here are some other things you might notice about eyesight and wearing glasses.
Lazy eyes?
Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.
Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us focus on objects in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).
From the age of about 40, the lens in our eye progressively hardens and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “presbyopia” and at the moment there are no treatments for this lens hardening.
Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.
Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.
The wrong glasses?
Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause eyestrain and headaches.
Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children as their visual system is still in development.
But it is more common for kids to develop long-term vision problems as a result of not wearing glasses when they need them.
By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in blurry or uncomfortable vision during daily wear.
Registered optometrists in Australia are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.
Younger children with progressive vision impairments may need more frequent eye tests. Shutterstock What about dirty glasses?
Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. Cleaning glasses regularly with a microfibre lens cloth will help.
While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can harbour bacteria with the remote but theoretical potential to cause eye infection.
To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can reduce bacterial contamination by 96% – but care should be taken as alcohol can damage some frames, depending on what they are made of.
When should I get my eyes checked?
Regular eye exams, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses expire within two years and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.
Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as glaucoma, will be recommended more frequent checks.
Eye checks can detect broader health issues. Shutterstock An online prescription estimator is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.
Conditions such as diabetes or high blood pressure, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.
James Andrew Armitage, Professor of Optometry and Course Director, Deakin University and Nick Hockley, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Skin Care Down There (Incl. Butt Acne, Hyperpigmentation, & More)
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Dr. Sam Ellis, dermatologist, gives us the low-down:
Where the sun don’t shine
Common complaints and remedies that Dr. Ellis covers in this video include:
- Butt acne/folliculitis: most butt breakouts are actually folliculitis, not traditional acne. Folliculitis is caused by friction, sitting for long periods, or wearing tight clothes. Solutions include antimicrobial washes like benzoyl peroxide and changing sitting habits (i.e. to sit less)
- Keratosis pilaris: rough bumps around hair follicles can appear on the butt, often confused with acne.
- Boils and abscesses: painful, large lumps; these need medical attention for drainage.
- Hidradenitis suppurativa: recurrent painful cysts and boils in skin creases, often in the groin and buttocks. These require medical intervention and treatment.
- Ingrown hairs: are common in people who shave or wax. Treat with warm compresses and gentle exfoliants.
- Hyperpigmentation: is often caused by hormonal changes, friction, or other irritation. Laser hair removal and gentle chemical exfoliants can help.
In the event that the sun does, in fact, shine on your genitals (for example you sunbathe nude and have little or no pubic hair), then sun protection is essential to prevent further darkening (and also, incidentally, reduce the risk of cancer).
For more on all of this, plus a general introduction to skincare in the bikini zone (i.e. if everything’s fine there right now and you’d like to keep it that way), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Evidence-Based Skincare That Beats Product-Specific Hype
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Stuck in fight-or-flight mode? 5 ways to complete the ‘stress cycle’ and avoid burnout or depression
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Can you remember a time when you felt stressed leading up to a big life event and then afterwards felt like a weight had been lifted? This process – the ramping up of the stress response and then feeling this settle back down – shows completion of the “stress cycle”.
Some stress in daily life is unavoidable. But remaining stressed is unhealthy. Chronic stress increases chronic health conditions, including heart disease and stroke and diabetes. It can also lead to burnout or depression.
Exercise, cognitive, creative, social and self-soothing activities help us process stress in healthier ways and complete the stress cycle.
What does the stress cycle look like?
Scientists and researchers refer to the “stress response”, often with a focus on the fight-or-flight reactions. The phrase the “stress cycle” has been made popular by self-help experts but it does have a scientific basis.
The stress cycle is our body’s response to a stressful event, whether real or perceived, physical or psychological. It could be being chased by a vicious dog, an upcoming exam or a difficult conversation.
The stress cycle has three stages:
- stage 1 is perceiving the threat
- stage 2 is the fight-or-flight response, driven by our stress hormones: adrenaline and cortisol
- stage 3 is relief, including physiological and psychological relief. This completes the stress cycle.
Different people will respond to stress differently based on their life experiences and genetics.
Unfortunately, many people experience multiple and ongoing stressors out of their control, including the cost-of-living crisis, extreme weather events and domestic violence.
Remaining in stage 2 (the flight-or-flight response), can lead to chronic stress. Chronic stress and high cortisol can increase inflammation, which damages our brain and other organs.
When you are stuck in chronic fight-or-flight mode, you don’t think clearly and are more easily distracted. Activities that provide temporary pleasure, such as eating junk food or drinking alcohol are unhelpful strategies that do not reduce the stress effects on our brain and body. Scrolling through social media is also not an effective way to complete the stress cycle. In fact, this is associated with an increased stress response.
Stress and the brain
In the brain, chronic high cortisol can shrink the hippocampus. This can impair a person’s memory and their capacity to think and concentrate.
Chronic high cortisol also reduces activity in the prefrontal cortex but increases activity in the amygdala.
The prefrontal cortex is responsible for higher-order control of our thoughts, behaviours and emotions, and is goal-directed and rational. The amygdala is involved in reflexive and emotional responses. Higher amygdala activity and lower prefrontal cortex activity explains why we are less rational and more emotional and reactive when we are stressed.
There are five types of activities that can help our brains complete the stress cycle. https://www.youtube.com/embed/eD1wliuHxHI?wmode=transparent&start=0 It can help to understand how the brain encounters stress.
1. Exercise – its own complete stress cycle
When we exercise we get a short-term spike in cortisol, followed by a healthy reduction in cortisol and adrenaline.
Exercise also increases endorphins and serotonin, which improve mood. Endorphins cause an elated feeling often called “runner’s high” and have anti-inflammatory effects.
When you exercise, there is more blood flow to the brain and higher activity in the prefrontal cortex. This is why you can often think more clearly after a walk or run. Exercise can be a helpful way to relieve feelings of stress.
Exercise can also increase the volume of the hippocampus. This is linked to better short-term and long-term memory processing, as well as reduced stress, depression and anxiety.
2. Cognitive activities – reduce negative thinking
Overly negative thinking can trigger or extend the stress response. In our 2019 research, we found the relationship between stress and cortisol was stronger in people with more negative thinking.
Higher amygdala activity and less rational thinking when you are stressed can lead to distorted thinking such as focusing on negatives and rigid “black-and-white” thinking.
Activities to reduce negative thinking and promote a more realistic view can reduce the stress response. In clinical settings this is usually called cognitive behaviour therapy.
At home, this could be journalling or writing down worries. This engages the logical and rational parts of our brain and helps us think more realistically. Finding evidence to challenge negative thoughts (“I’ve prepared well for the exam, so I can do my best”) can help to complete the stress cycle.
Journalling could help process stressful events and complete the stress cycle. Shutterstock/Fellers Photography 3. Getting creative – a pathway out of ‘flight or fight’
Creative activities can be art, craft, gardening, cooking or other activities such as doing a puzzle, juggling, music, theatre, dancing or simply being absorbed in enjoyable work.
Such pursuits increase prefrontal cortex activity and promote flow and focus.
Flow is a state of full engagement in an activity you enjoy. It lowers high-stress levels of noradrenaline, the brain’s adrenaline. When you are focussed like this, the brain only processes information relevant to the task and ignores non-relevant information, including stresses.
4. Getting social and releasing feel-good hormones
Talking with someone else, physical affection with a person or pet and laughing can all increase oxytocin. This is a chemical messenger in the brain that increases social bonding and makes us feel connected and safe.
Laughing is also a social activity that activates parts of the limbic system – the part of the brain involved in emotional and behavioural responses. This increases endorphins and serotonin and improves our mood.
5. Self-soothing
Breathing exercises and meditation stimulate the parasympathetic nervous system (which calms down our stress responses so we can “reset”) via the vagus nerves, and reduce cortisol.
A good cry can help too by releasing stress energy and increasing oxytocin and endorphins.
Emotional tears also remove cortisol and the hormone prolactin from the body. Our prior research showed cortisol and prolactin were associated with depression, anxiety and hostility.
Getting moving can help with stress and its effects on the brain. Shutterstock/Jaromir Chalabala Action beats distraction
Whether it’s watching a funny or sad movie, exercising, journalling, gardening or doing a puzzle, there is science behind why you should complete the stress cycle.
Doing at least one positive activity every day can also reduce our baseline stress level and is beneficial for good mental health and wellbeing.
Importantly, chronic stress and burnout can also indicate the need for change, such as in our workplaces. However, not all stressful circumstances can be easily changed. Remember help is always available.
If you have concerns about your stress or health, please talk to a doctor.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or Kids Helpline on 1800 55 1800.
Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong and Susan J. Thomas, Associate professor in Mental Health and Behavioural Science, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Buckwheat vs Oats – Which is Healthier?
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Our Verdict
When comparing buckwheat to oats, we picked the oats.
Why?
First of all, for any thinking about the health concerns sometimes associated with wheat: buckwheat is not a kind of wheat, nor is it even in the same family; it’s not a grain, but a flowering plant. Buckwheat is to wheat as a lionfish is to lions.
That said, while these are both excellent foods, one of them is so good it makes the other one look bad in comparison:
In terms of macros, oats have more carbs, but also more protein and more fiber.
When it comes to vitamins, a clear winner emerges: oats have more of vitamins B1, B2, B5, B6, and B9, while buckwheat is higher in vitamin K and choline.
In the category of minerals, things are even more pronounced: oats are higher in calcium, iron, magnesium, manganese, phosphorus, potassium, and zinc. On the other hand, buckwheat is higher in selenium.
All in all: as ever, enjoy both, but if you’re picking one, oats cannot be beaten.
Want to learn more?
You might like to read:
The Best Kind Of Fiber For Overall Health?
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Homeopathy: Evidence So Tiny That It’s Not there?
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Homeopathy: Evidence So Tiny That It’s Not There?
Yesterday, we asked you your opinions on homeopathy. The sample size of responses was a little lower than we usually get, but of those who did reply, there was a clear trend:
- A lot of enthusiasm for “Homeopathy works on valid principles and is effective”
- Near equal support for “It may help some people as a complementary therapy”
- Very few people voted for “Science doesn’t know how it works, but it works”; this is probably because people who considered voting for this, voted for the more flexible “It may help some people as a complementary therapy” instead.
- Very few people considered it a dangerous scam and a pseudoscience.
So, what does the science say?
Well, let us start our investigation by checking out the position of the UK’s National Health Service, an organization with a strong focus on providing the least expensive treatments that are effective.
Since homeopathy is very inexpensive to arrange, they will surely want to put it atop their list of treatments, right?
❝Homeopathy is a “treatment” based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself.
There’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.❞
The NHS actually has a lot more to say about that, and you can read their full statement here.
But that’s just one institution. Here’s what Australia’s National Health and Medical Research Council had to say:
❝There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment❞
You can read their full statement here.
The American FDA, meanwhile, have a stronger statement:
❝Homeopathic drug products are made from a wide range of substances, including ingredients derived from plants, healthy or diseased animal or human sources, minerals and chemicals, including known poisons. These products have the potential to cause significant and even permanent harm if they are poorly manufactured, since that could lead to contaminated products or products that have potentially toxic ingredients at higher levels than are labeled and/or safe, or if they are marketed as substitute treatments for serious or life-threatening diseases and conditions, or to vulnerable populations.❞
You can read their full statement here.
Homeopathy is a dangerous scam and a pseudoscience: True or False?
False and True, respectively, mostly.
That may be a confusing answer, so let’s elaborate:
- Is it dangerous? Mostly not; it’s mostly just water. However, two possibilities for harm exist:
- Careless preparation could result in a harmful ingredient still being present in the water—and because of the “like cures like” principle, many of the ingredients used in homeopathy are harmful, ranging from heavy metals to plant-based neurotoxins. However, the process of “ultra-dilution” usually removes these so thoroughly that they are absent or otherwise scientifically undetectable.
- Placebo treatment has its place, but could result in “real” treatment going undelivered. This can cause harm if the “real” treatment was critically needed, especially if it was needed on a short timescale.
- Is it a scam? Probably mostly not; to be a scam requires malintent. Most practitioners probably believe in what they are practising.
- Is it a pseudoscience? With the exception that placebo effect has been highly studied and is a very valid complementary therapy… Yes, aside from that it is a pseudoscience. There is no scientific evidence to support homeopathy’s “like cures like” principle, and there is no scientific evidence to support homeopathy’s “water memory” idea. On the contrary, they go against the commonly understood physics of our world.
It may help some people as a complementary therapy: True or False?
True! Not only is placebo effect very well-studied, but best of all, it can still work as a placebo even if you know that you’re taking a placebo… Provided you also believe that!
Science doesn’t know how it works, but it works: True or False?
False, simply. At best, it performs as a placebo.
Placebo is most effective when it’s a remedy against subjective symptoms, like pain.
However, psychosomatic effect (the effect that our brain has on the rest of our body, to which it is very well-connected) can mean that placebo can also help against objective symptoms, like inflammation.
After all, our body, directed primarily by the brain, can “decide” what immunological defenses to deploy or hold back, for example. This is why placebo can help with conditions as diverse as arthritis (an inflammatory condition) or diabetes (an autoimmune condition, and/or a metabolic condition, depending on type).
Here’s how homeopathy measures up, for those conditions:
(the short answer is “no better than placebo”)
Homeopathy works on valid principles and is effective: True or False?
False, except insofar as placebo is a valid principle and can be effective.
The stated principles of homeopathy—”like cures like” and “water memory”—have no scientific basis.
We’d love to show the science for this, but we cannot prove a negative.
However, the ideas were conceived in 1796, and are tantamount to alchemy. A good scientific attitude means being open-minded to new ideas and testing them. In homeopathy’s case, this has been done, extensively, and more than 200 years of testing later, homeopathy has consistently performed equal to placebo.
In summary…
- If you’re enjoying homeopathic treatment and that’s working for you, great, keep at it.
- If you’re open-minded to enjoying a placebo treatment that may benefit you, be careful, but don’t let us stop you.
- If your condition is serious, please do not delay seeking evidence-based medical treatment.
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