Self-Compassion – by Dr. Kristin Neff
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A lot of people struggle with self-esteem, and depending on one’s surrounding culture, it can even seem socially obligatory to be constantly valuing oneself highly (or else, who else will if we do not?). But, as Dr. Neff points out, there’s an inherent problem with reinforcing for oneself even a positive message like “I am smart, strong, and capable!” because sometimes all of us have moments of being stupid, weak, and incapable (occasionally all three at once!), which places us in a position of having to choose between self-deceit and self-deprecation, neither of which are good.
Instead, Dr. Neff advocates for self-compassion, for treating oneself as one (hopefully) would a loved one—seeing their/our mistakes, weaknesses, failures, and loving them/ourself anyway.
She does not, however, argue that we should accept just anything from ourselves uncritically, but rather, we identify our mistakes, learn, grow, and progress. So not “I should have known better!”, nor even “How was I supposed to know?!”, but rather, “Now I have learned a thing”.
The style of the book is quite personal, as though having a heart-to-heart over a hot drink perhaps, but the format is organized and progresses naturally from one idea to the next, taking the reader to where we need to be.
Bottom line: if you have trouble with self-esteem (as most people do), then that’s a trap that there is a way out of, and it doesn’t require being perfect or lowering one’s standards, just being kinder to oneself along the way—and this book can help inculcate that.
Click here to check out Self-Compassion, and indeed be kind to yourself!
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The Case of the Armadillo: Is It Spreading Leprosy in Florida?
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GAINESVILLE, Fla. — In an open-air barn at the edge of the University of Florida, veterinarian Juan Campos Krauer examines a dead armadillo’s footpads and ears for signs of infection.
Its claws are curled tight and covered in blood. Campos Krauer thinks it was struck in the head while crossing a nearby road.
He then runs a scalpel down its underside. He removes all the important organs: heart, liver, kidneys. Once the specimens are bottled up, they’re destined for an ultra-cold freezer in his lab at the college.
Campos Krauer plans to test the armadillo for leprosy, an ancient illness also known as Hansen’s disease that can lead to nerve damage and disfigurement in humans. He and other scientists are trying to solve a medical mystery: why Central Florida has become a hot spot for the age-old bacteria that cause it.
Leprosy remains rare in the United States. But Florida, which often reports the most cases of any state, has seen an uptick in patients. The epicenter is east of Orlando. Brevard County reported a staggering 13% of the nation’s 159 leprosy cases in 2020, according to a Tampa Bay Times analysis of state and federal data.
Many questions about the phenomenon remain unanswered. But leprosy experts believe armadillos play a role in spreading the illness to people. To better understand who’s at risk and to prevent infections, about 10 scientists teamed up last year to investigate. The group includes researchers from the University of Florida, Colorado State University, and Emory University in Atlanta.
“How this transmission is happening, we really don’t know,” said Ramanuj Lahiri, chief of the laboratory research branch for the National Hansen’s Disease Program, which studies the bacteria involved and cares for leprosy patients across the country.
‘Nothing Was Adding Up’
Leprosy is believed to be the oldest human infection in history. It probably has been sickening people for at least 100,000 years. The disease is highly stigmatized — in the Bible, it was described as a punishment for sin. In more modern times, patients were isolated in “colonies” around the world, including in Hawaii and Louisiana.
In mild cases, the slow-growing bacteria cause a few lesions. If left untreated, they can paralyze the hands and feet.
But it’s actually difficult to fall ill with leprosy, as the infection isn’t very contagious. Antibiotics can cure the ailment in a year or two. They’re available for free through the federal government and the World Health Organization, which launched a campaign in the 1990s to eliminate leprosy as a public health problem.
In 2000, reported U.S. cases dropped to their lowest point in decades with 77 infections. But they later increased, averaging about 180 per year from 2011 to 2020, according to data from the National Hansen’s Disease Program.
During that time, a curious trend emerged in Florida.
In the first decade of the 21st century, the state logged 67 cases. Miami-Dade County noted 20 infections — the most of any Florida county. The vast majority of its cases were acquired outside the U.S., according to a Times analysis of Florida Department of Health data.
But over the next 10 years, recorded cases in the state more than doubled to 176 as Brevard County took center stage.
The county, whose population is about a fifth the size of Miami-Dade’s, logged 85 infections during that time — by far the most of any county in the state and nearly half of all Florida cases. In the previous decade, Brevard noted just five cases.
Remarkably, at least a quarter of Brevard’s infections were acquired within the state, not while the individuals were abroad. India, Brazil, and Indonesia diagnose more leprosy cases than anywhere, reporting over 135,000 infections combined in 2022 alone. People were getting sick even though they hadn’t traveled to such areas or been in close contact with existing leprosy patients, said Barry Inman, a former epidemiologist at the Brevard health department who investigated the cases and retired in 2021.
“Nothing was adding up,” Inman said.
A few patients recalled touching armadillos, which are known to carry the bacteria. But most didn’t, he said. Many spent a lot of time outdoors, including lawn workers and avid gardeners. The cases were usually mild.
It was difficult to nail down where people got the illness, he added. Because the bacteria grow so slowly, it can take anywhere from nine months to 20 years for symptoms to begin.
Amoeba or Insect Culprits?
Heightened awareness of leprosy could play a role in Brevard’s groundswell of cases.
Doctors must report leprosy to the health department. Yet Inman said many in the county didn’t know that, so he tried to educate them after noticing cases in the late 2000s.
But that’s not the sole factor at play, Inman said.
“I don’t think there’s any doubt in my mind that something new is going on,” he said.
Other parts of Central Florida have also recorded more infections. From 2011 to 2020, Polk County logged 12 cases, tripling its numbers compared with the previous 10 years. Volusia County noted 10 cases. It reported none the prior decade.
Scientists are honing in on armadillos. They suspect the burrowing critters may indirectly cause infections through soil contamination.
Armadillos, which are protected by hard shells, serve as good hosts for the bacteria, which don’t like heat and can thrive in the animals whose body temperatures range from a cool 86-95 degrees.
Colonists probably brought the disease to the New World hundreds of years ago, and somehow armadillos became infected, said Lahiri, the National Hansen’s Disease Program scientist. The nocturnal mammals can develop lesions from the illness just as humans can. More than 1 million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the University of Florida’s Department of Large Animal Clinical Sciences.
How many carry leprosy is unclear. A study published in 2015 of more than 600 armadillos in Alabama, Florida, Georgia, and Mississippi found that about 16% showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos west of the Mississippi River, then spread east.
Handling the critters is a known hazard. Lab research shows that single-cell amoebas, which live in soil, can also carry the bacteria.
Armadillos love to dig up and eat earthworms, frustrating homeowners whose yards they damage. The animals may shed the bacteria while hunting for food, passing it to amoebas, which could later infect people.
Leprosy experts also wonder if insects help spread the disease. Blood-sucking ticks might be a culprit, lab research shows.
“Some people who are infected have little to no exposure to the armadillo,” said Norman Beatty, an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”
Campos Krauer, who’s been searching Gainesville streets for armadillo roadkill, wants to gather infected animals and let them decompose in a fenced-off area, allowing the remains to soak into a tray of soil while flies lay eggs. He hopes to test the dirt and larvae to see if they pick up the bacteria.
Adding to the intrigue is a leprosy strain found only in Florida, according to scientists.
In the 2015 study, researchers discovered that seven armadillos from the Merritt Island National Wildlife Refuge, which is mostly in Brevard but crosses into Volusia, carried a previously unseen version of the pathogen.
Ten patients in the region were stricken with it, too. At the genetic level, the strain is similar to another type found in U.S. armadillos, said Charlotte Avanzi, a Colorado State University researcher who specializes in leprosy.
It’s unknown if the strain causes more severe disease, Lahiri said.
Reducing Risk
The public should not panic about leprosy, nor should people race to euthanize armadillos, researchers warn.
Scientists estimate that over 95% of the global human population has a natural ability to ward off the disease. They believe months of exposure to respiratory droplets is needed for person-to-person transmission to occur.
But when infections do happen, they can be devastating.
“If we better understand it,” Campos Krauer said, “the better we can learn to live with it and reduce the risk.”
The new research may also provide insight for other Southern states. Armadillos, which don’t hibernate, have been moving north, Campos Krauer said, reaching areas like Indiana and Virginia. They could go farther due to climate change.
People concerned about leprosy can take simple precautions, medical experts say. Those working in dirt should wear gloves and wash their hands afterward. Raising garden beds or surrounding them with a fence may limit the chances of soil contamination. If digging up an armadillo burrow, consider wearing a face mask, Campos Krauer said.
Don’t play with or eat the animals, added John Spencer, a scientist at Colorado State University who studies leprosy transmission in Brazil. They’re legal to hunt year-round in Florida without a license.
Campos Krauer’s team has so far examined 16 dead armadillos found on Gainesville area roads, more than 100 miles from the state’s leprosy epicenter, trying to get a preliminary idea of how many carry the bacteria.
None has tested positive yet.
This article was produced through a partnership between KFF Health News and the Tampa Bay Times.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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The Paleo Diet
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What’s The Real Deal With The Paleo Diet?
The Paleo diet is popular, and has some compelling arguments for it.
Detractors, meanwhile, have derided Paleo’s inclusion of modern innovations, and have also claimed it’s bad for the heart.
But where does the science stand?
First: what is it?
The Paleo diet looks to recreate the diet of the Paleolithic era—in terms of nutrients, anyway. So for example, you’re perfectly welcome to use modern cooking techniques and enjoy foods that aren’t from your immediate locale. Just, not foods that weren’t a thing yet. To give a general idea:
Paleo includes:
- Meat and animal fats
- Eggs
- Fruits and vegetables
- Nuts and seeds
- Herbs and spices
Paleo excludes:
- Processed foods
- Dairy products
- Refined sugar
- Grains of any kind
- Legumes, including any beans or peas
Enjoyers of the Mediterranean Diet or the DASH heart-healthy diet, or those with a keen interest in nutritional science in general, may notice they went off a bit with those last couple of items at the end there, by excluding things that scientific consensus holds should be making up a substantial portion of our daily diet.
But let’s break it down…
First thing: is it accurate?
Well, aside from the modern cooking techniques, the global market of goods, and the fact it does include food that didn’t exist yet (most fruits and vegetables in their modern form are the result of agricultural engineering a mere few thousand years ago, especially in the Americas)…
…no, no it isn’t. Best current scientific consensus is that in the Paleolithic we ate mostly plants, with about 3% of our diet coming from animal-based foods. Much like most modern apes.
Ok, so it’s not historically accurate. No biggie, we’re pragmatists. Is it healthy, though?
Well, health involves a lot of factors, so that depends on what you have in mind. But for example, it can be good for weight loss, almost certainly because of cutting out refined sugar and, by virtue of cutting out all grains, that means having cut out refined flour products, too:
Diet Review: Paleo Diet for Weight Loss
Measured head-to-head with the Mediterranean diet for all-cause mortality and specific mortality, it performed better than the control (Standard American Diet, or “SAD”), probably for the same reasons we just mentioned. However, it was outperformed by the Mediterranean Diet:
So in lay terms: the Paleo is definitely better than just eating lots of refined foods and sugar and stuff, but it’s still not as good as the Mediterranean Diet.
What about some of the health risk claims? Are they true or false?
A common knee-jerk criticism of the paleo-diet is that it’s heart-unhealthy. So much red meat, saturated fat, and no grains and legumes.
The science agrees.
For example, a recent study on long-term adherence to the Paleo diet concluded:
❝Results indicate long-term adherence is associated with different gut microbiota and increased serum trimethylamine-N-oxide (TMAO), a gut-derived metabolite associated with cardiovascular disease. A variety of fiber components, including whole grain sources may be required to maintain gut and cardiovascular health.❞
Bottom line:
The Paleo Diet is an interesting concept, and certainly can be good for short-term weight loss. In the long-term, however (and: especially for our heart health) we need less meat and more grains and legumes.
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Cherries vs Blueberries – Which is Healthier?
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Our Verdict
When comparing cherries to blueberries, we picked the blueberries.
Why?
It was close! And blueberries only won by virtue of taking an average value for cherries; we could have (if you’ll pardon the phrase) cherry-picked tart cherries for extra benefits that’d put them ahead of blueberries. That’s how close it is.
In terms of macros, they are almost identical, so nothing to set them apart there.
In the category of vitamins, they are mostly comparable except that blueberries have a lot more vitamin K, and cherries have a lot more vitamin A. Since vitamin K is the vitamin that’s scarcer in general, we’ll call blueberries’ vitamin K content a win.
Blueberries do also have about 6x more vitamin E, with a cup of blueberries containing about 10% of the daily requirement (and cherries containing almost none). Another small win for blueberries.
When it comes to minerals, they are mostly comparable; the largest point of difference is that blueberries contain more manganese while cherries contain more copper; nothing to decide between them here.
We’re down to counting amino acids and antioxidants now, so blueberries have a lot more cystine and tyrosine. They also have slightly more of amino acids that they both only have trace amounts of. And as for antioxidants? Blueberries contain notably more quercetin.
So, blueberries win the day—but if we had specified tart cherries rather than taking an average, they could have come out on top. Enjoy both!
Want to learn more?
You might like to read:
Take care!
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Magnesium Glycinate vs Magnesium Citrate – Which is Healthier?
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Our Verdict
When comparing magnesium glycinate to magnesium citrate, we picked the citrate.
Why?
Both are fine sources of magnesium, a nutrient in which it’s very common to be deficient—a lot of people don’t eat many leafy greens, beans, nuts, and so forth that contain it.
A quick word on a third contender we didn’t include here: magnesium oxide is probably the most widely-sold magnesium supplement because it’s cheapest to make. It also has woeful bioavailability, to the point that there seems to be negligible benefit to taking it. So we don’t recommend that.
Magnesium glycinate and magnesium citrate are both absorbed well, but magnesium citrate is the most well-absorbed form of magnesium supplement.
In terms of the relative merits of the glycine or the citric acid (the “other part” of magnesium glycinate and magnesium citrate, respectively), both are also great nutrients, but the amount delivered with the magnesium is quite small in each case, and so there’s nothing here to swing it one way or the other.
For this reason, we went with the magnesium citrate, as the most readily bioavailable!
Want to try them out?
Here they are on Amazon:
Magnesium glycinate | Magnesium citrate
Enjoy!
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Ouch. That ‘Free’ Annual Checkup Might Cost You. Here’s Why.
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When Kristy Uddin, 49, went in for her annual mammogram in Washington state last year, she assumed she would not incur a bill because the test is one of the many preventive measures guaranteed to be free to patients under the 2010 Affordable Care Act. The ACA’s provision made medical and economic sense, encouraging Americans to use screening tools that could nip medical problems in the bud and keep patients healthy.
So when a bill for $236 arrived, Uddin — an occupational therapist familiar with the health care industry’s workings — complained to her insurer and the hospital. She even requested an independent review.
“I’m like, ‘Tell me why am I getting this bill?’” Uddin recalled in an interview. The unsatisfying explanation: The mammogram itself was covered, per the ACA’s rules, but the fee for the equipment and the facility was not.
That answer was particularly galling, she said, because, a year earlier, her “free” mammogram at the same health system had generated a bill of about $1,000 for the radiologist’s reading. Though she fought that charge (and won), this time she threw in the towel and wrote the $236 check. But then she dashed off a submission to the KFF Health News-NPR “Bill of the Month” project:
“I was really mad — it’s ridiculous,” she later recalled. “This is not how the law is supposed to work.”
The ACA’s designers might have assumed that they had spelled out with sufficient clarity that millions of Americans would no longer have to pay for certain types of preventive care, including mammograms, colonoscopies, and recommended vaccines, in addition to doctor visits to screen for disease. But the law’s authors didn’t reckon with America’s ever-creative medical billing juggernaut.
Over the past several years, the medical industry has eroded the ACA’s guarantees, finding ways to bill patients in gray zones of the law. Patients going in for preventive care, expecting that it will be fully covered by insurance, are being blindsided by bills, big and small.
The problem comes down to deciding exactly what components of a medical encounter are covered by the ACA guarantee. For example, when do conversations between doctor and patient during an annual visit for preventive services veer into the treatment sphere? What screenings are needed for a patient’s annual visit?
A healthy 30-year-old visiting a primary care provider might get a few basic blood tests, while a 50-year-old who is overweight would merit additional screening for Type 2 diabetes.
Making matters more confusing, the annual checkup itself is guaranteed to be “no cost” for women and people age 65 and older, but the guarantee doesn’t apply for men in the 18-64 age range — though many preventive services that require a medical visit (such as checks of blood pressure or cholesterol and screens for substance abuse) are covered.
No wonder what’s covered under the umbrella of prevention can look very different to medical providers (trying to be thorough) and billers (intent on squeezing more dollars out of every medical encounter) than it does to insurers (who profit from narrower definitions).
For patients, the gray zone has become a billing minefield. Here are a few more examples, gleaned from the Bill of the Month project in just the past six months:
Peter Opaskar, 46, of Texas, went to his primary care doctor last year for his preventive care visit — as he’d done before, at no cost. This time, his insurer paid $130.81 for the visit, but he also received a perplexing bill for $111.81. Opaskar learned that he had incurred the additional charge because when his doctor asked if he had any health concerns, he mentioned that he was having digestive problems but had already made an appointment with his gastroenterologist. So, the office explained, his visit was billed as both a preventive physical and a consultation. “Next year,” Opasker said in an interview, if he’s asked about health concerns, “I’ll say ‘no,’ even if I have a gunshot wound.”
Kevin Lin, a technology specialist in Virginia in his 30s, went to a new primary care provider to take advantage of the preventive care benefit when he got insurance; he had no physical complaints. He said he was assured at check-in that he wouldn’t be charged. His insurer paid $174 for the checkup, but he was billed an additional $132.29 for a “new patient visit.” He said he has made many calls to fight the bill, so far with no luck.
Finally, there’s Yoori Lee, 46, of Minnesota, herself a colorectal surgeon, who was shocked when her first screening colonoscopy yielded a bill for $450 for a biopsy of a polyp — a bill she knew was illegal. Federal regulations issued in 2022 to clarify the matter are very clear that biopsies during screening colonoscopies are included in the no-cost promise. “I mean, the whole point of screening is to find things,” she said, stating, perhaps, the obvious.
Though these patient bills defy common sense, room for creative exploitation has been provided by the complex regulatory language surrounding the ACA. Consider this from Ellen Montz, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services, in an emailed response to queries and an interview request on this subject: “If a preventive service is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, then the plan issuer may impose cost sharing for the office visit.”
So, if the doctor decides that a patient’s mention of stomach pain does not fall under the umbrella of preventive care, then that aspect of the visit can be billed separately, and the patient must pay?
And then there’s this, also from Montz: “Whether a facility fee is permitted to be charged to a consumer would depend on whether the facility usage is an integral part of performing the mammogram or an integral part of any other preventive service that is required to be covered without cost sharing under federal law.”
But wait, how can you do a mammogram or colonoscopy without a facility?
Unfortunately, there is no federal enforcement mechanism to catch individual billing abuses. And agencies’ remedies are weak — simply directing insurers to reprocess claims or notifying patients they can resubmit them.
In the absence of stronger enforcement or remedies, CMS could likely curtail these practices and give patients the tools to fight back by offering the sort of clarity the agency provided a few years ago regarding polyp biopsies — spelling out more clearly what comes under the rubric of preventive care, what can be billed, and what cannot.
The stories KFF Health News and NPR receive are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score.
Perhaps most disturbing: These unexpected bills might discourage people from seeking preventive screenings that could be lifesaving, which is why the ACA deemed them “essential health benefits” that should be free.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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This Is Your Brain on Food – by Dr. Uma Naidoo
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“Diet will fix your brain” is a bold claim that often comes from wishful thinking and an optimistic place where anecdote is louder than evidence. But, diet does incontrovertibly also affect brain health. So, what does Dr. Naidoo bring to the table?
The author is a Harvard-trained psychiatrist, a professional chef who graduated with her culinary school’s most coveted award, and a trained-and-certified nutritionist. Between those three qualifications, it’s safe to she knows her stuff when it comes to the niche that is nutritional psychiatry. And it shows.
She takes us through the neurochemistry involved, what chemicals are consumed, made, affected, inhibited, upregulated, etc, what passes through the blood-brain barrier and what doesn’t, what part the gut really plays in its “second brain” role, and how we can leverage that—as well as mythbusting a lot of popular misconceptions about certain foods and moods.
There’s hard science in here, but presented in quite a pop-science way, making for a very light yet informative read.
Bottom line: if you’d like to better understand what your food is doing to your brain (and what it could be doing instead), then this is a top-tier book for you!
Click here to check out This Is Your Brain On Food, and get to know yours!
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