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People With Autoimmune Diseases Experience 'Significantly' More Mental Health Symptoms, Study Shows

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August 7, 2023

People With Autoimmune Diseases Experience 'Significantly' More Mental Health Symptoms, Study Shows

A new study found that over half of people with an autoimmune disease also have depression and anxiety.
Nearly 1 in 10 people worldwide—13% of women and 7% of men—have an autoimmune disease.
Experts recommend people prioritize their autoimmune care and mental health care in tandem.

More than 50% of people with an autoimmune disease also suffer from depression and anxiety, a new study finds.

The new research, published in Rheumatology, found that while more than 50% of all people with autoimmune disorders experience depression and anxiety, many are never screened for the health conditions.

On top of that, more than half of those living with an autoimmune disease had rarely—or never—reported their mental health symptoms to a healthcare provider.

Nearly 1 in 10 people worldwide—13% of women and 7% of men—have an autoimmune disease. Considering this number, and the correlation between mental health and autoimmune diseases, a growing number of people are suffering in silence.

“The range and prevalence of these neurological and psychiatric symptoms were higher than previously found and much higher than clinicians expected,” Melanie Sloan, PhD, the lead researcher on the study and a research associate in the Department of Public Health and Primary Care, University of Cambridge, told Health.

"For patients, the important part is that they are definitely not alone if they're getting these types of symptoms, and it is only by telling their doctors that they can get support," she said.

Man talking to a doctor — Getty Images / Westend61

Underreported, Underserved Mental Illnesses Among Autoimmune Patients

To better understand this correlation, the researchers surveyed nearly 1,900 people with autoimmune disorders and asked about their neurological and psychiatric symptoms. They also surveyed nearly 300 healthcare providers for additional insight.

Sloan and her team discovered that 55% of people experienced depression, 57% experienced anxiety, 89% experienced severe fatigue, and 70% experienced some sort of cognitive dysfunction such as memory issues.

These rates were dramatically higher than anticipated. For instance, 47% of people with lupus reported having suicidal thoughts compared with the original estimate of 15%.

The researchers noted that many people with an autoimmune disease were less likely to report their mental health problems or ask for help. Most stayed silent due to a fear of being stigmatized. For those who did share their concerns, they reported being ignored or not having their symptoms documented.

"Many people, even without these rheumatic diseases, share a fear of stigma about mental health symptoms that they will be judged," Sloan said.

She explained that due to the length of time it can take to be properly diagnosed with an autoimmune disease, many patients lose trust in healthcare providers and, in some cases, their own interpretation of their symptoms.

"They are afraid that if they report any mental health or neurological symptoms that it may lead to a return of those pre-diagnosis days and that their future disease symptoms will be dismissed as being due to mental health," Sloan said.

Another obstacle is that mental health symptoms are not always visible or testable.

"We found some clinicians, particularly the psychiatrists and the nurses very much valued the patient reports, but that some other [providers] felt more comfortable when they had a blood test or a scan result, or could see for themselves a symptom," Sloan said. "They wanted objective evidence."

But the identification of mental health conditions is more reliant on listening to and believing a person's reports.

"Most people just desperately want to be helped to have better lives and need their doctors to validate these distressing symptoms, and not work with a model of 'it has to be seen to be believed,'" she said.

The Connection Between Autoimmune Diseases and Mental Illness

While the link between autoimmune disease and mental health is complex and not fully understood, it does involve interactions on both a biological and a psychological level, said Brent Nelson, MD, an adult interventional psychiatrist and chief medical information officer at PrairieCare, a division of Newport Healthcare.

These connections are due to the complex interplay between cells of the immune system and cells of the brain.

Nelson explained that an autoimmune disease causes the body's immune cells to attack itself. This impacts both the body and brain cells.

“Several factors contribute to this connection including inflammation and immune system brain communication,” Nelson said. “This inflammation can extend to the brain and may affect mood-regulating neurotransmitters, leading to an increased risk of mood disorders.”

At a psychological level, an autoimmune disease impacts both stress and coping.

"Dealing with the challenges of an autoimmune disease may affect a person's coping mechanisms, in that an individual feels less able to cope with daily life stressors as they are expending a large amount of resources coping with their disease," Nelson said.

Does Ozempic Increase the Risk of Suicidal Thoughts? Here's What Experts Say

Protecting Mental Health Amidst an Autoimmune Disease

Protecting mental health in any capacity starts with an awareness of the problem, James Jackson, PsyD, a research associate professor of medicine from the Vanderbilt University School of Medicine told Health.

Since people with autoimmune diseases have unique vulnerabilities, there needs to be a heightened emphasis on the importance of self-care and access to mental health interventions.

"This focus can serve as a buffer against new or worsening mental health concerns," Jackson said.

He also recommends that healthcare providers treating autoimmune diseases connect with mental health professionals.

"Connecting with providers like psychologists or social workers and enlisting them as formal members of a treatment team is not only helpful but often vital and can lead to the early identification of psychological problems which, of course, is a key," he said.

Managing Mental Health and an Autoimmune Disease

Nelson recommends the following to help prioritize your mental health while managing your autoimmune disease:

Work closely with a primary care provider along with autoimmune specialists to access care specific to your autoimmune disorder
Consult with mental health professionals, such as psychiatrists, therapists, and counselors, to access medications, develop coping strategies, and address emotional challenges
Practice stress-reducing techniques like meditation, yoga, or mindfulness to help manage the emotional impact of your disease
Surround yourself with a support network of family, friends, or support groups to share experiences and emotions with
Educate yourself about your autoimmune disease to better understand its management and potential effects on mental health

— Managing Mental Health and an Autoimmune Disease

According to Nelson, living with a chronic illness like an autoimmune disease also can lead to increased stress, anxiety, and depression, especially when coping with the symptoms, managing treatments, and dealing with potential limitations in daily life.

This can be emotionally challenging, leading to feelings of frustration, isolation, and helplessness.

Nelson emphasized that it's crucial to advocate for yourself and stay informed. You also need to keep talking about your mental health symptoms until you find the right healthcare provider.

"Therapy, of course, isn't perfectly effective but, in general, when [people] get the mental health support they need, they improve," Jackson said. "[They also] develop the coping skills they need to live with difficult symptoms that they didn't ask for and that they don't want—often learning not just how to survive but to thrive."

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Eating Too Many Cherries Can Give You Diarrhea—Here's Why

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August 7, 2023

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Eating Too Many Cherries Can Give You Diarrhea—Here's Why

TikTok users are warning people that eating too many cherries can cause gastrointestinal issues.
Though cherries do contain fiber, it's more likely that their sugar alcohols are giving people diarrhea.
To avoid stomach issues, stick to eating a single serving or two of cherries in one sitting.

woman holding a bowl of cherries — Iuliia Pilipeichenko/Getty Images

It’s peak cherry season in the U.S., and TikTok users are here with a warning: The fruit could give you diarrhea.

TikTok is packed with posts from people discussing how having too many cherries could lead to gastrointestinal issues. “It’s cherry season, so it’s a good time to remind you that if you eat an entire bag of cherries, you will likely have diarrhea, stomach pains, be bloated, feel very uncomfortable,” registered dietitian Erin Judge said in one video. “So, spread them out.”

Fellow TikToker @bananacowgirl jokingly shared a video of herself dancing around her living room while eating cherries and spitting out the seeds, writing in the caption, “POV I eat the whole container and get diarrhea.”

TikTok isn’t always known for being a reliable source of health information, but posts like these may have you wondering: Can cherries actually make you poop more than usual? And if so, why?

Here’s what you need to know about your favorite stone fruit.

Cherries Can Have a Laxative Effect

It turns out there’s something to the TikTok claims. “Cherries contain sorbitol and xylitol, both of which are sugar alcohols,” Deborah Cohen, DCN, associate professor in the Department of Clinical and Preventive Nutritional Sciences at Rutgers University, told Health. “When consumed in large amounts, they can have a laxative effect.”

Sugar alcohols are a group of low-calorie, sweet-tasting compounds that occur naturally in some foods and are also commonly used in sugar-free products like gums, candies, and energy drinks.

Unlike regular sugar, the intestines don’t absorb sugar alcohols, Ilana Kersch, RD, a clinical nutritionist at NewYork-Presbyterian/Columbia University Medical Center, told Health. “Instead, [they draw] water into the gut, which can soften hard stool and increase the muscle contractions that move the stool along,” Kersch said.

Cherries also contain insoluble fiber, another element that can speed up stool movement through the gut, Kersch said. Insoluble fiber “is found in most kinds of fruit, and especially in the skin and peel,” she added.

However, the fiber in cherries “is not considered excessive,” Cohen said. (For reference, one cup of cherries has three grams of fiber, while raspberries have eight grams and oranges have four grams.)

The sugar alcohols are likely the primary reason why cherries can make you poop, stressed Cohen. However, she acknowledged that you’d need to eat an excessive amount of cherries to get to the point where you’d need to run to the bathroom. The exact amount varies by person, though, and includes factors like your personal sensitivity to sugar alcohols and whether you have any underlying gastrointestinal conditions like irritable bowel syndrome, she said.

In addition to their fiber and sugar alcohol content, cherries are also a source of salicylates, or a group of chemicals derived from salicylic acid.

Plants have natural salicylates as part of their defense system against pathogens or environmental stress, but synthetic salicylates are commonly found in medications like aspirin.

Some people can be sensitive to salicylates—known as salicylate intolerance or sensitivity—that can cause symptoms including asthma, rhinitis, nasal polyps, chronic gastrointestinal irritation, or urticaria after ingestion.

But cherries have some essential vitamins and minerals to humans as well, including vitamin C, potassium, and manganese.

Other Fruits That Can Make You Poop

Like cherries, many fruits contain fiber and sugar alcohols, both of which keep your bowels running smoothly.

Kersch said that fruits that have similar levels of sorbitol to cherries include:

Apples
Pears
Plums
Prunes
Dates
Apricots
Nectarines
Peaches
Blackberries

Watermelon doesn’t contain sorbitol, but it does include mannitol, another sugar alcohol that acts like sorbitol in your gut, Kersch said.

Just like eating a typical serving of cherries won’t have you chained to the toilet, Kersch said chowing down on a reasonable amount of other fruits containing fiber and sugar alcohols probably won’t give you tummy troubles either. The same goes for vegetables such as mushrooms, cauliflower, and snow peas, which also contain mannitol.

Tips for Eating Cherries

If you’re constipated and eyeing cherries as a possible remedy, it’s worth a try—as long as you don’t overdo it.

In general, you can help constipation by ramping up consumption of dietary sources of sugar alcohols and fiber. According to the Dietary Guidelines for Americans, the average adult should aim to have about 28 grams of fiber a day for a 2,000-calorie diet.

Cohen suggested making fruits, vegetables, whole grains, nuts, seeds, and legumes a large part of your diet. She also recommended drinking a lot of water and limiting intake of dairy and meat, which contain little fiber and can be harder to digest.

Could the Added Sugars in Your Diet Put You at Risk for Kidney Stones?

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August 4, 2023

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Could the Added Sugars in Your Diet Put You at Risk for Kidney Stones?

New research found that eating a diet high in added sugar may make a person more susceptible to kidney stones.
About 10% of Americans will develop kidney stones at some point in their life.
Experts recommend maintaining a healthy weight, exercising regularly, and avoiding an excess of added sugar and processed foods to keep a lower risk of developing kidney stones.

woman eating doughnut — Karl Tapales/Getty Images

Eating a diet with lots of added sugars might make a person more susceptible to kidney stones, according to new research.

The study, published Friday in Frontiers in Nutrition, suggests that reducing added sugar consumption could lower a person’s risk of developing kidney stones. Added sugars are found in many processed foods, and especially so in sugar-sweetened sodas, fruit drinks, candy, ice cream, cakes, and cookies.

The reach of the research could be vast, as it’s estimated that about 10% of Americans will develop kidney stones at some point in their lifetimes.

More research is needed to say definitively if added sugar is causing kidney stones, Shan Yin, MD, study author and doctor of urology in the Affiliated Hospital of North Sichuan Medical College in Nanchong, China, told Health in an email.

However, the study does support the idea that there is some association between the two.

“We’ve known for some time that processed foods and sugars increase risk of kidney stones,” Anna Zisman, MD, director of the kidney stone prevention program at the University of Chicago Medicine, told Health. “I think the study is quite confirmatory and should impact on how we eat, and [how we] counsel our kidney stone patients.”

Here’s what experts had to say about why people’s diets can impact their kidney stone risk, and how to best avoid kidney stones.

Kidney Stones Associated With Added Sugar Consumption

The true cause of kidney stones is a bit of a mystery, and there aren’t any foolproof treatments to completely prevent them, Dave Friedlander, MD, MPH, assistant professor of urology at the University of North Carolina School of Medicine, told Health.

In general though, kidney stones form when people get “an overabundance of certain minerals in the urine that accumulate and eventually form a crystallized stone,” Friedlander explained. Not only can they can become extremely painful, but they may also lead to infections, swollen kidneys, renal insufficiency, and even end-stage renal disease.

There are already a few known risk factors for kidney stones—including being an adult male or having obesity, chronic diarrhea, dehydration, inflammatory bowel disease, diabetes, and gout. This newest research suggests that consumption of added sugars might also be worth adding to the list.

“The researchers were particularly interested in understanding whether or not there was association between self-reported levels of sugar consumption and self-reported renal colic episodes, or kidney stones,” Friedlander said.

For the study, Yin and his colleagues analyzed data from more than 28,300 participants in the National Health and Nutrition Examination Survey (NHANES), collected between 2007 and 2018.

Study participants, made up of both women and men, were at least 20 years old, and self-reported if they had a history of kidney stones. Researchers estimated each participant's daily intake of added sugars, based on two interviews regarding what they had recently eaten. (Participants were specifically asked if they'd had any syrups, honey, dextrose, fructose, or pure sugar in the past 24 hours).

From there, each participant also received a healthy eating index score, summarizing their diets, looking at both beneficial components (fruits, vegetables, and whole grains) and potentially harmful foods (refined grains, sodium, saturated fats).

After adjusting for adjusting for certain factors like age, race, gender, and clinical comorbidities like diabetes, the researchers found that the percentage of energy intake (calories) from added sugars in a person's diet was associated with a higher prevalence of kidney stones, Yin said.

People who derived more than 25% of their total calories from added sugars had an 88% higher risk of developing kidney stones than people who derived less than 5% of their total calories from added sugars.

The study also showed that participants from 'Other' ethnicities—like Native American or Asian people—were more likely to develop kidney stones when exposed to large amounts of added sugars, compared to Mexican American, other Hispanic, non-Hispanic White, and non-Hispanic Black people.

What Are Kidney Stones?

Diet's Impact on Kidney Stone Risk

The new research doesn't prove that added sugars cause kidney stones; instead, it only shows an association between the two. The makeup of the study, which was observational in nature and relied on self-reported data, is also a limitation.

“Further studies are needed to explore the association between added sugar and various diseases or pathological conditions in detail,” Yin said in a news release.

"For example, what types of kidney stones are most associated with added sugar intake? How much should we reduce our consumption of added sugars to lower the risk of kidney stone formation? Nevertheless, our findings already offer valuable insights for decision-makers," Yin added.

Consumption of added sugars aside, previous research has shown that other aspects of diet play a large role in kidney stone risk, Zisman said.

Three types of kidney stones—calcium stones, uric acid stones, and cystine stones—have largely been associated with diet.

Calcium stones (calcium oxalate stones and calcium phosphate stones) are linked to increased consumption of oxalate-rich foods (nuts, legumes, rhubarb, spinach, and wheat bran), sodium, and animal proteins. Calcium stones, however, are not associated with increased calcium intake—instead, it's recommended that people with calcium stones get enough calcium from food sources.

Uric acid stones are also associated with eating more animal protein and people with a history of uric acid stones may want to get their protein from other plant-based sources. Drinking enough water is the most important lifestyle factor for cystine stones.

Can Sparkling Water Cause Kidney Stones?

Assessing Risks to Avoid Kidney Stones

Kidney stones may affect one in 10 in the U.S., but their presentation can vary quite widely.

“It can range from being completely asymptomatic,” Zisman said, “[to being] a chronic burden where people are passing stones on a weekly or monthly [basis].”

In these cases, symptoms are "not subtle," so kidney stones result in high rates of emergency room visits and billions in healthcare costs, she explained. People can experience nausea, vomiting, blood in their urine, fevers, and severe flank pain, or pain in the abdomen below the ribs, she said.

It’s especially important that people be aware of kidney stones, as their prevalence has been increasing globally over the past three decades. Highly-processed and generally unhealthy diets may be in part to blame, Zisman said. Luckily, this is typically something that a person can improve upon.

Even though the study didn’t confirm that added sugar is causing kidney stones per se, reducing added sugar consumption may not be a bad idea—that might also help lower risks of cardiovascular disease, cognitive issues, diabetes, obesity, and some cancers.

But beyond diet, more individual lifestyle factors should be considered, too.

Having a family history of kidney stones raises risk, as does living in the Southeast, Friedlander explained. Kidney stones may also be more common or severe among people with certain jobs or socioeconomic statuses, or among people with certain conditions, such as diabetes or Crohn’s disease.

For the average person though, Zisman said the best thing to do is to maintain a healthy lifestyle and generally take things in moderation. Even just exercising frequently and maintaining a healthy weight may lower a person's risk of kidney stones, Yin added.

“If somebody does have a history of kidney stones, then we would want to evaluate their individual risk factors,” she said. “[But generally] just avoiding processed foods and extra added sugars is a good idea for a variety of health reasons, including kidney stone production.”

7 Health Benefits of Cutting Out Sugar

Why Is There a Leprosy Outbreak in Florida? Here's What You Need to Know

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August 4, 2023

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Why Is There a Leprosy Outbreak in Florida? Here's What You Need to Know

Central Florida is experiencing a leprosy outbreak, according to a new report from the CDC.
This leads researchers to believe the infection is endemic to the region.
Experts note that leprosy cases in the United States, even including this outbreak, are extremely rare and able to be treated with the right medical care.

Central Florida is experiencing a leprosy outbreak, according to a new report from the Centers for Disease Control and Prevention (CDC).

While the infection may seem to have more biblical connotation than real-time relevance, Central Florida is experiencing a bit of a leprosy hotbed. The area now makes up nearly one in five leprosy cases detected in the US.

Historically, Florida has not been known as a leprosy hotspot. But the data surrounding this outbreak features a variety of patients who've come down with leprosy without leaving the state of Florida.

This suggests that the illness is now endemic in the state.

The letter also notes that other Florida residents have become infected with leprosy, which suggests that the illness is now endemic in the state. Endemic simply means a disease or infection is consistently present in a certain region.

The CDC has stressed that no travel warning has been issued for the state of Florida. While there are certain leprosy factors all individuals may want to be aware of, visiting the area does not imply contamination.

Below, experts break down how leprosy outbreaks occur, how they can be contained, and what you need to know if you believe you've been infected with leprosy.

Leprosy bacteria — Getty Images / KATERYNA KON/SCIENCE PHOTO LIBRARY

How Leprosy Outbreaks Happen

While it may sound like an ancient disease, leprosy cases have been happening in the United States for years.

“In the 1980s, case numbers were in the 400s each year,” report co-author Rajiv Nathoo, MD, a dermatologist and complex clinic director for Advanced Dermatology and Cosmetic Surgery Clinics in Orlando, told Health. “Now, it’s about 150 a year.”

Case counts vary in the US each year, reaching 216 in 2019 and dropping to 159 in 2020.

Leprosy, also known as Hansen’s disease, can spread from person to person, but it requires prolonged contact with someone who is infected.

“This is not something you get from shaking hands,” said Anne W. Rimoin, PhD, MPH, a professor of epidemiology at the UCLA Jonathan and Karin Fielding School of Public Health.

Most leprosy cases in the US have been in people who recently traveled outside the country where leprosy cases are more common, or those who had direct contact with nine-banded armadillos, animals that are known carriers of the disease.

“But there’s a subset of folks—especially here in Florida—that haven’t left Florida,” Nathoo said. “That’s one of the reasons why we wanted to highlight our case and discuss the local cases.”

While it’s not entirely clear why leprosy has become embedded in central Florida, there are some theories, report co-author and dermatologist Charles Dunn, MD, told Health.

“The most common method of transmission is person to person, but that typically requires prolonged, intense close contact,” said Dunn, who serves as the chief resident at Kansas City University–Graduate Medical Education/Advanced Dermatology and Cosmetic Surgery Consortium in Orlando.

He noted that about 75% of new cases of leprosy in Florida have no known cause.

“Some people have direct contact with armadillos and that makes sense,” he said. “For the others, the question is whether there are environmental sources of leprosy that we haven’t seen, like soil or plants from areas that armadillos have inhabited.”

Or, perhaps there's another animal that's spreading leprosy in the US that researchers just haven't identified yet, Dunn said.

What Is the Difference Between Viral and Bacterial Infection?

Containing a Leprosy Outbreak

As of now, there are no major concerns about leprosy spreading outside of central Florida, although experts say it can happen.

“We may have many more cases—you just don’t know,” Rimoin said. “If you don’t look for it, you don’t know it’s there.”

She noted the importance of public health surveillance and being aware of what’s happening in the community around you.

While, hypothetically, leprosy spreading outside the state could happen, it's unlikely to.

“The numbers of people infected are so, so small, even with the new cases in Florida,” Carrie Kovarik, MD, a professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, told Health.

“So far, we’re not seeing these in vacation travelers to central Florida and I don’t even think people in Florida need to panic," she said.

Stanley H. Weiss, M.D., an epidemiologist and professor at Rutgers New Jersey Medical School and the Department of Biostatistics & Epidemiology at the Rutgers School of Public Health, told Health there’s no need to avoid traveling to Central Florida over leprosy fears.

“People should not change their travel plans,” he said. “This is still very rare within the US.”

Symptoms of Leprosy

Leprosy can impact several areas of the body, including the skin, nerves, and mucus membranes. Symptoms can include:

Discolored, flat patches of skin
Growths on the skin
Thick, stiff, or dry skin
Painless ulcers on the soles of feet
Painless swelling or lumps on the face or earlobes
Loss of eyebrows or eyelashes
Numbness of affected areas of the skin
Muscle weakness or paralysis
Enlarged nerves
Eye problems that may lead to blindness
Stuffy nose
Nosebleeds

Treating Someone With Leprosy

If left untreated, leprosy can lead to paralysis, chronic ulcers on the bottoms of the feet, blindness, and nose disfigurement.

Leprosy can be “difficult to diagnose,” particularly in its early stages, Kovarik said, pointing out that skin rashes are common.

Nathoo explained that the telltale sign of leprosy rashes is usually a lack of feeling on the affected patches or an unusual sensation over them.

If you develop symptoms of leprosy, experts emphasize it’s important to see a doctor as soon as possible.

“People get worried when they hear about a disease that’s known from biblical times but, at that time, little was known about transmission and there was no way of treating it,” Weiss said. “Today, we have drugs that are usually very effective in treating leprosy.”

Leprosy is diagnosed via a skin biopsy, and treatment usually involves a combination of two or three antibiotics used at the same time—dapsone with rifampicin, and sometimes clofazimine.

If left untreated, leprosy can cause serious complications, including blindness, paralysis, and deformities, so it’s important to seek care if you suspect that you have it, Kovarik said.

But, again, leprosy diagnoses are very unusual in the US.

“This is a very rare disease,” Kovarik said. “There is good treatment if someone were to get this infection. It’s curable.”

What Is a Respiratory Syncytial Virus (RSV) Infection?

Recall: Birth Control Pill Tydemy May Not Be As Effective, FDA Says

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August 4, 2023

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Recall: Birth Control Pill Tydemy May Not Be As Effective, FDA Says

Two lots of Tydemy birth control pills have been recalled because they may have ”reduced effectiveness.”
The potential ineffectiveness is suspected due to low levels of ascorbic acid in both lots and an additional “known impurity” in one of the lots.
Experts recommend anyone with impacted medication switch to a different, equivalent birth control as soon as possible.

Two lots of Tydemy, the birth control medication, have been recalled because they may not be effective, the Food and Drug Administration announced on Tuesday.

The two recalled lots were distributed nationwide between June 3, 2022 and May 31, 2023, and have the following codes:

L200183, expiry date January 2024
L201560, expiry date September 2024

Lupin, the pharmaceutical company that manufactures Tydemy, said that the recalled pills were sold in the U.S. to mail-order pharmacies, wholesalers, drug chains, and supermarkets. The company alerted its consumers about the voluntary recall on July 29.

The birth control pills were found to contain low levels of one ingredient—ascorbic acid. These low levels could impact the medication’s effectiveness, possibly resulting in unexpected pregnancy for consumers.

Specifically, lot L200183 tested low for ascorbic acid and “high for a known impurity,” Lupin said.

So far, the FDA says it has not received any reports of adverse events from people taking the recalled Tydemy.

Lupin urged wholesalers, retailers, and distributors to stop the sale and distribution of the affected drugs immediately.

Consumers who may have taken the recalled Tydemy should continue to take their medication, Lupin said, but should get in touch with their healthcare provider as soon as possible to find an alternative medication.

Tydemy comes in blister packs of 28 pills, and the recalled lots were sold in sets of one or three-blister packages. The lot numbers can be found on the side of the carton, the company said.

“Find the birth control package that you have at home, or if you don’t have it, you can call your pharmacy and they should be able to let you know if you were given one of the lot numbers that were even affected,” Chelsea Thibodeau, DO, assistant professor of family medicine and community health at the University of Minnesota Medical School, told Health.

Issuing the recall was the safest thing to do, Thibodeau said, but it is out of an abundance of caution.

“Don’t panic,” she advised.

People should also get in touch with their doctor if they think that they may have experienced any health issues due to taking the recalled birth control pills—these can be reported to the FDA’s MedWatch program.

With further questions or more information regarding a reimbursement, people who took the recalled Tydemy can call Inmar Rx Solutions at 866-480-8206 during normal business hours.

Tydemy birth control pills — Lupin / Food and Drug Administration

Why Are These Birth Control Pills Less Effective?

The Tydemy pill is made up of three ingredients, Thibodeau explained: an estrogen called ethinyl estradiol, a progesterone called drospirenone, and a folate supplement.

Even though she doesn’t personally see Tydemy often in her line of practice, Thibodeau said that there are a number of similar medications with this type of chemical makeup.

There’s no issue with these ingredients—instead, the pills may be missing out on adequate levels of ascorbic acid, which is just another name for vitamin C, Thibodeau said.

The concentrations of vitamin C in the body can impact estrogen levels, she explained.

“The thought is that if vitamin C levels are not the same as what was tested, then there’s concern that the estrogen levels may be different in people taking these pills,” Thibodeau said. “Thus, the efficacy of the birth control may have decreased.”

In addition to the risk of unexpected pregnancy, people who were taking recalled Tydemy might also experience bleeding or other menstruation symptoms if the estrogen levels aren’t functioning in the pill properly, Thibodeau said.

But that being said, low levels of ascorbic acid aren’t necessarily a threat to human health, she said, unlike some other medication recalls in which medications can be actively risky for people taking them.

The Best Birth Control Options To Consider for Your 20s and Beyond

Getting Contraception That Works

Though the recall is precautionary, it’s important that people check the specific lot code of the Tydemy they’re taking so that they can get access to fully effective pills as soon as possible.

People can check with their doctor or pharmacy to see which specific lot of Tydemy they were prescribed if they don’t have the packaging on hand, Thibodeau said.

If someone was taking the recalled medication, it should be fairly easy to switch to something that works.

“Their doctor can either prescribe an equivalent contraceptive,” she said. “There’s no problem in switching birth control pills if they’re equivalent—the next day when you’re due for your pill, you just take the new prescription.”

According to Thibodeau, Yasmin or its generic forms have the same estrogen and progesterone that Tydemy does, and people can take a folate supplement separately—that would be an equivalent option people could switch to.

If people are interested, they could also try to get in touch with their pharmacy to see if they could simply get Tydemy with a different and non-recalled lot code, Thibodeau added.

“[Healthcare providers] should be able to offer a pretty easy solution,” she said.

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Here's What Drinking or Bathing In Borax Can Do to the Body (Hint: It's Not Good)

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August 3, 2023

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Here's What Drinking or Bathing In Borax Can Do to the Body (Hint: It's Not Good)

A new trend has surfaced on TikTok, with some creators ingesting or bathing in borax and water.
Despite users' claims, there are no health benefits to ingesting or bathing in borax—instead, the practice can be quite dangerous and potentially deadly.
People should not automatically accept claims on TikTok as facts, and should be cautious before trying a new viral trend.

close-up of 20 Mule Team Borax — Lauren A. Little/MediaNews Group/Reading Eagle via Getty Images

A new, potentially dangerous trend has surfaced on TikTok, with some viral creators ingesting or bathing in mixtures of borax and water—all for supposed "health benefits."

Though most of the videos showing people consuming borax in earnest have been taken down from the platform, quite a few exist of creators explaining why the trend is a bad idea, including one from TikTok user Chem Thug, whose video includes snippets of people who have “hopped on the borax train.”

"Y'all need to get off this train," Chem Thug, who is a PhD candidate in synthetic organic chemistry, told his followers, while pleading with viewers not to eat anything that comes out of a laundry box. "This is patently dangerous."

Experts outside of TikTok are also warning people to avoid the trend at all costs.

“Everybody is looking to feel better, so I understand why it’s tempting to try something,” said Emily Cohen, MD, an emergency medical physician and medical toxicologist at NYU Langone Health. “But something that’s objectively unsafe—like borax—won’t work for anybody.”

But certain questions remain, including: Why would people think a product like borax might infer health benefits? And what does ingesting borax to do the human body? Here's what to know.

What Is Borax?

Borax—also known as sodium borate, sodium tetraborate, or disodium tetraborate—is a white powdery substance that's used as a household cleaner or laundry detergent booster. The mineral itself is made up of sodium, oxygen, and boron.

Although borax is commonly confused with boric acid, the two aren't the same.

“Both borax and boric acid are readily available and are easy to confuse with one another,” K. Ashley Garling, PharmD, a clinical assistant professor of pharmacy practice at the University of Texas at Austin College of Pharmacy, told Health. “Boric acid is used as a pesticide while borax is more in household products.”

Boric acid is created when a hydrogen or other acid is added to borax, making the new compound hydrogen borate, or boric acid. The compound is used as an insecticide—it kills bugs by disrupting their stomachs and nervous systems.

Both substances—borax or boric acid—are not intended for human consumption.

Does TikTok's BORG Trend Really Promote Harm-Reduction—Or Is It Just Binge Drinking?

Why Are People Ingesting Borax?

It's not entirely clear why people are ingesting borax, or which benefits they expect to experience in doing so.

In some now-deleted TikTok videos, one user suggested that soaking in a bathtub of borax mixed with water relieved body aches and pains. Another used the hashtags “#jointpainrelief” and “#painrelief” in a video about ingesting borax. Still, another connected the compound to relieving inflammation, arthritis, and fibromyalgia.

Some TikTok creators who are working to debunk the borax trend are also suggesting that people may be conflating borax with boron, which is a trace element found in many foods. TikTok users have suggested that it could be a boron deficiency which is making people claim to "feel better" after ingesting borax.

But none of those claims about any health benefits of borax are accurate. First and potentially most important: Borax, the chemical compound—the stuff bought in the laundry aisle—is not intended to be consumed by humans, and there's a lack of evidence on borax and human health because of that.

Things get a little murkier when it comes to boron, the chemical element. Boron can be found in a variety of food sources—the main sources of boron in the U.S. diet are coffee, milk, apples, dried and cooked beans, and potatoes.

But boron is not considered an essential nutrient in the human diet, and the research is still out on whether it has a clear biological function (like how calcium is associated with healthy bones and teeth, or how iron is essential to blood production). There is no recommended dietary allowance (RDA), adequate intake (IA), or daily value (DV) for boron.

It’s possible too that people are also confusing borax for boric acid. Currently, boric acid can be used to treat some vaginal yeast infections, due to its bacteriostatic properties, or its ability to make bacteria stop growing, said Emily Cohen, MD, an emergency medical physician and medical toxicologist at NYU Langone Health. But even then, boric acid is not meant to be ingested—it’s applied inside the vagina.

Dangers of Ingesting Borax

According to Cohen, ingesting Borax is at best unhelpful, and at worst quite dangerous.

Borax is toxic to humans and can have reproductive and developmental consequences, as well as effects on the nervous system and on kidney function. If it comes into contact with the skin or is inhaled it can cause irritation, and the most common symptoms of ingesting borax include: nausea, persistent vomiting, abdominal pain, diarrhea, erythematous and exfoliative rash, unconsciousness, depression, and renal failure.

Ingesting boric acid is quite dangerous as well. “It should never be ingested,” Cohen told Health. “The most common clinical effects if somebody ingests boric acid are mostly gastrointestinal effects like nausea, vomiting, and diarrhea. And the vomit and diarrhea can actually be green-blue in color, which is alarming for people.”

There’s also the issue of ingesting something not made for human consumption. In his now-viral TikTok video, user Chem Thug explains that facilities that don’t make things for humans to consume don’t have the same controls in place as facilities that do.

"What this ultimately means," he said, "is that not only is that final product may be contaminated with all sorts of other things, but they also don't have to say that on the list of ingredients because it's not really meant for human consumption."

Cold Plunging Is All Over TikTok—But Is It Safe?

Safer Solutions

It's understandable that people want to feel their best, and will often try untested "home remedies" to cure what ails them—but it's important to remember that many people on TikTok aren't medical professionals.

If you have joint pain or believe they are dealing with other conditions like arthritis or fibromyalgia, the first thing to do is consult with a healthcare professional to get an accurate diagnosis and personalized treatment options.

“Inflammation, joint pain, arthritis all have evidence based, long standing, therapy and treatment," Garling said. "For short-term and minor discomfort talk to your pharmacist about something safe and over-the-counter. For long-term or severe discomfort see a doctor to ensure something more serious is not going on.”

And though it's unlikely, if someone believes they may not be getting enough boron on their diet, there are a number of safe dietary adjustments to make, including adding more legumes, fruits, or tubers to their diets—all of which are rich in boron. In particular, prune juice, avocado, raisins, and peaches have particularly high concentrations of boron and are still part of a healthy diet.

Finally, if someone has been ingesting borax or boric acid and they’re worried about negative gastrointestinal or other effects, they should get in touch with a poison control expert, said Cohen. The Poison Control hotline at 1-800-222-1222 is available 24/7, and people can call for free advice and support.

Your Heart Loves Exercise—Even If You Only Do It on the Weekends

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August 3, 2023

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Your Heart Loves Exercise—Even If You Only Do It on the Weekends

New research found that people who exercise only one or two days a week will likely receive the same cardiovascular benefits as though who spread exercise out throughout the week.
Researchers noted that it mattered less how many times someone exercised throughout the week, and more how much time people exercised.
Experts recommend people start slow and work their way up to more time spent exercising each week.

People who exercise solely on the weekend are likely to get the same cardiovascular benefits as those who spread out their workouts throughout the week, a new study finds.

Finding time to work out each day can sometimes be a challenge, but the new research found that these “weekend warriors” don’t necessarily miss out on certain benefits because they keep their exercise to one or two days a week.

As compared to people who were inactive, weekend warriors and more regular exercisers both saw lower rates of atrial fibrillation, heart attack, heart failure, and stroke.

The findings come from a study published on July 18 in JAMA that looked at data from nearly 90,000 participants.

“Both have protective effects for cardiovascular disease, showing that it doesn’t really matter if you’re able to exercise every day,” Ronald Maag, MD, assistant professor of cardiology at Baylor College of Medicine and medical director of the Baylor Heart Clinic, told Health.

Maag explained that instead of when you exercise, the important piece to focus on is how many minutes of exercise you‘re doing weekly. It matters less how many workout sessions you’re doing and more so how many total minutes you spend exercising.

Here’s what experts had to say about why weekend warriors and consistent exercisers see similar benefits, and what to know about working out on the weekends.

Older woman stretching — Getty Images / Marko Geber

Similar Health Benefits Across Different Exercise Routines

The benefits or drawbacks to being a weekend warrior have been studied before, but in this study, researchers wanted to get a wider, more concrete pool of evidence, explained Shaan Khurshid, MD, MPH, lead study author and staff electrophysiologist at Massachusetts General Hospital.

Khurshid and his team looked at almost 90,000 participants enrolled in the U.K. Biobank cohort who wore wrist accelerometers to track their movement over the course of one week.

In this analysis, researchers were specifically looking at the relationship between cardiovascular health and moderate-to-vigorous physical activity (MVPA)—this includes exercises such as walking, jogging, stationary cycling, and elliptical.

The Centers for Disease Control and Prevention (CDC) recommend that all adults get at least 150 minutes of MVPA each week, so researchers used this metric for categorizing people’s activity levels.

Anyone who didn’t reach that weekly threshold of activity was considered inactive. Weekend warriors were classified as those who met the threshold, but at least 50% of their recommended movement happened in just one or two days, said Khurshid.

Participants were called “active regular” if they got 150 minutes of MVPA weekly, but the activity was more spread out.

After tracking participants for a week, researchers waited another six years to follow up. At that time, they reviewed the last six years of a participant’s life to see how many cardiovascular events had occurred, like heart attack, heart failure, atrial fibrillation, and stroke events.

“The main finding was that both the active weekend warrior and the active regular patterns were associated with significantly lower rates of those events—20% to 40%—and differences between them were very small,” Khurshid told Health.

On average, participants in the study actually exceeded the 150-minute MVPA recommendation and got about 230 minutes of weekly exercise.

Khurshid pointed out that the amount of time spent exercising didn’t change the results, assuming that amount was over the CDC's 150 minutes per week. People at the 25th percentile exercised for 115 minutes weekly, and those at the 75th percentile had 403 minutes of movement, but the rate of cardiovascular events was similar.

“Regardless of where we drew that line, we saw very similar patterns of decreased risk of cardiovascular events with a weekend warrior versus regular activity,” Khurshid said. “So it didn’t seem to matter.”

The similarity between both groups also persisted when researchers made the definition of a weekend warrior more stringent. Even when people concentrated 75% of their weekly movement in one to two days, Khurshid explained, they still saw similar benefits as their more active peers.

The Benefits of 10 Minutes of Moderate to Vigorous Activity Daily

Good News for Those With Busy Schedules

The study is more evidence that if people can make some time to exercise each week—even if it’s not an everyday thing—it can do wonders for heart health.

“Even if you go a few days between sessions where you’re doing a lot of exercise, those benefits aren’t going away,” Khurshid said. “Even up to a week apart [appears] to be enough of a regularity such that you still get the physical benefits from it.”

The research also reinforces just how important exercise is when it comes to keeping the body healthy.

“Exercise is good for weight loss. Exercise is good for lowering blood pressure. Exercise is good for lowering cholesterol, and it’s also good for preventing diabetes or helping control diabetes,” Maag said.

All of these things combined make it less likely that a person is going to have a negative cardiovascular event, such as a heart attack, he explained.

Though the paper endorses weekend warrior exercise schedules, there are a few things people may want to keep in mind before moving all their workouts to Saturday and Sunday.

For one, there may be some benefit to implementing a routine—having movement be a part of your everyday routine makes it easier to stick with it, Maag said.

There are also other benefits to exercise such as better sleep and more energy, and many people may feel better after they work out. It’s not clear if the weekend warrior routine provides the same level of benefit in these other areas.

“Exercise affects conditions across the spectrum of disease—things like mental health, respiratory disease, even infectious disease. Do we see similar benefits for weekend warriors versus regular activity across other disease types?” Khurshid asked. “We’re interested in looking at that.”

And whenever a person switches up their exercise routine, Khurshid added, it’s important to start slow.

“We don’t want people to go from zero to 60 when they read this paper, [and] go exercise for three hours if they [haven’t] exercised before in weeks or months,” he said. “We advise people to listen to their body.”

But working your way up to longer periods of physical activity can be a great strategy for people who find it challenging to get 30 minutes of exercise five times a week, as the CDC suggests.

It may also mean that one or two days of exercise could be used as an intervention method for people who are potentially at risk of cardiovascular issues, Khurshid added.

“Sometimes life gets in the way,” Maag said. “People are busy with kids and jobs and things, but they might be able to put that time away on the weekend to get those things done. It’s not a one size fits all type thing.”

How To Make Exercise Easier—Even When You Don't Want To Work Out

Do You Snore? Your Heart Health Might Be at Risk

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August 3, 2023

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Do You Snore? Your Heart Health Might Be at Risk

New research found that people with obstructive sleep apnea have a higher risk of cardiovascular disease.
The severity of sleep apnea someone has will likely impact the severity of their cardiovascular risk.
Experts recommend people sleep on their sides, maintain a healthy weight, and avoid sedatives in order to lessen the likelihood of cardiovascular risk due to sleep apnea.

People with obstructive sleep apnea have an increased risk of cardiovascular disease, a new study finds.

The new study, published in the American Journal of Respiratory and Critical Care Medicine, connected the increased risk to decreased blood oxygen levels caused by interrupted breathing that often occurs due to sleep apnea.

An example of this interrupted breathing is snoring, which is one of the most common symptoms of obstructive sleep apnea.

Researchers analyzed data from more than 4,500 middle-aged and older adults to find what aspects of obstructive sleep apnea could be the reason for greater cardiovascular risks. These adults participated in the Osteoporotic Fractures in Men Study (MrOS) and the Multi-Ethnic Study of Atherosclerosis (MESA).

Specifically, the research team looked at hypoxic burden (a decrease in blood oxygen levels) ventilatory burden (interrupted breathing from airway blockage), and nighttime arousals (when an individual wakes up as a result of interrupted breathing, resulting in elevated heart and blood pressure).

In MESA, hypoxic burden was associated with a 45% greater cardiovascular risk. In MrOS, the increased risk was 13%.Ventilatory burden accounted for 38% of increased risks in MESA and 12% in MrOS.

In MESA, nighttime arousals weren’t linked with cardiovascular events; these interruptions were associated with cardiovascular-related deaths in MrOS.

How Is Sleep Apnea Diagnosed?

Severity of Sleep Apnea Affects the Risk of Cardiovascular Disease

The level of sleep apnea someone experiences often coincides with their level of cardiovascular risk.

“The paper revealed that patients with more hypoxic burdens (lower oxygen levels and ventilation) related to their sleep apnea have greater cardiovascular risk,” said Henry Yaggi, MD, MPH, BA, director of the Yale Centers for Sleep Medicine at Yale School of Medicine.

Disruptions to sleep aren't just annoying—the more intense they are, the more they are likely to heart health.

“Patients who have an elevated heart rate response to sleep apnea also are at higher [cardiovascular] risk, and they have a significant risk reduction in cardiovascular events associated with CPAP," Yaggi said. "More severe sleep apnea during REM sleep also appears to heighten cardiovascular risk.”

In general, mild obstructive sleep apnea has not been shown to be associated with the same risk of cardiovascular disease as moderate or severe obstructive sleep apnea in most large-scale studies, Sudha Tallavajhula, MD, sleep medicine specialist with UTHealth Houston and TIRR Memorial Hermann, told Health.

Additionally, “mild obstructive sleep apnea may put individuals at increased risk for elevated blood pressure,” Tallavajhula said. “There is certainly an increased risk for cardiovascular disease with more severe degrees of obstructive sleep apnea.”

Positive airway pressure (PAP) is one of the main treatments for sleep apnea.

According to Yaggi, “This therapy is a small device that generates airflow delivered to an interface where patients sleep at night."

He explained that this treatment opens the upper airway during sleep, preventing it from closing off using a stent.

"This helps to stabilize breathing during sleep, improves sleep quality, and can eliminate the oxygen desaturations related to sleep apnea," he said.

Other Sleep Disorders Can Also Impact Cardiovascular Risk

It’s important to note that sleep apnea is only one sleep disorder that can be harmful to heart health.

“Insomnia (difficulty initiating or maintaining sleep), short sleep duration, and periodic limb movements during sleep have also been demonstrated increased cardiovascular risk,” said Yaggi.

He pointed out that the recommended sleep duration for adults is at least 7 hours, and people should avoid getting less than that

Rigved Tadwalkar, MD, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA agreed that chronic insomnia affects cardiovascular risk. The sleep disorder is often associated with higher rates of hypertension and heart disease.

“Sleep-disordered breathing, a term used to more broadly describe a variety of abnormal sleep-related conditions, is also similarly linked to cardiovascular disease,” Tadwalkar said.

Other examples of conditions with sleep-disordered breathing include hypoventilation syndromes and central sleep apnea (CSA).

CSA differs from obstructive sleep apnea (OSA) in that the individual stops breathing or breathes very shallowly due to the brain not sending the proper hormonal signal to the muscles that control breathing, as opposed to OSA, wherein the airway becomes mechanically blocked, Tadwalker explained.

Lowering Your Risk of Cardiovascular Disease

According to Yaggi, “Sleep apnea is a readily treatable condition, and several very effective therapies exist, including positive airway pressure therapy (PAP), oral appliance therapy, and upper airway neurostimulation (INSPIRE).”

In addition to improving sleepiness, sleep disruption, and quality of life symptoms, these treatments may help improve cardiovascular risk, especially among patients with more severe sleep apnea who have significant oxygen desaturation and increases in their heart rate in response to sleep apnea breathing events, Yaggi said.

Tallavajhula said that treatments of OSA have been known to decrease the risk of cardiovascular events, like heart attack and stroke. And the early someone starts treating their OSA, the better.

“Diagnosing and treating obstructive sleep apnea early on has the potential to reduce long-term cardiac and neurological disease risk," he said.

Tallavajhula explained that the gold standard for treating obstructive sleep apnea is the usage of continuous positive airway pressure [CPAP] machines.

“These machines generate pressurized air to maintain airway patency during sleep and therefore minimize reductions in blood oxygen,” he said.

Other interventions like rational weight loss, avoiding sleeping on your back, reducing alcohol intake prior to bedtime, and addressing structural causes like nasal allergies also can help reduce the severity of sleep apnea.

Tadwalker also pointed out the association between weight reduction and improvement in sleep apnea severity.

He also noted a few other small, achievable tips like “sleeping on the side as opposed to the back, as to prevent airway collapse, and avoiding specific medications such as sedatives, as these can relax the muscles of the throat, potentially exacerbating sleep apnea.”

How Is Sleep Apnea Treated?

One Woman Has Died and Another Was Hospitalized After Drinking Too Much Water—Here's What to Know

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August 3, 2023

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One Woman Has Died and Another Was Hospitalized After Drinking Too Much Water—Here's What to Know

One woman has died and another was hospitalized as a result of drinking too much water, recent news reports have shown.
Though rare, water intoxication (or hyponatremia) occurs when a person drinks so much water that the electrolytes in their blood become diluted.
Symptoms of hyponatremia include nausea or vomiting, headache, confusion, and fatigue, among other things.

woman drinking water during exercise break — Oscar Wong/Getty Images

One woman has died and another was hospitalized as a result of drinking too much water, according to recent news reports.

The events show that, while hydration is important to health, it is possible to drink too much water.

TikTok user Michelle Fairburn shared her experience of being hospitalized for "water poisoning" on the platform in July, after "drinking an excessive amount of water as part of the "75 Hard" challenge, which requires people to drink a gallon of water a day.

According to Fairburn, she began feeling nauseated and weak on day 12 of the challenge. She also had "major diarrhea" and a "band of fire…in [her] abdomen and [her] lower back." Those symptoms sent her to her doctor, who eventually diagnosed her with a "severe sodium deficiency."

Though Fairburn has since recovered, another woman—an Indiana mother of two named Ashley Summers—died from water toxicity last month.

Summers, 35, reportedly told family members she felt like she "couldn't drink enough water" and ended up drinking four bottles of water in 20 minutes. She later passed out in her garage and never regained consciousness.

Though fatal water intoxication is rare, it can happen—here's what to look out for.

How Much Water Should You Drink Each Day?

Drinking Too Much Water

The biggest concern of drinking too much water is developing a condition called hyponatremia, which may also be known as water intoxication, water poisoning, or overhydration.

Hyponatremia occurs when a person drinks so much water that the electrolytes in the blood become diluted, Natasha Trentacosta, MD, pediatric and adult sports medicine specialist and orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, told Health.

“A generally healthy person’s kidneys are going to be able to regulate that water balance,” Eric Adkins, MD, an emergency room physician at The Ohio State University Wexner Medical Center, told Health. “But once the kidneys can’t keep up with excreting water, the body’s sodium levels become more and more diluted. It’s progressive and can be dangerous.”

Sodium, one of the body’s key electrolytes, helps control blood pressure, nerves, and muscles. It also plays a crucial role in balancing the body’s fluids. If sodium levels fall too low—below 135 milliequivalents per liter (mEq/L)—extra water can enter cells and induce swelling, which can cause severe symptoms.

“Hyponatremia may present with lethargy or altered mental status as the brain is sensitive to sodium levels in the blood,” said Trentacosta. “Nausea and vomiting and loss of coordination may occur as well.”

According to the National Kidney Foundation, other potential symptoms include:

Irritation or restlessness
Headaches
Loss of appetite
Muscle weakness or cramping

If someone continues to drink too much water, they can even develop seizures or fall into a coma, said Trentacosta.

Health Benefits of Drinking Water

How Much Water Is Too Much?

There are no uniform guidelines on excessive water intake. Rather, the U.S. National Academies of Sciences, Engineering, and Medicine recommends an amount of fluids that people should aim to consume: 15.5 cups for men and 11.5 cups for women. That includes fluids from food—not just water. (75 Hard's recommended gallon of water a day equates to 16 cups, at least 4.5 cups more than the recommended amount for Fairburn.)

“Too much water is going to be somewhat proportional as far as the size of the person,” Adkins said. Everyone’s body composition and hydration needs are slightly different, he added.

Adkins recommended paying attention to the color of your urine to determine if you’re drinking too much water. “If it looks dark—orange or dark yellow—it’s an indication that you’re not getting enough water. You want to make sure it’s closer to light yellow,” he said.

But if you find that you’re “drinking so much that it looks like you’re constantly urinating out water” and you’re having other symptoms, it’s “probably a sign that your water intake is too aggressive," he said.

If you’re doing a hard workout, he suggested having a drink that contains electrolytes, like a sports drink or coconut water, to help balance out sodium levels.

According to Adkins, the average person doesn’t have to worry about hyponatremia. On the flip side, most people don’t drink enough water.

“We don’t see a ton of people coming into the emergency department with this, but there are rare scenarios where people are being aggressive with their water intake,” he said.

Trentacosta said hyponatremia more often affects athletes. People in the intensive care unit or elderly patients are also more likely to develop hyponatremia, according to Adkins, because the condition can result from excessive water intake but also other factors, such as diarrhea, extreme sweating, and vomiting.

Treatment for Hyponatremia

Treatment depends on the severity of the condition, said Adkins. If doctors suspect you have sodium deficiency, they usually do blood and urine tests to determine your levels.

“If it’s a mild case, the kidneys will help return the balance to normal if you can limit the amount of water intake by the person,” Adkins said. But doctors will give you medication or an IV to slowly raise sodium levels in more severe cases.

“We have to have really tight control around the correction of the sodium in the body,” Adkins said. If doctors “overcorrect” the imbalance too quickly, it can impact the brain by destroying the protective sheath around nerves called myelin, he said.

If someone has a mild imbalance, sodium levels may become normal within a few hours after limiting water intake, according to Adkins. It may take several days in more severe cases.

Fortunately for Fairburn, she felt much better after her hospital visit, saying she went from feeling "like a negative ten" the previous day to a six. While Fairburn revealed plans to continue 75 Hard, she said she'd no longer be participating in the water portion of the challenge.

The 6 Foods That Need to Be Part of Your Diet for Better Heart Health

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August 2, 2023

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The 6 Foods That Need to Be Part of Your Diet for Better Heart Health

A diet filled with six key foods can help lower your risk of cardiovascular disease and early death, according to new research.
Eating whole fruits, vegetables, legumes, nuts, fish, and whole-fat dairy products can help lower a person’s risk of cardiovascular events, including heart attacks and strokes.
Researchers say the new study emphasizes the power of nutrition, and how intakes of heart-healthy foods can influence health outcomes.

woman making breakfast smoothie — miniseries/Getty Images

Making six key foods a regular part of your diet may lower your risk of cardiovascular disease, new research shows.

For the study, published in the European Heart Journal, researchers analyzed data from six international studies that included 245,000 participants—with and without prior cardiovascular disease—from 80 countries. They used a diet score from the Prospective Urban and Rural Epidemiological (PURE) study, ongoing research run by the Population Research Health Institute.

The researchers found that having a diet filled with whole fruits, vegetables, legumes, nuts, fish, and whole-fat dairy products helped lower a person’s risk of cardiovascular disease, including heart attacks and strokes.

“The biggest gains in avoiding premature cardiovascular disease and deaths globally is expected to occur by increasing the intake of healthy foods to a moderate degree, especially in poorer world regions,” Andrew Mente, MSc, PhD, lead researcher for the study and associate professor at McMaster University, told Health.

Mente highlighted that the study was global in scope instead of centered on high-income or Western countries, the focus of many previous diet studies. He said those studies may not apply to people who live in lower to middle-income countries, where inadequate intake—rather than excess consumption—of certain foods may cause health issues.

Cardiovascular diseases are the leading cause of death globally, resulting in an estimated 17.9 million deaths each year, according to the World Health Organization. A third of those deaths occur prematurely in people younger than 70. An unhealthy diet lacking protective foods such as vegetables and whole grains is considered a main cardiovascular disease risk factor.

“This study emphasizes the power of nutrition, and that low intakes of heart healthy foods are associated with poor outcomes,” Martha Gulati, MD, director of preventive cardiology and associate director of the Preventive and Rehabilitative Cardiac Center in the Smidt Heart Institute at Cedars-Sinai, told Health.

TikTok Is Obsessed With Brazil Nuts—But Are They Really That Good for You?

The Six Key Foods for Heart Health

Based on their findings, the researchers recommend eating two to three daily servings of both fruit and vegetables, two daily servings of dairy, and one daily serving of nuts.

"The score also includes three to four weekly servings of legumes and two to three weekly servings of fish," Mente said. "Possible substitutes included whole grains at one serving daily, and unprocessed red meat or poultry at one serving daily."

This study differs from other papers because researchers focused on a broad range of natural foods eaten in moderation rather than a diet limited to a small number of foods, Sheri Berger, RDN, CDCES, registered dietitian nutritionist at El Camino Hospital Cardiac & Pulmonary Wellness Center, told Health.

"[Their findings] suggest it is better to consume key quality foods such as fruits, vegetables, nuts, legumes, fish, and dairy rather than focus on limiting foods high in saturated fat such as whole fat dairy and meat," she said.

Including certain foods while not limiting others may make the PURE diet easier to stick to than other diets, ultimately resulting in better cardiovascular outcomes, said Gulati.

She noted that “the most interesting aspect of this study” is the finding that dairy—about two daily servings of whole-fat milk, yogurt, or cheese—can be included with other beneficial foods as part of a nutritious diet.

“We advise, currently, that the consumption of saturated fat—which often comes from animal products—increases the risk for cardiovascular disease and this study does not support that,” she said. “We may need to re-evaluate how we advise about whole-fat [dairy] products but I still think that it is more [that] the diet was overall better.”

The study also provided more evidence that increasing consumption of foods known to be cardio-protective—fish, nuts, vegetables, and legumes—does indeed protect heart health, said Gulati.

Study: Women With This Common Heart Disorder Experience Faster Cognitive Decline Than Men

How To Eat To Prevent Cardiovascular Disease

An inclusive plant-based diet is a great choice for heart disease prevention, said Berger. This type of diet focuses on whole plant foods like fruits, vegetables, legumes, and nuts. However, dairy and quality protein from animals can be included too.

"For example, meals could feature a large portion of colorful fruits and vegetables, quality protein from fish, meat, nuts, and/or legumes, fiber rich whole grains such farro, brown rice, or quinoa, and a source of dairy a couple times per day," Berger said. "Generally, there is no one magic food or property of one food that by itself protects the heart. It is what we eat regularly that will affect heart health and overall health."

There’s no need to worry if you can’t eat nuts, fish, or any of the other recommended foods identified in the study, experts told Health. Not having them in your diet doesn’t necessarily mean you’re at greater risk for cardiovascular disease.

Mente said researchers observed the biggest health gains with a diet score of four out of a maximum of six, with modest additional health benefits with scores above four. "So improving intake in even three or four of these foods would produce a marked protection," he said.

Nuts can also be replaced with pumpkin seeds, chia seeds, or ground flaxseed, said Gulati. Additionally, algal oil supplementation can fill in nutrient gaps for omega-3s.

Gulati noted that a heart-healthy diet doesn't include large amounts of foods high in saturated fats and should include no trans fats, such as fried foods and packaged baked goods. She said that many processed foods tend to be a mainstay of diets worldwide because they are relatively cheap and easy to access. These foods don't make as much room for heart-healthy foods in a person's diet.

"We all need variety in our diet, and joy with the meals we eat, which is partially the food, [but also] the access to healthy food choices," Gulati said. “The important element is overall diet quality from nourishing foods."