Category: RECIPES

Migraine is a common and disabling headache disorder. Painful migraine headaches frequently affect people between the ages of 18 and 44. Many common medication treatments for migraine may cause side effects that are difficult to tolerate, and can lead people to not take their medications as recommended, or to stop taking them altogether. A recent study suggests that up to 20% of patients with migraine have used opioids to treat their pain in the past year. Therefore, there is a great need for better and more tolerable treatments for people who have migraines.

Research has shown that combining behavioral treatments with preventive medication treatments works better for preventing headaches than medications alone. Mindfulness practice has also been associated with improvements in individuals with chronic pain, including migraine. Mindfulness is the mind-body treatment that involves purposely focusing one’s attention on the present momentary awareness and accepting it without judgment.

Stress is a well-known trigger for migraine. Moreover, stressful events have been associated with people experiencing more frequent or chronic migraines versus having them occasionally. Mindfulness can result in stress reduction, reduced emotional response to stress, and improved general happiness. In patients with migraine, pain severity and unpleasant symptoms can be reduced with this treatment.

Mindfulness can potentially strengthen emotional and cognitive control of pain by helping to train someone with migraine to reassess their pain in a nonjudgmental way and modify their evaluation of the pain. In addition, mindfulness practices can help to control depression, anxiety, and pain catastrophizing (an exaggerated negative feeling toward pain experiences), which can play a role in chronic migraine.

The study

In a recent study published in JAMA, a group of researchers investigated whether mindfulness-based stress reduction may provide benefit for people experiencing migraine. The study randomly assigned half of participants with migraine to the mindfulness treatment and the other half to only headache education.

The mindfulness-based stress reduction treatment incorporated eight weeks of two-hour, in-person classes, which included sitting and walking meditation, body scanning (sequential attention to parts of the body), and mindful movement (bodily awareness during gentle stretching using hatha yoga), bringing attention back to the natural rhythm of the breath. In addition, the study participants were encouraged to build their capacity to address physical and mental perceptions of their pain, and they were provided audio files for at-home practice.

The headache education treatment included a standardized protocol of eight weeks of two-hour, in-person classes that contained education about the biological, psychological, and environmental processes associated with migraines, headache triggers, and stress. The patients were also given time for questions, answers, and discussion during each class.

The results

The researchers demonstrated that mindfulness-based stress reduction treatment significantly improved people’s disability, quality of life, self-efficacy, pain catastrophizing, and depression compared to patients who only had headache education. Reductions in monthly migraine days were observed in those with mindfulness-based stress reduction treatment, but were not significantly different from those receiving headache education. The authors of the study explain that the reason they could not demonstrate improvement in the headache frequency could be the use of an active control group such as headache education, which itself may result in improvement of headache frequency.

Most importantly, the study demonstrated that mindfulness-based treatments can reduce the burden of migraine. With mindfulness, the participants of the study may have learned a new way of processing pain that may have a significant effect on their long-term health. The results of this study have major implications for both patients and clinicians, and the research can support a holistic, integrative treatment plan for patients with migraine, with less emphasis on nonmedical treatments.

What you can do

Many healthcare providers, including headache specialists, pain specialists, neurologists, and primary care physicians, have started to incorporate mindfulness-based treatment in their practices, or they have sought mindfulness-based programs or specialists for their patients.

There are also many ways for patients with migraine to practice mindfulness at home. Patients with migraine can integrate some of the following mindfulness-based practices in their daily life, including during a migraine headache:

• Accept yourself, your present moment.
• Lie on your back or in a comfortable position with no distractions, and direct your awareness to your body and breathing. Scan your body and observe your feet, legs, hands, arms, and other parts of your body.
• Try to sit down in a comfortable and quiet place, close your eyes, take a deep breath. Try to do breathing exercises, paying attention to the sensations of your breath while inhaling and exhaling.
• Sitting or walking meditation done outside in nature may be very relaxing. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance.

Resources

There many are apps and quality resources for mindfulness and migraine learning and practice. Here are few online resources to explore:

Body scan mindfulness exercise for pain (Harvard Health Publishing)

Mindfulness Meditation for Migraine (American Migraine Foundation)

Mindfulness series for Migraine & Headache Disorders (Miles for Migraine)

Mindfulness and Migraine (National Headache Foundation)

Breathe. Count to 10. Take a walk. These strategies have long been advised to help you pause and rethink your reaction when you’re seeing red and an inch away from exploding. Under normal circumstances — maybe a little stress at home or at work — those strategies can be useful. But you may find they’re less effective in the pressure cooker we’ve been living in since the pandemic began. What can you do to avoid reaching your boiling point?

For insight, I turned to psychologist Stuart Ablon, founder and director of Think:Kids in the department of psychiatry at Harvard-affiliated Massachusetts General Hospital. Ablon is an expert at defusing explosive behavior among kids and teens with severe developmental delays in problem solving, flexibility, and tolerance to frustration — the skills that keep us from melting down.

Pandemic stress blocks our coping abilities

Ablon says many adults are struggling with a lack of these skills right now — not because we haven’t developed them, but because pandemic stress is blocking them. “When we humans are chronically stressed, we lose access to the part of our brain that performs skills like flexibility and tolerance,” Ablon says.

Blocked skills can reduce our coping abilities to those of little children, like toddlers who scream when they don’t get their way.

Practice empathy

Ablon says it’s crucial to stay calm or “regulated” when you’re feeling mad or upset, so you can access the skills needed to maintain control. And the best way to remain calm, Ablon says, is by practicing empathy — trying to sense another person’s perspective or point of view.

“Empathy is the most powerful human regulator we have. It’s been proven to de-escalate people in the most challenging of prison settings, and it can also work on an airplane or in line at Starbucks,” Ablon says. “Think about it: when someone listens to you and tries to understand your point of view, it calms you. You can feel your heart rate drop.”

How does empathy help you?

Calming others is great, but how does being empathetic keep you from exploding? It has a domino effect.

• Trying to understand someone else's point of view may change your mind about how you want to react. It will also give you something important to do, which will keep you focused so you can remain calm.
• Being calm enables you to access coping skills like problem solving, flexibility, and tolerance to frustration.
• Accessing your coping skills strengthens your ability to keep your cool.
• Because you’re calm, you’ll keep someone else from exploding, which in turn helps you continue to stay calm.

Four steps to help you stop seeing red

To practice empathy, Ablon recommends the following steps.

• Adopt a mindset that people are doing the best they can. “We’re all trying our best to handle what the world is throwing at us, with the skills we’re able to access at that moment. None of us wants to be losing it,” Ablon says. “Think to yourself, ‘This person I’m interacting with isn’t giving me what I want, but this person is doing the best they can right now.’ If you can exude that, you will help regulate them. It’s incredibly contagious — the same way a parent who stays calm can soothe a crying baby, or a kindergarten teacher with supreme calmness can regulate a whole class.”
• Be curious, not furious. Ablon recommends asking questions without jumping to conclusions, so you can find out where people are coming from. What are their circumstances? What’s driven them to this moment? What do they need?
• Practice active listening. “One of the most powerful things you can do to regulate someone is to repeat back to them what you’re hearing from them in your own words. It makes them feel heard,” Ablon says. “So ask questions, and when you get information, reflect back what you’ve heard. It’s called active listening.”
• Offer reassurance. Remind the person you’re talking to that you’re trying to help. “Say, ‘I’m just trying to understand. I know you must have an important reason and I want to hear more. I’m not trying to get you upset. I want to work things out.’ That’s very calming and regulating,” Ablon says.

It may not be easy to remain empathetic in these challenging times. But the more you practice this skill, the more empathetic you’ll become. That can deliver significant results. “If you can stay calm and approach someone kindly and with understanding,” Ablon says, “it will head things off at the pass for both of you.”

Some things are not debatable. Rain falls from the sky. Elevators go up and down. Orange traffic cones are orange. But because we interpret the world through our experiences, a lot isn’t so definitive.

The boss might say, “Good job,” and we wonder why they didn’t say, “Great job.” We see someone looking in our direction and they seem angry, so we believe that they’re mad at us, and no other explanation makes sense.

What’s happening is that we’re distorting our experience, jumping to conclusions, mind reading, and going to the worst-case scenario. When we do this, we shrink our successes and maximize our “failures,” and because it can be an automatic process, it’s hard to tell when it’s happening. “You don’t know you’re wearing magnifying glasses,” says Dr. Luana Marques, associate professor of psychology at Harvard Medical School.

So what can you do to see things more clearly and with a more balanced perspective? It takes practice and a willingness to tolerate discomfort, but as with addressing any problem, it starts with awareness.

What’s happening when we magnify failures and jump to negative conclusions?

We like to process information quickly, and we use filters to help do that. If we believe, “I’m no good,” all words and behaviors that support that contention just make everything easier.

“The brain doesn’t want to spend energy trying to fight that,” Marques says. And the brain responds depending on the distortion. If something causes anxiety, say from a curious look or comment, the limbic system is activated and we’re in fight-or-flight mode, hyper-focused on the threat, not thinking creatively or considering alternative, less threatening options.

But sometimes, there’s no threat in play. We’re just thinking, probably overthinking, when we question our abilities and minimize our accomplishments.

So what can you do about it?

Label the type of thinking distortion

It helps to define our distortions, the common ones being:

• Catastrophizing: Taking a small incident and going to the worst-case scenario.
• Black-and-white thinking: Seeing only all-or-nothing possibilities.
• Jumping to conclusions: Assuming what will happen rather than waiting to see what will actually happen.
• Mind reading: Assuming what someone is thinking without much evidence.

When you label it, you can better understand and recognize what your go-to distortion is, because “we tend to do one more than another,” Marques says.

After that, it helps to take your emotional temperature by asking: Am I stressed? Am I sweating? Is my heart pounding or my breathing shallow? It brings you more into the moment and it allows you to think about what you were doing that brought on the response, such as, “I was trying to guess the outcome.” It’s another way to pinpoint the distortion you tend to favor, she says.

Challenge the distortion

Whichever distortion it is, you want to examine your assumption by looking for other evidence. If you question your boss’s reaction to you, ask yourself: What does my boss really say? What does this person say about other people? Have I received raises and promotions? Am I given good projects?

An easy trap with distortions is that they’re plausible. A person who is mad at me would give me a look. A person who hated me wouldn’t text me back. Maybe so, but think of five other possible explanations, Marques says. This exercise engages the prefrontal cortex, which takes you out of the fight-or-flight mode and expands your thinking. You’re then problem-solving and not solely keyed on one option.

You also want to ask an essential question: is this thinking helpful? You might realize that all your thinking/wondering/worrying does is make you anxious. Gaining that presence might be enough to get you off the path of distorted thinking. “Asking and answering the question about your thinking pauses the brain, and you potentially see the world differently,” she says.

Being balanced and kind to ourselves

As you examine and attempt to control your distortions, be mindful of how you treat yourself. Self-criticism is a really easy trap to fall into, but try talking to yourself as you would a friend. Better yet, imagine you’re speaking to a child. Your language would be considerate, supportive, and you wouldn’t use words such as “stupid” or “dumb.” This approach also shifts you into the detached, third person. “You get out of your head,” Marques says. “We’re cleaning our magnifying glasses a little bit.”

Lastly, realize that you’re not looking to switch your attitude from “I’m unworthy” to “I’m super-great.” That’s just trading one extreme for another. All you want is to counterbalance your distortion, then let it go. Countering thinking distortions is a lot like meditation, where you practice acknowledging your thoughts without getting hooked onto them.  “You don’t have to magnify or minimize.” Marques says.

Various versions of low-carbohydrate diets have been popular for many years. The details of what is allowed and what is not vary quite a bit, and the amount of carbohydrates also differs. Too often these diets contain plates piled high with bacon, meat, eggs, and cheese. Due to the high saturated fat content in these diets, doctors and nutritionists worry about their potential adverse effect on cardiovascular disease.

The American Heart Association recommends aiming for about 13 grams of saturated fat, which is about 6% of 2,000 calorie diet. Recently, a new study published in the American Journal of Clinical Nutrition suggests that at least in the short term a low carb diet with a higher amount of saturated fat might still be heart-healthy. But is it that simple? Let’s take a look at what this randomized diet trial did and what the results really mean.

What did the study actually involve?

The 164 participants in this study were all considered overweight or obese, and had just finished a weight loss trial to lose 12% of their body weight. They were randomly assigned to one of three diets containing different proportions of carbohydrates and fat. Protein content was kept the same (at 20% calories) for everyone. They were not planning to lose any more weight.

The three diets were:

• Low carbohydrates (20%), high fat (60%), saturated fat comprising 21% of calories: this resembles a typical low-carbohydrate diet and has much higher saturated fat than recommended.
• Moderate carbohydrate (40%), moderate fat (40%), saturated fat comprising 14% of calories: this is not far from the typical American diet of 50% carbohydrates and 33% fat, and it is quite similar to a typical Mediterranean diet, which is slightly lower in carbohydrates and higher in fat than an American diet.
• High carbohydrate (60%), low fat (20%), saturated fat comprising 7% of calories: this meets the recommendation of the Dietary Guidelines for Americans and is a typical high-carbohydrate diet, including a lot of grains, starchy vegetables, and fruits or juices.

The study participants received food prepared for them for 20 weeks. They had their blood measured for a number of risk factors of cardiovascular disease, and a lipoprotein insulin resistance (LPIR) score was calculated using a number of blood markers to reflect the risk for cardiovascular disease. (LPIR is a score that measures both insulin resistance and abnormal blood cholesterol all in one number, and it is used for research purposes.)

The researchers found that at the end of eating these diets for five months, the participants in each of the three groups had similar values of cardiovascular disease markers, such as the LIPR score an and cholesterol blood levels.

What were the participants actually eating?

Alas, those who were eating the low-carbohydrate diet were not piling up their plate with steak and bacon, and those eating the high-carbohydrate diets were not drinking unlimited soda. All three diets were high in plant foods and low in highly processed foods (it is easier to stick to a diet when all the food is prepared for you). Even the low-carbohydrate group was eating lentils, a good amount of vegetables, and quite a bit of nuts.

Even the two diets with higher than recommended amounts of saturated fats also were high in the healthy poly- and monounsaturated fats as well. For example, the diets contained a combination of higher amounts of healthy (salmon) and a small amount of unhealthy (sausage) choices. In addition, fiber intake (at about 22 grams/day) was slightly higher than the average American intake (18 grams/day). Overall, except for saturated fat being higher than recommended, the diet as a whole was quite healthy.

What is the take-home message?

Striving for a plant-based diet with saturated fat being limited to 7% of total calories remains an ideal goal. But for people who choose a low carb, high fat diet to jump start weight loss, keeping saturated fat this low even for a few months is challenging. This study at least provides some evidence that higher amounts of saturated fat in the context of a healthy diet do not seem to adversely affect certain cardiovascular risk markers in the short term. How it would affect actual disease — such as heart attack, stroke, and diabetes — in the long run is unknown. However, there is ample evidence showing that a diet that consists of healthy foods and has moderate amounts of carbohydrate and fat can lower the risk of these diseases.

Preventing diseases is a long-term process; a healthy diet must not only be effective, but it should also be flexible enough for people to stick to in the long run. Could a diet with lower amounts of healthy carbohydrates and ample healthy fats with a bit more saturated fat be healthy enough? As the researchers state, we need long-term testing to help answer the question.

For decades, in vitro fertilization (IVF) has enabled countless people to have children, often after years of disappointment. It’s a complex process, medically and emotionally. Those embarking on an IVF cycle are often laser-focused on the baby they long for. Most hope a cycle will yield several embryos, because it frequently takes more than one embryo transfer to achieve a successful full-term pregnancy.

Any remaining embryos may offer the hope of future pregnancies and additional children. Yet remaining embryos also bring difficult decisions to the fore — if not immediately, then in subsequent years. The decisions one person, or a couple, makes might be divided into five paths. One path — donating embryos to another person or couple hoping for children — carries with it many questions. This path, and those questions, are the subject of this post.

A decision pathway for people who became parents through IVF

If you became a parent through IVF and have remaining embryos, you are not alone. Estimates vary on the number of cryopreserved embryos in the United States, but it’s likely to be in the hundreds of thousands.

You may be among the many people or couples who plan to use their embryos, or among those whose family feels complete. And you may be starting to figure out what to do with your embryos, or you may be putting the decision on hold, paying for annual embryo storage and feeling no urgency to make a decision, since embryos can remain safely frozen for many years. Having “extras” in deep freeze may offer comfort, kind of a psychological insurance policy after years of disappointment and loss.

Sooner or later, though, most people find themselves at a decision point, considering these options:

• You can discard your remaining embryos. This may feel harder than you anticipated but absolutely doable. You see these embryos as part of the IVF process that enabled you to have your cherished child or children. The word “discard” sounds harsh, but you are not prepared to parent another child and do not see donating them to others as an option.
• You can decide to have an additional child. A larger family wasn’t what you’d planned on or hoped for, but you see extra embryos as part of IVF, and a new child as meant to be. You look at the family you have and decide it is worth undergoing at least one more embryo transfer before making a final decision to discard.
• You can decide to donate your embryos to science. Unfortunately, if you begin to explore this, you’ll discover there is no easy route for it. Perhaps you will choose to explore other possible pathways, or decide to focus on one of the other options.
• You can donate your embryos to another person or couple. For some, this feels natural: you have been given the gift of children and you want to pay it forward to others longing for pregnancy and parenthood. However, for many the decision to donate does not feel easy or natural. Rather, it poses a huge dilemma: you want to honor the embryos and offer them a chance at life, but you have unsettled feelings when you think of your genetic offspring being raised by another family.
• Not to decide is to decide. In listing options, it is important to acknowledge that some of your fellow IVF parents are deciding not to decide. They are among the many who have “abandoned” their embryos (the term clinics use for families that avoid contact). They stop paying their storage fees; they fail to respond to outreach calls and letters.

What questions arise if you choose to donate embryos to another family?

Writing in TheNew York Times about facing her own decision about unused embryos, author Anna Hecker said, “For me this far surpasses discomfort. I see it as a life-or-death decision, which makes it nearly impossible to make.”Having worked with couples making this decision, I can attest that this sense of the “nearly impossible” passes over time, as people grapple with their choice and come to a place of clarity and peace.

Below are some — though not all — questions you are likely to confront as you think about donating embryos. If you are part of a couple, you can sort through these questions with your partner. (If you are single, the decision is yours to make.)

• How would we feel about another family raising a child created with our genes?
• Would it feel okay if we knew the family we donate to, or could that make it harder, seeing what might have been our child growing up with others as parents?
• Is this fair to the children involved? How will our children feel knowing they have full genetic siblings in another family? What will they make of the fact that it was the random choice of an embryologist who determined which embryo would land in our family and which in another?
• How will children who come from our donation feel? Will they feel displaced, like they landed in the wrong family? Will they, perhaps, feel a bit like a science-fiction project?
• How will we feel about possible challenges in the future: our child gets sick, the family we donate to gets divorced, we fervently disagree with the parenting style and values of the other family?
• If we decide to donate, how should we go about finding a family? Does geography or demographics matter — for example, will it feel good or more complicated to have them nearby? Should we donate to a same-sex couple, an older single woman, or others?
• Do we want to tell family members and friends of our decision to donate our embryos? If so, how much do we share of this information?
• If there are several embryos, do we donate all to the same family or divide them? For those who feel strongly about not wanting to discard embryos, it may be important to ensure that none are discarded when the receiving family feels complete.
• If our embryos were created with the help of donor eggs and/or sperm, should we seek permission or approval from the donor? How do we go about this if we do not have access to the donor?

These questions are complicated, best made over time and with care. While you may want to make the decision soon so that you can feel closure and move on as a family, I have found this is one instance in life when moving slowly, visiting and revisiting a decision, accepting doubt and the need to take pauses, all contribute to you eventually feeling the rightness of your decision.

"No!"

It might have been endearing as your child’s first word, but dread often kicks in when that word starts to follow parental requests. Experiencing resistance to small or big asks? Stuck in arguments that seem to go in circles and leave you exasperated with unmet requests? The good news is that this pattern can be disrupted. First, you’ll need to identify reasons behind the opposition. Then you can apply relevant strategies to see more helpful behaviors instead.

Below are some examples of opposition drivers and tips to address them.

Difficulty with transitions

If you find that your child resists a request right after engaging in an activity, it might be that your child first needs time to transition. This can be a common experience when parents make requests while children are playing video games or another stimulating activity. One way to manage this is to give your child a five- or 10-minute heads-up (whichever they might need) that you will be asking for the game to stop. This gives your child time to find a place to pause if playing a video game and to transition.

Some families find it helpful to talk with their children before playtime begins to learn what game or activities will be taking place, and how much advance notice might be helpful before the activity would need to stop. This invites collaboration and shows that you respect that not all moments are ideal for stopping a game.

Independent streak

Children almost never are in control, and resistance can show up when that wears on them. Try to fold in elements of choice and control throughout the day for children (that are within a framework you determine) to create more of a balance with your requests. Perhaps you let a young child know that they will need to wear long sleeves and pants because of the weather, but they can pick which top and pair of pants to wear that day. Another idea is to invite your child to pick a side dish for a future dinner from a premade list of a few options.

It also helps to create opportunities for your child to practice being independent. This fosters mastery and offers experiences of feeling in control. This could look like your child preparing any parts of meals that are age-appropriate (for example, a three-year-old could pour cereal into a bowl; a five-year-old could measure ingredients for baking). The kitchen counter may be extra sticky as your child learns new skills. With time, your child will be more adept, and your counters will be cleaner.

Hunger and tiredness

We need both food and sleep to recharge our batteries. When we run low on either or both, it’s extra difficult to be our best selves. If you find that your child is crankier than usual, reflect on when your child last ate and how your child slept the night before (or napped if your child is of napping age). If it’s been a while since your child has eaten and/or your child did not sleep as much as usual, your child may need to recharge before being more receptive to requests. Have your child grab a healthy snack or meal if needed. If sleep is the issue, validate to yourself that this is frustrating that there is no quick fix. Acknowledge privately they are not their usual self at this moment and may be more receptive tomorrow.

Resistance also may crop up when children are coming down with a viral illness, so keep an eye out for any symptoms that may emerge.

Mental health challenges

Everyone has off days, but a persistent pattern of resistance to requests and distress following them may suggest that a child is experiencing mental health difficulties. For example, if a child appears oppositional every morning before school, it could be that they experience anxiety about going to school and are trying to avoid the distress they experience when there. In this case, it is important to ignore the "no" bait and focus on the emotion behind the refusal. Validate or acknowledge how your child is feeling to open the door to learn more. For example, you could say, "You seem really worried about going to school. What about school has been so tough lately?"

Use a similar approach for symptoms of depression, such as withdrawing from and refusing to engage in activities: validate your child’s feelings and invite your child to share more to help you understand their experiences. Discovering what is driving the resistance can allow you to develop a collaborative plan to support your child’s needs and get extra help if needed. Cognitive behavioral therapy is an evidence-based treatment for children experiencing anxiety and/or depression. Your pediatrician can be a helpful resource for mental health treatment referrals. The Anxiety & Depression Association of America also provides treatment resources.

Sometimes, oppositional behavior is pervasive. It can include a frequent loss of temper, irritability, difficulty following the rules, defiance of authority figures, spitefulness, and more. If these behaviors occur at home and also show up in other settings, such as at school, a child may be experiencing symptoms of oppositional defiant disorder. Parent training programs such as parent management training, along with problem-solving skills training, are evidence-based treatments, and pediatricians also may be able to provide relevant referrals.

Your patience understandably can wear thin if you find yourself facing repeated resistance. That experience, though, does not have to continue. You can help shift these patterns once you discover what is driving the "no."

Last winter, my wife shooed the dog and visiting toddlers away from our poinsettia plants, saying "they’re poisonous, you know."

I did not know. But it turns out that the belief that poinsettias are deadly is widespread. The same could be said for mistletoe and holly. But are their reputations for danger well-deserved? Since these plants are especially popular to brighten up homes or give as gifts during the holidays, I decided to look into it.

The risks of poinsettia

Could a plant so common and so well-liked in the winter holidays also be so dangerous? If it is dangerous, what problems does it cause? Must it be eaten to cause problems, or is it harmful to just be nearby? And if it’s not dangerous, why does the myth live on?

The answers to these questions are not easy to find. In fact, the bad reputation may have started in 1919, when an army officer’s child reportedly died after eating part of a poinsettia plant. It is unclear if the plant was responsible, though: many other reports describe mild symptoms, such as nausea or vomiting, but no deaths.

Decades ago, a study in the American Journal of Emergency Medicine analyzed nearly 23,000 cases of people eating poinsettia and found

• no fatalities
• nearly all cases (96%) required no treatment outside the home
• most cases (92%) developed no symptoms at all.

According to one estimate, a 50-pound child would have to eat more than 500 poinsettia leaves to approach a dose that could cause trouble. Similarly, pets may develop gastrointestinal symptoms after eating poinsettia, but these plants pose no major threat to animals.

The risks of mistletoe

The story is much the same for mistletoe. It’s not particularly dangerous, but may cause an upset stomach if eaten. In fact, mistletoe has been used for centuries as a remedy for arthritis, high blood pressure, infertility, and headache. The evidence isn’t high-quality for any of these uses, though.

Interest also centers on this plant’s potential as an anticancer treatment. Some extracts of mistletoe contain chemicals shown to kill cancer cells in the laboratory and to stimulate human immune cells. For example, a substance called alkaloids has similar properties as certain chemotherapy drugs used in the past to fight leukemia and other forms of cancer. However, a two-part 2019 review found that adding mistletoe extracts to conventional cancer treatments did not improve survival or quality of life.

No one suggests it's a good idea to eat this plant, accidentally or otherwise. But eating one to three berries or one or two leaves is unlikely to cause serious illness, according to the authors of a 1986 review of multiple studies. And no significant symptoms or deaths were described in one report of more than 300 cases of eating mistletoe. However, some sources warn that serious problems or even death may occur if enough is ingested. The specific dose required to cause death is unknown but, fortunately, it appears to be so high that consuming enough to be lethal is extremely rare.

The risks of holly

This plant can be dangerous to people and pets. The berries of holly plants are poisonous. If eaten, they may cause crampy abdominal pain, drowsiness, vomiting, and diarrhea. While no one would recommend eating holly, it is unlikely to cause death. And for at least one type of holly, knowing the Latin name would be enough to discourage ingestion: the yaupon holly is also called Ilex vomitoria.

The bottom line

No one should eat poinsettias, mistletoe, and holly, but if small amounts are consumed, they are unlikely to cause serious illness. It seems to me that the dangers of these plants appear to be vastly overestimated.

Perhaps the most dangerous thing about mistletoe and poinsettias is the choking hazard the berries pose for young kids, although that risk is not unique to plants: any small object poses similar risks. Try to keep holiday plants out of the reach of small children and pets. And keep in mind that berries may fall from these plants and wind up on the floor.

If a child or pet eats leaves or berries from these holiday plants, or any other plants, check in with poison control, your pediatrician, or your veterinarian. But unless a particularly large "dose" is consumed, don’t be surprised if the recommendation is to simply watch and wait.

Still concerned even if you know the risks are low? You can always regift holiday plants you receive to friends with no children or pets, or find other ways to decorate your home for the holidays.

Just about everyone experiences knee pain at some point in their lives. Most of the time, it follows an injury or strenuous exercise and resolves in a few days, but knee pain can last months or even years, depending on the cause. A new study suggests telehealth programs designed for people with knee osteoarthritis may help ease pain, improve ability to function, and possibly even lead to weight loss.

What is osteoarthritis of the knee?

Osteoarthritis (OA) — the age-related, “wear-and-tear” degeneration of the knee joint — is the number one cause of chronic knee pain, affecting nearly a quarter of people age 40 or older. It’s responsible for most of the 600,000 knee replacements in the US each year, and more than $27 billion in annual healthcare spending.

How is it treated?

No treatment for knee OA is ideal or works in every case. Standard approaches to treatment include pain management, exercise, and loss of excess weight.

For pain, people with knee OA may consider

• anti-inflammatory drugs that are rubbed on the skin, such as diclofenac gel
• anti-inflammatory medicines, such as ibuprofen
• pain relievers, such as acetaminophen
• injections of corticosteroids.

Opiates, arthroscopic surgery, and other injected treatments are not routinely recommended due to risks, lack of proven benefit, or both. Knee replacement surgery has a high success rate for knee OA, but is generally considered a last resort because it’s major surgery that requires significant recovery time.

Virtual visits can help

Before the COVID-19 pandemic, many people with knee OA regularly saw their healthcare providers to

• monitor their pain and ability to function
• consider changes in treatment
• check for treatment side effects
• determine if other problems are contributing to symptoms.

It turns out, much of this can be done virtually. The pandemic made it a necessity. And a new study suggests it works.

What did the study on knee osteoarthritis find?

The study demonstrated that telehealth visits are a good way to provide care to people with knee OA. The researchers enrolled nearly 400 participants who had knee OA and were overweight or obese. They were divided into three groups:

• Group 1 was given access to a website that provided information about OA, including pain medications, exercise, weight loss, and pain management.
• Group 2 received the same information as group 1, and also engaged in six exercise sessions with a physical therapist by videoconference. These sessions lasted 20 to 45 minutes and included advice about self-management, behavioral counseling, and education about choosing exercise equipment.
• Group 3 followed the same format as group 2, and also had six consults by videoconference with a dietitian about weight loss, nutrition, and behavioral resources. These sessions also lasted 20 to 45 minutes.

After six months, participants in groups 2 and 3 reported pain relief compared to Group 1. On a pain scale of 1 to 10:

• group 3 improved more than group 1 by 1.5 points
• group 2 improved more than group 1 by about 1 point.

People in groups 2 and 3 also had better scores for function compared to group 1. All of these improvements were considered meaningful and held up for at least 12 months.

In addition, those assigned to group 3 lost about 20 pounds over the course of the study, while the other groups’ weights were nearly unchanged. That’s an important finding, because excess weight can worsen osteoarthritis of the knee. Losing excess weight can improve symptoms and help prevent the arthritis from getting worse.

Since there was no comparison with in-person care, it’s impossible to say whether these virtual visits were better, worse, or similar to an office visit. In addition, this study did not report the costs of these virtual sessions, the long-term impact of virtual visits, or whether repeated virtual visits could maintain the improvements people reported.

The bottom line

The pandemic is giving researchers an opportunity to seriously study the potential value and limitations of virtual care on a large scale. If these visits are as good as or better than in-person visits for certain conditions and the costs are no greater, that’s a big deal. A virtual visit can eliminate time spent in travel and the waiting room, and possible parking fees that can make a brief doctor’s visit an expensive undertaking that takes half the day. Virtual care also has the potential to reach patients who otherwise cannot get to their doctor’s office.

Of course, telehealth isn’t equally available to everyone due to language barriers, technical abilities, health insurance plans, or simply not having access to smartphones, computers, or data plans. Some states are letting emergency measures supporting telehealth services expire. And some insurers may resort to pre-pandemic rules about coverage or physician licensing that create uncertainty about the future of telehealth.

This study and others suggest that it may be a mistake to curb telehealth just when it’s catching on. More studies like the one described here may make the case to insurers, regulatory agencies, healthcare providers, and patients that the future of medical care should rely on more, not less, virtual healthcare, and encourage approaches that overcome barriers to its use.

How well are you protecting yourself against heart disease, the nation’s leading cause of death? A check of five important numbers can give you a good idea.

“For my patients, I typically look at their blood pressure, blood sugar, LDL cholesterol and triglycerides values, and their waist circumference,” says Harvard Heart Letter editor-in-chief Dr. Deepak L. Bhatt, who directs interventional cardiovascular programs at Harvard-affiliated Brigham and Women’s Hospital. Those values provide a picture of a person’s overall health and, more specifically, what factors they may need to address to lower their chance of a heart attack or stroke, he says.

Below are the ideal values for each measurement, along with why they’re important and targeted advice for improving them. Universal suggestions for improving all five measurements appear at the very end.

How do your heart health numbers stack up?

While the ideal values are good goals for most people, your doctor may recommend different targets based on your age or other health conditions.

Blood pressure

Less than 120/80 mm Hg

Blood pressure readings tell you the force of blood pushing against your arteries when your heart contracts (systolic blood pressure, the first number) and relaxes (diastolic blood pressure, the second number). Your blood pressure reflects how hard your heart is working (when you’re resting or exercising, for example) and the condition of your blood vessels. Narrowed, inflexible arteries cause blood pressure to rise.

Why it matters to heart health: High blood pressure accelerates damage to blood vessels, encouraging a buildup of fatty plaque (atherosclerosis). This sets the stage for a heart attack. High blood pressure forces the heart’s main pumping chamber to enlarge, which can lead to heart failure. Finally, high blood pressure raises the risk of strokes due to a blocked or burst blood vessel in the brain.

What helps: A diet rich in potassium (found in many vegetables, fruits, and beans) and low in sodium (found in excess in many processed and restaurant foods); minimizing alcohol.

LDL cholesterol

Less than 100 mg/dL

A cholesterol test (or lipid profile) shows many numbers. Doctors are usually most concerned about low-density lipoprotein (LDL) cholesterol, particles that makes up about two-thirds of the cholesterol in the blood.

Why it matters to heart health: Excess LDL particles lodge inside artery walls. Once there, they are engulfed by white blood cells, forming fat-laden foam cells that make up atherosclerosis.

What helps: Limiting saturated fat (found in meat, dairy, and eggs) and replacing those lost calories with unsaturated fat (found in nuts, seeds, and vegetable oils).

Triglycerides

Less than 150 mg/dL

Perhaps less well-known than cholesterol, triglycerides are the most common form of fat in the bloodstream. Derived from food, these molecules provide energy for your body. But excess calories, alcohol, and sugar the body can’t use are turned into triglycerides and stored in fat cells.

Why it matters to heart health: Like high LDL cholesterol, elevated triglyceride values have been linked to a higher risk of heart attack and stroke.

What helps: Limiting foods that are high in unhealthy fats, sugar, or both; eating foods rich in omega-3 fatty acids (such as fish); avoiding alcohol.

Blood sugar

Less than 100 mg/dL

High blood sugar defines the diagnosis of diabetes. Type 2 diabetes is most common. It occurs when the body develops insulin resistance (insulin enables cells to take in sugar) and does not produce enough insulin to overcome the resistance.

Why it matters to heart health: High blood sugar levels damage blood vessel walls and cause sugar (glucose) to attach to LDL. This makes LDL more likely to oxidize — another factor that promotes atherosclerosis. Excess sugar in the blood also makes cell fragments called platelets stickier so they’re more likely to form clots, which can trigger a heart attack or stroke.

What helps: Avoiding sugary beverages and foods high in sugar; eating whole, unprocessed grains instead of foods made with refined grains (white flour, white rice).

Waist circumference

Whichever number is lower:

Less than half your height in inches

OR

Women: Less than 35 inches

Men: Less than 40 inches

Measure your waist around your bare abdomen just above your navel (belly button). A big belly — what doctors call abdominal or visceral obesity — usually means fat surrounding internal organs.

Why it matters to heart health: Visceral fat secretes hormones and other factors that encourage inflammation, which triggers the release of white blood cells involved in atherosclerosis.

What helps: Consuming fewer calories, especially those from highly processed foods full of sugar, salt, and unhealthy types of fat.

Universal advice to improve all five measures of heart health

If one or more of your numbers is above ideal levels, you’re far from alone. Most Americans are overweight or obese and have bigger-than-healthy bellies. Excess weight and waist circumference affect blood pressure, LDL cholesterol, triglycerides, and blood sugar. Eating a healthy, plant-based diet can help. Regular exercise also helps: aim for at least 30 minutes of moderate-intensity exercise like brisk walking most days. Other lifestyle habits that can lower your heart disease risk include getting seven to eight hours of sleep nightly and managing your stress level.

If you have trouble losing weight despite your best efforts, this is because obesity is a complex disease with many causes. A family history of weight issues can make it more likely that you’ll have the same issues managing your weight. A diet high in ultra-processed foods, sugar, and fat and being sedentary also contribute to weight gain. Stress and struggles with mental health, including medications to treat certain mental health conditions, poor sleep, and hormonal changes, are all factors that further contribute to weight gain.

There are many ways to combat excess weight, but there is no single solution. If you are trying to lose or maintain your weight, you may want to try yoga. There is good research that yoga may help you manage stress, improve your mood, curb emotional eating, and create a community of support, all of which can help with weight loss and maintenance.

Yoga can also help you burn calories, as well as increase your muscle mass and tone. Yoga may reduce joint pain, which in turn allows you to exercise more and increase your daily activities. These are only some of the many benefits of yoga.

Yoga can help you manage stress that can impact weight gain

Yoga is derived from the Sanskrit word yuj, which means to unite the body, mind, and emotions. It is a holistic mind-body practice that improves many of the causes of weight gain.

Some people may experience stress as physical pain or sleep deprivation, or it may be psychological and cause feelings of anxiety and agitation. Stress leads to an increase in the hormone cortisol. Cortisol increases abdominal fat, decreases muscle mass, causes cravings for fat and sugar-rich food, and thus can lead to obesity.

Yoga can decrease stress and cortisol levels, enhance mood, decrease anxiety and depression, improve sleep, and improve chronic conditions such as hypertension and diabetes, reducing the need for medications that can cause weight gain.

Yoga is not a band-aid for excess weight, but it may work on the underlying causes. Its benefits extend beyond the calories-in-versus-calories-out equation.

Yoga can improve mindfulness related to eating behaviors

Most of us who crave ice cream after 9 pm or can’t stop eating potato chips know that these behaviors hurt our chances of losing weight. We all know that eating vegetables, whole grains, lean protein, etc. is good for our health and weight. While this knowledge is necessary, it seems insufficient to help us stick to our healthy eating plans.

One of yoga’s benefits is that it improves mindfulness of the body and awareness of body sensations. This is why yoga is called “moving meditation.” Research shows that you don’t have to do any formal sitting meditation to get the mindfulness benefits of yoga.

By improving mindfulness, yoga decreases emotional eating, stress eating, and binge eating. These habits sabotage our weight loss efforts and can cause a negative spiral of guilt and shame, which often leads to giving up.

A study published in 2015 showed that practicing yoga led to healthier eating, including lower fat intake and an increase in vegetables and whole grains.

The bottom line: the best diet plan is the one that you can stick with over the long term, and by improving mindfulness, yoga can help you make healthier food choices.

A yoga community can provide acceptance and support

Going to a gym can be intimidating, and may provoke feelings of not belonging for some people with larger bodies. By contrast, yoga culture embodies kindness, support, and self-acceptance.

Yoga teachers and advanced practitioners can serve as role models and inspire newer students to live a healthier lifestyle. Research shows that social networks influence behaviors that affect weight. The yoga network encourages positive health behaviors, and being a part of such a community can make a meaningful difference for weight loss. This type of community can be hard to find with other types of exercise.

Practitioners should look for a safe, comfortable environment. A welcoming yoga group may help you improve your self-esteem and confidence. Find a local studio that feels nurturing and not overwhelming, with other practitioners at your level. Teachers can help beginners or those with physical limitations by modifying poses. You might have to try a few different classes before you find an instructor or a class that you like. Don’t give up after the first one!

If you can’t find a local studio, there are always online options on YouTube and Instagram, with classes at all levels. There are instructors who understand what it is like to be a larger size, and having an inclusive, body-affirming attitude shows that yoga is not just for “skinny people.” Some share inspirational stories of how yoga helped them overcome their own weight struggles, depression, and binge eating. If you are a beginner, consider signing up for a short challenge to get committed to the practice.

The benefits of yoga are universal — no matter what your shape or size. It can take weeks or months to establish a yoga practice, and frequent practice is key for long-lasting benefits.

Follow Dr. Anekwe on Twitter @Chikagirl

Follow Dr. Reddy on Twitter @NiyotiReddy