Health & Fitness

In Ohio, suicide is the leading cause of death for children aged 10 to 14, according to a report from the Ohio Department of Health,¹ and the second leading cause of death among 15- to 34-year-olds.²

The alarming numbers follow sobering data from the World Health Organization (WHO),³ which identified suicide as the second leading cause of death among 15- to 29-year-olds in 2016, worldwide. Suicide rates have been on the rise throughout the U.S., including in Ohio, where, from 2007 to 2018, the number of suicides among youth ages 10 to 24 increased by 56%, while the suicide rate increased by 64%.⁴

Suicide Deaths in Ohio Increased by Nearly 45%

When all age groups were factored in, suicide rates in Ohio rose by nearly 45% from 2007 to 2018, according to the report, with most suicides committed among adults aged 45 to 64. Overall, five people die due to suicide daily in the state, while one youth commits suicide every 33 hours.⁵

While suicides increased the most among youth, other populations also saw steep increases, including black men, with an increase of nearly 54% from 2014 to 2018, and adults aged 65 years and older, who had a nearly 48% rise from 2007 to 2018.⁶ Men were also about four times more likely to commit suicide than women.

A CDC report also revealed that students in Cleveland, Ohio, are more likely to attempt suicide than students in other cities. The report found that 2 in 10 high school students in the city tried to commit suicide in 2015, which means 20% of the high school population is suicidal.⁷

Cleveland is also home to the school district with the second-highest poverty rate in the U.S., along with close to 4,000 homeless students, which plays a role in suicide risk. Poverty, domestic violence, parental separation and other adverse childhood experiences that are more common in Cleveland youth than in other areas, account for some of the suicidal tendencies.

“It is not surprising, considering the environment in our urban setting, but it’s always alarming,” said Cleveland Metropolitan School District psychologist Bill Stencil to News 5 Cleveland. “High areas of poverty also have the stressors that go along with it, which may lend themselves to contemplating suicide, or actually attempting.”⁸

Suicide Is the 10th Leading Cause of Death in the US

As in Ohio, suicide rates rose across the U.S. from 1999 to 2016, making it the 10th leading cause of death. In 2016, nearly 45,000 Americans aged 10 and older committed suicide, and more than half of them did not have a diagnosed mental health condition.

“Relationship problems or loss, substance misuse, physical health problems and job, money, legal or housing stress often contributed to risk for suicide,” the CDC noted, but added, “Suicide is rarely caused by a single factor.”⁹ Suicide rates varied across the U.S., from a low of 6.9 per 100,000 residents per year in Washington to a high of 29.2 per year in Montana.

However, rates increased in nearly all U.S. states, 25 of which had increases of more than 30%. CDC principal deputy director Dr. Anne Schuchat called suicide a “tragedy for families and communities across the country.”¹⁰

Nearly 800,000 People Die by Suicide Globally Every Year

In calling suicide a “serious global public health issue,” WHO said the nearly 800,000 people who die by suicide annually is more than the number of people killed by malaria, breast cancer, war or homicide.¹¹ Even among teenagers aged 15 to 19 years, suicide is the second leading cause of death after road injury.

“ … [M]any suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship breakup or chronic pain and illness,” WHO noted, adding:¹²

“In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with suicidal behaviour.

Suicide rates are also high amongst vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. By far the strongest risk factor for suicide is a previous suicide attempt.”

Farmers, particularly those in rural agricultural areas in low- and middle-income countries, are also disproportionately affected. It’s estimated that self-poisoning with pesticides is responsible for 20% of suicides worldwide.¹³ In India, alone, about 16,000 farmers die due to suicide every year.¹⁴

Because intentional pesticide poisoning is so common among farmers, WHO cited reducing access to pesticides as an “underused but highly effective strategy” for suicide prevention:¹⁵

“The intervention that has the most imminent potential to bring down the number of suicides is restricting access to pesticides that are used for self-poisoning. The high toxicity of many pesticides means that such suicide attempts often lead to death, particularly in situations where there is no antidote or where there are no medical facilities nearby.”

Should the US Have a Psychologist General?

Writing in Scientific American, Kirk J. Schneider, a psychologist and member of the Council of the American Psychological Association, suggested a novel idea: that Congress should create a “psychologist general,” an office that would be dedicated to Americans’ mental health, similar to that of the surgeon general for physical health needs.¹⁶

Anxiety disorders represent the most common mental illness in the U.S., with 40 million U.S. adults affected.¹⁷ Further, in the U.S., an estimated 3.2 million adolescents between the ages of 12 and 17 suffer from depression, defined as having at least one major depressive episode in a year.¹⁸

This accounts for 13.3% of adolescents, who experienced a period of at least two weeks with a depressed mood, loss of interest in daily activities and other symptoms, such as problems with sleep, appetite, energy, concentration or feelings of self-worth. Depression among adolescents is on the rise, increasing by 30% in the last 10 years,¹⁹ which could be one factor in why suicide rates are also increasing.

As Schneider noted, while the U.S. has the Public Health Services to communicate health recommendations to the public, and the Substance Abuse and Mental Health Services Administration (SAMHSA), which is geared toward mental health, SAMHSA focuses on addition and “shorter-term, behavioral modalities,” and is medically oriented, which “may not be adequate to address the intense psychological needs of many in the nation.”²⁰ Schneider explained:²¹

“Such a position could be filled by a psychologist, a counselor, a social worker, a researcher or a psychiatrist — but he or she must have specific expertise in psychological approaches to public mental health …

[T]here are indications that many in our society are overmedicated and that potent psychological methodologies could give people the resources to function more sustainably on their own or in conjunction with appropriate medical care.”

There is clearly a lack of mental health support in the U.S., and what does exist often uses medications as a first line of treatment, when a more comprehensive approach is warranted.

In fact, in 2013 1 in 6 Americans was taking antidepressants or some other type of psychiatric drug, and most appear to be taking them long-term.²² Meanwhile, suicide rates continue to rise, and antidepressant drugs, which may increase suicide risk, are not the answer for most.

The 12 Warning Signs of Suicide

According to the CDC, the 12 warning signs that someone may be contemplating or getting close to suicide are:²³

Feeling like a burden	Being isolated	Increased anxiety
Feeling trapped or in unbearable pain	Increased substance use	Looking for a way to access lethal means
Increased anger or rage	Extreme mood swings	Expressing hopelessness
Sleeping too little or too much	Talking or posting about wanting to die	Making plans for suicide

The Ohio Department of Public Health also noted the following warning signs of suicide:²⁴

• A major change in mood or behavior, appearing consistently unhappy, depressed, irritable or withdrawn from family and friends
• Poor grades in school or bad performance in extracurricular activities
• Problems with concentration or changes in energy level or sleep schedule
• Hurting themselves (wrist cutting, burning self)
• History of depression or family history of depression

“If you know someone is struggling, you may be able to help save someone’s life by recognizing the warning signs and steps to take,” Ohio Gov. Mike DeWine said.²⁵ If you notice someone showing signs of contemplating suicide, it’s recommended that you ask them directly if they’re having suicidal thoughts.

“Asking about suicide does not increase the risk of suicide but does open up conversation,” the Ohio Department of Public Health explains. From there, be sure to listen to the person’s response and respond accordingly. Be sure to keep lethal means, such as firearms, away from them and call 911 if you’re in the middle of a crisis.

For ongoing support, call the National Suicide Prevention Lifeline (1-800-273-8255) or the Crisis Text Line (text “4hope” to 741 741). For more information about how to prevent suicide, see bethe1to.com.

1. Ask how they are feeling and if they are considering ending their life, or if they have a plan to do so
2. Don't let them be alone and do your best to keep them safe
3. Make yourself available to them
4. Reach out to them daily and help them connect to others
5. Follow up

Comprehensive Care for Mental Health

If you or a loved one is having suicidal thoughts, the important first step is getting help. In the longer term, however, lifestyle-based strategies, including dietary changes and exercise, are important. Certain foods are dense sources of nutrients known to help prevent depression as well as help recover from it, for instance. Twelve such antidepressant nutrients include:²⁶

Folate	Iron	Long-chain omega-3 fatty acids (EPA and DHA)
Magnesium	Potassium	Selenium
Thiamine	Vitamin A	Vitamin B6
Vitamin B12	Vitamin C	Zinc

These can be found in such foods as seafood, particularly wild-caught Alaskan salmon, herring, sardines and anchovies, leafy greens, cruciferous vegetables and grass fed organ meats. If you’re struggling with mental health, it’s best to work with a holistic health care provider who can ensure you’re getting the nutrients your body needs to function optimally on a mental level.

Learning how to use an energy psychology tool like the Emotional Freedom Techniques (EFT) can also make an enormous difference if you suffer from depression or any other kind of emotional challenge.

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The loss of daylight hours during winter is a common cause of seasonal affective disorder (SAD), a type of depression that hits seasonally and lifts as spring and summer rolls back around.

The fact that SAD occurs when the days begin to darken and sunlight is at a minimum is not a coincidence. Your health and mood are intricately tied to exposure to sunlight. For example, your serotonin levels (the hormone typically associated with elevating your mood) rise when you're exposed to bright light.

Your melatonin level also rises and falls — inversely — with light and darkness. When it's dark, your melatonin levels increase, which is why you may feel tired when the sun starts to set, and in the heart of winter, this may be at as early as 3 p.m. if you live far from the equator. Light and darkness also control your biological clock, or circadian rhythm, which impacts hormones that regulate your appetite and metabolism.

As explained in the paper, “Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches,” published in the journal Depression Research and Treatment in 2015:¹

“… SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as ‘winter blues.’ Less often, SAD causes depression in the spring or early summer.

Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD … Typical treatment includes antidepressant medications, light therapy, vitamin D, and counselling.”

Considering the many health risks associated with antidepressants, and the fact that their efficacy is right on par with placebos, my recommendation is to avoid them if at all possible.

Aside from light therapy and vitamin D, other drug-free treatment options include optimizing your omega-3 level, exercise, the Emotional Freedom Techniques (EFT) and normalizing your circadian rhythm, all of which will be reviewed here.

The Role of Vitamin D

As explained in the featured paper,² vitamin D appears to play a role in the activity of serotonin, a mood-balancing hormone, and melatonin, a hormone that responds to light and dark.

People with SAD tend to have lower serotonin and higher melatonin levels, which can account for the fatigue, tiredness and depressed mood typically associated with this condition. According to the Depression Research and Treatment paper:³

“A systematic review and meta-analysis concluded that low levels of vitamin D are associated with depression … During the winter months of November through February, those living about 33 degrees north or 30 degrees south of the equator are not able to synthesize vitamin D.

Many people with SAD and S-SAD have insufficient or deficient levels of vitamin D, and although no further studies have confirmed the findings, research investigating this association suggests that taking 100,000 IU daily may improve their symptoms.

Taking vitamin D before winter darkness sets in may help prevent symptoms of depression. Adverse reactions or intoxication is rare but could occur from doses of more than 50,000 IU per day.”

Vitamin D deficiency is very common, and should be a top consideration when you’re looking for a solution to flagging mood and energy — especially if it occurs during fall and winter months.

Ideally, you’ll want to get your vitamin D level tested twice a year, in summer and winter, when your levels are highest and lowest. This will help you fine-tune your dosage over time. While regular sun exposure is the best way to optimize your vitamin D level, this isn’t possible in many areas during the winter, thus necessitating the use of oral supplements instead.

GrassrootsHealth has a helpful calculator that can help estimate the dose required to reach healthy vitamin D levels based upon your measured starting point. The optimal level you’re looking for is between 60 and 80 ng/ml, and for all-around health, you’ll want to maintain this level year-round.

Omega-3 Fats Are Important Too

Another nutrient that can be helpful is marine-based omega-3. As noted in a 2009 review⁴ of three studies looking at the impact of omega-3 supplementation on patients with unipolar depression, childhood major depression and bipolar depression:

“Twelve bipolar outpatients with depressive symptoms were treated with 1.5-2.0 g/day of EPA for up to 6 months. In the adult unipolar depression study, highly significant benefits were found by week 3 of EPA treatment compared with placebo.

In the child study, an analysis … showed highly significant effects of omega-3 on each of the three rating scales. In the bipolar depression study, 8 of the 10 patients who completed at least one month of follow-up achieved a 50% or greater reduction in Hamilton depression scores within one month.”

In another study⁵ published that same year, people with lower blood levels of omega-3s were found to be more likely to have symptoms of depression and a more negative outlook while those with higher blood levels demonstrated the opposite emotional states.

A more recent review,⁶ published in 2015, pointed out that “Cell signaling and structure of the cell membrane are changed by omega-3-fatty acids, which demonstrates that an omega-3-fatty acid can act as an antidepressant.”

Importantly, this paper also points to research showing that the ratio of omega-3 to omega-6 is an important factor that can influence your depression risk. People with severe symptoms of depression have been found to have low concentrations of omega-3 in conjunction with considerably higher concentrations of omega-6.

You can learn more about the importance of this ratio in “Getting Your Omega-3 to Omega-6 ratio Right Is Essential For Optimal Health.” The key, really, to normalizing this ratio is to increase your omega-3 intake while simultaneously lowering your omega-6 consumption. This means you’ll need to ditch processed and fried foods, as they’re typically loaded with omega-6-rich vegetable oils.

Get Tested Today

GrassrootsHealth, which is conducting consumer-sponsored research into both vitamin D and omega-3, is one of your most cost-effective alternatives when it comes to testing.

Their vitamin D testing kit enrolls you into the GrassrootsHealth D*Action project, where your anonymized data will help researchers to provide accurate data about the vitamin D status in the population, the level at which disease prevention is obtained, and guidance on dosing to achieve optimal levels.

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Their vitamin D, magnesium and omega-3 test kit is another option that will allow you to check the status of several vital nutrients at once. Each kit contains instructions for how to collect your blood sample. You then mail in your sample and fill out a quick online health questionnaire through GrassrootsHealth. A link to your test results will be emailed to you about a week after your blood samples have been received.

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Light Therapy Is More Effective Than Antidepressants

Light therapy,⁷ using full-spectrum nonfluorescent lighting that has blue light to artificially mimic sunlight, is among the most effective treatment options for SAD. You want to avoid fluorescents as they emit large amounts of dirty electricity. Ideally, have the light exposure in the morning, well after sunrise. As noted in the Depression Research and Treatment paper:⁸

“Knowing the difference decreased daylight can make in triggering SAD and S-SAD, approaches seeking to replace the diminished sunshine using bright artificial light, particularly in the morning, have consistently showed promise …

Light boxes can be purchased that emit full spectrum light similar in composition to sunlight. Symptoms of SAD and S-SAD may be relieved by sitting in front of a light box first thing in the morning, from the early fall until spring …

Typically, light boxes filter out ultraviolet rays and require 20–60 minutes of exposure to 10,000 lux of cool-white… light daily during fall and winter.

This is about 20 times as great as ordinary indoor lighting … Light therapy should not be used in conjunction with photosensitizing medications such as lithium, melatonin, phenothiazine antipsychotics, and certain antibiotics.”

While light therapy can take up to four weeks before you notice an improvement, it was shown to be more effective than antidepressants for moderate to severe depression in a 2015 study.^9,10 In it, the researchers evaluated the effectiveness of light therapy, alone and in conjunction with the antidepressant fluoxetine (sold under the brand name Prozac).

The eight-week trial included 122 adults between the ages of 19 and 60, who were diagnosed with moderate to severe depression. The participants were divided into four groups, receiving:

• 30 minutes of light therapy per day upon waking, using a 10,000 lux Carex brand day-light device, classic model, plus a placebo pill
• Prozac (20 mg/day) plus a deactivated ion generator serving as a placebo light device
• Light therapy plus Prozac
• Placebo light device plus placebo pill (control group)

In conclusion, the study found that the combination of light therapy and Prozac was the most effective — but light therapy-only came in at a close second, followed by placebo. In other words, the drug treatment was the least effective of all, including placebo.

The mean changes in the Montgomery-Åsberg Depression Rating Scale from baseline to the eight-week end point was 16.9 for the combination therapy (active light- and drug therapy), and 13.4 for light therapy alone.

Blue Light During Daytime Hours May Improve Your Mood

In addition to the bright white light used in light therapy, blue light has also been shown to be useful. According to a 2010 study,¹¹ blue light appears to play a key role in your brain's ability to process emotions, and its results suggest that spending more time in blue-enriched light could help prevent SAD.

Blue light is prevalent in outdoor light, so your body absorbs the most during the summer and much less in the winter. Because of this, the researchers suggested that adding blue light to indoor lighting, as opposed to the standard yellow lights typically used, may help boost mood and productivity year-round, and especially during the winter.

Keep in mind, however, that blue light after sunset or before sunrise should be avoided, as it can disrupt your circadian rhythm. In fact, one of the reasons for insomnia and poor sleep is related to excessive exposure to blue light-emitting technologies such as TV and computer screens, especially in the evening.

The blue light depresses melatonin production, thereby preventing you from feeling sleepy. So, to be clear, you only want to expose yourself to blue light in the morning, and possibly afternoon, but not in the evening.

In “How the Cycles of Light and Darkness Affect Your Health and Well-Being,” researcher Dan Pardi explains the peculiar effect blue light has on your brain, which sheds further light on why it’s so important to expose yourself to blue light during daytime hours only, and why you need to avoid it at night:

"[R]ods and cones in the eye... are specialized cells that can transduce a photo signal into a nerve signal... In the mid-90s, a different type of cell was discovered... [called] intrinsically photosensitive Retinal Ganglion Cells (ipRGC).

It does the same thing as rods and cones: it transduced light to a nerve signal. But instead of the signal going to your visual cortex, it goes to your master clock. Those cells are most responsive to blue light. If you can block blue light, you can actually create something called circadian darkness or virtual darkness.

What that means is that you can see, but your brain doesn't think that it's daytime; your brain thinks that it's in darkness. That is actually a practical solution for living with artificial light in our modern world...

With more awareness, future digital devices will adjust lighting in the evening to automatically dim and emit amber/red light [instead of blue]. This is much better for healthy circadian rhythms and sleep quality."

Address Insomnia

As you can tell by Pardi’s explanation above, the blue light issue is closely related to your sleep quality and circadian rhythm maintenance, and this too is an important component of mental health.

Historically, humans went to sleep shortly after sunset and woke up when the sun rose. Straying too far from this biological pattern will disrupt delicate hormonal cycles in your body, which can affect both your mood and your health. Indeed, the link between depression and lack of sleep is well established, and sleep disturbance is one of the telltale signs of depression.¹²

Sleep therapy has also been shown to significantly improve depression. While there are individual differences, as a general rule, you’ll want to aim for about eight hours of sleep per night.

For many, this will require going to bed earlier, which can be difficult if you’ve been watching TV or using electronics beforehand, as the blue light from the screen suppresses your melatonin production.

So, an important part of the solution is to avoid screen-time for a couple of hours before bed. Alternatives to not watching TV or using electronics is to install a blue light modulating software such as Iris,¹³ or using blue-blocking glasses.

Just make sure you don't wear blue blocking glasses during the daytime, which is when you need the blue light exposure. Also, make sure the glasses filter out light between 460 to 490 nanometers (nm), which is the range of blue light that most effectively reduces melatonin. You can easily tell this by looking at a blue light and if it doesn’t disappear with the glasses, it is not blocking that frequency.

Exercise Helps Prevent Depression

Like sleep, exercise can impact your risk of depression. Even a minimal amount of exercise may be enough to combat depression in some people — as little as one hour a week could prevent 12% of future cases of depression, according to one study.¹⁴

Participants were followed for 11 years in this study, during which time it was revealed that people who engaged in regular leisure-time exercise for one hour a week, regardless of intensity, were less likely to become depressed. On the flipside, those who didn't exercise were 44% more likely to become depressed compared to those who did so for at least one to two hours a week.

Exercise benefits your brain and mood via multiple mechanisms, including creating new, excitable neurons along with new neurons designed to release the GABA neurotransmitter, which inhibits excessive neuronal firing, helping to induce a natural state of calm¹⁵ — similar to the way anti-anxiety drugs work, except that the mood-boosting benefits of exercise occur both immediately after a workout and on in the long term.

Exercise also boosts levels of potent brain chemicals like serotonin, dopamine and norepinephrine, which may help buffer some of the effects of stress. What's more, anandamide levels are known to increase during and following exercise.¹⁶ Anandamide is a neurotransmitter and endocannabinoid produced in your brain that temporarily blocks feelings of pain and depression. It can also be activated with CBD products.

Tap for Symptoms of Depression

Last but not least, EFT, a form of psychological acupressure, is a noninvasive way that can help treat symptoms of depression, whether related to seasonal light differences or not.

Some people avoid energy psychology, believing it's an alternative form of New Age spirituality. Nothing could be further from the truth. It is merely an advanced tool that can effectively address some of the psychological short circuiting that occurs in emotional illnesses.

It is not associated with any religion or spiritual outlook at all, but merely an effective resource you can use with whatever spiritual belief you have. In the video above, EFT practitioner Julie Schiffman demonstrates how you can use EFT to relieve your symptoms.

It’s the Season To Be Glad, Not SAD

Since SAD is triggered by the loss of light, it makes sense that light therapy is among the most effective treatments. Vitamin D and/or omega-3 deficiency, as well as lack of sleep and exercise, can also play a significant role, so addressing these basic lifestyle factors could also be what you need to avoid the winter blues.

In closing, it may be worth noting that it's natural for your body to want to slow down somewhat in the wintertime. While this can be difficult when your work and personal life dictate otherwise, allowing yourself to slow down a bit and surrender to the overwinter process may ultimately help you to respect your body's circadian rhythm, and recharge.

That said, this doesn't mean you should plant yourself on the couch for the winter and not venture outdoors. On the contrary, staying active and spending time outdoors during the day are among the best "cures" for SAD.

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The end of the year is looming and the festive season has officially begun, which means Christmas lunches are catch up dinners are filling out the diary.

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The days of face tune and over-filtered images are over, with celebrities posting #real images on the ‘gram.

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Researchers have developed a new tool to predict the global spread of human infectious diseases, like dengue, and track them to their source.

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Researchers have found that warmer temperatures, at levels expected under most climate change projections, can lead to higher concentrations of arsenic in rice grains.

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New research reveals how a week in the dark rewires brain cell networks and changes hearing sensitivity in adult mice long after the optimal window for auditory learning has passed. With further study, cross-modal learning -- the manipulation of one sense to induce change in another sense -- could be used to help people with disabilities. For example, temporary sight deprivation might be used to help deaf and hearing-impaired people adapt to cochlear implants and hearing aids.

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Probiotics -- or 'good bacteria' -- have been used to treat infant colic with varying success. In a new trial, investigators have shown that drops containing a particular probiotic strain (Bifidobacterium animalis subsp. lactis BB-12) reduced the duration of daily crying by more than 50% in 80% of the 40 infants who received the probiotic once daily for 28 days, with beneficial effects on sleep duration and on stool frequency and consistency.

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Chaperone proteins in human cells dynamically interact with the protein alpha-Synuclein, which is strongly associated with Parkinson's disease. A disturbed relationship to these 'bodyguards' leads to cell damage and the formation of Lewy bodies typical for Parkinson's disease.

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Scientists have developed a method for rapidly discovering potential cancer-treating compounds that work by resurrecting anti-tumor activity in immune cells called T cells. Cancerous tumors often thrive because they render T cells dysfunctional or 'exhausted.' The new method uncovers medicinal compounds that can restore the function of these T cells, making cancers vulnerable to them again.

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Using innovative RNA sequencing techniques, researchers identified a promising novel treatment for lymphatic filariasis, a disabling parasitic disease that is difficult to treat. The potential new therapy is an experimental cancer drug called JQ1 and targets proteins found prominently in the worm's genome; it appears to effectively kill the adult worms in a laboratory setting, according to the study.

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For nearly two decades, the American Heart Association (AHA) has recommended that people with coronary heart disease (CHD) consume omega-3-fatty acids (the kinds of fatty acids found in fish and fish oil) to prevent another heart attack. This recommendation was based on early randomized, controlled trials, which found that fish oil supplementation was associated with lower rates of stroke, heart attack, and death in people who already had heart disease. On the other hand, the impact of fish oil supplements on preventing a first heart attack or stroke (primary prevention) was never clearly demonstrated.

Recently there have been large trials examining the complex relationship between fish oil and heart health. The results have been mixed and somewhat confusing, leaving both patients and physicians to wonder: will fish oil supplements reduce my risk of heart disease?

What’s the connection between fish oil and heart health?

How might omega-3-fatty acids found in fish oil provide heart health? Multiple possibilities have been proposed and are supported by animal research. These protective mechanisms include

• stabilizing blood flow in and around the heart
• reducing blood triglyceride levels
• lowering blood pressure
• preventing blood clots
• reducing inflammation.

Research examining each of these is ongoing.

Many studies, varied results

Despite these animal data, clinical studies in humans have not consistently supported the protective benefits of fish oil supplementation.

A meta‐analysis published in JAMA Cardiology found no clear benefit to fish oil supplements in preventing heart disease or major cardiovascular disease (CVD) events such as heart attack or stroke, in people who were at increased risk for CVD.

This was followed by the publication of the ASCEND and VITAL trials, both with mixed results. In ASCEND, which examined diabetic patients without known CHD, fish oil supplements did not reduce heart attacks or strokes, but did significantly lower risk of death from heart attack and stroke. VITAL examined the effects of fish oil on primary prevention in people with regular risk of heart disease, and also failed to find a significant reduction in all major CVD events. However, there were fewer heart attacks in study subjects who took fish oil supplements, particularly in those who did not eat fish.

The REDUCE‐IT trial was published next. This trial looked at the effect of high-dose fish oil supplements on people with high blood triglyceride levels who were at elevated CVD risk. In contrast to previous studies, REDUCE-IT found a significant reduction in cardiovascular events among study subjects who took the high-dose fish oil supplements. While most studies have tested 1 gram or less of fish oil with a combination of eicosapentaenoic acid (EPA) and docosahexaenoic (DHA), REDUCE-IT used a dose of 4 grams of EPA alone. (Vascepa, a prescription version of the EPA fish oil supplement used in REDUCE-IT, is FDA-approved to treat very high triglyceride levels of 500 mg/dl or higher. In November, the FDA expanded its approval of Vascepa; it can now be prescribed to reduce the risk of cardiovascular events like heart attack and stroke.)

In October 2019, a repeat of the JAMA Cardiology meta-analysis, but now including 13 trials instead of the original 10, was published in the Journal of the American Heart Association. The addition of these three trials increased the sample size by almost 65%, from 77,917 study participants to 127,477 participants. In reanalyzing the expanded data, researchers found that fish oil omega‐3 supplements lowered risk for heart attack and CHD death. There was no effect on stroke. Interestingly, risk reductions appeared to be linearly related to omega‐3 dose. In other words, the higher the dose, the greater the risk reduction.

What does this mean for you?

Omega-3 supplements from fish oil appear to be heart-healthy and have a protective effect on CHD. But before we all start reaching for supplements, it may be worth following a heart-healthy diet full of fresh fruits and vegetables, with lean protein such as fish, as recommended by the AHA. For those of us at highest risk, especially those with elevated triglyceride levels, it is worth speaking with your physician about high dose EPA fish oil supplements.

The post The complicated relationship between fish oil and heart health appeared first on Harvard Health Blog.

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Statistics from the American Heart Disease 2019 update shows cardiovascular disease (CVD) is still the leading cause of death, although the rate decreased by 18.6% from 2006 to 2016.¹ Despite this reduction, 1.05 million people were expected to have a coronary event in 2019, including 720,000 first time and 335,000 recurrent events.

Nearly every 40 seconds someone has a heart attack or a stroke. In 2014-2015 the annual financial burden for CVD was estimated at $351.2 billion. In the survey, the data showed awareness of the symptoms of a heart attack was low.²

This has a negative impact on early diagnosis and treatment of a heart attack, which is linked to a higher potential for survival and return to normal activities when more of the heart muscle can be saved.

According to the Centers for Disease Control and Prevention,³ nearly 47% of sudden cardiac death happens outside of a hospital, which suggests people may be unaware they have heart disease, or they don't act on early warning signs of a heart attack.

Those at greater risk of a cardiac event include people who have other medical conditions such as diabetes or practice specific lifestyle choices, such as eating a poor diet, excessive alcohol use, smoking or lack of physical activity.

Protein Linked to Muscle Damage Raises Risk of Death

Once your heart has begun to be damaged by a heart attack, the heart muscle releases a protein, troponin, which is responsible for helping to regulate contractions in skeletal and heart muscle.⁴ Emergency room physicians test for blood levels of this protein, along with other clinical tests, to evaluate the likelihood a patient is having a heart attack.

The level of the protein and other test results help clinicians make choices about immediate treatment. A new analysis from the National Institute for Health Research Health Informatics Collaborative led by researchers from London looked at data from 250,000 patients who had troponin tests completed.

The information was grouped by age and then compared against the test results and the patient's health outcomes in the following three years. The researchers were interested in comparing the differences in troponin levels across age ranges, specifically in the senior population, as well as investigating the significance of the different levels of the protein.

The new data showed even a slight raise in the level of protein was associated with an increased risk of early death in all age groups. They also found the higher the level, the higher the risk of death in those who had suffered a heart attack.

However, patients who had the highest levels had a lower risk of dying, which the researchers theorized was due to the likelihood the patient had an event requiring surgery that may have reduced the risk of death. The data also showed patients from 18 to 29 years with raised levels had a tenfold higher potential risk of dying than those in the same age range without raised levels of troponin.

When the patients were over 80 years with raised levels, 46% died within three years.⁵ The lead scientist of the study commented in a press release:⁶

"There have been many advances in treating heart disease yet it remains the leading cause of death in the UK and around the world. This is the first study to address the implications of raised troponin in a real world large sample of patients across a wide range of ages.

Doctors will be able to use this information to help identify the risk of early death in patients who have a troponin level measured; this could lead to interventions at a much earlier stage in a wider group of patients than are currently treated."

Other Things Can Also Raise Troponin Levels

The results also revealed, even if the patient had not been diagnosed with a heart attack, those who had higher levels of troponin had an increased risk of death.⁷ When you are healthy, levels of troponin are low enough they are usually undetectable. The levels begin rising three to four hours after heart damage and may stay elevated for 14 days.

However, troponin protein may be released into your bloodstream following more than a heart attack.⁸ Physicians from the Cleveland Clinic discuss several other health conditions during which your body releases troponin, which may signal an increased risk of death without early treatment.

Can You Have a Heart Attack and Not Know It?

Although the terms are used interchangeably, a heart attack and cardiac arrest are not the same thing. A heart attack affects the oxygen supply to your heart while a cardiac arrest affects the electrical impulse. During a heart attack, restriction of oxygen occurs with a blockage to the blood supply, but the remainder of the muscle continues to beat.

During a cardiac arrest, the electrical system is affected by conditions such as heart failure, arrhythmias or ventricular fibrillation, usually resulting in a loss of consciousness and heartbeat. In some instances, just before cardiac arrest, you may notice abnormal gasping or there may be seizure activity at the beginning of the event.

Symptoms of a heart attack are not always obvious. However, immediate treatment often results in higher survival rates and loss of less heart muscle from lack of oxygen. Common symptoms of a heart attack include:

Chest pain or discomfort	Upper body discomfort	Shortness of breath
Breaking out in a cold sweat	Nausea	Sudden dizziness
Feeling unusually tired	Lightheadedness

Not all heart attacks begin with crushing chest pain as is depicted on television or in the movies. Women are less likely to report chest pain during a heart attack and more likely to perceive the symptoms as stress or anxiety. Women use terms such as "pressure," "tightness" or "discomfort" rather than chest pain.

While 30% of women will seek medical care compared to 22% of men, physicians tend to misdiagnose or dismiss the symptoms of a heart attack in women rather than men. Other symptoms that may indicate a heart attack is in progress include:

Anxiety attack	Back pain
Heartburn	Hot flashes
Extreme fatigue	Feeling electric shocks down on the left side
Numbness and stiffness in the left arm and neck	Feeling like there is a large pill stuck in your throat

Know Your Risk Factors and Take Action

Research published in the American Journal of Cardiology found women who addressed six lifestyle factors had the greatest impact on their heart health. In the study, nurses were followed for 20 years, starting around age 37.

Those who adhered to all six guidelines lowered their risk of heart disease by 92%. Researchers on the team estimated more than 70% of heart attacks could be prevented by implementing:

Healthy diet	Achieving a normal BMI (body fat percentage is more accurate)
Getting at least 2.5 hours of exercise each week	Watching television seven or fewer hours per week
Not smoking	Limiting alcohol intake to one drink or less per day

While none of these factors should come as a surprise, they collectively have an impressive impact on your cardiac risk. With respect to BMI, note that your waist-to-hip ratio is a more reliable predictor of risk than BMI, as it reflects the amount of visceral fat you carry. Another factor that can increase inflammation, activate your sympathetic nervous system and trigger a heart attack is stress.

Additionally, sitting for long periods of time raises your risk of a heart attack. This means intermittent movement and spending time at the gym or exercising at home are important factors to lowering your risk of CVD.

Some of the uncommon symptoms may lead you to believe you are not having a heart attack. Even if you're not sure, it is vital that you call for immediate emergency assistance as time is a significant factor in improving your potential for survival.

An ambulance is the best and safest way to reach the hospital because emergency personnel can use treatments enroute before reaching the emergency room. Emergency medical personnel would rather treat you for a non-life-threatening condition then have you die because you are unwilling to go for treatment.

Talk with your health care provider about your risks and keep important information with you in case of an emergency. For instance, write down all your medications and supplements you're taking and have the card laminated, keeping it in your wallet or purse.

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Expert Review by Maryam Henein

As reported in a November 12, 2019, Financial Times article,¹ dozens of popular health websites are tracking, storing and sharing your personal data, including WebMD (the leading health website) and Healthline (currently the third most popular health site²).

These two websites also, as of this year, dominate Google health searches, which virtually guarantees their continued growth and influence. “Establishment, big corporate pharma websites like WebMD are monopolizing the first page of results,” Google Whistleblower Zach Vorhies confirmed in an interview with The Epoch Times.³

I wrote about how these two websites use and share your data in my November 8, 2019, article “Shocking Proof How Google Censors Health News.” I’ve also covered this issue in other articles, so the Financial Times’ report came as no surprise to me.

What some might not know is that this kind of information sharing is illegal in Europe. As reported by Financial Times:⁴

“Using open-source tools to analyse 100 health websites, which include WebMD, Healthline, Babycentre and Bupa, an FT investigation found that 79 per cent of the sites dropped ‘cookies’ — little bits of code that, when embedded in your browser, allow third-party companies to track individuals around the internet. This was done without the consent that is a legal requirement in the UK.”

Seventy-eight percent of the sites shared user data with DoubleClick, Google’s advertising arm, while 48% shared data with Amazon. Facebook, Microsoft and AppNexus, another advertising firm, also received user data.

What this means is DoubleClick, Google’s ad service, will know which prescriptions you’ve searched for on these websites, thus providing you with personalized drug ads, and Facebook will know what you’ve searched for in WebMD’s symptom checker, as well as any diagnoses you received.

European Law Is Unambiguous and Far Stricter Than the US

According to Financial Times,⁵ “keywords such as ‘heart disease’ and ‘considering abortion’ were shared” from several sites, including Healthline, and eight of the 100 sites tested included specific identifiers that allow third parties to tie the information to specific individuals. Tracker cookies were also dropped without consent or before any consent was given.

The following graphic, created by Financial Times, illustrates the flow of data from BabyCenter.com, a site that focuses on pregnancy, children’s health and parenting, to third parties, and the types of advertising these third parties then generate.

Wolfie Christl, a technologist and researcher, told Financial Times:⁶  “These findings are quite remarkable, and very concerning. From my perspective, this kind of data are clearly sensitive, has special protections under the [General Data Protection Regulation] and transmitting this data most likely violates the law.”

Phil Smith, director-general of the U.K.s Incorporated Society of British Advertisers told Campaignlive.com⁷ that the EU’s General Data Protection Regulation — which was implemented in May 2018 — is unambiguous and straight-forward: Websites must request and obtain “explicit consent for the sharing of ‘special category data,’” which includes health data.

Other special category data considered to be particularly sensitive and needing explicit consent to be shared include race, ethnic origin, political persuasion, religious affiliation, trade union membership, genetics, biometrics, sexual orientation and details relating to your sex life.

Weeding Out ‘Undesirables’ 

In response to Financial Times’ report, Google said it “does not build advertising profiles from sensitive data,” and that it has “strict policies preventing advertisers from using such data to target ads."⁸ Well, if it’s not being used to personalize medical ads, what is the health data being used for, and why is it collected and shared in the first place?

According to Tim Libert, a computer scientist at Carnegie Mellon University who developed the open-source tool Financial Times used to investigate the information sharing, medical information can be used to “prey on the ill and vulnerable.”⁹ Health data can also be used to secretly discriminate against certain individuals. As noted by Libert:¹⁰

“As medical expenses leave many with less to spend on luxuries, these users may be segregated into ‘data silos’ of undesirables who are then excluded from favorable offers and prices. This forms a subtle, but real, form of discrimination against those perceived to be ill.”

Your Mental Health Data Is Also Shared

A September 3, 2019, report¹¹ by the data privacy advocacy group Privacy International revealed mental health websites are also sharing sensitive personal data with third parties — including the answers and results from depression tests — again without the consent required under EU law.

This analysis looked at 136 European mental health web pages, finding 97.8% of them had third-party elements such as cookies, and 76.04% had third-party trackers for marketing purposes.¹²

What’s more, some websites shared data with third parties in hypertext transfer protocol (HTTP) rather than hypertext transfer protocol secure (HTTPS), used for secure communications over a computer network, which means the data, which contains unique identifiers, is susceptible to interception by hackers as well.¹³

Two sites, the NHS mood test and depression.org.nz, also used “session replay scripts,” which “can be used to log (and then play back) everything users typed or clicked on a website.”¹⁴ In other words, they would be able to tell whether you altered your test answers and/or searches.

Opt Out Option Is Still Not User Friendly

On a side note, Financial Times brings up a popup about its cookies and gives you the option to opt out of advertising based on your use of the Financial Times site. It also gives you the option to opt out of advertising based on your online activity, which is tracked by third party cookies linked to its site.

Looking at their Manage Cookies page,¹⁵ you can get a feel for just how extensive that online activity tracking is. There are dozens of third party trackers, and you’d have to go to each one to opt out! Who has time for all of that — especially since you have to do that for every browser you use, and for every site you visit? While having the option to opt out is a step in the right direction, it’s still an unmanageable system for most users.

As noted in the Privacy International report, “The burden should be on websites to protect user privacy by design and by default.”¹⁶ In the meantime, Privacy International offers the following recommendations “to anybody looking for help and support online”:¹⁷

• Block third party cookies on your browsers
• Use ad blockers and antitracking add-ons
• Before completing an online test for a mental health condition, make sure the website is trustworthy. If in doubt, seek out information from public health bodies, medical professionals or qualified charities
• In the U.K., Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. In the U.S., the suicide prevention lifeline is 1-800-273-8255. Other international helplines can be found at www.befrienders.org

Health Publishers Make Millions Off Online Searches

A recent AdBeat blog¹⁸ reviews just how all of this personal information is being used to generate millions in advertising revenue. Health websites obviously attract drug ads and sponsorships, and the pharmaceutical industry has deep pockets. In his blog, Bradley Nickel points out that:

“According to the Pew Research Center, 72% of people looked online for health information within the past year … WebMD reports an average of 206 million unique users per month, and over 400 billion page views per quarter.”

There are many ways in which all these page views can be turned into revenue. Nickel reviews the monetization strategies of five health publishers: LifeScript (a women’s health publisher), WebMD, HealthCentral, eMedTV and Healthline.

Estimates suggest WebMD made $10,977,280 in advertising revenue in six months, which means its total revenue for a single year could reach as high as $22 million. A majority of this revenue comes from direct buys.

A majority of ads on WebMD are for over-the-counter drugs, which are strategically placed on related pages, meaning if you’re searching for “common cold,” you’re likely to find ads for Nyquil, Tylenol Cold & Flu, Sudafed and similar cold and flu remedies.

Healthline Is All About Matching Users to Its Advertisers

Healthline is not too far behind WebMD with an estimated six-month ad revenue of $7,025,644, with a majority of it coming from direct buys. Unlike WebMD, Healthline’s top ads are prescription drugs. As noted by Nickel:¹⁹

“Direct Buys are the name of the game when it comes to monetizing traffic from sites related to health and wellness. A prescription drug company is a publisher’s dream.

Drug companies tend to have lots of cash to spend on advertising, a desire for large amounts of traffic, and getting permission to advertise prescription drugs on Google and other ad networks can be difficult.”

In all, Healthline Media made more than $100 million in 2018. A big part of its rapidly growing success is its focus on content, AdExchanger contends.²⁰ Before 2011, Healthline licensed content and didn’t create any of its own — a decision that threatened to bankrupt the company. According to AdExchanger:²¹

“Today, Healthline employs 150 clinicians to review articles and cites academic research in stories. When Google revamped its search algorithm in fall 2018, with the ‘Medic’ update,²² which changed the rankings for health sites based on the quality of their content, Healthline saw even more organic traffic sent its way.”

In an interview with AdExchanger, Healthline Media CEO David Kopp explains how user data are used to satisfy the needs of its direct advertisers. “Several hundred data points” are monitored internally, Kopp says, and for 32% of the company’s advertisers, the first or second metric is audience quality or cost per qualified user.

“For pharma, it might be someone diagnosed with a disease, and for a hospital, it might be someone looking for an ER in a geographic area,” he says. To allow advertisers to reach their target audience, Healthline places their advertisements “on content that is relevant to the product.”

This, clearly, is the most effective way to sell a product. Talk about its benefits in an article, and have ads for that very product in the side bar. This, by the way, is illegal for nutritional supplements. I cannot tell you about how to use berberine to treat your Type 2 diabetes and link to a berberine product in my online store, for example. Yet, this is precisely what they’re doing with drugs.

Healthline also offers condition-specific apps, where users can connect with others who have the same medical condition as they. This, undoubtedly, gives advertisers a first-row seat with a captive audience — a very select group of people they can be sure are looking for specific remedies and products.

Boycott Google to Protect Your Privacy

In addition to all of this data mining, Google is also actively manipulating search results and making decisions about what you’re allowed to see and what you’re not based on its own and third party interests — a topic detailed in a November 15, 2019, Wall Street Journal investigation.²³

The dangers of censorship, data mining of sensitive information and tracking should be self-evident. It won’t take long before most people think and believe whatever Google and its advertisers want people to think and believe, and spend their money accordingly.

This data mining could also end up being used in some sort of “social credit” system, similar to what already exists in China. Imagine not being allowed to purchase airplane tickets because you’re suspected of having a cold, based on your online searches and purchases, for example.

Or, think what would happen if you are being denied a gym membership because you’ve been logged as having an STD. In truth, personal data can be misused in any number of unimaginable and discriminatory ways.

Now, more than ever, we must work together to share health information with others by word of mouth, by text and email. We have built in simple sharing tools at the top of each article so you can easily email or text interesting articles to your friends and family.

My information is here because all of you support and share it, and we can do this without Big Tech’s support. It’s time to boycott and share! Here are a few other suggestions:

Become a subscriber to my newsletter and encourage your friends and family to do the same. This is the easiest and safest way to make sure you’ll stay up to date on important health and environmental issues.

If you have any friends or relatives who are seriously interested in their health, please share important articles with them and encourage them to subscribe to our newsletter.

Consider dumping any Android phone the next time you get a phone. Android is a Google operating system and will seek to gather as much data as they can about you for their benefit. iPhone, while not perfect, appears to have better privacy protections.

Use the internal Mercola.com search engine when searching for articles on my site.

Boycott Google by avoiding any and all Google products: Stop using Google search engines. Alternatives include DuckDuckGo24 and Qwant25 Uninstall Google Chrome and use Brave or Opera browser instead, available for all computers and mobile devices.26 From a security perspective, Opera is far superior to Chrome and offers a free VPN service (virtual private network) to further preserve your privacy If you have a Gmail account, try a non-Google email service such as ProtonMail,27 an encrypted email service based in Switzerland Stop using Google docs. Digital Trends has published an article suggesting a number of alternatives28 If you’re a high school student, do not convert the Google accounts you created as a student into personal accounts

Sign the “Don’t be evil” petition created by Citizens Against Monopoly

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